Make a PACT with Patients and Get Involved in Diabetes Care

Growing evidence suggests that integrating clinical pharmacy specialists into medical care teams that focus on diabetes improves glycemic control, and leads to better clinical outcomes in primary care settings. Pharmacists who work for the US Veterans Administration (VA) seem to be leaders in this area. Patients enrolled in the VA Healthcare System frequently have diabetes, with diabetes being the third most common diagnosis in the system. Veterans who do not receive care from the VA Healthcare System are at higher risk.

The journal Pharmacy Practice has published a new study conducted by VA pharmacists employed at the DeBakey Veterans Affairs Medical Center in Houston-Fort Worth, Texas. It provides further evidence that pharmacists can help patients gain control over fluctuating blood sugar levels.

These pharmacists set out to evaluate the impact of Patient-Aligned Care Teams (PACTs) in community practice. They enrolled 184 veterans. VA guidelines suggest targeting a range of 7 to 8.5 for individuals with established microvascular or macrovascular disease, comorbid conditions, or life expectancy shorter than 5 to 10 years. The VA population tends to have many of these conditions, and with an average age of 65, targets less stringent than 7 may also be appropriate.

At the study start, veterans’ baseline hemoglobin A1c (HbA1c) levels were 10.6. These numbers improved significantly over the following 12 months, steadily falling until they reached approximately 7.6 at the end of 12 month period.

Most veterans were prescribed insulin, metformin, and a sulfonylurea at baseline. Clinical pharmacist engaged in the PACT tended to:

• Effect changes in metformin prescribing for patients who had worsening renal function
• Discontinue sulfonylureas in older patients with high risk of hypoglycemia and concomitant insulin
• Add insulin to patients who needed more aggressive treatment; and optimize oral medication dosing

They also helped patients with lifestyle modification education, and adherence assessment.

This is another study that links better use of pharmacists and their extensive education for patients who are treated through ambulatory care or outpatient settings, and have diabetes.

Reference

Gardea J, Papadatos J, Cadle R. Evaluating glycemic control for patient-aligned care team clinical pharmacy specialists at a large Veterans Affairs medical center. Pharmacy Practice 2018;16(2):1164.