Effect of Pharmacist Care on Type 2 Diabetes in Rural Areas
Jeannette Y. Wick, RPh, MBA, FASCP
The prevalence of diabetes is 17% higher in rural areas than in urban areas. Factors such as distance to clinics, financial restrictions, cultural barriers, and poor health literacy all can contribute to a delayed diagnosis and higher risk of diabetes complications. A new study suggests that integrating pharmacist care in diabetes management for rural settings can increase access to care and improve patient outcomes.
The study, published in Annals of Pharmacotherapy, shows pharmacist care improves diabetes-related outcomes in a rural family medicine clinic compared to primary care provider (PCP) intervention alone.
The single-center, case-control study was conducted at the University of Florida Health Family Medicine Clinic located in medically underserved Dixie County, Florida. Twenty-one study patients were matched 1:1 with control patients based on baseline characteristics. Pharmacists and/or primary care providers saw these patients at least twice at the clinic over a 1-year period and the researchers evaluated electronic medical records retrospectively.
Researchers found that patients were more likely to achieve an A1c reduction of greater than or equal to 0.5%, which was statistically significant (OR = 7.51; 95% CI = 1.54-36.61; P <.01), when exposed to pharmacist care in addition to that of a PCP. While these results were not statistically significant, patients receiving pharmacist care also achieved a 1.11% mean A1c reduction from baseline compared to a 0.58% reduction in non-pharmacist managed patients, however, this difference was not statistically significant. The researchers call readers' attention to an ample number of studies that show A1c changes of this magnitude led to a clinically significant decrease in microvascular complications risks.
Additional diabetes-related outcomes were also improved, including ACE inhibitor/ARB use, statin use, and regular nephropathy screening.
Pharmacy visits are 45-60 minutes in length and focus solely on diabetes management, whereas a PCP visit provides shorter face-time to address a number of conditions. An interdisciplinary approach to diabetes management improves care and outcomes, especially in rural areas where PCP shortages decrease patient access.
These findings are not generalizable due to the small sample of patients studied, but other larger studies have produced similar results.
Future studies to compare pharmacist care with that of mid-level practitioners would be worthwhile to support proposed legislation to recognize pharmacists as health care providers.
Moreau C, Sando KR, Zambrano DH. Assessing the Effect of Pharmacist Care on Diabetes-Related Outcomes in a Rural Outpatient Clinic. Ann Pharmacother. 2016; doi: 10.1177/1060028016685731. [Epub ahead of print]