Endpoint
Primary endpoint
( Table 2). Similarly, the percentage of patients meeting CMS quality measures C09: Diabetes Care— Eye Exam( 61.3 % vs 56.4 %, P = 0.68), and D12: Statin Use in Persons with Diabetes( SUPD)( 80.7 % vs 83 %, P = 0.79), were similar between the two groups. In the logistic regression model on HbA1c, the odds ratio for the pharmacist intervention was 0.668( 95 % CI: 0.283-1.579, p = 0.36), adjusting for endocrine status( OR = 0.743 with 95 % CI: 0.345-1.599, p = 0.45).
The difference from qualifying HbA1c was compared to the patient’ s HbA1c at the end of the study period. The mean difference in HbA1c was a decrease of 2.4 % in the pharmacist intervention group and a decrease of 2.3 % in the control group( P = 0.64)( Table 2). Kidney health evaluations were also explored as this MIPS measure is being actively addressed by both pharmacists and physicians at WVUH MGP. It was found that 77.4 % of patients in the pharmacy intervention group completed this evaluation compared to 66 % in the
TABLE 2: Clinical Endpoints
Pharmacist Intervention( n = 31)
Control( n = 94)
P value
HbA1c < 9 % 19( 61.3) 65( 69.1) 0.51
Secondary endpoint Difference in HbA1c ¶ 2.4 + 2.4 2.3 + 2.3 0.64 Statin therapy 25( 80.7) 78( 83) 0.79
Kidney health evaluation
24( 77.4) 62( 66) 0.27
ACEi / ARB * 10( 83.3) 17( 63) 0.28 Eye exam 19( 61.3) 53( 56.4) 0.68 Hospitalizations 8( 25.8) 34( 36.2) 0.38 ED Visits 15( 48.4) 30( 31.2) 0.13 All data are reported as n(%) or mean + standard deviation unless otherwise specified
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Patients were included if they had a repeat HbA1c within the study period. Pharmacist intervention( n = 28); Control( n = 88) * Patients were included if uACR > 30 mg / g. Pharmacist intervention( n = 12); Control( n = 27)
HbA1c: hemoglobin A1c; ACEi: angiotensin-converting enzyme inhibitor; ARB: angiotensin II receptor blocker; ED: emergency department; uACR, urine albumin-creatinine ratio control group( P = 0.27). Of note, this measure is going to be a CMS Star measure for 2026. Based on the completion of the kidney health evaluation, patients were screened to determine if they were appropriately on ACE / ARB therapy if uACR > 30 mg / g. With this analysis, there were 12 patients included in the pharmacist intervention group and 27 in the control group. In the pharmacist intervention group, 83.3 % of patients were appropriately on ACE / ARB therapy if their uACR was > 30 mg / g compared to 63 % in the control group( P = 0.28).
Hospitalizations and ED visits were also explored; 25. 8 % of patients in the pharmacist intervention group were admitted at least once during the study period compared to 36.2 % in the control group( P = 0.38)( Table 2). However, more patients in the pharmacist intervention group( 48.4 %) had an ED visit compared to the control group( 31.2 %)( P = 0.13).
DISCUSSION
Our findings demonstrate that pharmacists can play an important role in meeting diabetes-related CMS quality measures. Data from this single-center retrospective cohort study suggests that pharmacists practicing under a collaborative practice agreement are just as likely to meet CMS quality measures compared to patients solely managed by a physician. While there was no statistically significant difference in the primary outcome, this was likely because the difference between the two groups was too small relative to our sample size. By contrast, another study found that pharmacists were more likely to meet this quality measure compared to a non-pharmacist cohort. 4 While none of the outcomes in this study were statistically significant, the results do indicate encouraging trends and potential benefits.
While managing diabetes, it is important to evaluate patients holistically and ensure they have appropriate labs and health screenings, even if these items are not CMS quality measures. This study shows that patients managed by pharmacists were more likely to complete an eye exam and kidney health evaluation compared to the control group. Out of those who received a kidney health evaluation, 83.3 % of patients in the pharmacist intervention group were appropriately on ACE / ARB therapy compared to 63 % in the control group. This data provides insight into the fact that the patients followed by a pharmacist may be more therapeutically optimized. Additionally, these findings corroborate other studies that have shown pharmacy intervention can increase the prevalence of screening exams in this patient population. 6
Other key outcomes analyzed included hospitalizations and ED visits as preventing such occurrences means saving the health-system money and resources. Notably, patients followed by a pharmacist had less admissions( 25.8 %) compared to the control group( 36.2 %). While this was not statistically significant, preventing any number of hospitalizations can save the health system thousands of dollars. While pharmacist intervention was associated with fewer hospitalizations, there were more ED visits in this group.
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