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Original Investigation
Health Care Reform
Sep 12, 2011

Team-Based Care Approach to Cholesterol Management in Diabetes Mellitus: Two-Year Cluster Randomized Controlled Trial

Author Affiliations

Author Affiliations: Providence Medical Group, Portland, Oregon (Drs Pape, Siemienczuk, LeBlanc, and Gillanders and Mss Rozenfeld and Bonin); Department of Quality and Care Improvement, Bellin Health System, Green Bay, Wisconsin (Dr Hunt); and Division of General Internal Medicine, Oregon Health and Science University, Portland (Dr Butler).

Arch Intern Med. 2011;171(16):1480-1486. doi:10.1001/archinternmed.2011.417

Background Creative, cost-effective interventions to improve the quality of care of chronic illnesses are needed. This study was designed to evaluate the impact of remote physician-pharmacist team-based care on cholesterol levels in patients with diabetes mellitus (DM).

Methods This 2-year prospective, cluster randomized controlled trial was conducted within the Providence Primary Care Research Network in Oregon. Participants at least 18 years of age were identified by a diagnosis of DM. The intervention included remote physician-pharmacist team-based care focused on cholesterol management in DM. All clinicians in the study had access to the health information technology tool CareManager, which provided automated DM-related point-of-care prompts, a Web-based registry, and performance feedback with benchmarking. Study outcomes included the difference in low-density lipoprotein cholesterol (LDL-C) goal attainment, mean LDL-C, prescribed lipid-lowering therapy, and patient satisfaction between the intervention and control arms.

Results A total of 6963 patients with DM cared for by 68 physicians in 9 clinics were evaluated. Patients in the intervention arm were more likely to achieve their target LDL-C levels compared with controls (78% vs 50%; P = .003). The mean LDL-C level was 12 mg/dL lower in the intervention arm compared with the control arm (P < .001). The rate of LDL-C testing was significantly higher in the intervention arm compared with the control arm. Patients in the intervention arm were also 15% more likely to receive a prescription for a lipid-lowering medication (P = .008). There was no significant difference in patient satisfaction between study arms (P = .15).

Conclusion Remotely located physician-pharmacist team-based care resulted in significantly improved LDL-C levels and goal attainment among patients with DM.