12.11.2013

ORLANDO — Diabetic patients who were counseled by pharmacists did better at managing their blood sugar over a 2-year period than patients in standard treatment, researchers reported here.

Diabetic patients who worked with pharmacists experienced mean reductions in hemoglobin A1c (HbA1c) of -1.24, which were sustained for 2 years, compared with smaller average reductions in control patients (HbA1c -0.59, P=0.009), John J. Ko, PharmD, MS, of the Scott & White Health Plan in Austin, Texas, and colleagues reported at the meeting of the American Society of Health-System Pharmacists.

“Pharmacists are underutilized healthcare professionals who have demonstrated effective clinical competency in managing diabetic patients,” Ko and colleagues wrote.

As part of central Texas’s Scott & White’s Medication Management Program, pharmacists were placed in an ambulatory care setting to communicate with diabetic patients about their condition, make medication adjustments when necessary, and promote self-management through condition education.

For this study, Ko and colleagues looked at the electronic medical records and medical and pharmacy claims of high-risk type 2 diabetes patients in the Scott & White system from 2006 through 2012. At baseline, all participants were ages 18-62 and had HbA1c >7.5%, and 56% were on insulin therapy.

Over the course of 2 years, 75 age-, gender-, and condition-matched controls in standard treatment and 75 patients in the Medication Management Program were followed for diabetic control measures and overall medical and drug costs.

At baseline, average HbA1c levels were 9.30 in the medication management group, and 9.26 in the controls.

Average annual drug costs at the start of the study were $3,952 among medication management participants, and $3,005 among controls. These costs increased by the end of the first year to $6,038 in the medication management patients, but to only $3,640 in controls.

By the end of the second year, drug costs increased a bit in both groups at $7,083 for medication management participants, and $3,736 for controls. But overall, the drug costs were significantly lower among those in the control group.

Less disparity was found between groups when it came to medical costs. Medical costs included claims for inpatient, outpatient, emergency department, and ambulance services.

At baseline, medication management participants’ annual medical costs were an average of $6,490, which increased to $7,181 by the end of the first year, and to $8,862 by the end of the second.

For controls, medical costs averaged $5,228 at baseline, $6,108 after 1 year, and $8,743 after 2 years.

Ko and colleagues concluded that the medication management program helped diabetic patients control HbA1c levels in the long term at no greater medical costs over the course of 2 years.

“Pharmacists in the outpatient setting can see patients and be effective in managing diabetic medications. Overall, my study found the reduction in the HbA1c to be significant. As for the cost at 2 years, it was a wash; however, we will be examining it from a longer time period,” Ko told MedPage Today in an interview.

Ko also said that he expected the cost-effectiveness of the medication management program to improve incrementally every year for the next 5-10 years by driving drug and medical costs down through solid patient-centered disease managment.