The Diabetes Initiative Program significantly improved A1C, total cholesterol, HDL cholesterol, triglycerides and LDL cholesterol in patients with poorly controlled diabetes who did not respond to the usual treatment. Collaboration between physician and pharmacist in a university internal medicine clinic is another potential model for patients with uncontrolled diabetes. This collaboration has enabled pharmacists to identify and overcome barriers to patient-specific care, provide individual diabetes training and manage medications. Pharmacists` involvement in diabetes management through collaboration with physicians has had a direct impact on the percentage of patients who have achieved glycemic and lipid goals. A total of 201 drug modifications have been implemented. 73% of patients needed a change of medication. The most frequent changes in medications have included the addition or adaptation of metformin (20%), insulin therapy (16%), thiazolidinedione (10%), sulfamides hypoglycemics (6%), enzyme inhibitors in conversion of angiotensin (25%), hyperlipidemia (17%), aspirin (16%) vaccination (15%). The most common non-pharmacological interventions were the completion of individualized diabetes education (100%) compared to the DSME program (46%), compared to a medical assistance program (18%), and the ordering of laboratory tests (A1C [53%], microalbumin [50%], lipid profile [43%] and serum chemistry [35%]). The Diabetes Initiatives Program has used several recommendations from the Institute of Medicine and the ADA to improve the care of our patients.4,6 Patient-centered care has been provided by identifying patient-specific barriers for appropriate care and referral. In addition, patients received individualized diabetes training as needed and at an appropriate pace. Implementation of the program in a primary care practice, in collaboration with physicians, facilitated the goal, decision-making and dissemination of knowledge among physicians, pharmacists and patients. The purpose of this manuscript is to describe the results of a collaborative practice controlled by pharmacists in a federally qualified health centre in an undernourished urban setting.
Pharmacists in a primary care team managed patients with chronic diseases using a collaborative practice agreement. Pharmacists, pharmacists and students in care treated patients with type 2 diabetes. The first visit included past medical history, medication reconciliation, adherence determination and patient knowledge of diabetes pathophysiology, care plan, including diet and exercise, medications and possible complications. Pharmacists had the power to optimize drugs and order laboratory tests and remittances. Diabetes, hypertension and drug use outcomes were collected and analyzed to assess the effects of pharmacy clinical services. Patient and provider satisfaction was assessed through targeted group surveys and interviews. Ninety-nine patients were included in the evaluation. The average value of the A1c was 9.8% at inclusion and 8.4% for follow-up (p< 0.05). Significant improvements were made in A1c <9%, angiotensin receptor inhibitors, and statin and smoking cessation during follow-up (p< .05).
Eleven suppliers who responded to the satisfaction survey answered 73% of the questions by mutual agreement. The seven patients who participated in the satisfaction survey and the focus group were satisfied with the management of pharmacists. The focus group focused on similar personal goals, barriers and interests in food education. In a collaborative care team, pharmacists were able to have a significant influence on improving the health outcomes of patients with type 2 diabetes and the perception of the vital role of pharmacists. Despite the publication and wide dissemination of these recommendations, many patients with diabetes still do not reach