Impact of a comprehensive pharmacist medication-therapy management service

Figures & data

Figure 1. Patients screening and enrollment flow chart.

Table 1. Baseline characteristics.

	Control (n = 73)	Intervention (n = 28)	p Value	Weighted controls	p Value
Age, mean (SD), years	62.8 (14.6)	65.4 (10.3)	0.38	64.8	0.80
Length of history with diabetes, mean (SD), years	15.2 (12.9)	19.2 (14.2)	0.18	16.3	0.43
Charlson Comorbidity Index score, mean (SD)	5.3 (2.9)	5.9 (2.4)	0.40	5.5	0.57
Sex, n (%)
Female	37 (50.7)	17 (60.7)	0.37	(61.1)	0.97
Male	36 (49.3)	11 (39.3)		(38.9)
Race, n (%)
African American	12 (16.4)	12 (42.9)	0.03	(24.4)	0.35
Asian	1 (1.4)	0		(5.8)
White	56 (76.7)	15 (53.6)		(66.7)
Hispanic	1 (1.4)	1 (3.6)		(0.3)
Unknown	3 (4.1)	0		(2.6)
Diabetes type, n (%)
Type 1	21 (28.8)	6 (21.4)	0.46	(25.8)	0.67
Type 2	52 (71.2)	22 (78.6)		(74.2)
Smoking status, n (%)
Non-smoker	43 (58.9)	17 (60.7)	0.68	(58.2)	0.83
Former smoker	25 (34.3)	8 (28.6)		(27.5)
Unknown	1 (1.4)	0		(3.2)
Smoker	4 (5.5)	3 (10.7)		(11.0)
Insurance, n (%)
Private	31 (42.5)	18 (64.3)	0.21	(54.0)	0.52
Private/public	3 (4.1)	0		(4.0)
Public	38 (52.1)	10 (35.7)		(42.0)
None	1 (1.4)	0		(0)
Index admission related to diabetes, n (%)	54 (74.0)	21 (75.0)	0.94	(74.4)	0.96
Discharged from hospitalization at index discharge, n (%)	55 (75.3)	27 (96.4)	0.02	(88.6)	0.23
Discharged from ED/urgent care visit at index discharge, n (%)	18 (24.7)	1 (3.6)		(11.4)
Number of physician visits at index discharge, mean (SD)	1.2 (0.9)	2.5 (5.1)	0.04	1.1	0.15
Length of stay at index discharge, mean (SD), days	3.9 (3.9)	5.9 (6.7)	0.16	4.3	0.26
Time between index discharge and first visit, mean (SD), days	25.3 (24.7)	16.8 (17.3)	0.05	26.5	0.07
Number of diabetes-related drugs per patient at baseline, mean (SD)	4.9 (2.1)	6.0 (1.8)	0.02	5.6	0.43
Number of all drugs per patient at baseline, mean (SD)	10.0 (4.9)	11.0 (3.4)	0.36	11.3	0.65
Clinical indicators, mean (SD)
Baseline HbA1c, %	8.0 (1.7)	8.5 (2.5)	0.23	7.8	0.21
Baseline glucose, mg/dL	188.0 (82.4)	163.2 (75.5)	0.19	199.4	0.13
Baseline total cholesterol, mg/dL	168.4 (46.4)	174.1 (46.9)	0.65	176.4	0.90
Baseline BMI, kg/m^2	31.7 (8.5)	31.7 (6.6)	0.998	30.9	0.68
Baseline systolic pressure, mmHg	123.2 (17.4)	123.1 (21.3)	0.99	125.3	0.66
Baseline diastolic pressure, mmHg	69.7 (9.1)	66.0 (13.2)	0.11	70.2	0.20

BMI, body mass index; ED, emergency department; HbA1c, glycated hemoglobin A1C; SD, standard deviation.

Figure 2. Effect of propensity score weighting at reducing absolute standard difference among treatment groups.

Table 2. Health services utilization count rates over time, expressed as counts of transitions per patient.

