2025 Southeastern Residency Conference

Title: Assessing Provider Awareness and Confidence in Prescribing Connected Insulin Pens for Diabetes Management 
Authors: Caroline McKenna, PharmD & Casey Wells, PharmD, BCACP, CPP 
Objective: Determine provider readiness and confidence in prescribing connected insulin pens, caps, or buttons and comfortability in assessing generated reports. 
Self-Assessment Question: What is one benefit to using connected insulin pens (CIPs) for diabetes management? 
Background: 
Although there have been significant technological advancements around insulin delivery for the management of diabetes, some devices are underutilized due to lack of provider awareness. Connected insulin pens (CIPs) and pen caps offer an additional method for diabetes management in outpatient clinics. Various products, like the Abbott Bigfoot Pen, Lilly Tempo Button, Medtronic InPen, and NovoEcho Pens allow tracking of basal and/or bolus dosing, calculations for doses, and timing of insulin on board via Bluetooth and iOS/Android Smartphone applications. This study sought to assess provider readiness and confidence in prescribing connected insulin pens, caps, or buttons and comfortability in assessing generated reports.  
Methods: 
Baseline CIP prescribing levels were assessed through an internal dashboard for the four CIPs mentioned above. A survey was then distributed to 50 prescribers to investigate awareness of CIP products, who may qualify for use, comfortability in prescribing, and confidence in evaluating CIP-generated reports to adjust settings. Answers were provided via a Likert Scale (ex: 1 = Very Low Confidence and 5 = Very High Confidence). The final question from the survey asked how respondents would like to best learn about CIPs between a variety of modalities.  
Results: 
This abstract describes baseline prescribing trends and results from prescribers' readiness and confidence survey. Only 24 CIPs were prescribed by providers at baseline, with 95.8% being prescribed in the Internal Medicine and Endocrinology Clinic. Based on the initial survey results, 66% of responders had not heard of CIP technology. Of those who did have knowledge of CIP products, more than 75% had less than medium confidence in identifying patients who may qualify CIPs, with mixed opinions for patients who may qualify. The preferred learning methods for education about CIPs included live presentation by a pharmacist and a comparison sheet of available products.  
Conclusions: 
More education around connected insulin pens and pen caps is needed for prescribing providers caring for patients with diabetes. Educational sessions have been scheduled and comparison table compiled with intent to re-survey post-session and present at future conferences. 

Authors: Michaelyn Moretz, PharmD; Carrington Royals, PharmD; Sara Messier, PA-C; Reagan K. Barfield, PharmD, BCPS; P. Brandon Bookstaver, PharmD, FCCP, FISDA, BCPS; Robert Bailey


Objective: The purpose of this study is to assess whether pharmacist impact in mental health services will provide increased access to services and improved patient outcomes at a medically underserved Federally Qualified Health Center (FQHC) as compared to clinician interventions. 


Self-Assessment Question: Which of the following areas of behavioral health are pharmacists able to make an impact in? Select all that apply. 
A. Prescribing and monitoring psychiatric pharmacotherapy- Correct
B. Billing for services
C. Diagnosing patients with mental health disorders
D. Optimizing current patient medication regimens - Correct


Background: As the number of mental health clinicians continues to decrease, there is a disproportional demand for adequate provider access. Pharmacist-driven medication therapy adjustments improve access opportunities in this population with the goal of improving quality of life and outcomes for adults with various mental health disorders. Though the use of psychiatric medications is becoming more accepted by the public, there is an indwelling lack of confidence in continued care by providers due to the disease complexity, as well as schedule limitations and the overwhelming need for increased providers in rural areas. Pharmacists are becoming a proposed solution in performing these beneficial services. 


Methods: Established patients of a medically underserved FQHC enrolled in current mental health services eligible for a pharmacotherapy consult within the 6-month study period were included. The primary endpoint for the study was the change in measurable outcomes via mental health screening scores. The secondary endpoints were the potential revenue generation based on pharmacist visits overall and overall impact. Cost-savings and financial benefits were measured by revenue generated over the 6-month study period overall and the conversions of patients to the FQHC pharmacy. Impact was measured by patient satisfaction, disease improvements, adequate lab monitoring, medications reconciled, patient assistance provided through programs, and no-show rates.


