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Outcomes of a pharmacist-managed glucose collaborative practice agreement
Vidya Pugazhenthi1, Travis B Dick2, Matthew Call3
1Intermountain Medical Center, Murray, UT. vidya.pugazhenthi@imail.org.
Summary
A pharmacist-managed glucose collaborative practice agreement (CPA) did not significantly alter glycemic control in hospitalized patients. However, it led to a longer length of stay and increased pharmacist workload for diabetes management.
Area of Science:
- Endocrinology
- Pharmacology
- Hospital Pharmacy Practice
Background:
- Effective inpatient glucose management is crucial for patient outcomes.
- Collaborative Practice Agreements (CPAs) allow pharmacists to manage specific aspects of patient care, including diabetes.
- Evaluating the impact of pharmacist-led interventions on glycemic control is essential for optimizing hospital-based diabetes care.
Purpose of the Study:
- To investigate the impact of a pharmacist-managed glucose collaborative practice agreement (CPA) on glycemic control in hospitalized patients.
- To compare glycemic control, hypoglycemia rates, and hyperglycemia rates between pharmacist-managed and non-pharmacist-managed patient cohorts.
- To assess the effect of the CPA on length of stay and workload metrics.
Main Methods:
- Retrospective data analysis of 5146 hospitalized, noncritically ill patients from December 2012 to June 2014.
- Patients received subcutaneous insulin with blood glucose ≥ 140 mg/dL.
- Cohorts were divided based on CPA implementation and glucose management provider (pharmacist vs. nonpharmacist).
Main Results:
- No statistically significant difference in glycemic control (percentage of days within 70-180 mg/dL) was observed across cohorts (p > 0.05).
- Rates of hypoglycemia, severe hypoglycemia, and severe hyperglycemia were not significantly different between groups.
- The pharmacist-managed cohort experienced a significantly longer length of stay (p < 0.001), with a 25.8% increase in pharmacist-managed glucose consults post-CPA.
Conclusions:
- Pharmacist-managed glucose management via CPA at a tertiary medical center maintained glycemic control comparable to nonpharmacist providers.
- While clinical outcomes were similar, the CPA was associated with increased length of stay and pharmacist workload.
- Further research may be needed to optimize CPA models for inpatient diabetes care to balance clinical effectiveness with resource utilization.
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