A Multidisciplinary Quality Improvement Program to Improve Diabetes Care at a Free Clinic

Area of Science:

• Clinical Pharmacy
• Internal Medicine
• Public Health

Background:

• Uninsured populations face barriers to managing chronic conditions like diabetes and hypertension.
• Intensive, multidisciplinary care models may improve outcomes in resource-limited settings.

Purpose of the Study:

• To assess the effectiveness of a pharmacist and dietitian-led, patient-centered intervention for uninsured free clinic patients with uncontrolled diabetes and hypertension.
• To evaluate changes in hemoglobin A1c and blood pressure.

Main Methods:

• Retrospective chart review of a quality improvement project involving 30 uninsured patients with hemoglobin A1c ≥ 9.0%.
• Patients received 6 individual encounters over 12 months with a pharmacist and dietitian.
• Pharmacist managed medications and self-management goals; dietitian focused on diet and exercise strategies.

Main Results:

• Significant reductions in mean hemoglobin A1c were observed at 3 months (-3.4%) and 12 months (-4.0%).
• Systolic blood pressure also showed reductions at 3 months (-6 mmHg) and 12 months (-17 mmHg).
• 17 patients completing 3 months had a mean age of 55.5 years and baseline hemoglobin A1c of 11.5%.

Conclusions:

• An intensive, multidisciplinary, patient-centered approach significantly lowered hemoglobin A1c in uninsured patients with diabetes refractory to standard care.
• This collaborative model demonstrates effectiveness in improving patient outcomes within a free clinic setting.
• Free clinics can adapt this multidisciplinary strategy using available personnel.