Results: In progress


Conclusion: In progress

Title: 
Evaluating the Impact of “On the Spot”– a Remote Pharmacy Hypertension Consult Service 


Authors:
Briana Bethune; Jamie Coates; Naomi Yates


Background:   
Nearly half of adults in the United States have hypertension, although only 22.5% are considered controlled. Studies have shown that pharmacist intervention can improve management of hypertension through scheduled pharmacy appointments. However, no studies appear to examine pharmacist impact on blood pressure during nurse visit appointments where clinical pharmacy is not physically present. The purpose of this study was to determine whether immediate remote blood pressure consultation by clinical pharmacy specialists reduces time to blood pressure goal in patients diagnosed with hypertension.  


Methods:  
This IRB-exempt, observational, retrospective cohort study was conducted within an integrated healthcare delivery system. This study included adult patients diagnosed with hypertension who had a blood pressure reading between 140-179/90-109 mmHg after repeat check at a nurse visit from November 2023 to August 2024. Patients were excluded from the study if they were pregnant, receiving hospice/palliative care, or had a GFR < 30 mL/min/1.73 m². Patients in the treatment group received an immediate consultation from a remote, on-call pharmacist for medication review and optimization as needed.  Patients in the control group received usual care where the “Doctor of the Day” was consulted for recommendation(s) as their schedule permitted.  The primary outcome of this study was to assess time to blood pressure goal (defined as ≤ 140/90 mmHg) for patients managed by the “On the Spot” pharmacy hypertension consult service compared to patients who received usual care. The secondary objectives were to evaluate medication optimization, change in blood pressure from baseline, and the percentage of patients who achieved blood pressure goal compared to usual care. The tertiary objective was to compare the percentage of patients enrolled in remote blood pressure monitoring (RBPM) where “On the Spot” was utilized versus usual care. Results were assessed at 4 months post intervention and data was analyzed using descriptive statistics.  


Results:
The study included 1,726 participants with 1466 patients in the control group and 260 patients in the intervention group. The average time to achieve blood pressure control was 31.93 ± 27.43 days in the control group and 31.21 ± 25.85 days in the intervention group, showing no statistically significant difference (p=0.72). Patients that received medication changes on the day of the nurse visit at a higher rate in the intervention group (62.31%) compared with the control group (35.54%, p<0.0001). The percentage of patients who achieved the blood pressure goal of ≤ 140/90 mmHg was similar between both groups with 87.08% in the control group and 88.21% in the intervention group (p= 0.51).  Similarly, changes in systolic and diastolic blood pressure from baseline were comparable in the control and intervention groups (systolic: -24.91 vs. -23.06 mmHg, p = 0.13; diastolic: -8.27 vs. -9.76 mmHg, p = 0.09, respectively). The percentage of patients enrolled in RBPM was significantly higher in the intervention group at 63.08% versus 6.55% in the control group (p<.0001). 


Conclusion:
The "On the Spot" remote pharmacy hypertension consult service demonstrated a significant impact on process measures, including higher rates of medication optimization and enrollment in RBPM compared to usual care. While the time to blood pressure control and overall blood pressure control rates were similar between groups, the higher medication intervention rates and RBPM enrollment suggest that integrating remote pharmacist consults into nurse visits enhances hypertension management workflow efficiency. Benefits include reducing delays in care, clearing physician and nurse schedules, and increasing rate of follow up. These findings highlight the value of immediate remote pharmacist intervention and underscore the potential for integrated remote pharmacy services to enhance hypertension management in healthcare systems.

Title: Tripping on Serotonin and Norepinephrine Reuptake Inhibitors: Evaluating the Fall Risk in Older Adults using Claims Data 


Authors: Lakedra White, Chelsea Keedy, Kristen Pierce, Jianing Xu, Jinae Lee, Hanna Kim, Daniel Hall, Ashlee Greene, Jessica Osborn, Joshua Caballero


Background: Major depressive disorder is a common mental health issue in older adults, often treated with antidepressants. However, their use can increase the risk of falls and fractures which can significantly contribute to morbidity and mortality in this population. Most research has focused on selective serotonin reuptake inhibitors, despite the widespread use of serotonin and norepinephrine reuptake inhibitors in older adults. Overall, limited data exist on the comparative fall risk among serotonin and norepinephrine reuptake inhibitors. As a result, this study aims to assess differences in fall risk associated with serotonin and norepinephrine reuptake inhibitors in an older population.


