Abstract: FR-PO957

Provider versus Pharmacy Led Initiation of ACEI or ARB

Session Information

  • Patient Safety
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Patient Safety

  • 1501 Patient Safety


  • Mazurek, Kelly, Uniiversity of Washington, Seattle, Washington, United States
  • Fleet, Margaret E., Uniiversity of Washington, Seattle, Washington, United States
  • Young, Bessie A., Uniiversity of Washington, Seattle, Washington, United States

Guideline attainment in diabetes and early diabetic nephropathy is difficult. Primary care provider (PCP) directed recommendations can either be from a specialist or from a pharmacist. Studies looking at the efficacy of either approach have been mixed. The purpose of this study was to determine whether a provider (Nephrologist) versus pharmacy led invention, consisting of initiation of an ACEI or an ARB (Ac/Ar), was more effective.


Data were collected from the Diabetes Registry at the Veterans Affairs (VA) Puget Sound Health Care System. Search criteria were: diabetes mellitus, hypertension or blood pressure >140/90 mmHg, albuminuria >30 mg/g, and not being on an Ac/Ar. Exclusion criteria were taking an Ac/Ar, previously enrolled in pharmacy clinic, anaphylaxis or angioedema to an Ac/Ar, ESRD or no longer being a VA patient. Patients were followed over 7 months. Nephrology recommendations and guidelines were given to PCPs for starting an Ac/Ar. PCPs had the option to place an electronic nephrology consult to manage the intervention. On the other hand, the pharmacy team identified patients and placed referrals to a pharmacy clinic. The primary pharmacist made decisions on drug initiation, monitoring, titration and laboratory tests based on the same recommendations. The primary outcome was the rate of Ac/Ar initiation.


A total of 34 patients were found in the provider group and 19 patients in the pharmacy group. There was a trend towards increased efficacy in the pharmacy led team (58%) over the provider led team (41%). However, there was no statistical difference (p 0.56). A post study survey showed that majority of participants favored that pharmacists identify, start and manage recommendations.


A pharmacy led intervention was no more effective than a provider led intervention in implementing current standards of care for diabetic patients. On the pharmacy arm, patients were more likely to have follow-up appointments if they were by telephone rather than in person. Telephone intervention is less burdensome and may lead to more successful interventions and continuity of care. PCPs are often overwhelmed with their patient panel and correct medication management can go overlooked. Pharmacists are just as effective, are more accessible health care practitioners and are well positioned to implement appropriate medication use.