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ABSTRACT
Objectives: To develop a computer-based diabetic registry for patients with diabetes mellitus enrolled in a large Independent Physicians Association (IPA) in the Midwest. Using the IPA's patients with diabetes HbA1c (glycosylated hemoglobin) value, perform an audit to assess optimal therapeutic goals: To determine if implementation from a Pharmacist to refine therapeutic regimens of type 2 diabetes mellitus patients on selected oral agents, will improve clinical outcomes. To improve the IPA's compliance with HEDIS (Health Plan Employer Data and Information Set) Standards of Measurement.
Design: Part I of a three part clinical analysis, using retrospective lab data and prescription claims records.
Setting: An Independent Physicians Association with approximately eighty physicians located in the Midwest Region.
Patients: Patient's within the IPA were gathered from physician documentation of diabetes using the IC9-250 code. Medication data was obtained from insurance prescription claims.
Methodology: The computer based diabetic registry consisted of information on the patient's name, date of birth, membership ID, age/gender, primary care physician, patient visits, HbA1c results, lab data, medication/strength, comments, and a box to check outliers. Therapeutic suggestions were made to augment clinical goals.
Results: A total of 502 patients were assessed. Patients with an HbA1c greater than 8.5% were marked as outliers and therapeutic recommendations were made. A total of 169 patient's were recommended for Glucovance (glyburide and metformin HCL) conversion. Those patient's were found to be on combination therapy or uncontrolled on oral agents including a sulfonylurea or biguanide.
Conclusion: Groundbreaking opportunities are becoming more prevalent for pharmacists to become active participants in health care initiatives surrounding diabetes disease state management. Institutions are under greater demands to comply with goals of the ADA and with HEDIS on managing patients with diabetes.