Pharmacist Consults Increase after Collaborative Care Agreements

DECEMBER 14, 2016
Jeannette Y. Wick, RPh, MBA, FASCP
The 2015 American Diabetes Association (ADA) Standards of Medi­cal Care in Diabetes encourages institutions to take a multidisciplinary approach in developing protocols to help patients achieve glycemic targets. Hyperglycemia affects as many as 50% of hospitalized patients. Poor glucose control is associated with worsening patient outcomes, such as prolonged wound healing, increased risk of secondary infections, and increased hospital stays.
Three pharmacists have published a retrospective analysis examining a glucose collaborative practice agree (CPA) at Intermountain Medical Center in Murray, Utah in the American Journal of Health-System Pharmacy.
The cohort study examined patients on noncritical care floors prior to the collaborative care agreement, and revisited their care after. The researchers enrolled more than 5000 patients with point of care glucose levels of 140 mg/dL or greater. They included medical telemetry, cardiology, orthopedics, oncology, surgery, transplant, neurol­ogy, and rehabilitation floors.  Patients who transferred to these floors were included in the study, and were evaluated for during their stay.  
The researchers categorized patients into 4 subgroups: provider managed patients pre-CPA,  pharmacist-managed pre-CPA, provider-managed post CPA, and pharmacist-managed post CPA.
Mean blood glucose between the pharmacist-controlled cohort and the non-pharmacist cohorts was insignificant. The pharmacist controlled cohort had a longer length of stay, although this may be because referred patients were more complex.

After the CPA was implemented, pharmacist-managed glucose consults increased by 25.8%. This indicates that when aware of this option, attending physicians and nurse practitioners are receptive to this service.
This study demonstrates that pharmacists can assist in patients’ blood glucose control, and provides the same benefit to that of other providers. This also transfers some of the work from physicians and nurse practitioners, and allows them to focus more on overall patient care.
Pugazhenthi V, Dick TB, Call M. Outcomes of a pharmacist-managed glucose collaborative practice agreement. Am J Health Syst Pharm. 2016;73(23 Supplement 6):S148-S154.