Pharmacists improve care of diabetics while cutting costs, research shows

Dec 29, 2009

The role of pharmacists hasn't received much attention in the debate on the cost of health care. But national and regional studies show that when pharmacists directly participate in patient care, they significantly reduce treatment costs and improve outcomes.

A study on diabetic patients by the University at Buffalo School of Pharmacy and Pharmaceutical Sciences identified cost savings with improvements in a key indicator of in diabetes patients, the measurement. The A1C provides a three-month average of the amount of excess glucose in the blood. Higher A1Cs indicate that a patient is at higher risk for developing long-term complications associated with diabetes, such as or vision problems.

Published last spring in the Journal of the American Pharmacists Association, the UB study of 50 patients with Type 2 diabetes demonstrated that in just six months clinical pharmacists, in collaboration with primary care providers, were able to significantly reduce patients' A1C levels.

In the UB study, patients' A1C levels were reduced by an average of 1.1 percent, from an average of 8.5 percent to 7.4 percent, one year after being enrolled in the program, while also improving the overall metabolic profile.

"Our results show that enhancing the patient's access to care through collaborative physician-pharmacist relationships can yield lower blood glucose levels, improve the overall metabolic profile and reduce costs to the payer," says Erin Slazak, PharmD, UB clinical assistant professor of pharmacy practice and board certified pharmacotherapy specialist.

These clinical improvements occurred while monthly costs per patient went down by approximately $212, around $2,500 per year, even though there were nominal increases in the cost of medications prescribed.

The key to success?

"Patients had unlimited access to pharmacists throughout the year," says Slazak.

Patients referred to the UB program had been identified by their primary care providers as having difficulty controlling their blood sugar. Slazak notes that it was not uncommon to see patients with glucose levels as high as 400 mg/dl (normal levels are below 100 mg/dl).

The UB pharmacists spent an initial one-hour appointment with each patient, where they worked up detailed health records covering dietary information and all medications and disease conditions, and then reviewed them with each patient.

After that, patients could call or make appointments with pharmacists at will.

"We did extensive education with patients about how to manage their conditions," says Slazak. "In many cases, we were instrumental in getting them to start insulin. There is a lot of resistance to that, and not just because it's an injection."

For patients in the initial stages of administering insulin, she says it was common to be contacted once every few days. The pharmacists then made suggestions to physicians about changes in medications, dosages or lifestyle that might be beneficial to their patients.

That kind of individualized attention is far from the norm for diabetic patients.

"Nationwide, the standard of care is that the primary care provider manages diabetes alone," says Slazak. "Pharmacists typically do not have direct involvement."

That is partly because some states, including New York, have not yet approved collaborative practice agreements between physicians and pharmacists. In the Buffalo study, for example, physicians were required to review pharmacists' recommendations and approve all interventions first. Completion of the review process and approval occurred in only half of the cases, potentially limiting the overall benefit to the patient.

"We know there's a long-term clinical and economic benefit to pharmacists working directly with patients and we think that can continue to grow," says Scott V. Monte, PharmD, UB clinical assistant professor of pharmacy practice and director of Diabetes and Cardiovascular Research, CPL Associates, LLC, in Buffalo. "Pharmacists can help achieve better outcomes if given the chance."

Explore further: Researchers identify potential risk factors for urinary tract infections in young girls

add to favorites email to friend print save as pdf

Related Stories

Tech-check-tech

Jan 04, 2007

Regulation set to take effect tomorrow, Jan. 5, 2007, is designed to reduce medication errors in California hospitals and free pharmacists for greater involvement in direct patient care rather than in non-discretionary (clerical) ...

Clinical pharmacists can reduce drug costs

Dec 23, 2008

Clinical pharmacy services can significantly reduce the cost of prescription drugs and save money elsewhere in the health care system, according to a new study by researchers at the University of Illinois at Chicago.

Pharmacists as educators can improve asthma outcomes

Jun 24, 2008

New research has shown that up to 90 per cent of people on asthma medications are using their inhalers incorrectly leading to poor asthma control, increased hospital visits and increased cost of treatment.

Recommended for you

An approach to fighting the Ebola virus

25 minutes ago

Terrible suffering in Western Africa has refocused the world's attention on Ebola viruses, for which there is no vaccine or cure. The viruses are masters of their attack, but researchers are working hard to fight them, said ...

UN Ebola pointman to visit west Africa

2 hours ago

The UN's new pointman on Ebola was due to arrive in west Africa on Thursday for a visit aimed at shoring up health services in the region where at least 1,350 lives have been lost to the virus.

Two Americans with Ebola leave hospital (Update)

4 hours ago

Two American missionaries who fell ill with the dangerous Ebola virus while working in Liberia have recovered and have been released from an Atlanta hospital, doctors said Thursday.

Leprosy: Myanmar struggles with ancient scourge

8 hours ago

High in the hills of Myanmar's war-torn borderlands, a clutch of new leprosy cases among communities virtually cut off from medical help is a sign that the country's battle with the ancient disease is far from over.

User comments : 0