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BACKGROUND/RATIONALE:
Good blood pressure (BP) control among patients with diabetes is essential in preventing diabetes complications and has been found to be not only cost-effective but cost-saving. Nonetheless, over 25% of VA patients with diabetes do not have adequate BP control. Among these poorly controlled patients, over 65% have problems with medication adherence or inadequate intensification of medications. We therefore propose a partnership with the VA Pharmacy Benefits Management (PBM) Office and VISN 11 to evaluate a tailored clinical pharmacist-based intervention to improve medication management, adherence and BP control.
OBJECTIVE(S):
The specific objectives of this implementation study are: 1) To evaluate the effects of the intervention on blood pressure (primary outcome) and glycemic and lipid control (secondary outcomes); 2) To assess the impact of the intervention on patients' adherence to blood pressure, anti-hyperglycemic, and lipid-lowering regimens, and intensity of these regimens; 3) To evaluate the cost-effectiveness of the intervention compared to usual care; 4) To evaluate the level of attainment of intervention implementation, examine the process of intervention implementation, and determine the potential for sustainability.
METHODS:
In this cluster randomized implementation trial, we will proactively identify, using clinical automated data, all diabetes patients within 3 VA sites who have poor blood pressure control and either poor refill adherence or insufficient medication intensification. Adherence and treatment intensification patterns will also be evaluated for glycemia and lipids if either of these risk factors is poorly controlled. Clinical pharmacists, trained in motivational interviewing techniques and guided by computerized adherence modules, will identify barriers to medication adherence and provide adherence counseling. They will also be authorized to change and titrate medications following site-specific algorithms. Patients in the non-intervention (control) teams will receive usual care. Blood pressure control and refill adherence will be assessed 6-months after the end of the 12-month intervention period. We will also conduct a formative evaluation during the course of the study and assess implementation attainment and potential for dissemination.
FINDINGS/RESULTS:
There are no current findings.
IMPACT:
In June, 2005, Dr. Jonathan Perlin challenged VA researchers to help VA provide the right care to the right patient at the right time. As he suggested, much of that care can be provided through creative use of information technology and tailored team-based care. The planned intervention, based on a partnership with VA PBM and VISN 11, addresses that challenge. Moreover, once shown to be effective, a similar approach could be used for many other chronic conditions, such as congestive heart failure and chronic pain. Specific products will also include the algorithm and programming codes for generating the gap and intensification measures, the template for presenting patient information to pharmacists, interactive computerized adherence counseling content modules, and a pharmacist training curriculum.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases
DRE:
Treatment
Keywords:
Diabetes, Pharmaceuticals, Hypertension
MeSH Terms:
none
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