Methods: A retrospective cohort study was completed using the MarketScan® Medicare Supplemental claims from 2015 to 2021. The study included adults aged 65 and older with a prescription claim for a serotonin and norepinephrine reuptake inhibitor (i.e., duloxetine, venlafaxine, desvenlafaxine, milnacipran, and levomilnacipran). Individuals were followed for 30 days after their prescription claim to identify falls, defined using International Classification of Diseases, 9^th Revision codes E8800- E8889 and International Classification of Diseases, 10^th Revision codes W00-W19 and V00141. The primary outcome was the percentage of patients who experienced a fall within 30 days of the medication claim. Descriptive statistics were used for analysis. A larger study will similarly compare fall risk and related injury in older adults newly started on these agents. The date of their first prescription claim will be defined as the index date. Individuals will be excluded if they are prescribed serotonin and norepinephrine reuptake inhibitors or selective serotonin reuptake inhibitors within the preceding two months. Individuals will also be excluded if they have a history of fall or related injury within the preceding six months.


Results: There were 194,821 individuals with a prescription claim for a serotonin and norepinephrine reuptake inhibitor from 2015 to 2021. The average age was 72.5 (+/-8.1) years and 70% were female. Within 30 days of the prescription claim, 2,171 (1.1%) patients experienced a fall. The serotonin and norepinephrine reuptake inhibitor approximate prescribing rate included duloxetine (65%), venlafaxine (30%), desvenlafaxine (4%), milnacipran (0.8%), and levomilnacipran (0.4%). The serotonin and norepinephrine reuptake inhibitor fall rate included duloxetine (1.22%), venlafaxine (0.96%), milnacipran (0.76%), desvenlafaxine (0.70%), and levomilnacipran (0.54%).


Conclusion: Preliminary findings suggest a fall rate of approximately 1% within the first 30 days for most serotonin and norepinephrine reuptake inhibitors. While duloxetine appears to have the highest fall rate, further comparisons between serotonin and norepinephrine reuptake inhibitors are needed to determine statistical and clinical significance. Additionally, it is unknown if specific doses may be associated with an increased risk of falls and fractures which needs to be further elucidated. These findings can assist providers in carefully selecting the safest serotonin and norepinephrine reuptake inhibitor and dose for older patients.

Title: Improving Compliance with Gout Management Guidelines: Implementing a Standardized Order Menu for HLA-B*58:01 Testing in Veterans

Authors: Roslyn Mays; Mary Kalyn Pounders

Background/Purpose: 
Gout is a common and significant health issue among veterans, particularly in those with comorbid conditions like chronic kidney disease and cardiovascular disease. Allopurinol, the first-line recommended treatment for gout, carries the rare risk of a severe adverse hypersensitivity reaction, allopurinol hypersensitivity syndrome (AHS). The risk of AHS is higher in those with the HLA-B*58:01 allele, which is most prevalent in African American and Asian populations. The American College of Rheumatology (ACR) 2020 Gout Management Guidelines recommend routine genetic testing for HLA-B*58:01 in these higher-risk ethnicity groups before initiation of allopurinol. As of July 2024, preliminary data from the Atlanta VA revealed significant noncompliance with these guideline recommendations. This project aimed to improve compliance with the ACR allele testing recommendations by implementing a standardized order menu with prompts for allele testing in recommended patient groups, thus in hopes of reducing the risk of AHS in at-risk veterans.

