As healthcare continues to progress, the role of the pharmacist is expanding beyond the traditional dispensing role into direct patient care activities. Pharmacists are using their medication expertise to identify, resolve, and prevent medication-related problems through enhanced clinical services such as medication therapy management (MTM), comprehensive medication reviews, and immunization services. Providing such expanded direct patient care clinical services requires pharmacists to apply evidence-based principles and continually advance their knowledge through practicing medication-related research.
One area of interest for pharmacist researchers is further exploring the impact of pharmacist-provided clinical services on important patient outcomes such as changes in hemoglobin A1c (HbA1c) levels, blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C). As an integral part of the healthcare team, it is important for pharmacists to add to the body of evidence demonstrating how their clinical interventions can optimize therapeutic goals and reduce healthcare costs. Research studies examining pharmacist impact on disease state management give credence to the expanding clinical role of pharmacists and help justify reimbursement for pharmacist cognitive services from payers.
A good example of a research paper topic would be to conduct a retrospective cohort study comparing HbA1c, BP, and LDL-C goal attainment in patients with type 2 diabetes who received MTM services from a pharmacist compared to those who did not receive MTM. The study could analyze electronic health record (EHR) data from patients who met the inclusion criteria of having a diagnosis of type 2 diabetes for at least 6 months, were on a stable regimen of oral hypoglycemic medications for 3 months, and had at least 3 visits in the last 12 months to assess outcomes.
Key aspects of the research methods would include defining the intervention group as patients who received at least one MTM visit from a pharmacist during the study period where medication therapy issues were addressed. The comparison group would consist of patients who met the selection criteria but did not receive any MTM services from a pharmacist. The primary outcomes of interest would be the proportion of patients in each group who achieved the recommended goals of HbA1c <7%, BP <130/80 mmHg, and LDL-C <100 mg/dL at the end of the study period. Secondary outcomes could examine changes in average HbA1c, BP, and LDL-C levels from baseline between the two groups.
Statistical analyses would first compare baseline demographics and clinical characteristics between groups using chi-square tests for categorical variables and student’s t-tests for continuous variables. To determine the impact of the intervention while adjusting for potential confounding variables, multivariate logistic regression analysis could then be conducted for each goal attainment outcome. Additional analyses may also examine outcomes stratified by duration of diabetes or other risk factors. Results would be reported as odds ratios with 95% confidence intervals. The proposed study has several strengths. First, using retrospective EHR data allows for a larger sample size compared to a prospective study design. Furthermore, the comparison of usual care to pharmacist intervention in a real-world clinical setting increases the generalizability of findings. Limitations include the non-randomized nature of group assignment and potential confounding from unmeasured variables. To address some limitations, propensity score matching could be conducted to balance groups on covariates. This pharmacist research study exemplifies how pharmacists can utilize available clinical data and apply methodologically sound techniques to add to the growing body of evidence supporting pharmacists’ direct patient care roles. Findings could help pharmacy stakeholders advocate for expanded MTM reimbursement in efforts to address the growing need for pharmacist involvement in managing chronic diseases. With further collaboration between pharmacist researchers and clinicians, the full potential of pharmacists to optimize medication therapy and patient outcomes will continue to be realized.