Debbie C. Byrd

Pharmacist-Physician Collaboration for Diabetes Care: The Diabetes Initiative Program:

BACKGROUND: Multiple complications can arise secondary to poor control of glucose, blood pressure, and cholesterol in a patient with diabetes. OBJECTIVE: To evaluate the effect of a pharmacist-physician collaboration on attainment of diabetes-related measures of control. METHODS: This was a prospective, multicenter, cohort study. Patients were enrolled from 7 practice sites throughout Tennessee if they had been diagnosed with type 2 diabetes, were aged 18 years or older with a life expectancy greater than 1 year, and were English speaking. Pregnant women were excluded. Patients were followed for 12 months following enrollment by informed consent. The pharmacist-physician collaboration method was established prior to study initiation. Primary outcomes included hemoglobin A1c (A1C), number of patients with A1C less than 7%, and percentage of patients with A1C greater than 9%. RESULTS: Of the 206 patients enrolled, the mean age was 59.73 years, and most were male (59.71%) and white (66.02%). The A1C was reduced by an average of 1.16% (p < 0.0001). The proportion of patients with A1C less than 7% increased from 12.75% at baseline to 36.76% at study conclusion (p = 0.0002). The proportion of patients with A1C greater than 9% decreased from 34.15% to 16.50%, (p < 0.0001). CONCLUSIONS: Pharmacist-physician collaborative management at multiple practice locations and types of setting (eg, private, academic, Veterans Affairs medical center) has a positive impact on glycemic control and diabetes-related health maintenance. This was accomplished without increasing the total number of antihyperglycemic agents prescribed and without an increase in patient-reported episodes of hypoglycemia.

Pharmacist-Physician Collaboration for Diabetes Care Cardiovascular Outcomes

Background: Only 23% of patients are meeting all goals for cardiovascular complications of diabetes. Objective: The purpose of our study is to evaluate the effect of a pharmacist-physician collaboration on attainment of cardiovascular-related goals in patients with type 2 diabetes. Methods: This prospective, multicenter cohort enrolled patients from 7 practice sites that were members of the University of Tennessee Pharmacist Practice Based Research Network (UT Pharm Net). Patients were included if they were diagnosed with type 2 diabetes, at least 18 years of age and English speaking. Pregnant patients were excluded. Patients were followed for 12 months after enrollment. Primary cardiovascular outcomes included reduction in systolic blood pressure, diastolic blood pressure, and low-density lipoprotein (LDL) as well as the proportion of patients achieving a blood pressure goal of <130/80 mm Hg and proportion of patients achieving an LDL goal of <100 mg/dL. Results: For the 206 patients enrolled, the average age was 59.7 years; the majority were male (59.7%) and white (66%). When compared with baseline, the postintervention mean systolic (P < .0001), diastolic blood pressure (P = .0003), and LDL (P < .0001) decreased significantly. The proportion of patients achieving a blood pressure of <130/80 mm Hg increased 21.8% (P < .0001), and the proportion of patients achieving an LDL of <100 mg/dL increased 12% (P = .0023). Conclusions: The results of our study indicate that collaborative management has a positive impact on decreasing cardiovascular risk and assists patients in attaining national goals for blood pressure and cholesterol.

Capacity Ratios to Assess the Solvency of a College’s Advanced Pharmacy Practice Experience Program

Objective. To use the capacity ratio to determine solvency in 10 advanced pharmacy practice experiences (APPEs) offered by a college of pharmacy. Methods. Availability in each APPE was determined based on preceptor responses, and student need was tabulated from 3 preference forms. Capacity ratios were calculated by dividing preceptor availability by the sum of student requests plus 20% of student requests; ratios ≥ 1 indicated solvency. For the 3 required APPEs, minimum capacity ratios were calculated by dividing availability by the sum of student number plus 20% of the student number. When possible, the capacity ratio for the APPE was calculated by geographic zone. Results. The 3 required APPEs had statewide minimum capacity ratios that were consistent with solvency: advanced community (2.8), advanced institutional (1.6), and ambulatory care (2.5). Only 3 of 7 elective APPEs demonstrated solvency. The elective APPEs for which requests exceeded availability were association management (0.8), emergency medicine (0.8), cardiology (0.6), and human immunodeficiency virus (HIV) ambulatory care clinic (0.4). Analysis by zone revealed additional insolvent practice experiences in some locations. Conclusions. The capacity ratio allowed for assessment of 10 APPEs and identification of practice experience areas that need expansion. While the capacity ratio is a proposed standardized assessment, it does have some limitations, such as an inability to account for practice experience quality, scheduling conflicts, and geographic zone issues.

