2025 Southeastern Residency Conference

TITLE: Impact of a Pharmacist Led Medication Adherence Team on A1c 
AUTHORS: Rion Poland; Niaima Geresu; Cindy Nee; Mary Katherine Cheeley 
 
BACKGROUND: Chronic diseases such as hypertension, diabetes, and heart disease account for over 85% of healthcare spending in the United States and remain leading causes of death and disability. While clinical trials have demonstrated that optimal medication adherence improves clinical outcomes, real-world data often reveal suboptimal adherence. Time constraints and staffing limitations often impede community pharmacists’ ability to effectively address medication adherence in a real-world setting. This study evaluates the effect of a pharmacist-led medication adherence program on clinical outcomes in patients with uncontrolled diabetes.
 
METHODS: This single-center, retrospective chart review included patients who had an A1c of 9% or higher and whose anti-diabetic medication(s) were 10 to 30 days past their refill due date at a Grady pharmacy between October 1, 2023, and March 31, 2024. Patients successfully contacted by a medication adherence pharmacist were assigned to the intervention group, while those who could not be reached were included in the control group. Patients without follow-up A1c values were excluded. The primary outcome assessed the difference in A1c change between the two groups. Secondary outcomes included the change in A1c from baseline within each group and the percentage of patients achieving an A1c goal of less than 9%.
 
RESULTS: A total of 391 patients were included in the study, with similar baseline characteristics between groups. The majority of patients were uninsured, on insulin therapy, and prescribed at least two antidiabetic medications. Within the intervention group, over 70% of patients were contacted once by the medication adherence pharmacist. Following the study period, over 25% of patients in both the intervention and control groups achieved an A1c below 9%, with rates of 27.4% and 26%, respectively. Regarding the primary outcome, the intervention group demonstrated a median A1c reduction of 0.7 (IQR: -0.5 to -2.2), while the control group experienced a median reduction of 0.75 (IQR: -0.8 to -1.9). The difference between groups was not statistically significant (p = 0.302). However, within-group analysis revealed a significant A1c reduction in both groups. In the intervention group, the median A1c decreased from 10.9 (IQR 9.8–12.5) to 10.2 (IQR 8.7–12) (p < 0.001). Similarly, the control group experienced a decrease from 11.0 (IQR 9.8–12.5) to 10.3 (IQR 8.8–11.9) (p = 0.0013). The median time between pre- and post-intervention A1c measurements was similar between groups, with the intervention group at 22 weeks (IQR 14.7–33.1) and the control group at 22.6 weeks (IQR 16.25–40.1).
 
CONCLUSION: While the pharmacist-led adherence intervention group was associated with a significant reduction in A1c, the degree of improvement did not differ significantly from the control group. These findings suggest that medication adherence pharmacists may positively influence patient outcomes; however, additional patient-specific factors likely contribute to A1c reduction. Future studies should explore social determinants of health, including socioeconomic status, housing stability, and provider follow-up, as potential barriers to improved adherence. Assessing these factors through patient surveys or adherence metrics, such as the percentage of days covered, may provide further insight. While additional strategies may refine adherence interventions, patient adherence remains a critical component of chronic disease management.