Reducing Emergency Room Visits among Patients with Diabetes by Embedding Clinical Pharmacists in the Primary Care Teams

Details

• Alternative Title:
  Med Care
• Personal Author:
  Moreno, Gerardo ; Fu, Jeffery Y ; Chon, Janet S. ; Bell, Douglas S. ; Grotts, Jonathan ; Tseng, Chi-Hong ; Maranon, Richard ; Skootsky, Samuel S. ; Mangione, Carol M.
• Description:
  Background:
  
  Pharmacists are effective at improving control of cardiovascular risk factors, but it less clear whether these improvements translate into less ER use and fewer hospitalizations. The UCMyRx program embed pharmacists in primary care.
  
  Objective:
  
  To examine if the integration of pharmacists into primary care was associated with lower ER and hospital use for patients with diabetes.
  
  Design:
  
  Quasi-experimental study with comparator group.
  
  Subjects:
  
  The analytic sample included patients with diabetes with uncontrolled cardiovascular risk factors (A1c >9%, blood pressure > 140/90 mmHg, LDL-cholesterol >130 mg/dL) who had one or more visits in either a UCMyRx (648 patients, 14 practices) or usual care practice (1944 patients, 14 practices).
  
  Measures:
  
  Our outcomes were ER and hospitalization rates as measured before and after the consultations between UCMyRx and usual care. Our predictor variable was the pharmacist consultation. Poisson Generalized Estimating Equations model was used to estimate the adjusted predicted change in utilization before and after the pharmacist consultation. The Average Treatment Effect on the Treated was estimated.
  
  Results:
  
  In models adjusted, the adjusted mean predicted number of ED visits/month during the year prior to consultation was 0.09 among UCMyRx patients. During the year after initiating the care with the pharmacists, this rate decreased to an adjusted mean monthly rate of 0.07, with an ATET=.021 (p = 0.035), a predicted reduction of 21% in ED visits associated with the clinical pharmacist consults. There was a non-significant predicted 3.2% reduction in hospitalizations over time for patients in the UCMyRx program.
  
  Conclusions:
  
  Clinical pharmacists are an important addition to clinical care teams in primary care practices and significantly decreased utilization of the emergency room among patients with poorly controlled diabetes.
  
  
• Subjects:
  Aged Aged, 80 And Over Blood Pressure Cholesterol, LDL Diabetes Mellitus Emergency Service, Hospital Female Health Services Heart Disease Risk Factors Hospitalization Humans Male Medication Therapy Management Middle Aged Motivational Interviewing Patient Acceptance Of Health Care Patient Care Team Pharmacists Polypharmacy Primary Health Care

  More +
• Source:
  Med Care. 59(4):348-353
• Pubmed ID:
  33427796
• Pubmed Central ID:
  PMC7954858
• Document Type:
  Journal Article
• Funding:
  U18DP006140/ACL/ACL HHSUnited States/ ; K23 AG042961/AG/NIA NIH HHSUnited States/ ; P30 AG021684/AG/NIA NIH HHSUnited States/ ; R18 DK105464/DK/NIDDK NIH HHSUnited States/ ; UL1 TR001881/TR/NCATS NIH HHSUnited States/
• Volume:
  59
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:a79c3a49835ed371e53e7083cfa013083138251e3c157604589803532a338d73
• Download URL:
  https://stacks.cdc.gov/view/cdc/158041/cdc_158041_DS1.pdf
• File Type:
  [PDF - 71.68 KB ]