Reducing Costs and Improving Outcomes in Diabetes

Orlando—With fewer physicians, rising healthcare costs, and an increasing population, treating patients is becoming more difficult. For instance, >24 million people in the United States ≥20 years of age have diabetes, and the total costs associated with disease were estimated at $218 billion in 2007, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Yet, the Association of American Medical Colleges’ 2010 report indicated the United States had a shortage of 16,000 primary care physicians, which is expected to increase to 125,000 by 2015. By collaborating with physicians, pharmacists could help ease the burden, extend access to more people, and improve chronic disease management, according to Michael Taitel, PhD, director of health outcomes and analytics for Walgreen Co. Dr. Taitel spoke at the NAMCP meeting in a session titled Pharmacist-Led Diabetes Education: An Innovative Approach to Health Outcomes and Cost Reduction in Chronic Disease Management. The NIDDK estimates that every 24 hours, 4384 new cases of diabetes are diagnosed, and 839 people die from diabetes directly or with diabetes as a contributing cause. Dr. Taitel also cited a 2009 UnitedHealthcare report that said treating patients with diabetes and complications costs $30,000 per year, 3 times more than diabetes patients who are in control of their disease. In the past year, government officials have proposed several patient management models, such as medical homes, accountable care organizations, and electronic self-service. However, Dr. Taitel said each model faces financial and funding issues, particularly with an additional 32 million people gaining access to insurance in 2014 as part of the Patient Protection and Affordable Care Act. Although pharmacists’ main responsibility is advising patients on how to properly use medication, Dr. Taitel said pharmacists’ roles have expanded to include drug safety monitoring, identifying drug–drug interactions, providing chronic care management, reviewing drug utilization and medication therapy management, participating in public health initiatives such as smoking cessation and diabetes education, and working on multidisciplinary clinical care teams. Dr. Taitel discussed programs that show patients can benefit from pharmacists’ intervention. In the Diabetes 10-City Challenge, a program sponsored by 30 employers, community pharmacists work with diabetes patients on managing their disease through setting goals, properly using their medications, and keeping track of their condition. Citing a 2008 article in the Journal of the American Pharmacists Association, Dr. Taitel said after 1 year in the program, patients reduced their average hemoglobin A1c (HbA1c) test result by 5.2%, their low-density lipoprotein cholesterol (LDL-C) level by 3.1%, their systolic blood pressure by 2%, and their diastolic blood pressure by 2.5%. In addition, there was a 42% increase in the number of patients receiving influenza vaccination and a 79% increase in the number of patients undergoing foot examinations. In addition, DiabetesCARE and CardioCARE are comprehensive care management and medication therapy management programs in which patients underwent an initial hour-long assessment, followed by three 2-hour sessions on self-management. They then had quarterly follow-up visits to review their progress and undergo a limited examination. After a year, patients with an HbA1c score >9 had their levels drop by 16%, and patients with an LDL-C score <130 mg/dL increased their score by 29%. Vaccinations for influenza increased 16%, while vaccinations for pneumonia increased 18%. Walgreen Co has also implemented several disease management programs, according to Dr. Taitel. In the Dimensions program, pharmacists began providing diabetes education on April 1, 2008, to patients identified through their employers or third-party administrators. Patients did not have a copayment for their diabetes medications, and they received free blood glucose testing supplies. The patients first had a 1-hour consultation with a pharmacist, followed by monthly follow-ups in which patients underwent a physical examination and had their health status assessed. Dr. Taitel said the patients’ average HbA1c score decreased from 7.72 to 7.05, which was statistically significant. The results also indicated statistically significant improvement in systolic blood pressure, diastolic blood pressure, high-density lipoprotein cholesterol, and body mass index.