Methods: 
This was a single-site, retrospective quality improvement project designed to evaluate the impact of a standardized HLA-B*58:01 allele order menu on compliance with the ACR 2020 gout management guideline recommendations. Eligible participants included veterans aged 18 or older prescribed allopurinol for non-hematologic or oncologic indications within the timeframe both prior to and following the implementation of the order menu in July 2024. Eligible patients were identified using the VA National Quality Enhancement Research Initiative (QUERI) Gout Safety Dashboard. Patients prescribed allopurinol for conditions other than gout, such as tumor lysis syndrome, were excluded using prescriber data. Baseline data was collected on key variables such as race/ethnicity, urate-lowering therapy (ULT) status, HLA-B*5801 allele testing results, and the type of prescribing provider (primary care physician or rheumatologist). The primary endpoint was the percentage of new ULT users prescribed allopurinol who received guideline-recommended HLA-B*58:01 testing before and after introducing the standardized order menu. Statistical analysis was used to compare testing compliance rates before and after the intervention. Upon data review, the impact of the order menu on allele testing was assessed to identify specific areas needing improvement, allowing for future targeted interventions in areas of continued non-compliance.

Results:
Upon review, after the implementation of the order menu, the percentage of new ULT users with guideline recommended HLA-B*58:01 test results increased by 5.2%. The total number of patients with an HLA-B*58:01 test result increased from 3.6% to 5.1%. The percentage of African American (AA) patients tested for the allele rose by 2.2%, while Asian patients demonstrated a 3.9% increase. While these changes are encouraging with a new ULT non-compliance rate decrease from 96.7% to 91.6%, more than 90% of at-risk patients remained untested, indicating that more targeted interventions may be necessary to achieve substantial improvements.

Conclusion:
The introduction of a standardized HLA-B*58:01 allele testing order menu resulted in a modest increase in testing compliance for new ULT users. While this increase is a positive step, the continued rate of non-compliance suggests the need for further refinements in the intervention. Potential future directions for this project include enhancing provider education, incorporating automated reminders, and exploring other interventions or tools to further enhance facility compliance. Continued monitoring and refinement of this intervention will be essential to achieving better compliance rates to the ACR 2020 gout guideline recommendations, and thus, a further reduction in risk for AHS development in at-risk veteran groups.

Title: Impact Assessment of Food Deserts and Food Insecurity on Diabetes Mellitus


Authors: 
Allison Eppenauer


Background: 
The worldwide epidemic and challenges of managing diabetes mellitus (DM) is partially driven by the intake of nutrient-poor and highly processed foods, however access to nutrient dense foods can be limited by financial restrictions and proximity to supermarkets. Areas of low access have been identified by the United States Department of Agriculture (USDA) Economic Research Service (ERS) Food Access Research Atlas as ‘food deserts’. As negative health outcomes of residing in food deserts or experiencing food insecurity have been previously demonstrated in other studies, this study aims to evaluate if these factors are an area that requires additional focus within the current population of patients with DM at the Ralph H. Johnson Veterans Affairs Healthcare System (RHJVAHS). Identification or focus on patients residing in food deserts or experiencing insecurity may allow clinicians to streamline preventative interventions during diabetes management to improve outcomes.


Methods: 
This project is a retrospective observational longitudinal cohort study for quality improvement comparing DM outcomes in veterans residing in a food desert/experiencing food insecurity and those not residing in a food desert/experiencing food insecurity. Eligible patients in the study included all patients enrolled within the RHJVAHS catchment area who had an active ICD 9/10 code diagnosis of DM or A1c > 6.5% between January 1, 2016 and December 31, 2018 with at least one annual visit with a VA provider in a primary location. Patients were then targeted over a follow up period to include lab values, hospitalizations, and deaths during the follow up period. 

The primary endpoint for this project was to determine if there is a significant difference in the frequency of uncontrolled A1c or urine albumin-creatinine ratio (UACR) based on a composite status of residing in a food desert or experiencing food insecurity and food insecurity alone. The secondary endpoint analyzed the difference in the frequency of all-cause hospitalizations, DM-related hospitalizations and mortality based on a composite status of residing in a food desert or experiencing food insecurity and food insecurity alone.


Results: Of the 4,209 veterans included in this study, 2054 (49%) patients were found to be residing in a food desert. 18 (0.004%) of patients screened positive for food insecurity. The primary outcome of uncontrolled A1c and UACR did not differ significantly between between the composite group of non-food desert/non-food insecurity (NFD/NFI) vs food-desert/food insecurity (FD/FI).  A1c >7% occurred in 45.7% of NFD/NFI vs. 44.2% FD/FI; p = 0.338.) A1c >8% occurred in 16.8% of NFD/NFI vs. 15.1% FD/FI; p = 0.133.) UACR >30 occurred in 39.1% of NFD/NFI vs. 39.5% FD/FI; p = 0.791. UACR >300 occurred in 4.2% of NFD/NFI vs. 5.4% FD/FI; p = 0.167. 

