(153) Pharmacist-Led Interventions in Comprehensive Medication Management: Impact on 90-Day Post-Discharge A1c Levels

Background: : Transitions of care (TOC) pose a significant risk for patients with poorly controlled diabetes, particularly those lacking access to timely outpatient follow-up. Pharmacists integrated into transitional care teams can address medication issues, reinforce self-management, initiate and adjust therapy, bridging gaps until follow-up occurs. Through early intervention and ongoing support, pharmacists lay the groundwork for more efficient and effective visits and improve clinical outcomes.

Objective: : This quality improvement (QI) initiative compared glycemic control in recently hospitalized patients with poorly controlled diabetes (A1c >8%) discharged home, comparing those who received Comprehensive Medication Management (CMM) services versus those who did not. The primary goal was a 1.1% point A1c reduction within 90 days.

Methods: : Between October 2024 and April 2025, adults (≥18 years) with A1c >8%, a valid phone number, and a hospital-affiliated provider were enrolled after discharge. Pharmacists conducted up to six telehealth CMM visits over 90 days, identifying therapy gaps through patient consultation, provider collaboration, and record review. A driver diagram guided interventions, focusing on provider uptake, patient engagement, and follow-up. Descriptive statistics and paired t-tests were used.

Results: : As of April 2025, 96 patients enrolled in the treatment group; 60 completed at least one pharmacist visit and reached the full 90-day period, forming the evaluable cohort. Patients, on average, completed three visits; 75% completed three or more visits. The average baseline A1c was 10.73%. Among 40 patients with both baseline and follow-up A1c results, the average reduction was 2.6% points (SD: 2.34), a statistically significant change (t = –7.03, p < 0.0001), indicating meaningful glycemic improvement. Pharmacists made 131 recommendations for 53 patients (88%) to modify medication therapy. Of the 112 provider responses, 84% were accepted. At study completion, outcomes will be compared to a control group of recently discharged patients not enrolled in CMM.

Conclusions: : Telehealth CMM by a pharmacist resulted in a statistically and clinically significant reduction in A1c within 90 days post-discharge in patients with poorly controlled diabetes. High provider acceptance and strong patient engagement support the model’s feasibility. These findings highlight pharmacist-led care as a scalable solution to close transitional care gaps, optimize therapy, and improve outcomes. Future direction includes exploring delegation protocols to further expand pharmacist impact.

Sponsorship:: Scriptology/White Plains Hospital