PMID- 29672567
OWN - NLM
STAT- MEDLINE
DCOM- 20180723
LR  - 20240323
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 13
IP  - 4
DP  - 2018
TI  - Costs and effectiveness of pharmacist-led group medical visits for type-2 
      diabetes: A multi-center randomized controlled trial.
PG  - e0195898
LID - 10.1371/journal.pone.0195898 [doi]
LID - e0195898
AB  - 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 >7% 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<0.05 for both); however, there was no 
      significant difference between the study arms (adjusted p = 0.45). There were no 
      significant differences on improvement from baseline in A1c, 
      systolic-blood-pressure, and LDL as well as health-related quality-of-life 
      measures between the study arms. Compared to 13 months prior, the increase in 
      per-person outpatient expenditure from baseline was significantly lower in the 
      group visit versus the standard care arm, both during the study intervention 
      period and at 13-months after study interventions. The overall VHA healthcare 
      costs/person were comparable between the study arms during the study period (p = 
      0.15); then decreased by 6% for the group visit but increased by 13% for the 
      standard care arm 13 months post-study (p<0.01). 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. TRIAL REGISTRATION: 
      NCT00554671 ClinicalTrials.gov.
FAU - Wu, Wen-Chih
AU  - Wu WC
AUID- ORCID: 0000-0002-2834-2024
AD  - Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans, 
      VA Medical Center, Providence, RI.
AD  - Department of Medicine, Brown University, Providence, RI.
AD  - University of Rhode Island College of Pharmacy, Kingston, RI.
FAU - Taveira, Tracey H
AU  - Taveira TH
AD  - Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans, 
      VA Medical Center, Providence, RI.
AD  - Department of Medicine, Brown University, Providence, RI.
AD  - University of Rhode Island College of Pharmacy, Kingston, RI.
FAU - Jeffery, Sean
AU  - Jeffery S
AD  - University of Connecticut School of Pharmacy, Storrs, CT.
AD  - West Haven VA Medical Center, West Haven, CT.
FAU - Jiang, Lan
AU  - Jiang L
AD  - Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans, 
      VA Medical Center, Providence, RI.
FAU - Tokuda, Lisa
AU  - Tokuda L
AD  - VA Pacific Islands Health Care System, Honolulu, HI.
FAU - Musial, Joanna
AU  - Musial J
AD  - University of Connecticut School of Pharmacy, Storrs, CT.
FAU - Cohen, Lisa B
AU  - Cohen LB
AD  - Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans, 
      VA Medical Center, Providence, RI.
AD  - University of Rhode Island College of Pharmacy, Kingston, RI.
FAU - Uhrle, Fred
AU  - Uhrle F
AD  - VA Pacific Islands Health Care System, Honolulu, HI.
LA  - eng
SI  - ClinicalTrials.gov/NCT00554671
PT  - Clinical Trial
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20180419
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Aged
MH  - Ambulatory Care/*economics
MH  - Comorbidity
MH  - *Cost-Benefit Analysis
MH  - Diabetes Mellitus, Type 2/diagnosis/drug therapy/*epidemiology
MH  - Female
MH  - Hospitals, Veterans
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Patient Acceptance of Health Care
MH  - Pharmaceutical Services/*economics
MH  - *Pharmacists
MH  - Primary Health Care/economics
MH  - United States/epidemiology
PMC - PMC5908172
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2018/04/20 06:00
MHDA- 2018/07/24 06:00
PMCR- 2018/04/19
CRDT- 2018/04/20 06:00
PHST- 2017/12/29 00:00 [received]
PHST- 2018/03/29 00:00 [accepted]
PHST- 2018/04/20 06:00 [entrez]
PHST- 2018/04/20 06:00 [pubmed]
PHST- 2018/07/24 06:00 [medline]
PHST- 2018/04/19 00:00 [pmc-release]
AID - PONE-D-17-45172 [pii]
AID - 10.1371/journal.pone.0195898 [doi]
PST - epublish
SO  - PLoS One. 2018 Apr 19;13(4):e0195898. doi: 10.1371/journal.pone.0195898. 
      eCollection 2018.