Does the presence of a pharmacist in primary care clinics improve diabetes medication adherence?

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• 作者：Beverly Mielke Kocarnik (1)
  Chuan-Fen Liu (2) (3)
  Edwin S Wong (2) (3)
  Mark Perkins (2)
  Matthew L Maciejewski (4) (5)
  Elizabeth M Yano (6) (7)
  David H Au (2) (8)
  John D Piette (10) (9)
  Chris L Bryson (1) (2)
  
• 关键词：Pharmacist ; Medication adherence ; Diabetes mellitus ; Oral hypoglycemic agent ; Patient ; centered medical home
• 刊名：BMC Health Services Research
• 出版年：2012
• 出版时间：December 2012
• 年：2012
• 卷：12
• 期：1
• 全文大小：282KB
• 参考文献：1. Rozenfeld Y, Hunt JS, Plauschinat C, Wong KS: Oral antidiabetic medication adherence and glycemic control in managed care. / Am J Manag Care 2008,14(2):71-5.
  2. Cramer JA: A systematic review of adherence with medications for diabetes. / Diabetes Care 2004,27(5):1218-224. dx.doi.org/10.2337/diacare.27.5.1218">CrossRef
  3. Ho PM, Rumsfeld JS, Masoudi FA, McClure DL, Plomondon ME, Steiner JF, Magid DJ: Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. / Arch Intern Med 2006,166(17):1836-841. dx.doi.org/10.1001/archinte.166.17.1836">CrossRef
  4. Yeaw J, Benner JS, Walt JG, Sian S, Smith DB: Comparing adherence and persistence across 6 chronic medication classes. / J Manag Care Pharm 2009,15(9):728-40.
  5. Davidson MB, Karlan VJ, Hair TL: Effect of a pharmacist-managed diabetes care program in a free medical clinic. / Am J Med Qual 2000,15(4):137-42. dx.doi.org/10.1177/106286060001500403">CrossRef
  6. Coast-Senior EA, Kroner BA, Kelley CL, Trilli LE: Management of patients with type 2 diabetes by pharmacists in primary care clinics. / Ann Pharmacother 1998,32(6):636-41. dx.doi.org/10.1345/aph.17095">CrossRef
  7. Jaber LA, Halapy H, Fernet M, Tummalapalli S, Diwakaran H: Evaluation of a pharmaceutical care model on diabetes management. / Ann Pharmacother 1996,30(3):238-43.
  8. Skaer TL, Sclar DA, Markowski DJ, Won JK: Effect of value-added utilities on prescription refill compliance and health care expenditures for hypertension. / J Hum Hypertens 1993,7(5):515-18.
  9. Chisholm-Burns MA, Kim Lee J, Spivey CA, Slack M, Herrier RN, Hall-Lipsy E, Graff Zivin J, Abraham I, Palmer J, Martin JR, / et al.: US pharmacists' effect as team members on patient care: systematic review and meta-analyses. / Med Care 2010,48(10):923-33. dx.doi.org/10.1097/MLR.0b013e3181e57962">CrossRef
  10. Jha AK, Perlin JB, Kizer KW, Dudley RA: Effect of the transformation of the Veterans Affairs Health Care System on the quality of care. / N Engl J Med 2003,348(22):2218-227. dx.doi.org/10.1056/NEJMsa021899">CrossRef
  11. Kizer KW, Dudley RA: Extreme makeover: transformation of the Veterans Health Care System. / Annu Rev Public Health 2009, 30:313-39. dx.doi.org/10.1146/annurev.publhealth.29.020907.090940">CrossRef
  12. Smith M, Bates DW, Bodenheimer T, Cleary PD: Why pharmacists belong in the medical home. / Health Aff 2010,29(5):906-13. dx.doi.org/10.1377/hlthaff.2010.0209">CrossRef
  13. Chapko MK, Borowsky SJ, Fortney JC, Hedeen AN, Hoegle M, Maciejewski ML, VanDeusen Lukas C: Evaluation of the department of veterans affairs community-based outpatient clinics. / Med Care 2002,40(7):555-60. dx.doi.org/10.1097/00005650-200207000-00001">CrossRef
  14. Yano EM, Fleming B, Canelo I, Lanto AB, Yee T, Wang M, Wright S, Cuerdon T: / Results for the primary care director module of the VHA Clinical Practice Organizational Survey. Sepulveda, CA: VA HSR&D Center for the Study of Healthcare Provider Behavior; 2008.
  15. Yano EM, Soban LM, Parkerton PH, Etzioni DA: Primary care practice organization influences colorectal cancer screening performance. / Health Serv Res 2007,42(3 Pt 1):1130-149. dx.doi.org/10.1111/j.1475-6773.2006.00643.x">CrossRef
  16. Miller DR, Safford MM, Pogach LM: Who has diabetes? Best estimates of diabetes prevalence in the Department of Veterans Affairs based on computerized patient data. / Diabetes Care 2004,27(Suppl 2):B10-B21. dx.doi.org/10.2337/diacare.27.suppl_2.B10">CrossRef
  17. Wong ES, Piette JD, Liu CF, Perkins M, Maciejewski ML, Jackson GL, Blough DK, Fihn SD, Au DH, Bryson CL: Measures of adherence to oral hypoglycemic agents at the primary care clinic level: the role of risk adjustment. / Med Care 2012,50(7):591-98. dx.doi.org/10.1097/MLR.0b013e318249cb74">CrossRef
  18. Bryson CL, Au DH, Young B, McDonell MB, Fihn SD: A refill adherence algorithm for multiple short intervals to estimate refill compliance (ReComp). / Med Care 2007,45(6):497-04. dx.doi.org/10.1097/MLR.0b013e3180329368">CrossRef