Status of diabetes care among community pharmacy patients with diabetes: Analysis of the Medical Expenditure Panel Survey

OBJECTIVE To determine the status of diabetes care among community pharmacy patients with diabetes. DESIGN Cross-sectional observational study. SETTING United States, 2005. PATIENTS 1,455 community pharmacy patients aged 18 years or older with diabetes who were diagnosed before 2005. INTERVENTION Analysis of the Medical Expenditure Panel Survey. MAIN OUTCOME MEASURES Proportions of patients meeting American Diabetes Association (ADA) standards of medical care in diabetes. RESULTS In 2005, 1,455 patients with diabetes who were diagnosed before 2005 filled prescriptions through community pharmacies. Gaps occurred between the diabetes care of these patients and ADA standards. Examples include the following: ADA recommends at least two glycosylated hemoglobin (A1C) tests annually, but 19.52% of the study population reported less than two A1C tests in 2005; ADA recommends annual influenza vaccinations, but 42.46% of the study population reported not receiving an influenza vaccination in 2005; and ADA recommends weight control, but 83.74% of the study population was overweight or obese. CONCLUSION The current results demonstrate that many patients with diabetes are not receiving adequate care and that pharmacists have an opportunity to improve diabetes management.

The Use of Capacity Ratios in Introductory Pharmacy Practice Experiences

Objective. To describe the use of capacity ratios following the assignment of introductory pharmacy practice experiences (IPPEs) to a rising third-year pharmacy (P3) class. Methods. Practice experience availability for IPPEs was collected by means of preceptor response to requests. Following assignment of IPPEs to the rising P3 class, capacity ratios from the IPPEs available across the entire state and within each of 4 geographic zones were calculated. Capacity ratios for both community pharmacy and institutional pharmacy also were calculated. Results. The capacity ratio for IPPEs across the entire state was 2.11, which documents solvency. When the capacity ratios were calculated individually for community pharmacy and institutional pharmacy, solvency was also achieved. Likewise, IPPE capacity ratios were solvent in all 4 geographic zones. Conclusions. Capacity ratios are helpful in evaluating IPPE availability as they can be used to determine practice experience need in either type of practice experience or geographic zone.

Pharmacoeconomic Analysis of the Diabetes Initiative Program A Pharmacist-Physician Collaborative Care Model

Background: Diabetes treatment cost increased 41% from 2007 to 2011. Pharmacists have provided collaborative diabetes management for decades with improvement in disease-related end points. Few have reported economic benefits of pharmacist management of type 2 diabetes. Objective: The purpose was to determine if cost savings associated with hemoglobin A1c (A1C) and systolic blood pressure (SBP) change outweighed programmatic pharmacist-physician collaborative care model costs. Methods: This cost analysis of a 12 month, prospective, multicenter, observational study included English-speaking adults, 18 years or older, with type 2 diabetes mellitus, a life expectancy >1 year, and either a A1C >7%, SBP >130 mm Hg, diastolic blood pressure >80 mm Hg, or low-density lipoprotein concentration >100 mg/dL. Pregnant patients were excluded. Primary analysis outcome was average cost per outcome, ratio of net cost (numerator) and percentage achieving outcomes (denominator). Assessment outcomes included A1C reduction by at least 1% and SBP reduction by at least 5.6 mm Hg. Results: 206 patients were seen by pharmacists during 1612 encounters (mean = 7.8 encounters/patient). Pharmacists spent 983 hours caring for type 2 diabetes patients (mean 3.8 hours/patient). Base case net labor and program costs per patient were −

Evaluation of student factors associated with pre-NAPLEX scores.

66.77 and

Interstitial Pneumonitis from Treatment with Gemcitabine

106.81, respectively. Improvement in A1C and SBP yielded

Perceived Barriers to Scholarship and Research Among Pharmacy Practice Faculty: Survey Report from the AACP Scholarship/Research Faculty Development Task Force

421.01 in cost savings per patient. Labor and program average costs per patient for each outcome achieved were −

Barriers to Expanding Advanced Pharmacy Practice Experience Site Availability in an Experiential Education Consortium

100.40 and