A.M. Soliman

Optimal Diabetes Care Outcomes Following Face-to-Face Medication Therapy Management Services

Pharmacists play an integral role in influencing resolution of drug-related problems. This study examines the relationship between a pharmacist-led and delivered medication therapy management (MTM) program and achievement of Optimal Diabetes Care benchmarks. Data within Fairview Pharmacy Services were used to identify a group of patients with diabetes who received MTM services during a 2007 demonstration project (n=121) and a control group who were invited to receive MTM services but opted out (n=103). Rates of achieving optimal diabetes clinical management for both groups were compared using the D5 diabetes measure for years 2006, 2007, and 2008. The D5 components are: glycosolated hemoglobin (HbA1c<7%); low-density lipoprotein (<100 mg/dl); blood pressure (<130/80 mmHg); tobacco free; and daily aspirin use. Multivariate difference-in-differences (DID) estimation was used to determine the impact of 1 year of MTM services on each care component. Patients who opted in for MTM had higher Charlson scores, more complex medication regimens, and a higher percentage of diabetes with complications (P<0.05). In 2007, the percentage of diabetes patients optimally managed was significantly higher for MTM patients compared to 2006 values (21.49% vs. 45.45%, P<0.01). Nonlinear DID models showed that MTM patients were more likely to meet the HbA1c criterion in 2007 (odds ratio: 2.48, 95% confidence interval [CI]: 1.04-5.85, P=0.038). Linear DID models for HbA1c showed a mean reduction of 0.54% (95% CI: 0.091%-0.98%, P=0.018) for MTM patients. An MTM program contributed to improved optimal diabetes management in a population of patients with complex diabetes clinical profiles.

Comparison of two ventricular assist device dressing change protocols

Despite the decreased infection rate with contemporary, continuous-flow ventricular assist devices (VADs), driveline infections remain problematic. Daily dressing changes have been postulated to be an important factor in minimizing the rate of infections but pose a substantial burden to patients and caregivers. A novel technique featuring dressing changes every third day has been described by the Utah Artificial Heart Program, Intermountain Healthcare (permission was obtained from Utah Artificial Heart Program), but the two methods have not been directly compared within a single program. A pilot project testing the Utah protocol was performed and we subsequently performed a retrospec-

Patient Characteristics Predicting the Frequency of Medication Therapy Management Visits for Patients With Diabetes

BACKGROUND Patient characteristics associated with a higher exposure to medication therapy management (MTM) and the relationship between frequency of MTM visits and meeting clinically defined goals of therapy have not been documented. OBJECTIVE The goal of this study was to evaluate factors predicting frequency of MTM visits for patients with diabetes and the impact of these visits on diabetes clinical outcomes. METHODS All patients with diabetes participating in a 2007 MTM demonstration project (N = 121) were included in the analysis. A negative binomial regression controlling for age, sex, presence of diabetes complications, taking insulin, Charlson score Index, and hypertension and cholesterol medication regimen composition was used to assess predictors of the number of MTM visits. Optimal diabetes management differences between the 2 groups defined according to median number of MTM visits (low frequency, ≤4; high frequency, >4) was compared by using Wilcoxon Mann-Whitney and χ(2) tests. RESULTS Having diabetes complications (relative risk = 2.83 [95% CI, 1.3-6.17]; P = 0.0088) and taking insulin (relative risk = 1.43 [95% CI, 1.12-1.83]; P = 0.0038) were associated with a higher number of MTM visits. At baseline, the high-frequency group had a significantly higher proportion of patients with insulin therapy (P < 0.01), higher proportion with diabetes complications (P = 0.07), and higher mean Charlson score (P = 0.08). The rate of optimal diabetes care was significantly lower in the high-frequency group before MTM (P = 0.02) but not statistically different from the low-frequency group during and 1 year after the demonstration project. CONCLUSIONS Patients with diabetes complications and using regimens that include insulin received more frequent MTM visits. MTM services delivered to a diabetes population with more complex disease or taking insulin have a positive impact on optimal diabetes care.