A total of 120 patients were referred to be included in this quality improvement project from September 08-March 09. Forty charts were selected, as a sample of thirty percent of the patients seen in this project to determine an overview of the outcomes for those patients referred to SafeMed program. A1C levels, blood pressure, and cholesterol levels were obtained, comparing current readings to previous readings from within the past year. The following were the results obtained for the thirty percent sample obtained from chart review:

1) 21 out of the 40 charts revealed patients with DMII. Out of these 21 patients, three patients had A1C levels out of the 5.5-7.0 acceptable range, 14 the rest of whom had stable A1C levels. Five of the patients had actually had an improvement of 1.0 point in their A1C level after five months of pharmaceutical counseling (see graph 1).

2) 36 of the patients referred to pharmaceutical counseling had hypertension. Out of these 36 patients, thirty had blood pressure levels that were within the JNC7 guidelines (not greater than 140/90) 15. Over the six months of PharmD counseling, four had seen improvement in their readings, but fell outside of the JNC 7 guidelines. Two had BP readings that had worsened over the year, and their levels were well above the accepted guidelines. One of these actually declined medication for his treatment, thus the uncontrolled hypertension (graph 2)

3) 35 of the charts of those patients referred to SafeMed had diagnosis of hypercholesterolemia. 34 of these patients had LDL levels < 130, which is within acceptable range for guidelines established by the AHA 16. Only one patient was found to have levels that were above the recommended, and this patient had declined treatment, choosing a lifestyle approach to combat an LDL level of 170 (see graph 3).

Both these objective and subjective outcomes were reported to the hospital's Clinical Improvement Committee at the end of the six month period.

Conclusion

  Pharmaceutical counseling is linked to improvement in medication adherence. The objective outcomes of pharmaceutical counseling showed the following:

  -Eighteen patients had A1C levels within acceptable ranges, four patients had an improvement in their A1C levels.

  -Thirty six of the patients had acceptable BP levels within acceptable JNC 7 range of < 130/90

  -Thirty four of patients with hyperlipidemia referred to counseling had LDL levels within AHA range of < 130, ten of whom had improvements in their LDL levels.

  These outcomes seem to substantiate the evidence that pharmaceutical counseling is correlated with improved outcomes for patients A1C, blood pressure, and cholesterol readings. The Clinical Improvement Committee conferred the value of this project, and is currently reviewing the possibilities for the sustainability of such a project through further grant funding for SafeMed outpatient pharmaceutical counseling.

  It is also apparent that drug therapy counseling provided by a multidisciplinary team of nurse practitioner, physician, nurse, and pharmacist also provides greater patient satisfaction with understanding drug regimens. This also leads to a reduction in medication errors and greater patient compliance.

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