  19. Kim N, Agostini JV, Justice AC: Refill adherence to oral hypoglycemic agents and glycemic control in veterans. / Ann Pharmacother 2010,44(5):800-08. dx.doi.org/10.1345/aph.1M570">CrossRef
  20. Cohen HW, Shmukler C, Ullman R, Rivera CM, Walker EA: Measurements of medication adherence in diabetic patients with poorly controlled HbA(1c). / Diabet Med 2010,27(2):210-16. dx.doi.org/10.1111/j.1464-5491.2009.02898.x">CrossRef
  21. Linzer M, Baier Manwell L, Mundt M, Williams E, Maguire A, McMurray J, Plane MB: Organizational climate, stress, and error in primary care. In / Advances in Patient Safety: From Research to Implementation. Edited by: Henriksen K, Battles JB, Marks ES, Lewin DI. Rockville, MD: Agency for Healthcare Research and Quality; 2005:65-7. [ / Research findings. AHRQ Publication No. 05-021-] Volume 1
  22. Varkey AB, Manwell LB, Williams ES, Ibrahim SA, Brown RL, Bobula JA, Horner-Ibler BA, Schwartz MD, Konrad TR, Wiltshire JC, / et al.: Separate and unequal: clinics where minority and nonminority patients receive primary care. / Arch Intern Med 2009,169(3):243-50. dx.doi.org/10.1001/archinternmed.2008.559">CrossRef
  23. Manwell LB, Williams ES, Babbott S, Rabatin JS, Linzer M: Physician perspectives on quality and error in the outpatient setting. / WMJ 2009,108(3):139-44.
  24. Breusch TS, Pagan AR: A simple test for heteroscedasticity and random coefficient variation. / Econometrica 1979,47(5):1287-294. dx.doi.org/10.2307/1911963">CrossRef
  25. Feiveson AH: Power by simulation. / Stata J 2002,2(2):107-24.
  26. Nkansah NT, Brewer JM, Connors R, Shermock KM: Clinical outcomes of patients with diabetes mellitus receiving medication management by pharmacists in an urban private physician practice. / Am J Health Syst Pharm 2008,65(2):145-49. dx.doi.org/10.2146/ajhp070012">CrossRef
  27. Lindenmeyer A, Hearnshaw H, Vermeire E, Van Royen P, Wens J, Biot Y: Interventions to improve adherence to medication in people with type 2 diabetes mellitus: a review of the literature on the role of pharmacists. / J Clin Pharm Ther 2006,31(5):409-19. dx.doi.org/10.1111/j.1365-2710.2006.00759.x">CrossRef
  28. Al Mazroui NR, Kamal MM, Ghabash NM, Yacout TA, Kole PL, McElnay JC: Influence of pharmaceutical care on health outcomes in patients with Type 2 diabetes mellitus. / Br J Clin Pharmacol 2009,67(5):547-57. dx.doi.org/10.1111/j.1365-2125.2009.03391.x">CrossRef
  29. Brooks AD, Rihani RS, Derus CL: Pharmacist membership in a medical group's diabetes health management program. / Am J Health Syst Pharm 2007,64(6):617-21. dx.doi.org/10.2146/ajhp060095">CrossRef
  30. Friedberg MW, Lai DJ, Hussey PS, Schneider EC: A guide to the medical home as a practice-level intervention. / Am J Manag Care 2009,15(10 Suppl):S291-S299.
  31. Reid RJ, Fishman PA, Yu O, Ross TR, Tufano JT, Soman MP, Larson EB: Patient-centered medical home demonstration: a prospective, quasi-experimental, before and after evaluation. / Am J Manag Care 2009,15(9):e71-e87.
  32. Bates DW: Role of pharmacists in the medical home. / Am J Health Syst Pharm 2009,66(12):1116-118. dx.doi.org/10.2146/ajhp080667">CrossRef
  33. / Department of Veterans Affairs Patient Centered Medical Home Model Concept Paper. docs/pcmh_ConceptPaper.doc" class="a-plus-plus">http://www1.va.gov/PrimaryCare/docs/pcmh_ConceptPaper.doc.
  34. Day TE, Li WM, Ingolfsson A, Ravi N: The use of queueing and simulative analyses to improve an overwhelmed pharmacy call center. / J Pharm Pract 2010,23(5):492-95. dx.doi.org/10.1177/0897190009358772">CrossRef
  35. McInnes DK, Gifford AL, Kazis LE, Wagner TH: Disparities in health-related internet use by US veterans: results from a national survey. / Inform Prim Care 2010,18(1):59-8.
  36. Welty TE, Willis SL, Welty EA: Effect of limited transportation on medication adherence in patients with epilepsy. / J Am Pharm Assoc 2010,50(6):698-03. dx.doi.org/10.1331/JAPhA.2010.09081">CrossRef
  37. LaVela SL, Smith B, Weaver FM, Miskevics SA: Geographical proximity and health care utilization in veterans with SCI&D in the USA. / Soc Sci Med 2004,59(11):2387-399. dx.doi.org/10.1016/j.socscimed.2004.06.033">CrossRef
  38. Stowasser DA, Collins DM, Stowasser M: A randomised controlled trial of medication liaison services, I: patient outcomes. / J Pharm Pract Res 2002,32(2):133-40.
  39. Haig GM, Kiser LA: Effect of pharmacist participation on a medical team on costs, charges, and length of stay. / Am J Hosp Pharm 1991,48(7):1457-462.
  40. The pre-publication history for this paper can be accessed here:dcentral.com/1472-6963/12/391/prepub" class="a-plus-plus">http://www.biomedcentral.com/1472-6963/12/391/prepub
  
