Reducing Emergency Department Visits Among Patients With Diabetes by Embedding Clinical Pharmacists in the Primary Care Teams
| Autor: | Jonathan Grotts, Chi-Hong Tseng, Richard Maranon, Gerardo Moreno, Jeffery Fu, Samuel S Skootsky, Janet S Chon, Douglas S. Bell, Carol M. Mangione |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Blood Pressure Pharmacists 0302 clinical medicine 80 and over Medicine 030212 general & internal medicine Generalized estimating equation Aged 80 and over Emergency Service diabetes 030503 health policy & services Health Services Middle Aged Hospitalization Cholesterol Health Policy & Services Public Health and Health Services Female 0305 other medical science Emergency Service Hospital medicine.medical_specialty medication management Average treatment effect Medication Therapy Management Pharmacist MEDLINE clinical pharmacists Motivational Interviewing Article LDL Hospital primary care 03 medical and health sciences Diabetes mellitus Diabetes Mellitus Humans Aged Patient Care Team Primary Health Care business.industry Public Health Environmental and Occupational Health Emergency department Cholesterol LDL Patient Acceptance of Health Care medicine.disease Clinical pharmacy Blood pressure Heart Disease Risk Factors Applied Economics Emergency medicine Polypharmacy business |
| Zdroj: | Med Care Medical care, vol 59, iss 4 |
| ISSN: | 1537-1948 |
| Popis: | Author(s): Moreno, Gerardo; Fu, Jeffery Y; Chon, Janet S; Bell, Douglas S; Grotts, Jonathan; Tseng, Chi-Hong; Maranon, Richard; Skootsky, Samuel S; Mangione, Carol M | Abstract: BackgroundPharmacists are effective at improving control of cardiovascular risk factors, but it less clear whether these improvements translate into less emergency department (ED) use and fewer hospitalizations. The UCMyRx program embed pharmacists in primary care.ObjectiveThe objective of this study was to examine if the integration of pharmacists into primary care was associated with lower ED and hospital use for patients with diabetes.DesignThis was a quasi-experimental study with a comparator group.SubjectsThe analytic sample included patients with diabetes with uncontrolled cardiovascular risk factors (A1C g9%, blood pressure g140/90 mm Hg, low-density lipoprotein-cholesterol g130 mg/dL) who had 1 or more visits in either a UCMyRx (648 patients, 14 practices) or usual care practice (1944 patients, 14 practices).MeasuresOur outcomes were ED and hospitalization rates as measured before and after the consultations between UCMyRx and usual care. Our predictor variable was the pharmacist consultation. Poisson generalized estimating equations model was used to estimate the adjusted predicted change in utilization before and after the pharmacist consultation. The Average Treatment Effect on the Treated was estimated.ResultsIn models adjusted, the adjusted mean predicted number of emergency department visits/month during the year before the consultation was 0.09 among UCMyRx patients. During the year after initiating the care with the pharmacists, this rate decreased to an adjusted mean monthly rate of 0.07, with an Average Treatment Effect on the Treated=0.021 (P=0.035), a predicted reduction of 21% in emergency department visits associated with the clinical pharmacist consults. There was a nonsignificant predicted 3.2% reduction in hospitalizations over time for patients in the UCMyRx program.ConclusionClinical pharmacists are an important addition to clinical care teams in primary care practices and significantly decreased utilization of the ED among patients with poorly controlled diabetes. |
| Databáze: | OpenAIRE |
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