Medication Therapy Management in Diabetes

Diabetes can be intimidating and complicated.

Pharmacists who take the time to properly educate patients about diabetes management, such as diet, exercise, medications, and behavior management, can help improve outcomes and reduce HbA1C levels.

Diabetes costs the United States more than $300 billion annually, so concerted efforts are needed to manage this disease.

A team of pharmacists at the University of Illinois Hospital and Health Sciences System published an article in the April 2016 issue of The Journal of Pharmacy Practice about the factors influencing enrollment at their academic ambulatory care facility’s medication therapy management (MTM) clinic. This comprehensive program has 5 service areas: access, adherence, care coordination, medication therapy review, and education.

All services were referral-based, and free. Pharmacists scheduled an initial 60-minute session with patients within 2 weeks of referral. Referral reasons included general disease state management, asthma, hypertension, diabetes, medication management, and adherence counseling.

The 2-year retrospective chart review study investigated all patients’ demographics, referrals, and electronic medical records. They also analyzed time lapse from referral date, scheduled appointments, distance from clinic, mode of transportation, disability status, past medical history, and number of active medications.

Of the 103 referrals analyzed, diabetes management accounted for 13% of them. In addition, 56% patients had diabetes, making it the second most prevalent disease state after hypertension.

Factors that affected MTM program enrollment included:

• Inability to contact patient
• Failure to appear
• Refusal
• Transportation issues
• Age
• Distance from clinic
• History of hypertension

Twenty-three patients failed to attend or refused an appointment.

Closer distance to the clinic, older age, and history of hypertension all positively predicted enrollment in the MTM program. More complex older patients were also more likely to request MTM services.

Extrapolations from this study will be difficult. It was performed at a single academic institution with only 800 patients, and the population was predominately Medicare- and Medicaid-insured, which may present unique barriers.

It’s clear that access is a crucial issue in health care. New strategies are needed to remove obstacles for pharmacist services and improve patient access.