Implementation of a pharmacist-run telephonic insulin titration service

Area of Science:

• Pharmacology
• Clinical Pharmacy
• Diabetes Management

Background:

• The need for improved diabetes care and medication management in primary care settings.
• The role of pharmacists in chronic disease management and patient care coordination.
• Challenges in achieving optimal glycemic control with insulin therapy.

Purpose of the Study:

• To describe a novel insulin titration-by-phone service delivered by pharmacists.
• To evaluate the impact of this pharmacist-led service on patient glycemic control (A1C).
• To assess patient care outcomes during the first year of the service's operation.

Main Methods:

• Implementation of a pharmacist-conducted insulin titration-by-phone service in an academic family medicine department.
• Patients referred by primary care providers (PCPs) received regular calls from pharmacists for insulin dose adjustments based on self-monitored glucose values.
• Pharmacist recommendations were approved by PCPs before patient notification.

Main Results:

• Analysis of 76 patients revealed a mean decrease in glycosylated hemoglobin (A1C) of 1.55% (P <0.001) within nine months.
• The most significant A1C reduction (1.4%) occurred within the first three months post-referral.
• Forty-one patients (54%) achieved at least a 1% decrease in A1C within nine months (P <0.001).

Conclusions:

• A pharmacist-run insulin titration-by-phone service effectively improves patient A1C levels.
• The most substantial glycemic improvements were observed in the initial three months of the service.
• This remote service demonstrates a valuable model for enhancing diabetes care and medication management in primary care settings.