Impact of pharmacist-led chronic disease management in a Federally Qualified Health Center

Abstract

Introduction: There is growing interest in pharmacist-led chronic disease management (CDM) for underserved populations such as those treated within Federally Qualified Health Centers (FQHCs). Objectives: To assess the impact of adding a pharmacist to the healthcare team within an FQHC for CDM. Methods: This is a non-randomized, 6-month prospective pilot study whereby any member of the healthcare team could refer a patient to receive CDM from a pharmacist. The primary outcome is change in disease control as measured by primary clinical endpoint. Primary clinical endpoints for the most common disease states include glycated hemoglobin (A1C) for type 2 diabetes mellitus (T2DM), systolic blood pressure (SBP) for hypertension, Generalized Anxiety Disorder-7 (GAD-7) score for anxiety, and Patient Health Questionnaire-9 (PHQ-9) score for depression. Primary clinical endpoints are compared using a paired t test for the modified intention-to-treat population. Secondary outcomes include change in self-reported health and healthcare utilization and difference in satisfaction with care between the primary care provider (PCP) and pharmacist. Results: Three hundred patients were enrolled of whom 199 were included. Most patients were referred by their PCP. Statistically significant differences in the mean primary endpoint were observed for all disease states with at least 20 participants, including T2DM (n = 96, change in A1C -2.1%, P < 0.001), hypertension (n = 32, change in SBP -29.7 mmHg, P < 0.001), anxiety (n = 25, change in GAD-7 score − 7, P < 0.001), and depression (n = 22, change in PHQ-9 score −11.1, P < 0.0001). While statistically significant changes in self-reported healthcare and healthcare utilization were not observed, patients were more satisfied with care. Conclusion: When provided with prescriptive authority and working within an interdisciplinary primary care team, pharmacists were able to impact clinical and humanistic outcomes in the FQHC, leading to improved CDM for a variety of illnesses. More studies should be conducted to validate these results in other settings.