Clinical Pharmacist Team-Based Care in a Safety Net Medical Home: Facilitators and Barriers to Chronic Care Management.

Funding Source

National Institutes of Health, Office of the National Coordinator for Health Information Technology, National Institute of General Medical Sciences

Grant Number

369,1 U54 GM104940


College of Pharmacy

Document Type


Publication Date



Collaborative care models incorporating pharmacists have been shown to improve quality of care for patients with hypertension and/or diabetes. Little is known about how to integrate such services outside of clinical trials. The authors implemented a 22-month observational study to evaluate pharmacy collaborative care for hypertension and diabetes in a safety net medical home that incorporated population risk stratification, clinical decision support, and medication dose adjustment protocols. Patients in the pharmacy group saw their primary care provider (PCP) more often and had higher baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) and A1c levels compared to patients who only received care from their PCPs. There were no significant differences in the proportion of patients achieving treatment goals (SBP <140, DBP <90; A1c < 8) or the magnitude of change in BP or A1c among patients who underwent collaborative care versus those who did not. Age, race, and number of PCP encounters were associated with BP and A1c trends. The median time to achieve disease control was longer in the pharmacy group. Although 70% of all patients with poorly controlled hypertension achieved treatment goals within 7 months, less than 50% of patients with poorly controlled diabetes achieved A1c < 8 within 15 months, suggesting that diabetes was harder to manage overall. Contextual factors that facilitated or hindered practice redesign included organizational culture, health information technology and related workflows, and pharmacy caseload optimization. Future studies should further examine implementation strategies that work best in specific settings to optimize the benefits of team-based care with clinical pharmacists.


DOI: 10.1089/pop.2015.0177
PubMed ID: 27124294

This study was supported by the Crescent City Beacon Community Initiative (administered by the Louisiana Public Health Institute [LPHI]; funded by the Office of the National Coordinator [ONC] for Health Information Technology??"90BC0014??"Subaward 369) and in part by 1 U54 GM104940 from the National Institute of General Medical Sciences of the National Institutes of Health (NIH), which funds the Louisiana Clinical and Translational Science Center.