OBJECTIVES: Bon Secours Mercy Health (BSMH) encompasses 63 primary care practices in Virginia (US), of which 12 employ pharmacists. At BSMH, pharmacists provide three primary services: annual wellness visits (AWV), comprehensive medication reviews (CMR), and disease state management (DSM). This research aims to identify clinical pharmacy services associated with quality measure achievement among Medicare patients for blood pressure (BP) control, glycemic control (HbA1c), and annual eye and foot exams.

METHODS: Retrospective, cross-sectional study analyzing electronic medical record data from January-December 2017. All Medicare patients aged 65-85 years and who were new to the pharmacist at one of the 12 practices were included. Quality measure achievement was based on the last measurement before the end of calendar year for BP and HbA1c, and receipt of annual eye and foot exams. Multiple logistic regression models were used to identify pharmacy services (AWV, CMR, DSM) associated with BP control (<140/90 mmHg) among patients with hypertension, and glycemic control (HbA1c<9%), eye and foot exams among patients with diabetes, controlling for demographics (age, sex, race).

RESULTS: A total of 483 Medicare patients were included. Patients were 63.8% female, 57.2% Caucasian, 41.1% Black, and were on average 73.1 years. Pharmacists provided AWV to 71.0% patients, CMR to 12.2%, and DSM to 20.1%. A diagnosis of hypertension was established for 76.3% patients and 48.5% had diabetes. Race was a significant predictor of BP control, with Blacks being less likely to meet BP control compared to Whites (OR=0.57, 95%CI 0.36-0.90). Receiving DSM was negatively associated with glycemic control (OR=0.16, 95%CI 0.03-0.91). CMR receipt (OR=6.14, 95%CI 1.2-31.4) was associated with completing a foot exam. No significant predictors were identified for eye exam receipt.

CONCLUSIONS: Pharmacy services examined had no or negative impact on BP and glycemic control. Future work will investigate how each service is delivered by pharmacists across practices to ensure standardization.