Collaborative drug therapy management for initiating and adjusting insulin therapy in patients with type 2 diabetes mellitus.

Purpose: Collaborative drug therapy management (CDTM) by pharmacists for initiating and adjusting insulin therapy in patients with type 2 diabetes mellitus in a Veterans Affairs Health Care System (VAHCS) is described.

Summary: During 2003-04, the Veterans Affairs Maryland Health Care System (VAMHCS) at Baltimore reported that 24% of its patients with diabetes had a glycosylated hemoglobin (HbA(1c)) value of >9% or no recently documented HbA(1c) and that 91% of its patients with an HbA(1c) value of >9% were treated with oral antihyperglycemic agents alone. To address this issue, clinical pharmacists at VAMHCS at Baltimore developed the insulin initiation clinic.

Antihypertensive Drug Utilization in Hypertensive Veterans With Complex Medication Profiles.

A pharmacy prescription database was used to identify patients at high risk for drug-related problems. Of the 1054 patients in the study, 687 had a diagnosis of hypertension. The utilization of antihypertensive medications was captured at three periods over 24 months (12 months before enrollment, at enrollment, and 12 months after enrollment).