The study by Nuttal et al in this issue of Baylor University Medical Center Proceedings addresses the challenge of management of patients with poorly controlled type 2 diabetes mellitus.1 Existing literature suggests that pharmacist interventions can improve outcomes but are underutilized for a variety of reasons such as cost and space. This study explores the question of whether using a remote pharmacist can achieve the same benefit.
This pilot study implemented a remote pharmacist within an accountable care organization. The pharmacists work collaboratively with physicians, reviewing patient charts, making medication recommendations, and facilitating education and monitoring. The study analyzed the mean change of hemoglobin A1c from baseline and whether the pharmacist recommendations were accepted or rejected. In the study, patients whose physicians accepted pharmacist recommendations showed a statistically significant mean reduction in hemoglobin A1c of −2.7%, compared to −0.6% in the group where recommendations were rejected.
The outcomes of this study help larger systems consider new ways to offer services and employ remote workers in a targeted way. The sample size was reflective of a small pilot and the ability to generalize is limited. However, the results are consistent with existing studies describing a positive impact of remote pharmacist management on patients with diabetes.2,3 Future studies examining the barriers to implementation of a pharmacist to the care team of diabetic patients would further add to the literature on this subject. This would help with break-even cost analysis and feasibility for different size clinics and systems. Additional study directions could target the demographics (years of experience, etc.) of the physicians who accept or reject the pharmacist recommendations. This would better define barriers to adoption. Regardless, this workflow is a good example of patient-centric team-based care.
—Michael McNeal, MD, MSc
Division of General Internal Medicine, Baylor Scott & White Central Texas Region, and Baylor College of Medicine, Temple, Texas, USA
michael.mcneal@bswhealth.org
References
- 1.Nuttall EC, Reynolds T, Kataria AD, et al. Evaluation of remote pharmacist intervention on type 2 diabetes hemoglobin A1c reduction in an accountable care organization. Proc (Bayl Univ Med Cent). 2024;37(5):774–780. doi: 10.1080/08998280.2024.2379195. [DOI] [PMC free article] [PubMed] [Google Scholar]
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- 3.Shane-McWhorter L, McAdam-Marx C, Lenert L, et al. Pharmacist-provided diabetes management and education via a telemonitoring program. J Am Pharm Assoc. 2015;55(5):516–526. doi: 10.1331/JAPhA.2015.14285. [DOI] [PubMed] [Google Scholar]