• 作者单位：Beverly Mielke Kocarnik (1)
  Chuan-Fen Liu (2) (3)
  Edwin S Wong (2) (3)
  Mark Perkins (2)
  Matthew L Maciejewski (4) (5)
  Elizabeth M Yano (6) (7)
  David H Au (2) (8)
  John D Piette (10) (9)
  Chris L Bryson (1) (2)
  
  1. Division of General Internal Medicine, University of Washington, 329 Ninth Ave, Campus Box 359780, Seattle, WA, 98104, USA
  2. Northwest Center for Outcomes Research in Older Adults, VA Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA, 98101, USA
  3. Department of Health Services, University of Washington, Box 357660, Seattle, WA, 98195, USA
  4. Center for Health Services Research in Primary Care, Durham VA Medical Center, 508 Fulton St, Durham, NC, 27705, USA
  5. Division of General Internal Medicine, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA
  6. Center for the Study of Healthcare Provider Behavior, Los Angeles VA 16111 Plummer St (152), Los Angeles, CA, 91343, USA
  7. Department of Health Services, University of California, 650 Charles Young Dr. S. 31-269 CHS, Box 951772, Los Angeles, CA, 90095, USA
  8. Department of Medicine, University of Washington, RR-512 Health Sciences, Box 356420, Seattle, WA, 98195, USA
  10. Department of Internal Medicine, University of Michigan School of Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
  9. VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Rd., Mail Stop 152, Ann Arbor, MI, 48105, USA
  

文摘

Background Although oral hypoglycemic agents (OHAs) are an essential element of therapy for the management of type 2 diabetes, OHA adherence is often suboptimal. Pharmacists are increasingly being integrated into primary care as part of the move towards a patient-centered medical home and may have a positive influence on medication use. We examined whether the presence of pharmacists in primary care clinics was associated with higher OHA adherence. Methods This retrospective cohort study analyzed 280,603 diabetes patients in 196 primary care clinics within the Veterans Affairs healthcare system. Pharmacists presence, number of pharmacist full-time equivalents (FTEs), and the degree to which pharmacy services are perceived as a bottleneck in each clinic were obtained from the 2007 VA Clinical Practice Organizational Survey—Primary Care Director Module. Patient-level adherence to OHAs using medication possession ratios (MPRs) were constructed using refill data from administrative pharmacy databases after adjusting for patient characteristics. Clinic-level OHA adherence was measured as the proportion of patients with MPR >= 80%. We analyzed associations between pharmacy measures and clinic-level adherence using linear regression. Results We found no significant association between pharmacist presence and clinic-level OHA adherence. However, adherence was lower in clinics where pharmacy services were perceived as a bottleneck. Conclusions Pharmacist presence, regardless of the amount of FTE, was not associated with OHA medication adherence in primary care clinics. The exact role of pharmacists in clinics needs closer examination in order to determine how to most effectively use these resources to improve patient-centered outcomes including medication adherence.