Document Type

Capstone Experience

Graduation Date

12-2023

Degree Name

Master of Public Health

Department

Epidemiology

First Committee Member

Nicole Kolm-Valdivia

Second Committee Member

Edward Peters

Third Committee Member

Kaitlyn Crosby

Abstract

Patients with uncontrolled diabetes, defined as a hemoglobin A1c value greater than 9%, are at an increased risk of diabetes progression. Primary care is often the first point of contact where patients with uncontrolled diabetes are identified and treated. Pharmacists are utilized in diabetes medication management of patients with uncontrolled diabetes as one component of primary care multidisciplinary models of care. This descriptive project describes the geospatial distribution of patients with uncontrolled diabetes from a single institution in the Omaha, Nebraska area who were exposed to pharmacists within a Patient Centered Medical Home (PCMH) model of care compared to those who were not. The data source included an automated electronic health record query of patients with hemoglobin A1c laboratory values greater than 9% between 2017 and 2021. The primary findings of this project were mapped using ArcGIS by zip code to show the proportion of patients with pharmacist involvement over the total number of identified patients with uncontrolled diabetes. Descriptive statistics to describe the patient characteristics is also presented as well as a log-binominal model predicting the outcome of the exposure to a PCMH pharmacist. Patient exposed to a PCMH pharmacist were statistically younger on index date (mean age 55.4 vs 57.1, p-value <0.001), had a higher proportion of female sex (54.0% vs 48.3%, p-value <0.001), had a higher proportion of Black or African American race (30.2% vs 19.1%, p-value <0.001), and had a lower proportion of no diabetes medications in the baseline period (11.1% vs 14.0%, p-value 0.008). The crude proportion of patients with uncontrolled diabetes who saw a pharmacist was 26.1% from the single institution in Omaha, Nebraska. North, northeast, and southeast Omaha had relatively numerically higher proportions of patients who were exposed to a PCMH pharmacist while areas with numerically lower proportions of patients were distributed around south Omaha and western Omaha.

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