Pharmacist-Led Telehealth Intervention in Patients with Uncontrolled Diabetes in Rural Appalachia
Location
D.P. Culp Center Ballroom
Start Date
4-5-2024 9:00 AM
End Date
4-5-2024 11:30 AM
Poster Number
53
Name of Project's Faculty Sponsor
KariLynn Dowling-McClay
Faculty Sponsor's Department
Pharmacy Practice
Competition Type
Competitive
Type
Poster Presentation
Presentation Category
Health
Abstract or Artist's Statement
State of Franklin Healthcare Associates (SoFHA) uses integrated healthcare services to deliver a broad spectrum of care. A major asset to SoFHA is their Clinical Excellence Team (CET) comprised of pharmacists, physicians, registered nurses (RN’s), and administrators working together to improve patient outcomes. This study’s objective was to determine whether poorly controlled diabetes in rural Appalachian patients could be improved through telehealth calls made by the CET’s RN case managers under the direction of a clinical pharmacist. In this retrospective observational study, researchers used data collected from SoFHA’s intervention to determine trends in outcomes for this patient population between September 1, 2020 and September 1, 2022. It was hypothesized that SoFHA’s intervention would improve glycemic control in these rural Appalachian patients. To be included, patients were 18 years of age or older, had a diagnosis of type 2 diabetes mellitus (T2DM), and had a glycated hemoglobin (A1C) greater than 8% (commercial insurance) or greater than 9% (Medicare) for two consecutive readings. Patients were excluded from this study if they had type 1 diabetes mellitus (T1DM), used insulin pumps, were unable to be contacted, declined enrollment, were enrolled for less than 3 months, or failed to adhere to the program. The primary outcome for this study was a reduction in patient A1C to below 8% or 9% on two consecutive readings, as dictated by the patient’s insurance provider. Secondary outcomes included changes in low-density lipoprotein (LDL), triglyceride (TG) to high-density lipoprotein (HDL) ratio, microalbumin (MALB) to serum creatinine (SCr) ratio, A1C, GFR, and time from enrollment to A1C measure at goal. For the purposes of data analysis, all patient data were de-identified by the CET prior to researcher analysis. Data collected regarding patient demographics included age, sex, atherosclerotic cardiovascular disease (ASCVD) risk score, zip code, and smoking status. Data collected from monitoring parameters at enrollment and at program completion or last enrolled visit included A1C, LDL, HDL, TG, total cholesterol (TC), blood pressure (BP), SCr, GFR, and MALB. Descriptive analysis was completed in Statistical Package for the Social Sciences (SPSS) Version 29. Means and standard deviations (SD) were used to describe parametric data. Changes in outcomes from baseline to completion or last visit were assessed with paired t-tests. 145 patients were followed for a mean 301 days (SD 147 days). Of the 145 patients followed, 141 had final A1C values reported. Of these patients, 85 (60.3%) achieved A1C values below their goal. The A1C at baseline (mean 10.2%, SD 1.45%) decreased to a mean of 8.7% (SD 1.48%) following the final visit (p<0.001). Average GFR declined during enrollment; all other values were unchanged. The findings of this study support the use of telehealth intervention in poorly controlled diabetic patients in rural Appalachia.
Pharmacist-Led Telehealth Intervention in Patients with Uncontrolled Diabetes in Rural Appalachia
D.P. Culp Center Ballroom
State of Franklin Healthcare Associates (SoFHA) uses integrated healthcare services to deliver a broad spectrum of care. A major asset to SoFHA is their Clinical Excellence Team (CET) comprised of pharmacists, physicians, registered nurses (RN’s), and administrators working together to improve patient outcomes. This study’s objective was to determine whether poorly controlled diabetes in rural Appalachian patients could be improved through telehealth calls made by the CET’s RN case managers under the direction of a clinical pharmacist. In this retrospective observational study, researchers used data collected from SoFHA’s intervention to determine trends in outcomes for this patient population between September 1, 2020 and September 1, 2022. It was hypothesized that SoFHA’s intervention would improve glycemic control in these rural Appalachian patients. To be included, patients were 18 years of age or older, had a diagnosis of type 2 diabetes mellitus (T2DM), and had a glycated hemoglobin (A1C) greater than 8% (commercial insurance) or greater than 9% (Medicare) for two consecutive readings. Patients were excluded from this study if they had type 1 diabetes mellitus (T1DM), used insulin pumps, were unable to be contacted, declined enrollment, were enrolled for less than 3 months, or failed to adhere to the program. The primary outcome for this study was a reduction in patient A1C to below 8% or 9% on two consecutive readings, as dictated by the patient’s insurance provider. Secondary outcomes included changes in low-density lipoprotein (LDL), triglyceride (TG) to high-density lipoprotein (HDL) ratio, microalbumin (MALB) to serum creatinine (SCr) ratio, A1C, GFR, and time from enrollment to A1C measure at goal. For the purposes of data analysis, all patient data were de-identified by the CET prior to researcher analysis. Data collected regarding patient demographics included age, sex, atherosclerotic cardiovascular disease (ASCVD) risk score, zip code, and smoking status. Data collected from monitoring parameters at enrollment and at program completion or last enrolled visit included A1C, LDL, HDL, TG, total cholesterol (TC), blood pressure (BP), SCr, GFR, and MALB. Descriptive analysis was completed in Statistical Package for the Social Sciences (SPSS) Version 29. Means and standard deviations (SD) were used to describe parametric data. Changes in outcomes from baseline to completion or last visit were assessed with paired t-tests. 145 patients were followed for a mean 301 days (SD 147 days). Of the 145 patients followed, 141 had final A1C values reported. Of these patients, 85 (60.3%) achieved A1C values below their goal. The A1C at baseline (mean 10.2%, SD 1.45%) decreased to a mean of 8.7% (SD 1.48%) following the final visit (p<0.001). Average GFR declined during enrollment; all other values were unchanged. The findings of this study support the use of telehealth intervention in poorly controlled diabetic patients in rural Appalachia.