Patient self-management program for diabetes: first-year clinical, humanistic, and economic outcomes.

OBJECTIVE To assess the outcomes for the first year following the initiation of a multisite community pharmacy care services (PCS) program for patients with diabetes. DESIGN Quasi-experimental, pre-post cohort study. SETTING 80 community pharmacy providers with diabetes certificate program training who were reimbursed for PCS by employers in Greensboro, N.C., Wilson, N.C., Dublin, Ga., Manitowoc County, Wis., and Columbus, Ohio. PATIENTS 256 patients with diabetes covered by self-insured employers' health plans. INTERVENTIONS Community pharmacist patient care services using scheduled consultations, clinical goal setting, monitoring, and collaborative drug therapy management with physicians and referrals to diabetes educators. MAIN OUTCOME MEASURES Changes in glycosylated hemoglobin (AIC), low-density lipoprotein cholesterol (LDL-C), blood pressure, influenza vaccinations, foot examinations, eye examinations, patient goals for nutrition, exercise, and weight, patient satisfaction, and changes medical and medication utilization and costs. RESULTS Over the initial year of the program, participants' mean A1C decreased from 7.9% at initial visit to 7.1%, mean LDL-C decreased from 113.4 mg/dL to 104.5 mg/dL, and mean systolic blood pressured decreased from 136.2 mm Hg to 131.4 mm Hg. During this time, influenza vaccination rate increased from 52% to 77%, the eye examination rate increased from 46% to 82%, and the foot examination rate increased from 38% to 80%. Patient satisfaction with overall diabetes care improved from 57% of responses in the highest range at baseline to 87% at this level after 6 months, and 95.7% of patients reported being very satisfied or satisfied with the diabetes care provided by their pharmacists. Total mean health care costs per patient were $918 lower than projections for the initial year of enrollment. CONCLUSION Patients who participated in the program had significant improvement in clinical indicators of diabetes management, higher rates of self-management goal setting and achievement, and increased satisfaction with diabetes care, and employers experienced a decline in mean projected total direct medical costs.