Objectives: Pharmacist-led diabetes collaborative drug therapy management (CDTM) has been shown to improve outcomes. Whether such programs are effective specifically in Medicaid patients, who face barriers to access and self-management, has not been well characterized. This pilot study explores glycemic control, utilization and costs associated with pharmacist-led CDTM in a small population of Medicaid patients with type 2 diabetes mellitus (T2DM).
Methods: A pre-post, historical cohort study was conducted of patients with T2DM and Medicaid coverage who received pharmacist-led CDTM in community-based primary clinics between 2008-2012. Outcomes included change in HbA1c, healthcare costs and utilization.
Results: This study included 79 Medicaid patients with T2DM who received pharmacist-led CDTM. A subset of 46 patients with Medicaid coverage through an affiliated Medicaid Plan, Healthy U, was identified for additional analysis. At 6-months follow-up, HbA1c was a mean (SD) of 2.0% (2.0) lower than the baseline of 10.3% (1.7). Primary care clinic encounters increased by a mean (median) of 3.4 (2) visits. Per patient health system charges increased by a mean (median) of $4,392 ($620) and the amount paid by Medicaid in the Healthy U subset was $822 ($68) higher in the follow-up period.
Conclusion: A pharmacist-led diabetes CDTM intervention was associated with improved glycemic control in Medicaid patients, which corresponded with a higher number of primary care visits and observed costs. These findings are consistent with studies not limited to Medicaid, suggesting that CDTM can be effective in type 2 diabetes patients with Medicaid coverage.
Keywords: Type 2 diabetes; clinical pharmacy service; costs; disparity.