Comparison of clinical pharmacy specialists and primary care physicians in treatment of type 2 diabetes mellitus in rural Veterans Affairs facilities

Purpose Results of a study to compare the impact of clinical pharmacy specialist (CPS) interventions with primary care physician (PCP) interventions in veterans with type 2 diabetes mellitus (T2D) in a rural setting are presented. Methods A retrospective analysis was performed examining veterans diagnosed with T2D with a glycosylated hemoglobin (HbA 1c ) of ≥8% receiving treatment at a rural community-based outpatient clinic associated with the Memphis Veterans Affairs Medical Center. Propensity score matching was used to create a 1:1 cohort of patients managed by physicians or clinical pharmacy specialists. Patients were evaluated as their own control and as compared cohorts. The primary outcome was the difference in HbA 1c . Secondary outcomes included changes in total cholesterol, low-density lipoprotein cholesterol, triglycerides, and body mass index. Results Data were collected from 124 patients ( n = 62 CPS patients, n = 62 PCP patients). Baseline HbA 1c in the CPS and PCP groups were 10.2% ± 1.9% and 9.6% ± 1.6%, respectively. Postintervention HbA 1c in the CPS cohort was 7.5% ± 1.1% (range, 6–11.7%), indicating an absolute reduction of 2.7% ( p 1c in the PCP cohort was 8.5% ± 1.5% (range, 5.4–12.6%), resulting in an absolute reduction of 1.1% ( p 1c absolute reduction of 1.6 percentage points compared to physician intervention ( p Conclusion Compared with physician intervention, clinical pharmacy intervention in the treatment of T2D led to a greater mean HbA 1c reduction in patients receiving care through VA facilities in rural settings.