Impact evaluation of a four-year academic-community partnership in provision of medication management and tertiary prevention services for rural patients with diabetes and/or hypertension

Elizabeth J Anderson; David Rhys Axon; Ann M Taylor; Victoria Towers; Terri Warholak; Melissa Johnson; Stephanie Forbes; Teresa Manygoats

doi:10.1016/j.pmedr.2019.101038

Impact evaluation of a four-year academic-community partnership in provision of medication management and tertiary prevention services for rural patients with diabetes and/or hypertension

Prev Med Rep. 2019 Dec 31:17:101038. doi: 10.1016/j.pmedr.2019.101038. eCollection 2020 Mar.

Authors

Elizabeth J Anderson¹, David Rhys Axon¹, Ann M Taylor¹, Victoria Towers², Terri Warholak¹, Melissa Johnson², Stephanie Forbes², Teresa Manygoats³

Affiliations

¹ University of Arizona College of Pharmacy, 1295 N Martin Avenue, PO Box 210202, Tucson, AZ 85721, USA.
² Medication Management Center, University of Arizona College of Pharmacy, 220 W. 6th St., USA Building Room B113, Tucson, AZ 85721, USA.
³ Arizona Department of Health Services, 150 North 18 Avenue, Phoenix, AZ 85007, USA.

Abstract

Medication therapy management (MTM) services, including targeted, pharmacist-delivered, tertiary prevention interventions, were provided to rural patients with chronic diseases via an academic-community partnership. The purpose of this investigation was to evaluate the overall program and pre/post patient outcomes from this four-year, multi-site collaboration. Five community health sites collaborated with a university-based MTM provider to deliver services in Arizona (2012-16). Eligible patients: were 18 or older (median 65 years); had a diagnosis of diabetes and/or hypertension; and resided in a rural community. Participants received an initial telephone consultation with the MTM pharmacist; follow-up consultations were conducted after 30 or 90 days for high- and low-risk patients, respectively. Community partner staff collected clinical data and addressed pharmacists' recommendations. Descriptive analysis and bivariate analyses of pre- and post-intervention results were conducted. Most (n = 410, 70%) of the 577 participants receiving an initial and follow-up consultation with the MTM pharmacist had both diabetes and hypertension. These individuals showed statistically significant improvements in fasting blood glucose (p < 0.0001), hemoglobin A1C (p = 0.0082) and systolic blood pressure (p = 0.009) while those with only one condition did not demonstrate significant changes. While the pre/post changes in chronic disease control indicators were statistically significant, the clinical significance was low to moderate. Patients with both comorbid diabetes and hypertension experienced benefit from collaborative, targeted MTM pharmacist-delivered, tertiary prevention interventions in tandem with community-based pharmacy resources. This multi-site MTM program showed promise in increasing patients' use of these services, yet effective strategies are needed to expand recruitment of eligible patients in the future.

Keywords: Diabetes; Hypertension; Intersectoral Collaboration; Medication Therapy Management; Rural Health Services.