SAT-856 - Implementing A Diabetic Pharmacotherapy Program within an Indigent Graduate Medical Education Ambulatory Internal Medicine Clinic

Integrating Pharmacist-Led Diabetes Management Into Resident and Non-Teaching Primary Care Clinics Serving Underserved Populations

Background:
Diabetes disproportionately affects underserved populations due to financial barriers, limited access to care, and low health literacy. Primary care clinics, particularly resident continuity clinics, face challenges in delivering comprehensive diabetes management because of time constraints, workforce limitations, and competing educational demands. Pharmacist-led diabetes programs have demonstrated improvements in glycemic control and medication adherence, but evidence describing implementation in resident training environments remains limited.

Objective:
To describe the implementation and early outcomes of a pharmacist-led diabetes management program integrated into a resident continuity clinic and a non-teaching primary care clinic serving underserved patients.

Methods:
A diabetes pharmacist was integrated through referral-based care in two ambulatory primary care settings under Collaborative Practice Agreements in accordance with state regulations. The non-teaching clinic launched in May 2023, and the resident continuity clinic launched in January 2024. Each site operated two half-days per week. Referral criteria included established primary care patients with an HbA1c of 9 percent or greater. Pharmacists provided medication adjustment, adherence counseling, and diabetes education. Patients remained enrolled until achieving two consecutive HbA1c values at age-appropriate goal.

Results:
The non-teaching clinic received 101 referrals, with 54 patients accepting services, resulting in 467 pharmacist-patient encounters. The resident continuity clinic received 42 referrals, with 25 patients accepting services, resulting in 136 encounters. Among patients with at least two documented HbA1c measurements, mean HbA1c decreased from 11.2 percent to 8.5 percent in the non-teaching clinic and from 11.4 percent to 8.6 percent in the resident continuity clinic.

Conclusions:
Integration of pharmacist-led diabetes management into primary care clinics, including a resident continuity clinic, was feasible and associated with meaningful improvements in glycemic control among high-risk patients. These findings support pharmacist involvement in interdisciplinary diabetes care and suggest this model may be adaptable to graduate medical education settings. Further evaluation is needed to assess sustainability, educational impact, and long-term outcomes.

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