OBJECTIVES: To assess whether differences exist in adherence to national consensus guidelines, between urban and rural patients receiving medication therapy management (MTM) for diabetes and/or hypertension.

METHODS: Patients participating in Year 1 of this study included those: 18 years and older, diagnosed with diabetes mellitus and/or hypertension, and living in rural Arizona communities (per Arizona statute) who received pharmacist-delivered, telephonic MTM services and a comprehensive medication review (CMR) from an academic-based MTM provider. Gaps in care were assessed according to national consensus guidelines for statins, beta-blockers, rescue inhalers, and inhaled corticosteroids, as part of the CMR. The pharmacist made recommendations for appropriate medication additions. Patient follow up consultations were conducted to determine whether prescribers acted on these recommendations. For this descriptive analysis, patients were categorized by Rural-Urban Commuting Area (RUCA) codes; RUCA codes 1-3=urban; 4-6=micropolitan; 7-10=small town).

RESULTS: A total of 384 patients received a CMR and follow-up consultation. Participants were predominantly female (urban=70.9%, micropolitan=64.9%, small town=61.5%), white (urban=75.2%, micropolitan=78.4%, small town=68.6%), non-Hispanic (urban=17.0%, micropolitan=83.8%, small town=68.0%%) and older (65-74 years, urban=34.8%, micropolitan=18.9%, small town=37.9%). Pharmacists recommended prescribers add a statin for 57 (n=262, 21.8%) patients and 19 (33.3%) additions were identified at follow-up (urban=8, micropolitan=3, small town=8). Adding a beta-blocker was recommended for 13 (n=63, 20.6%) patients; two additions (15.4%) were present at follow-up (small town=2). Recommendations were made for adding a rescue inhaler for seven (n=89, 7.9%) patients; three additions (42.9%) were identified at follow-up (urban=2, small town=1). None of the 13 inhaled corticosteroid recommendations were present at follow-up.

CONCLUSIONS

: Differences were observed in the pharmacist’s clinical guideline recommendations accepted by prescribers, between urban- and rural-dwelling patients. More concentrated efforts are warranted to increase prescribers’ acceptance of guideline recommendations, for rural-residing patients with diabetes and/or hypertension.