Prachanronarong K (Providence VAMC), Khatana SM
(Providence VAMC), Taveira TH
(Providence VAMC), Cohen LB
(Providence VAMC), Dooley AG
(Providence VAMC), Pirraglia PA
(Providence VAMC), Friedmann PD
(Providence VAMC), Wu W
Concurrent control of multiple cardiovascular risk factors in patients with diabetes mellitus (DM) is labor-intensive and can be difficult in traditional patient care settings. Weekly pharmacist-led group medical visits added to standard primary care for 4 consecutive weeks have shown to be effective in the concurrent control of diabetes and multiple cardiovascular risk factors in DM patients at the Providence VAMC. However, the sustainability of the efficacy of this program over a 6-month period, when relapse may occur, is unknown.
We conducted a randomized, controlled trial of pharmacist-led group medical visits versus usual care in diabetic veterans with hemoglobin A1c (A1c) > 7%, blood pressure (BP) > 130/80 mm Hg, and an LDL cholesterol > 100 mg/dL documented in medical records within six months of study enrollment. Group visits consisted of four weekly sessions followed by five monthly sessions. Each two hour session included one hour of subject-specific healthy lifestyle education and one hour of pharmacotherapeutic interventions provided by a clinical pharmacist. The 6-month change in glycemic control, blood pressure, and lipids from baseline was evaluated for the intervention arm and the usual care arm.
To date, 94 patients have completed the study. Participants in the group visits (n = 47) and the usual care group (n = 47) were similar in age (69.4±10.6 vs. 66.8±9.4 years) and baseline cardiovascular risk factors (Systolic BP 137.3±16.6 vs. 135.8±16.8 mmHg, Diastolic BP 74.0±9.6 vs. 75.2±10.1 mmHg; A1c 7.9±1.1% vs. 8.1±1.4%, tobacco smokers 14.9% vs. 8.5%), with the exception of LDL cholesterol (96.2±25.4 mg/dL vs. 110.1±37.8 mg/dL, p < 0.05). At 6 months, significant improvements from baseline were found in the intervention arm for Systolic BP (-10.2±20.4 mmHg, p < 0.01); LDL (-9.7±23.8 mg/dL, p < 0.01); and A1c (-0.4±1.2%, p < 0.05); while only the LDL was significantly improved for the usual care arm (-10.7±33.5 mg/dL, p < 0.05). There was no significant difference in tobacco cessation between groups.
The efficacy of pharmacist-led group medical visits for cardiovascular risk factor reduction is sustainable through monthly group visits for 6 months.
The results of this study present an efficacious and sustainable collaborative care approach to manage DM and reduce associated cardiovascular risk.