Collaborating with Community Pharmacists to Improve the Quality of Diabetes Care in an IPA-model HMO

OBJECTIVE: To assess the ability of community pharmacists to identify managed care patients with diabetes who are not achieving therapeutic goals. SETTING: A network of independent community pharmacists in West Virginia and southeastern Ohio in collaboration with The Health Plan of the Upper Ohio Valley. METHODS: Pharmacists conducted assessments of patients’ glycemic control (HbA1c ), blood pressure (BP), lipid levels (total cholesterol, low-den sity lipoprotein [LDL], high-density lipoprotein [HDL], triglycerides), and body mass index (BMI). The therapeutic goals were: HbA 1c less than 7%, BP lower than 130/85 mmHg, total cholesterol under 200 mg/dl, LDL less than 100mg/dl, HDL lower than 45 mg/dl, triglycerides under 200 mg/dl, and BMI lower than 30. These indices were measured during scheduled appointments in the pharmacy by pharmacists who had completed a certificate program in diabetes care. Reports on each patient’s status, along with recommendations, were sent to the patient’s physician. RESULTS: Fifty-four persons were enrolled in the pharmacist program and complete clinical data were obtained for 47 patients. The following percentages of patients were identified as not achieving the therapeutic goal for a particular measure: HbA1c: 63.9%, BP: 56.3%, total cholesterol: 38.3%, LDL: 69.8%, HDL: 76.5%, triglycerides: 57.4%, BMI: 61.9%. Patients who were not reaching the therapeutic target were referred to their physicians for additional evaluation. CONCLUSION: Pharmacists can identify a substantial number of persons with diabetes who are not achieving the goals for HbA 1c , blood pressure, lipids, and weight. This approach can facilitate the continuous assessment and improvement of care for managed care enrollees with diabetes.