	Controls		Intervention		p Value	Weighted controls
	Patients followed-up (n)	Cumulative utilization rate	Patients followed-up (n)	Cumulative utilization rate		Cumulative utilization rate	p Value
Hospitalization count rate
30 days post-discharge	73	0.03	27	0.04	0.81	0.04	0.96
60 days post-discharge	72	0.08	26	0.08	0.93	0.12	0.65
90 days post-discharge	71	0.14	26	0.15	0.90	0.20	0.74
120 days post-discharge	71	0.24	25	0.28	0.77	0.27	0.96
180 days post-discharge	59	0.37	24	0.46	0.68	0.43	0.92
Urgent care/ED visits count rate
30 days post-discharge	73	0.00	27	0.00	0.99	0.00	0.99
60 days post-discharge	72	0.01	26	0.08	0.16	0.02	0.35
90 days post-discharge	71	0.04	26	0.19	0.038*	0.04	0.06
120 days post-discharge	71	0.08	25	0.20	0.15	0.09	0.23
180 days post-discharge	59	0.10	24	0.25	0.12	0.11	0.18
Cumulative hospitalization/urgent care/ED visit/paramedic visits count rate
30 days post-discharge	73	0.03	27	0.04	0.81	0.04	0.96
60 days post-discharge	72	0.10	26	0.27	0.15	0.14	0.42
90 days post-discharge	71	0.20	26	0.46	0.12	0.25	0.38
120 days post-discharge	71	0.35	25	0.60	0.24	0.39	0.46
180 days post-discharge	59	0.53	24	0.96	0.13	0.59	0.30

*Statistically significant at alpha = 0.05; ED, emergency department.

Table 3. Cumulative count rate of hospitalizations and urgent care visits over 180 days (weighted analyses).

	90 days post-discharge		120 days post-discharge		180 days post-discharge
	Rate ratio	p Value	Rate ratio	p Value	Rate ratio	p Value
Cumulative outcome (hospitalizations and visits)
Intervention arm (vs control arm)	1.61	0.84	0.59	0.86	1.61	0.72
African American race	1.45	0.60	1.66	0.59	1.45	0.33
Discharged from hospitalization at baseline  (vs urgent care/ED visit/paramedic visit)	0.01	0.10	1.49	0.96	0.01	<0.01*
Number of physician visits at baseline	0.88	0.40	0.87	0.47	0.88	0.12
History with diabetes (10+ vs 0–5 years)	4.61	0.19	4.89	0.32	4.61	0.02*
History with diabetes (10+ vs 6–10 years)	0.16	0.50	1.19	0.98	0.16	0.22

*Statistically significant at alpha = 0.05.

ED, emergency department; HbA1c, glycated hemoglobin A1C.

Table 4. Imputed prescription medication and total costs at 6 months (weighted analyses).

	Pharmacy costs at 180 days				Total costs at 180 days
	80% Rx adherence		60% Rx adherence		80% Rx adherence		60% Rx adherence
	Cost ratio	p Value	Cost ratio	p Value	Cost ratio	p Value	Cost ratio	p Value
Treatment (intervention vs control arm)	0.65	0.13	0.65	0.13	0.73	0.20	0.76	0.26
Race (African American vs non-African American)	2.04	0.05*	2.04	0.05*	1.58	0.21	1.51	0.27
Discharged from hospitalization at baseline (vs urgent care/ED visit)	0.17	0.01*	0.17	0.01*	0.20	0.01*	0.20	0.01*
Number of physician visits at baseline	1.02	0.19	1.02	0.19	1.02	0.21	1.02	0.22
HbA1c >8.0% at baseline	0.75	0.37	0.75	0.37	1.17	0.69	1.26	0.57
History of diabetes (6–10 vs <6 years)	2.82	0.01*	2.82	0.01*	2.84	0.01*	2.81	0.01*
History of diabetes (>10 vs <6 years)	1.78	0.27	1.78	0.27	1.65	0.33	1.61	0.35

*Statistically significant at alpha = 0.05.

ED, emergency department; HbA1c, glycated hemoglobin A1C.