Author ORCID Identifier
https://orcid.org/0009-0005-3485-4033
Defense Date
2024
Document Type
Thesis
Degree Name
Master of Science
Department
Pharmaceutical Sciences
First Advisor
Teresa M. Salgado
Abstract
Background: Diabetes mellitus presents a multifaceted challenge that requires comprehensive care across various disciplines. Conventional models that focus solely on physician care may not achieve optimal outcomes. As the United States faces a potential shortage of primary care physicians by 2034, compounded by an aging population and population growth, the need for enhanced care models becomes evident. As healthcare transitions towards value-based care with a focus on achieving the quadruple aims (reducing care cost, enhancing patient satisfaction, improving population health, and elevating provider contentment), the burden on physicians to deliver comprehensive care increases substantially. This shifting landscape presents a unique opportunity for pharmacists to play a pivotal role.
Objective: This study aims to evaluate the impact of pharmacist-physician collaborative care (PPCC) on diabetes management to the standard of care (SC) in primary care clinics in Virginia.
Method: Using a retrospective observational cohort design, we analyzed electronic health record (EHR) data from Bon Secours Mercy Health primary care clinics to examine the effect of PPCC on HbA1c reduction over time and time-to-goal achievement for patients with poorly controlled diabetes to that of SC. Patients were 1:1 and 1:2 matched using propensity score matching. A generalized linear mixed model was employed to adjust for covariates and incorporate patient- and practice-specific random effects. Survival analysis was conducted to examine the time needed to reach the quality measure of HbA1c < 9.0%, with data analysis conducted using R statistical software.
Results: The study included 1293 patients (PPCC = 431; SC = 862) for the generalized linear mixed model. Patients under PPCC demonstrated significant improvement in HbA1c control at 4- (-0.79, p-value = 0.01), and 8-months (-1.21, p-value = 0.01). Compared to SC, PPCC exhibited substantial reductions in HbA1c levels from baseline (all p-values < 0.001) at 4 (PPCC −2.05, SC −1.39), 8 (PPCC −1.98, SC −0.90), and 12 months (PPCC −1.40, SC −1.34). For survival analysis, the sample included 466 patients (PPCC = 250; SC = 216). Among patients receiving PPCC, the median time to achieve the target HbA1c was significantly shorter than that of SC patients [127 days (95% CI: 115, 154) versus 191 days (95% CI: 158, 256), p < 0.001].
Conclusion: PPCC emerges as a superior approach, surpassing SC in enhancing glycemic control and expediting goal achievement for HbA1c < 9%. These findings highlight the added value of an interprofessional care approach, emphasizing the pivotal role of pharmacists in optimizing patient outcomes and addressing the growing diabetes epidemic. Harnessing the synergistic expertise of pharmacists and physicians not only fosters improved patient outcomes but also represents a paradigm shift towards a holistic, patient-centric approach in managing diabetes.
Rights
© Poorva B. Birari
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
5-10-2024