Abstract:
BACKGROUND:Diabetes requires close monitoring to achieve optimal outcomes and avoid adverse effects. Continuous glucose monitoring (CGM) is one approach to measuring glycemia and has become more widespread with recent advances in technology; however, ideal implementation of CGM into clinical practice is unknown. CGM can be categorized as personal CGM, which can be for at-home use to replace self-monitoring of blood glucose, or professional CGM (proCGM), which is used intermittently under the direction of a health care professional. The expanding role of the clinical pharmacist allows pharmacists to be at the forefront of implementing proCGM technology, but literature on the effect of pharmacist-driven proCGM is lacking. Pharmacists and physicians within 1 physician-owned clinic used proCGM technology differently. Pharmacists conducted 1 or 2 office visits to interpret data and make interventions, while physicians interpreted data 1 time and relayed interventions via phone. OBJECTIVES:To (a) compare the change in hemoglobin A1c from baseline to 6 months between the different methods of proCGM implementation, and (b) describe and compare the clinical interventions made as a result of the different methods of proCGM implementation. METHODS:In this retrospective cohort study, adults identified in the electronic medical record via Current Procedural Terminology code 95250 or 95251 undergoing proCGM with CGM data interpreted and baseline A1c ≥ 7% were included. Patients with additional CGM use within the 6-month follow-up period were excluded. Data collection included demographics, A1c at baseline and during the 6-month follow-up period, and CGM-associated interventions. Patients were categorized as undergoing 1 pharmacist-driven encounter (RPh1), 2 pharmacist-driven encounters (RPh2), or 1 physician-driven encounter (MD1) for proCGM implementation. Combined RPh1 and RPh2 (cRPh) data were also used for analysis. The primary outcome was change in A1c from baseline to 6 months, which was evaluated by analysis of covariance. RESULTS:Of 378 patient charts reviewed, 315 instances of proCGM implementation met inclusion criteria (58 RPh1, 35 RPh2, 222 MD1), and 253 had post-implementation A1c data for analysis of the primary outcome (52 RPh1, 30 RPh2, 171 MD1). Baseline A1c was 8.4%, 8.8%, and 9.1% with mean reduction from baseline to 6 months of 1.0%, 1.3%, and 0.6%, respectively. cRPh patients experienced a greater mean reduction in A1c compared with MD1 (P = 0.002). RPh2 patients had a statistically significant reduction compared with MD1 (P = 0.005), but RPh1 patients did not (P = 0.054). The number of CGM-associated pharmacological interventions was 1.33 for RPh1 patients, 1.63 for RPh2 at the first encounter and 1.34 at the second, and 1.17 for MD1. CONCLUSIONS:Pharmacist-driven implementation of proCGM was associated with greater A1c reductions and more pharmacological interventions versus physician-driven implementation. This study demonstrated improved clinical outcomes with pharmacists providing direct patient care through implementation of new diabetes technology. DISCLOSURES:No outside funding supported this study. The authors have nothing to disclose. Preliminary results of this work were presented at the American College of Clinical Pharmacy Virtual Poster Symposium, May 28-29, 2019. The abstract was not peer-reviewed because of enrollment in the Mentored Research Investigator Training (MeRIT) program. Final peer-reviewed results were presented at the American College of Clinical Pharmacy Annual Meeting; October 26-29, 2019; New York, NY.
journal_name
J Manag Care Spec Pharmjournal_title
Journal of managed care & specialty pharmacyauthors
Sherrill CH,Houpt CT,Dixon EM,Richter SJdoi
10.18553/jmcp.2020.26.5.600subject
Has Abstractpub_date
2020-05-01 00:00:00pages
600-609issue
5eissn
2376-0540issn
2376-1032journal_volume
26pub_type
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journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2019.25.10.1102
更新日期:2019-10-01 00:00:00
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journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2016.22.12.1394
更新日期:2016-12-01 00:00:00
abstract:DISCLOSURES:No funding contributed to the writing of this commentary. Brandsema reports consulting for Alexion, Audentes, AveXis, Biogen, Cytokinetics, PTC Therapeutics, Sarepta, and WaVe and has received research funding as a site investigator from Alexion, AveXis, Biogen, CSL Behring, Cytokinetics, Fibrogen, Pfizer, ...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章,评审
doi:10.18553/jmcp.2020.26.4.366
更新日期:2020-04-01 00:00:00
abstract:BACKGROUND:Natalizumab disease-modifying therapy for relapsing-remitting multiple sclerosis (MS) is efficacious in randomized controlled trials. Few studies have estimated the association between real-world natalizumab persistence behavior and relapse-related outcomes. OBJECTIVES:To (a) examine the impact of using nat...
