Evaluation of pharmacist impact on diabetes outcomes for telehealth and hybrid care delivery versus in-office visits

Background: Few studies have examined the effect of pharmacist-led telemanagement on diabetes outcomes during the COVID-19 pandemic.

Objectives: Assess for noninferiority for the absolute change in mean A1C between telehealth and hybrid groups versus the in-office group during the COVID-19 pandemic. Secondary objectives were to compare the percentage of patients achieving population health A1C goals and patient no-show rates between study groups.

Methods: A retrospective, noninferiority analysis was conducted for patients seen by a primary care pharmacist from November 1, 2020 to May 31, 2021 across 17 primary care clinics in the Northeast Ohio region of Cleveland Clinic. The noninferiority margin was prespecified at > 0.3% A1C reduction. Patients with a baseline A1C of 8% or greater were included. Patients were separated into 3 study groups (telehealth, in-office, and hybrid) based on the visit types that were conducted by the pharmacist during the study period.

Results: Hybrid care delivery (N = 366) was noninferior to in-office care delivery (N = 180), with regards to absolute change in mean A1C reduction (0.24% [95% CI: -0.13, 0.61], P = 0.002). Similar results were shown when comparing the telehealth group (N = 691) to the in-office group (0.04 [95% CI: -0.28, 0.36], P = 0.02). The mean A1C reduction in the in-office (1.36 ± 1.9), hybrid (1.60 ± 2.2), and telehealth (1.40 ± 2.0) groups were not significantly different (P = 0.23). Subgroup analyses showed that newly consulted patients had a larger reduction in A1C compared to the overall population, in all groups. No-show rates and percentage of patients achieving population health A1C goals were not significantly different based on visit type.

Conclusion: Telehealth and hybrid visit types were noninferior to in-office visits with regards to mean change in A1C reduction. Results demonstrate the importance of primary care pharmacists continuing to offer diverse visit types based on patient preference.