A randomized trial of a primary care-based disease management program to improve cardiovascular risk factors and glycated hemoglobin levels in patients with diabetes - 21/08/11
, Robb Malone, PharmD, CDE c, Betsy Bryant, PharmD, CDE c, Ayumi K. Shintani, PhD, MPH a, b, Britton Crigler c, Darren A. Dewalt, MD c, Robert S. Dittus, MD, MPH a, f, Morris Weinberger, PhD d, e, Michael P. Pignone, MD, MPH c
Requests for reprints should be addressed to Russell L. Rothman, MD, MPP, Internal Medicine and Pediatrics, Center for Health Services Research, Vanderbilt University Medical Center, Suite 6000, Medical Center East, Nashville, Tennessee 37232-8300Résumé |
Purpose |
To assess the efficacy of a pharmacist-led, primary care–based, disease management program to improve cardiovascular risk factors and glycated hemoglobin (A1C) levels in vulnerable patients with poorly controlled diabetes.
Methods |
A randomized controlled trial of 217 patients with type 2 diabetes and poor glycemic control (A1C level ≥8.0%) was conducted at an academic general medicine practice from February 2001 to April 2003. Intervention patients received intensive management from clinical pharmacists, as well as from a diabetes care coordinator who provided diabetes education, applied algorithms for managing glucose control and decreasing cardiovascular risk factors, and addressed barriers to care. Control patients received a one-time management session from a pharmacist followed by usual care from their primary care provider. Outcomes were recorded at baseline and at 6 and 12 months. Primary outcomes included blood pressure, A1C level, cholesterol level, and aspirin use. Secondary outcomes included diabetes knowledge, satisfaction, use of clinical services, and adverse events.
Results |
For the 194 patients (89%) with 12-month data, the intervention group had significantly greater improvement than did the control group for systolic blood pressure (−9 mm Hg; 95% confidence interval [CI]: −16 to −3 mm Hg) and A1C level (−0.8%; 95% CI: −1.7% to 0%). Change in total cholesterol level was not significant. At 12 months, aspirin use was 91% in the intervention group versus 58% among controls (P 
0.0001). Intervention patients had greater improvements in diabetes knowledge and satisfaction than did control patients. There were no significant differences in use of clinical services or adverse events.
Conclusion |
Our comprehensive disease management program reduced cardiovascular risk factors and A1C levels among vulnerable patients with type 2 diabetes and poor glycemic control.
Le texte complet de cet article est disponible en PDF.Keywords : Diabetes, Disease management, Cardiovascular risk factors, Pharmacists
Plan
| This project was completed with support from the Robert Wood Johnson Clinical Scholars Program, the University of North Carolina Program on Health Outcomes, the University of North Carolina Division of General Internal Medicine, University of North Carolina Hospital Performance Improvement Department, University of North Carolina Pharmacy, the Vanderbilt Center for Health Services Research, and the Vanderbilt Diabetes Research and Training Center. |
Vol 118 - N° 3
P. 276-284 - mars 2005 Retour au numéro
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