Abstract
Background:
Centers for Medicare & Medicaid Services (CMS)-designated Rural Health Clinics (RHCs) play a critical role in addressing diabetes in medically underserved areas. To address care gaps, 2 RHCs implemented an innovative collaborative pharmacist care model.
Objective:
This IRB-exempt retrospective study evaluated the impact of integrated pharmacist care on clinical outcomes for patients referred for diabetes management in 2 RHCs.
Methods:
Outcomes were analyzed for people receiving collaborative pharmacist-managed diabetes care between August 2021 and October 2023. Changes in pre-/postclinical outcomes and medication management were evaluated for patients who received pharmacist-provided care. The primary outcome was change in A1C from baseline to the end of the episode of care.
Results:
Ninety-three patients received care over a median (IQR) of 247 (143, 405.5) days. Mean A1C significantly decreased from 9.3% to 7.7% (P < 0.001). Guideline-directed medication optimization improved significantly for patients with concomitant atherosclerotic cardiovascular disease, chronic kidney disease, and obesity. Heart failure medication optimization showed improvement but was not statistically significant. Significant increases were observed in continuous glucose monitor (CGM) and statin use.
Conclusion and Relevance:
A collaborative pharmacist care model in RHCs significantly improved glycemic control and increased utilization of guideline-directed medication therapy for diabetes and cardiometabolic comorbidities. These findings add to the growing body of literature demonstrating positive clinical outcomes of pharmacist services in rural clinics and underscore the need for financial models that recognize the clinical value of pharmacist services in the RHC setting.
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