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Employer-based pharmacist intervention improves A1C levels, data suggest

Thursday, March 04 2010 | Comments

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What's This? An employer-based pharmacist intervention designed to give patients with diabetes individualized care and engage them in the management of their health is associated with significant reductions in hemoglobin A1C levels, blood pressure (BP), and health care use after 1 year, new findings indicate.

The Contract for Care intervention was implemented in February 2005 by CVS Caremark Corp. and Polk County, Fla., a self-insured government employer that insures approximately 8,500 county employees and their dependents. Individuals enrolled in the program (n=577) received copayment waivers for disease-related drugs (generics and preferred brands) and related supplies and nonprescription products. In addition, they met with a clinical pharmacist located on-site at the county's employee health clinic who developed individualized care plans with regular follow-up to address gaps in health education.

Outcome measures included changes in A1C levels (the primary outcome), blood glucose, blood pressure, and health care use among the participants who were still enrolled after 1 year (n=477).

Data showed that A1C levels decreased steadily among the participants during follow-up; 55% of the participants had an A1C level <=7% at baseline compared with 72% at follow-up.

Similarly, mean systolic BP declined 6 points (from 134 mm Hg to 128 mm Hg) and mean diastolic BP declined 4 points (from 81 mm Hg to 77 mm Hg).

In addition, hospital admissions dropped 30% and emergency department visits dropped 24%.

Michael Kushner, director of risk management for Polk County noted that--in addition to improved health outcomes--the partnership with CVS Caremark has led to cost savings for the employees enrolled and for the plan as a whole.

"The success of this type of program is particularly important when you realize that only about 28% of people with diabetes currently achieve optimal management of their disease, which includes adherence to antidiabetic medications as well as to other recommended therapies to treat comorbid conditions such as high BP," added Dr. Troyen Brennan, chief medical officer of CVS Caremark. (Iyer R, et al. Am J Health Syst Pharm 2010;67:312-316.)

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