The Diabetes Ten City Challenge: interim clinical and humanistic outcomes of a multisite community pharmacy diabetes care program.

OBJECTIVE: To assess clinical and humanistic outcomes 1 year after initiating the Diabetes Ten City Challenge (DTCC), a multisite community pharmacy health management program for patients with diabetes.

DESIGN: Interim observational analysis of deidentified aggregate data from participating employer clients.

SETTING: 29 employers at 10 distinct geographic sites contracting for patient care services with pharmacy providers in the community setting.

PARTICIPANTS: 914 patients with diabetes covered by self-insured employers' health plans who received 3 or more months of pharmacist care and had an initial glycosylated hemoglobin (A1C) measurement. Community-based pharmacists were trained in a diabetes certificate program and reimbursed for clinical services.

INTERVENTIONS: Community-based pharmacists provided patient care services using scheduled consultations, clinical goal setting, a validated patient self-management program tool, and health status monitoring within a collaborative care management model.

MAIN OUTCOME MEASURES: Changes in key direct and surrogate outcomes, including glycosylated hemoglobin (A1C), low-density lipoprotein (LDL) cholesterol., blood pressure measurements, and body mass index; influenza vaccinations; foot examinations; eye examinations; numbers of patients with goals for nutrition, exercise, and weight; and patient satisfaction.

RESULTS: At initial visit compared with 1 year, mean A1C decreased from 7.6% to 7.2%, mean LDL cholesterol decreased from 96 to 93 mg/dL, and mean systolic blood pressure decreased from 131 to 129 mm Hg. Increases were seen for influenza vaccination rate (from 43% to 61%), eye examination rate (from 60% to 77%), and foot examination rate (from 38% to 68%) for the initial visit to the end of the analysis period. For all patients in DTCC, those who perceived that their overall diabetes care was very good to excellent increased from 39% to 87%. Overall, 97.5% reported being very satisfied or satisfied with the diabetes care provided by pharmacists.

CONCLUSION: Employers demonstrated a willingness to offer a voluntary health benefit to employees and their dependents with diabetes that uses pharmacists to help participants achieve self-management goals. Patients participating in the first year of DTCC had measurable improvement in clinical indicators of diabetes management, higher rates of self-management goal setting, and increased satisfaction with diabetes care. Based on results of previous studies, these positive trends are expected to drive a corresponding decline in projected total direct patient medical costs.