CMS quality measure D12: Statin Use in Persons with Diabetes( SUPD) as well as the difference in HbA1c were also analyzed. The difference in HbA1c was similar amongst the pharmacist intervention and control group; a decrease in HbA1c of 2.4 % vs 2.3 % respectively. Similarly, there was no difference in the percentage of patients between the two groups in statin therapy use. This is likely due to the lack of patients in this study, however, other published data does support that pharmacists can identify patients with diabetes eligible for statin therapy and can even increase payer star ratings. 7, 8 It is important to highlight that only patients who were included in this study were analyzed for these measures. It is likely that pharmacists helped more patients with diabetes at WVUH MGP who were not included in the study meet these quality measures.
Prior to this study, there has been limited research published on how well pharmacists can meet CMS quality measures. To our knowledge, this is the first retrospective study analyzing pharmacist impact on multiple diabetes related CMS quality measures via a collaborative practice agreement.
Limitations of this study include the small sample size and disproportionate patient numbers amongst both groups, which was expected due to the nature of the CPA. The limited sample size resulted in the study not achieving power, making it difficult to draw definitive conclusions. It is imperative to note that the majority of WVUH MGP patients were excluded because they had a HbA1c < 9 %, indicating that the practice at baseline is performing well in meeting this triple-weighted Star measure. This is likely due to pharmacists being integrated into the practice setting at baseline and having been highly involved in diabetes management for years prior to the study period. Other resources including population health, dieticians, diabetes educators, and other diabetes related initiatives at WVUH also have an impact on patients meeting these measures at baseline. As previously mentioned, more patients in the control group were seen by endocrine, which also may skew the overall results as another provider was likely managing the patient’ s diabetes more closely than the primary care provider. Additionally, some patients in the pharmacist intervention group were difficult to contact, which hindered close follow-up in this group. Due to the sample size, any patient in the pharmacist intervention group that was difficult to contact would have a profound impact on the results overall. Ultimately this study only explored whether patients met CMS quality measures and not medication optimizations, which is a major role of the pharmacist.
CONCLUSION
Pharmacists practicing under a collaborative practice agreement demonstrated outcomes comparable to physician-only managed patients in meeting CMS quality measures for diabetes. Despite the study limitations, the data provides important insight into the potential positive impact a pharmacist can have on meeting CMS quality measures in the primary care setting. Further exploration is needed to evaluate even more so the likelihood of quality measure achievement, the clinical significance, the therapeutic optimization, the cost savings, and the effects on hospitalization rates of the pharmacist’ s involvement in the studied setting.
REFERENCES
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