(152) Leveraging clinical direct messaging to impact pharmacist-provider collaboration in diabetes management

Background: : Diabetes currently affects 11% of adults in the United States. Incretin-based therapy has increased in popularity for effectively improving diabetes outcomes, by mimicking the incretin hormone used to regulate blood sugar. There are two diabetes drug classes that target this hormone: glucagon-like-peptide-1 receptor (GLP-1) and dipeptidyl peptidase–4 inhibitor (DPP-4). Despite their individual clinical benefit, when used concomitantly, there is only a marginal improvement due to similar mechanisms. The concurrent use of these two products has implications, including increased out of pocket costs for patients, extended administration time, and implications for the providers with additional monitoring. Pharmacists can aid with identifying and effectively communicating with providers to optimize diabetes therapy.

Objective: : To evaluate concomitant diabetes therapy through pharmacist-led outreach focusing on de-prescribing by communicating to providers using the electronic health record (EHR) to send clinical direct messages.

Methods: : This evaluation utilized 10 months of pharmacy claims from an Evernorth reporting platform. A pharmacist identified patients, who were on concomitant therapy of GLP-1 and DPP-4 medications with an overlapping supply of 30 days. Pharmacists outreached providers utilizing the EHR to send patient-specific messages along with medical literature supported rationale. Once messages were sent, providers responded to discuss the patients through the EHR, phone or fax. Success was determined by discontinuing either the GLP-1 or DPP-4 medication. The control group was defined by patients whose providers did not receive any form of communication from the pharmacist. Bivariate tests and multivariable logistic regression were used to assess the impact of the program on discontinuation.

Results: : We identified 371 patients through pharmacy claims that were concomitantly on GLP-1 and DPP-4 medications from January 2023 through October 2023. Of those, 96 patients’ providers received a clinical direct message through the EHR, compared to 275 patients in the control group. Of those in the intervention group, 44.8% discontinued one of the drugs compared to 28% in the control (p=0.0025). Multivariable logistic regression, controlling for age and gender, showed intervention group with a 1.9 increase in odds of discontinuing compared to controls (p = 0.0132).

Conclusions: : Pharmacist-led outreach using clinical direct messaging demonstrates an effective way to communicate with providers on patient-specific information.

Sponsorship:: Express Scripts, an Evernorth Company