Physician-Pharmacist Collaboration Can Improve Diabetes Outcomes in Rural Populations

A physician-pharmacist collaborative management (PPCM) model for type 2 diabetes can significantly improve preventative care and drug therapy management in patients, especially those in rural areas. 

In a poster presentation held during the American Diabetes Association Virtual 81st Scientific Sessions, study author Angelina Vascimini, PharmD, PGY2 ambulatory care pharmacy resident at the University of Florida College of Pharmacy, discussed the effects of implementing a PPCM team to enhance provider reach and patient access to diabetes preventative care services.¹ 

“Comprehensive diabetes care is complex, involving targeted approaches for diabetes care while incorporating preventative management for macrovascular and microvascular complications.”

Rural populations in particular face unique health challenges, including elevated rates of diabetes risk factors, which are further affected by low health literacy, financial barriers, and reduced access to care. Implementing a PCCM team may assist in extending the physician’s reach in rural populations, Vascimini explained.

According to Vascimini, the goal of the study was to determine if active PPCM patients, or those seen by the team in the last 12 months, have improved preventative care measures and associated drug therapy management when compared with inactive PPCM patients, those who were seen once by the team at some point in time. The study investigators looked at outcomes divided into 2 categories for metrics:

• Macrovascular-specific metrics: Blood pressure management, lipid levels, related medication management, and atherosclerotic cardiovascular disease (ACVD) risk.
• Microvascular-specific metrics: Urine albumin creatinine ratio (UACR) levels and use of targeted medications, along with annual monitoring for foot and eye exams.

The investigators collected data for 172 patients overall: 92 active PPCM patients and 80 inactive PPCM patients.

Overall, the primary outcome for annual foot exam, annual/biannual eye exam, annual UACR, and lipid monitoring were statistically significant when comparing active PPCM patients with inactive PPCM patients. The other primary outcomes, such as appropriate drug therapy based on albuminuria, ASCVD risk, and blood pressure control, were not statistically significant.

“However, all patients included in the study were part of the PPCM model at some point during their care at the rural family medicine clinic, and as such review of appropriate medication therapy management was completed for all patients,” Vascimini said. “Participants were placed on appropriate medications while they were active PPCM patients, and likely remained on appropriate therapy when the patients became inactive.”

According to Vascimini, this could explain the lack of statistical difference between the other primary outcomes.

However, active PPCM patients, regardless of statistical significance, overall had better clinical metrics when compared with inactive PPCM patients.

“In conclusion, when access to care is limited in rural areas, an effective PPCM team can extend the reach of the physician improving care for patients,” Vascimini said.

Reference

1. Vascimini A, Sullivan T, Sakdipanichkul S, DeRemer CE. 883-P: Evaluating impact of the physician-pharmacist collaborative management (PPCM) team providing diabetes preventative care services. Presented at: American Diabetes Association Virtual 81st Scientific Sessions; June 25-29, 2021; online.