Pharmacist-Led Shared Medical Appointments for Multiple Cardiovascular Risk Reduction in Patients With Type 2 Diabetes

• Published in: The Diabetes educator Vol. 37; no. 6; pp. 801 - 812
• Main Authors: Cohen, Lisa B, Taveira, Tracey H, Khatana, Sameed Ahmed M, Dooley, Andrea G, Pirraglia, Paul A, Wu, Wen-Chih
• Format: Journal Article
• Language: English
• Published: United States SAGE Publications 01.11.2011
• Subjects: Aged; blood pressure; Cardiovascular Diseases - drug therapy; Cardiovascular Diseases - prevention & control; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - therapy; education; exercise; glycohemoglobin; Health Education - methods; Humans; hyperglycemia; hyperlipidemia; hypertension; lifestyle; low density lipoprotein cholesterol; Male; noninsulin-dependent diabetes mellitus; Patient Care Team; Patient Compliance; patients; Pharmacists; questionnaires; risk; risk factors; risk reduction; Risk Reduction Behavior; Self Care; Self-Help Groups; tobacco use; United States; Veterans; United States
• ISSN: 0145-7217; 1554-6063
• DOI: 10.1177/0145721711423980

Purpose To assess whether VA MEDIC-E (Veterans Affairs Multi-disciplinary Education and Diabetes Intervention for Cardiac risk reduction[EM DASH] Extended for 6 months), a pharmacist-led shared medical appointments program, could improve attainment of target goals for hypertension, hyperglycemia, hyperlipidemia, and tobacco use in patients with type 2 diabetes compared to standard primary care after 6 months of intervention. Methods A randomized, controlled trial of VA MEDIC-E (n = 50) versus standard primary care (n = 49) in veterans with type 2 diabetes, hemoglobin A1c (A1C) > 7%, blood pressure (BP) > 130/80 mmHg, and low density lipoprotein cholesterol (LDL-C) > 100mg/dl (2.59 mmol/l) in the previous 6 months was conducted. The VA MEDIC-E intervention consisted of 4 weekly group sessions followed by 5 monthly booster group sessions. Each 2-hour session included 1 hour of multidisciplinary diabetes specific healthy lifestyle education and 1 hour of pharmacotherapeutic interventions performed by a clinical pharmacist. Evaluation measures included lab values of A1C, LDL cholesterol, BP, and goal attainment of these values, and diabetes self-care behavior questionnaires at 6 months. Results The randomization groups were similar at baseline in all cardiovascular risk factors except for LDL, which was significantly lower in the MEDIC-E arm. At 6 months, significant improvements from baseline were found in the intervention arm for exercise, foot care, and goal attainment of A1C, LDL-C, and BP but not in the control arm. Conclusions The results of this study demonstrate that the pharmacist-led group intervention program for 6 months was an efficacious and sustainable collaborative care approach to managing diabetes and reducing associated cardiovascular risk.