Impact of an Interdisciplinary Diabetes Clinic in a Medically Complex Population
Background:
Diabetes management is particularly challenging in the context of multimorbidity and socioeconomic disadvantage. Collaborative diabetes care programs including clinical pharmacist specialists (CPSs) have been successful in improving surrogate clinical outcomes, decreasing diabetes-related complications, and reducing costs of care; however, there is minimal data available regarding the efficacy of these interdisciplinary interventions in a high risk, complex patient population (1-5).
The Center for Advanced Health Management (CAHM) is a comprehensive primary care clinic that employs an interdisciplinary team, including a CPS, and serves socioeconomically vulnerable patients who suffer from multiple disease states. This provides a unique population in which to assess the impact of interdisciplinary care on diabetes management in a high-risk, complex population.
Aims include:
1. Describe the interdisciplinary diabetes care model at VCU CAHM.
2. Demonstrate the impact of this model on A1C trends in patients with multimorbidity.
Methods:
We identified three adult patients with type 2 diabetes and at least two other diseases who were seen by the physician or nurse practitioner and referred to the pharmacist due to poor glycemic control. Each patient visited with the pharmacist every two-to-four weeks for diabetes co-management. Patients were referred to the on-site social worker, case manager, or psychiatric NP when necessary.
Each had an A1C drawn at least twice over the last 1 year, with one value before the first visit with the pharmacist and at least one value 3-4 months later. Patient demographic, clinic visit, and A1C data were obtained from chart review and de-identified.
Results:
The three patients had an average of 7 comorbidities including type 2 diabetes. All exhibited decreased A1C and no further hospitalizations after initiating visits with the pharmacist. The average was 6 visits with the pharmacist within 4 months, with an average decrease in A1C of 4.23 during the same period.
Conclusion:
Our work suggests that an interdisciplinary diabetes care model may lead to improved glycemic control in a medically and socially complex patient population.
Reflection:
This work demonstrates the importance of interdisciplinary collaboration within a patient-centered medical home in achieving glycemic control, particularly in a high risk, complex population.
References:
1. Schmidt, et al. Am J Health-Syst Pharm. 2019;76(Suppl 1):S9–S14.
2. Matzke, et al. Am J Health-Syst Pharm. 2018;75(14):1039–1047.
3. Ko, et al. J Manag Care Spec Pharm. 2016;22(1):32–37.
4. Biltaji, et al. J Pharm Health Serv Res. 2017;8(1):59–62.
5. Wu, et al, PloS One. 2018;13(4):e0195898.
