A pharmacist-led intervention to improve medication adherence is correlated with statistically significant decreases in hemoglobin A_1c (HbA_1c) levels among Hispanic patients with type 2 diabetes, according to study findings published in JAMA Network Open.

The UCMyRx initiative embeds motivational interviewing-trained pharmacists into primary care practices to help physicians manage patients who need complex care. Although previous research supports pharmacist-led interventions as effective strategies to reduce cardiovascular disease risk factors among Hispanic individuals with type 2 diabetes, data on other health outcomes remain limited.

To evaluate the effects of the pharmacist-led intervention on HbA_1c and systolic blood pressure, researchers conducted a quality improvement study using electronic health record data from University of California, Los Angeles primary care clinics between February and April 2023.  Participants were at least 18 years of age, had a type 2 diabetes diagnosis, self-reported as Hispanic, and had at least 1 face-to-face visit with a UCMyRx clinical pharmacist during the 2013 to 2018 study window.

Primary outcomes were changes in HbA_1c levels and systolic blood pressure levels. The HbA_1c exposure population was limited to patients with an initial HbA_1c concentration of at least 8%, whereas the systolic blood pressure exposure population was limited to patients with an initial reading of at least 140 mmHg.

The study included a total of 931 participants, of whom the mean age was 64 years, 59.3% were women, and 49.7% preferred speaking English. The HbA_1c and blood pressure outcome sample sizes were 396 and 795 patients, respectively.

Compared with the total sample, both the HbA_1c and blood pressure subgroups had higher proportions of individuals aged older than 65 years and women, lower proportions of individuals with private insurance, and were receiving more medications on average.  

The adjusted analyses showed that having at least 1 UCMyRx visit was associated with a significant decrease in HbA_1c levels (β, -0.46%; 95% CI, -0.84% to -0.07%). However, the researchers noted no association between an UCMyRx visit and systolic blood pressure (β, -1.71 mmHg; 95% CI, -4.00 to 0.58).

When stratified by language preference, the analyses showed a significant negative association between UCMyRx exposure and HbA_1c concentration among individuals in the HbA_1c subgroup with a preference for English (β, -0.59%; 95% CI, -1.13% to -0.06%; P =.03) but no significant trend among those with a preference for a non-English language.

The researchers found no significant associations between frequency of UCMyRx visits and outcomes. The sensitivity analyses with White comparison groups showed no significant differences in outcomes between Hispanic and White patients.

Study limitations include an inability to generalize its findings to other groups besides Hispanic patients with type 2 diabetes who were being treated at a southern Californian academic health center during the study window, visit count stipulations for the comparison but not treatment groups, and a lack of detailed data on the content of the pharmacist-led interventions.

The researchers wrote, “These findings suggest that pharmacist-led intervention may be a strategy for improving some outcomes among Hispanic patients with type 2 diabetes.”