CVS proves pharmacists impact diabetes outcomes

WOONSOCKET, R.I. Serving as yet one more indicator of the vital role that pharmacists play in the U.S. healthcare system is a program implemented by CVS Caremark and Polk County, Fla., that clearly illustrates how clinical pharmacist interventions can improve diabetes outcomes for patients.

As explained in the case study published in a recent issue of the American Journal of Health-Systems Pharmacists, the program has resulted in improvements in key clinical measurements for enrolled members, such as decreased glycosylated hemoglobin and lowered blood pressure levels. A reduction in emergency room visits and in-patient hospital admissions also were recorded — improvements that also should be noted given the current strain on emergency rooms.

According to the Centers for Disease Control and Prevention, in 2006 there were 119.2 million visits to emergency rooms, or 40.5 visits per 100 persons, continuing a long-term rise in both indices.

To understand how the program has helped those with diabetes manage their health, let’s back up to February 2005, which is when Polk County, a self-insured government employer client, implemented the Contract for Care program. Polk County is one of the largest population concentrations in the Southeast and the fourth largest county in Florida at 2,010 total sq. mi.

Enrolled Polk County employees agree to work with a CVS Caremark clinical pharmacist, located on-site at the county’s employee health clinic, to develop individualized care plans and coordinate regular follow-up. Enrolled members receive copay waivers on disease-related medications — generic and branded — as well as related supplies and nonprescription products.

Sound a bit familiar? Think: The Asheville Project. The Asheville Project began in 1996 as an effort by the City of Asheville, N.C., a self-insured employer. The goal: to provide education and personal oversight for employees with such chronic health problems as diabetes. Patients were teamed with community pharmacists, who made sure they were using their medications correctly, and soon began experiencing improved outcomes.

At the end of the first year of Polk County’s Contract for Care program, 477 members were enrolled and were included in the analysis.

The study’s primary outcome was the change in clinical values for glycosylated hemoglobin, a critical measurement of blood sugar levels. Secondary outcomes included changes in such utilization metrics as all-cause hospitalization, ER visits and blood pressure values. After one year, the reduction in glycosylated hemoglobin values was especially high among members in the critical risk group, with nearly 78% of these members achieving a significant reduction. Mean systolic blood pressure decreased six points, and mean diastolic blood pressure decreased four points. Medical claims data revealed a 30% drop in all cause-hospitalizations and a 24% drop in ER visits for enrolled members.

Clearly, the benefits of the program are twofold; not only are enrollees improving their health, but it also underscores the importance of pharmacist intervention in improving patient health outcomes. This couldn’t be more critical as the healthcare-reform battle rages on and retail pharmacy solidifies its foothold on the front lines.