The primary outcome did not differ in patients with food insecurity alone with overall similar findings to the composite group. Although not statistically significant, patients with food insecurity had higher UACR >30 (63.6% in those experiencing food insecurity vs. 39.2% in those without, p = 0.098.)

The secondary outcome of all-cause hospitalization rate, DM-related hospitalizations, and mortality did not differ between NFD/NFI vs. FD/FI - about 20% of patients were hospitalized for any reason, 4% hospitalized due to complications of DM, and~20% of patients passed away. In food insecurity alone, all-cause hospitalizations was higher in those experiencing food insecurity vs. those not (44.4% vs 20.8%, respectively, OR 3.0 (1.2 - 7.7); p = 0.014.) DM-related hospitalizations did not differ between groups (3.7% in food insecurity vs. 5.6% in non-food insecurity; p = 0.864.) Mortality was also higher in patients with food insecurity (44.4% vs 20.2%, respectively, p = 0.018)

Additionally, patients with food insecurity had higher odds of missing a UACR lab value within the reporting period (19.7% vs 38.9%; OR 2.6 (1.0 - 6.7) ; p = 0.042.)


Conclusion: 
In summary, there was no difference in DM outcomes (UACR, A1c, hospitalizations, or mortality) between patients residing in a food desert/experiencing food insecurity versus those who are not. Patients with food insecurity were less likely to be evaluated for UACR despite the fact their UACR >30 trended higher than patients without food insecurity. Additionally, patients with food insecurity were more likely to be hospitalized for any reason or have higher mortality rate than those without food insecurity. The project was limited by the small patient population included in the food insecurity group which likely contributed to underreported findings. Data was not collected from other facilities, limiting the information available for patients seen at other medical centers which is an especially important consideration for patients residing in rural areas that may not seek care at the VA facility a significant distance away. Patients were also excluded if their address changed during the follow-up period. 

PURPOSE:
Recognizing that veterans have a higher prevalence of cardiovascular disease (CVD) and CVD-related mortality than the general population, there is a need to manage risk factors, including blood pressure. Over 70% of patients within the Veterans Affairs healthcare system have hypertension (HTN), but less than 33% have controlled blood pressure. To address the issue of uncontrolled blood pressure and reduce CVD risk, a remote, population health-based, pharmacist-managed quality improvement HTN management service was implemented at a rural Veterans Affairs clinic. This project aims to evaluate the implementation of the service.
 
METHODS:
This retrospective study evaluated the implementation of the pharmacist-managed HTN clinic using the RE-AIM implementation science framework, a five-domain model designed to assess the impact and implementation of health interventions. The domains of reach, effectiveness, and implementation were evaluated. Reach outcomes included the demographics of veterans who participated in the clinic. Effectiveness outcomes were collected at three months and the most recent visit. Outcomes included changes in baseline blood pressure and home monitoring, the percentage of veterans whose blood pressure was controlled,  and the number and types of interventions completed. Implementation outcomes include the average number of patient visits, percentage of eligible patients completing at least one visit, average number of completed visits, number of unsuccessful visit attempts, percentage of calls successfully completed, and number and types of barriers to blood pressure management.
 
RESULTS:
In progress
 
CONCLUSION:
In progress

Title: Proper Sodium-Glucose Transport Protein 2 Inhibitor use in New York Heart Association class II-IV heart failure patients
Authors:
Primary: Mary Sizer
Secondary: Melissa Johnson, Joseph Crosby, Akshaya Arunkumar, Ashlee Greene
Objective: To determine if HF patients are being prescribed SGLT2 inhibitors more often in collaborative care of a physician and pharmacist versus a physician alone in the primary care setting.
Self-Assessment Question: To be presented with slides
Background:
Sodium-Glucose Transport Protein 2 (SGLT2) inhibitors were recently added to the heart failure guidelines in 2022 and can help prevent heart failure hospitalizations by up to 30%. Being a Class I recommendation for heart failure with reduced ejection fraction and a Class 2a recommendation for preserved ejection fraction, it is crucial that these medications are used correctly in the outpatient setting. Pharmacists are not consulted on all heart failure patients in primary care offices at our health system. Identifying these potential gaps in care would ultimately improve outcomes for patients and help advocate for further pharmacy involvement within primary care offices.
 
