Shay Phillips PharmD, BCPS, CDCES, BC-ADM; Jamayla Culpepper MD, MPH; Madelyn Welch BA; Katherine J. O’Hare BSPH; Willa Chen, BS; Yhenneko Taylor PhD; William Anderson, MS; Hazel Tapp PhD
Corresponding Author: Shay Phillips PharmD, BCPS, CDCES, BC-ADM; Atrium Health Carolinas Medical Center. Email: shay.phillips@atriumhealth.org
Section: Original Research
Publication: June 3, 2021
Background: The percentage of adults achieving hemoglobin A1c (A1c) goals less than 7% continues to suffer, highlighting a need to implement more effective healthcare strategies. Use of multidisciplinary teams is recommended. The study objective was to evaluate the effects of a multidisciplinary approach on behavioral outcomes and mean change in A1c in the immediate start (intervention) versus 6-month delay (control) groups at 6 months. Methods: This randomized controlled study assessed 111 patients recruited from a safety-net primary care clinic between February 2014 and August 2018. A pharmacist-led multidisciplinary team (physician champions; social worker; behavioral health; nurses; residents, and research assistant) enhanced coordination, integration, and intensification of diabetes care. A1c values were measured every 3 months and the self-efficacy scale to measure behaviors was evaluated at baseline and at 6 months. Depression screening and diabetes self-management education were incorporated into visits, and patients eligible for shared decision making (SDM) contributed to therapy choices. Results: The average patient age was 55 years. Sixty-six percent of the patients were female; greater than 80% were African American. After 6 months from baseline, the intervention group showed an A1c decrease of 2.4 compared to the control group’s decrease of 1.1 (p= 0.02). The mean increase in the self-efficacy score in the intervention group at baseline versus after 6 months showed a statistically significant change (p = 0.01) compared to the control group (p = 0.26). Results revealed a post-hoc association between A1c and PHQ-9 such that patients with a higher baseline PHQ-9 score (> 10) experienced a greater mean decrease in A1c. Conclusions: Use of a multidisciplinary clinic team in a safety-net primary care practice improved mean A1C control and behavioral outcomes for patients with type 2 diabetes as compared to control group.