Improving HbA1c and Diabetes Preventative Screening Measures in Spanish-Speaking Patients With Clinical Pharmacist Care: A Quality Improvement Initiative.

Abstract

To evaluate the impact of clinical pharmacist interventions on HbA1c and adherence to diabetes preventative screenings among Spanish-speaking adults with uncontrolled type 2 diabetes. This retrospective evaluation of a quality improvement initiative included Spanish-speaking adults with baseline HbA1c of 8% or greater who received at least 1 clinical pharmacist visit at a Federally Qualified Health Center. Outcomes included changes in glycemic control and timely preventive care screenings (diabetic eye exam, diabetic foot exam, urine albumin-to-creatinine ratio [UACR] test, and statin use), analyzed using logistical regression and McNemar's test. Among 70 included patients, the mean age was 55.6 years, with 65.7% of patients identifying as female and 62.9% having Medicaid insurance. The baseline mean HbA1c was 11.0%. Within 12 months, 40 patients achieved HbA1c <8% (Cochran's <i>Q</i>₅ = 142.88, <i>P</i> < .0001). Gender and insurance status were significant predictors of success. The odds of a timely diabetic eye exams (odds ratio [OR]: 8.67, 95% confidence interval [CI]: 2.66-44.74, <i>P</i> < .0001), foot exams (<i>P</i> < .0001), and UACR tests (OR: 4.80, 95% CI: 1.80-16.11, <i>P</i> = .0008) increased. Spanish-speaking patients exposed to clinical pharmacist care observed significant improvements in glycemic control and timely preventative care screening.