Methods:
This was a multi-center, retrospective study identifying SGLT2 inhibitor use in outpatient heart failure New York Heart Association (NYHA) class II-IV patients at St. Joseph’s/Candler primary care clinics from August 1, 2023, to August 1, 2024. Patients were identified through a report capturing heart failure ICD10 codes and reviewed for eligibility. Patients considered for inclusion were at least 18 years old with a diagnosis of heart failure that followed at participating St. Joseph’s/Candler affiliated offices. Patients that were on dialysis, had a reported allergy or contraindication for use, or were pregnant/lactating were excluded. Eligible patients were stratified into physician/pharmacist cohort or a physician-only cohort. Medication data was obtained and patients were classified into groups SGLT2 inhibitor use and no use. The primary objective was to determine if heart failure patients are being prescribed SGLT2 inhibitors more often in collaborative care of a physician and pharmacist versus a physician alone in the primary care setting. Secondary objectives included determining if patients were prescribed appropriate heart failure doses, determining if appropriate outpatient use correlates with less hospital admissions, and comparing rates of use in heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Data was analyzed to determine any gaps of care or implicating trends at the participating primary care clinics.
 
Results:
Three hundred forty-eight patients were screened for eligibility with total n of 300. Pharmacy was consulted on 82 of the 300 patients with 30/82 on a SGLT2 inhibitor (36.6%). Of the 30 patients on a SGLT 2 inhibitor in the pharmacist/physician cohort, 28 of them had correct heart failure dosing (93.3%). The remaining 2 patients in the pharmacy cohort had diabetes and were receiving the recommended dose for diabetes. The physician-only cohort (218 patients) was found to have 73 patients on a SGLT2 inhibitor (33.4%). Fifty-one of these patients were found to be on correct heart failure dosing (69.8%) with 10 of the remaining 22 patients with incorrect dosing being due to diabetes (45.4%). Hospital admissions due to heart failure were less prevalent in the pharmacy cohort (31.77% vs 44.0%). The pharmacy/physician cohort had 13 patients with HFrEF, 7 of which were on an SGLT2 inhibitor (53.8%) compared to 26/56 patients in the physician-only cohort. Likewise, 23/69 patients with HFpEF were on an SGLT2 inhibitor in the pharmacy group (33.3%) with 47/162 (29.0%) in the physician-only group.
 
Conclusions: 
Rates of SGLT2 inhibitor use in heart failure patients NYHA class II-IV were overall higher in the pharmacist/physician group, although comparable between the groups. The biggest impact was seen in the heart failure dosing. Pharmacy involvement resulted in appropriate dosing for all patients on a SGLT2 inhibitor. All-cause hospitalizations were similar; however, hospitalizations due to heart failure saw the largest difference favoring pharmacy involvement.  Collaborative care was more likely to prescribe a SGLT2 inhibitor for both heart failure with reduced and preserved ejection fraction. 

TitleAuthorsPractice SiteBackgroundEvaluate the impact of a pharmacist-led weight loss medication management service in a Veteran population.MethodsThis was a retrospective, prospective quality improvement initiative. Eligible Veterans with verifiable participation in the comprehensive lifestyle intervention (CLI) provided by our facility, MOVE!, were prescribed one of the following five medications approved by the Food and Drug Administration for weight loss: naltrexone/bupropion, orlistat, phentermine/topiramate, semaglutide, or tirzepatide. Veterans were excluded if they were not established with a Department of Veterans Affairs (VA) primary care provider. Data was collected via the Computerized Patient Records System (CPRS).  Post-medication initiation, Veterans were assessed by a Clinical Pharmacist Practitioner (CPP) at 4-week intervals to assess tolerability and weight loss.  Results47 Veterans were included. 28 (59.57%) achieved ≥ 5% TWBL. 