journal_title:Journal of managed care & specialty pharmacy
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doi:10.18553/jmcp.2015.21.3.210
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journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2014.20.8.862
更新日期:2014-08-01 00:00:00
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journal_title:Journal of managed care & specialty pharmacy
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更新日期:2016-07-01 00:00:00
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journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2014.20.9.914
更新日期:2014-09-01 00:00:00
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journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2016.22.1.40
更新日期:2016-01-01 00:00:00
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journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2014.20.4.357
更新日期:2014-04-01 00:00:00
abstract:BACKGROUND:The misuse of prescription drugs is a serious public health problem. Although controlled substance (CS) prescribing, in particular, opioid analgesics, has recently declined, the volume of prescriptions in 2015 was still 3 times higher than in 1999. To curb the high volume of CS prescribing, a national health...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2019.25.3.392
更新日期:2019-03-01 00:00:00
abstract:BACKGROUND:Despite multiple treatment options, the prognosis of pulmonary arterial hypertension (PAH) remains poor. PAH patients experience a high economic burden due to comorbidities, hospitalizations, and medication costs. Although combination therapy has been shown to reduce hospitalizations, the relationship betwee...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2018.17391
更新日期:2018-08-01 00:00:00
abstract:BACKGROUND:In the United States, many children with cerebral palsy (CP) obtain health care coverage through managed Medicaid, but little is known about the current demographics or management of this high-need, complex population. OBJECTIVE:To develop U.S. population-level information about the prevalence of CP, manage...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2019.25.7.817
更新日期:2019-07-01 00:00:00
abstract:BACKGROUND:Cancer is a major cause of mortality and a major contributor to health care costs in the United States. An increasing number of cancer patients are treated with oral cancer therapy. Older patients are more likely to have cancer and to be at risk for adherence problems with oral cancer drugs. As a result of s...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2014.20.7.669
更新日期:2014-07-01 00:00:00
abstract:BACKGROUND:Current evidence of the effects of pharmacy services on asthma outcomes are not conclusive, since most pharmacy services comprise a variety of interventions. OBJECTIVE:To assess the effect of a service containing self-management support delivered by community pharmacists to patients with asthma. METHODS:A ...
journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章,meta分析
doi:10.18553/jmcp.2018.24.11.1184
更新日期:2018-11-01 00:00:00
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pub_type: 杂志文章,随机对照试验
doi:10.18553/jmcp.2016.15248
更新日期:2016-06-01 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2015-11-01 00:00:00
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更新日期:2021-01-20 00:00:00
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pub_type: 杂志文章
doi:10.18553/jmcp.2016.22.5.598
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pub_type: 杂志文章
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pub_type: 杂志文章
doi:10.18553/jmcp.2015.21.8.678
更新日期:2015-08-01 00:00:00
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journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2017.23.8.831
更新日期:2017-08-01 00:00:00
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pub_type: 杂志文章
doi:10.18553/jmcp.2017.17203
更新日期:2017-12-01 00:00:00
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journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
doi:10.18553/jmcp.2018.24.5.423
更新日期:2018-05-01 00:00:00
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pub_type: 杂志文章
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更新日期:2021-01-01 00:00:00
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pub_type: 杂志文章
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更新日期:2015-01-01 00:00:00
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pub_type: 杂志文章
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更新日期:2016-02-01 00:00:00