Impact of pharmacist intervention on glucagon prescribing patterns in an outpatient internal medicine teaching clinic

Abstract

Objectives: To examine changes in the rate of glucagon prescribing within an internal medicine resident clinic following pharmacist-led interventions and to analyze glucagon prescribing patterns.

Setting: Urban, internal medicine residency teaching clinic.

Practice description: Providers in the teaching clinic include internal medicine residents, supervised by faculty attending physicians. The pharmacy team consists of students, residents, and faculty pharmacists.

Practice innovation: This uncontrolled quality improvement project consisted of a first analysis (September 2016 to August 2017) and a second analysis (September 2016 to January 2018) to determine the difference in rate of glucagon prescribing. Patients were at least 18 years old with a diagnosis of type 1 or type 2 diabetes mellitus (T1DM and T2DM) and managed with basal insulin plus at least one dose of bolus insulin or with premixed insulin. Pharmacist-led interventions included 2 distinct educational sessions about glucagon prescription for the residents and faculty members, and implementation of standardized written communication for recommendations.

Evaluation: Data collected were analyzed with rates and descriptive statistics.

Results: Of the patients with T1DM and T2DM who were included and deemed eligible for glucagon, 9 of 188 (4.79%) during first analysis versus 27 of 203 (13.30%) during second analysis were prescribed glucagon-an 8.51% increase. Hypoglycemia not leading to hospitalization (44.44%) was the primary trigger for glucagon prescribing, and the peak prescribing month was October 2017 (25.93%).

Conclusion: Pharmacist-led intervention was associated with an increased rate of glucagon prescribing for patients with T1DM and T2DM within the resident teaching clinic. To improve further on the results, the research team plans to perform subsequent Plan, Do, Study, Act cycles to continuously improve the rate of prescriptions for at-risk patients. Overall, this project could encourage other pharmacy teams to evaluate strategies to increase glucagon prescribing and to evaluate clinical outcomes within outpatient primary care clinics.