Costs and Effectiveness of Pharmacist-led Group Medical Visits for Type-2 Diabetes: A Multi-center Randomized Controlled Trial

Objectives The effectiveness and costs associated with addition of pharmacist-led group medical visits to standard care for patients with Type-2 Diabetes Mellitus (T2DM) is unknown. Methods Randomized-controlled-trial in three US Veteran Health Administration (VHA) Hospitals, where 250 patients with T2DM, HbA1c \u3e7% and either hypertension, active smoking or hyperlipidemia were randomized to either (1) addition of pharmacist-led group-medical-visits or (2) standard care alone for 13 months. Group (4–6 patients) visits consisted of 2-hour, education and comprehensive medication management sessions once weekly for 4 weeks, followed by quarterly visits. Change from baseline in cardiovascular risk estimated by the UKPDS-risk-score, health-related quality-of-life (SF36v) and institutional healthcare costs were compared between study arms. Results After 13 months, both groups had similar and significant improvements from baseline in UKPDS-risk-score (-0.02 ±0.09 and -0.04 ±0.09, group visit and standard care respectively, adjusted p Conclusions Addition of pharmacist-led group medical visits in T2DM achieved similar improvements from baseline in cardiovascular risk factors than usual care, but with reduction in the healthcare costs in the group visit arm 13 months after completion compared to the steady rise in cost for the usual care arm

Consort diagram showing the enrollment, randomization and follow-up of study participants.

<p>Consort diagram showing the enrollment, randomization and follow-up of study participants.</p

Consort diagram showing the enrollment, randomization and follow-up of study participants.

<p>Consort diagram showing the enrollment, randomization and follow-up of study participants.</p

Comparison of change in the components of SF-36v over time between pharmacist-led group visits and standard care.

<p><b>C</b>hange from baseline in health status was not significantly different between participants in the group visits or the standard care arms.</p

Change of VHA expenditure in healthcare costs of study patients.

<p>Change of VHA expenditure in healthcare costs of study patients.</p

Change in hemoglobin A1c, blood pressure and lipids during the study period.

<p>There were no significant differences on improvement from baseline in A1c, systolic-blood-pressure, and LDL between group visits and standard care.</p

Baseline characteristics of study patients.

<p>Baseline characteristics of study patients.</p