Photo Credit: Feodora Chiosea

Pharmacist involvement in primary care chronic disease co-management of hypertension and T2D improved patients’ blood pressure and hemoglobin A1c.

Primary care patients with hypertension and type 2 diabetes (T2D) mellitus who had a clinical pharmacist visit for chronic disease co-management showed significant improvements in blood pressure and hemoglobin A1c (HbA1c) compared with controls, according to a study in the Journal of Primary Care & Community Health.

“These results demonstrate that pharmacist integration into a value-based primary care clinic may improve measures of chronic disease associated with morbidity and mortality,” wrote corresponding author Sashi Moodley, MD, MBA, and colleagues.

From December 2022 to December 2023, a clinical pharmacist trained and supported by a retail pharmacy participated in a value-based care model at primary care sites in Phoenix, Arizona. The study analyzed outcomes for 43 patients with hypertension and 125 patients with T2D with a clinical pharmacist visit. Under a collaborative drug therapy management agreement, primary care clinicians referred patients to the pharmacist, who then prescribed and titrated therapies accordingly.

“Patients enrolled in pharmacy services received medication education and management, quality gap closure, and adherence initiatives focused on improving measures of chronic disease control through in-person and telehealth visits,” the researchers wrote.

The study compared changes in systolic BP, diastolic BP, and HbA1c for patients exposed to the intervention with results from matched control patients with the same chronic diseases from the Phoenix market health system.

In patients with hypertension, the clinical pharmacy model was associated with a significant reduction in systolic BP: the researchers reported a −10.2 mmHg difference-in-difference. Unadjusted results were −16.6 mmHg for the exposure group and −6.3 mmHg for the control group.

At −2.0 mmHg, the difference-in-difference for diastolic BP favored the clinical pharmacy model but was not significant. In unadjusted results, diastolic BP changes were −5.4 mmHg in the exposure group and −4 mmHg in the control group.

In patients with T2D, the difference-in-difference was a significant −1.16% in favor of the clinical pharmacy model. Unadjusted HbA1c results were −1.6% in the exposure group and a −0.3% in the control group.

Primary care clinicians did not report any complaints or concerns throughout the study.

“These results have encouraged further development of this model, with the goal of scaling and integrating retail pharmacists into direct patient care,” the researchers wrote. “Further study at a greater scale will be beneficial to validate these results.”