BACKGROUND: Sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) are cardio- and kidney-protective, yet their uptake in clinical practice has been suboptimal. The association between pharmacists embedded in primary care clinics and prescribing rates of SGLT2i and GLP-1RA is unknown.
OBJECTIVE: To compare the prescribing rates of SGLT2i and GLP-1 RA among primary care clinics with and without embedded pharmacists.
METHODS: A cross-sectional study using electronic health record data from Bon Secours Mercy Health outpatient clinics across Virginia (2019, 2020, 2021) included patients ≥18 years old with type 2 diabetes and either cardiovascular disease (CVD), including atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF), or chronic kidney disease (CKD), and ≥1 outpatient visit. Adults with type 1 diabetes, CKD stage 4/5, end-stage kidney disease, on dialysis, pregnant, or on hospice or palliative care were excluded. Overall and condition-specific prescribing rates were compared between the eight clinics with embedded pharmacists versus five matched clinics without pharmacists using generalized linear mixed modeling with a random practice-level effect.
RESULTS: The 6,377 included patients had a mean age of 68.6 years, 49.8% were female, 36.8% were Black, and 73.2% were Medicare beneficiaries. The overall raw prescribing rate was higher at clinics with embedded pharmacists (16.2%) versus those without (13.8%), and for patients with ASCVD or CKD, but not HF, though this difference did not reach statistical significance when adjusting only for the pharmacist group (P=0.76) or after adjusting for age, sex, race, and insurance coverage (P=0.49). Factors associated with higher prescribing rates included being older, male, or commercially insured.
CONCLUSION: Prescribing rates for SGLT2i and GLP-1 RA were numerically higher in primary care clinics with embedded pharmacists than those without; however, the difference was not statistically significant.