By medication:

• semaglutide (n=32): 59.38% achieved ≥5% TBWL, 90.63% ≥3% TBWL
• tirzepatide (n=6): 83.33% achieved ≥5% TBWL
• phentermine/topiramate (n=6): 50% achieved ≥5% TBWL
• orlistat (n=2): 50% achieved ≥5% TBWL
• naltrexone/bupropion (n=1): 0% achieved ≥3% TBWL

ConculsionsPharmacist-led medication management of anti-obesity medications appeared effective in achieving the primary endpoint of 5% TBWL or greater at 12 weeks after medication initiation. As anticipated, semaglutide and tirzepatide displayed the highest success rates. One limitation of this quality improvement initiative was the small sample sizes for some medications, namely the oral medication options.  The findings align with clinical trial data and highlight the role of pharmacists in optimizing weight loss therapy. Future initiatives may focus on assessing success rates beyond 3 months to identify the long-term benefit of a pharmacist-led weight management medication service. 

Title: Diabetes Outcomes of Patients Followed by Embedded Pharmacists in Primary Care Clinics


Authors: Cassie Twisdale, Amy Robinson, Danielle Land, Alex Ewing 


Objective: Identify diabetes outcomes and early impacts of having embedded pharmacists in primary care clinics


Self Assessment Question: Which of the following were early impacts within 3-6 months of having pharmacists manage diabetes in primary care clinics?
A) Significant lowering of A1c
B) Close follow up with phone visits
C) Increased prescribing of GLP-1 agonists
D) All of the Above


Background: The American Diabetes Association supports the use of a collaborative, multidisciplinary team approach to improve patient care when managing diabetes. Pharmacists ensure patients are on optimal guideline directed medical therapy, provide patient education, and monitor with close follow-up to allow for quicker dose escalations. Prisma Health recently embedded clinical pharmacists into two additional primary care clinics. This study will assess the pharmacists’ impact on quality of care by comparing diabetes outcomes of patients managed by newly embedded clinical pharmacists to diabetes outcomes of patients managed exclusively by providers.  


Methods: A multicenter, observational, retrospective cohort study was conducted examining adults 18 years of age or older with a diagnosis of diabetes and a hemoglobin A1c (A1c) above 8%. Patients in the pharmacist intervention group were referred to the PharmD between December 2023 to March 2024 and were required to have at least two interactions with the pharmacists during the study period. Comparator clinics were two primary care clinics within the health system that did not have an embedded pharmacist but were of similar size and patient demographics to the investigated clinics. Patients meeting inclusion criteria from the comparator clinics were randomly selected for analysis using a random number generator. The primary outcome was the reduction in A1c from baseline to next A1c three to six months later. Secondary outcomes include percent of patients on a continuous glucose monitor (CGM), number of CGM touchpoints or interpretations, number of visits during study period, use of evidence-based therapies, emergency room or hospital admissions related to diabetes care, weight loss, and number of patients assisted with medication access issues.  


Results: A total of 98 patients were included in the IRB-approved study with 49 patients in the pharmacist intervention group and 49 patients in the comparator primary care provider group. Baseline characteristics were similar between groups. The pharmacist group had a change in A1c from 9.97% to 7.83% at 3-6 months while the provider group had change in A1c of 9.51% to 9.36% at 3-6 months. A significant difference was found with the pharmacist group lowering A1c by 2.14% compared to the provider group lowering by 0.15% (p<0.001). Secondary outcomes of phone encounters, medication adjustment, continuous glucose monitor use, and assistance with medication access were statistically significant (p<0.001 for all). Pharmacists also initiated more GLP-1 RAs compared to provider (20 additional patients vs 1 additional patient, p<0.001). In patients with cardiovascular disease, pharmacists also had significantly more patients on a GLP-1 RA compared to the provider group (68.42% vs 11.76%, p=0.002) No significant differences were found between groups with SGLT-2 inhibitor use, emergency room or hospital admissions related to diabetes care or weight loss.


Conclusion: Pharmacist management of type 2 diabetes significantly lower A1c.  Pharmacists were able to provide closer follow up and assist with more medication access and continuous glucose monitor assessment than primary care providers. The early impacts of pharmacist management of diabetes can help to provide additional justification of more pharmacists in the primary care setting. Additionally, the impacts of pharmacists on diabetes outcomes help to support an automatic referral to pharmacists for patients with uncontrolled diabetes.