'Ten Cities Challenge' diabetes education program publishes positive results

A collaborative effort among the American Pharmacists Assn. Foundation (APhA Foundation; Washington, DC), a couple dozen employer-based health plans, and with financial support from GlaxoSmithKline, called the Diabetes Ten City Challenge (DTCC), was initiated during 2005. The goal was to evaluate the medical and economic benefits of active intervention in patient care, in the form of patient coaching by pharmacists. Final economic and clinical results have just been published in the J. of APhA (May/June; 2009;49:e52-60).

“It’s well known that diabetes is a national public health issue, with one of every five healthcare dollars being spent on it,” says William Ellis, executive director of the APhA Foundation and a coauthor of the study. “DTCC shows that intervention results in improved patient health and lower overall insurance costs, and that the model of using pharmacists as coaches can work on a broad basis.” The study comprised 573 patients, in ten cities nationally, whose employer-based plans agreed to cover the costs of medication co-pays and of interventions, over a two-year period ending in December 2007 (overall data were normalized for one year for each individual patient). Statistically significant improvements were seen in glycosylated hemoglobin, cholesterol and blood pressure—all relevant to diabetes care, along with better vision testing and foot examination patterns. Factoring in the extra costs (of the coaching and other interventions, and of greater medication use), and comparing patient health costs to a projected level based on actual medical claims plus inflation, the study showed an overall savings of $1,079, or 7.4%, per patient, despite medication costs rising 32% over what had been projected. (Measurements of actual pharmaceutical consumption are not part of what APhA reported in the published study.)

“Larger-scale tests like these demonstrate the value of medication in managing chronic disease, which is a message that needs to be heard in Washington as well as in the healthcare system,” says Andy Hartsfield, VP of public policy and advocacy at GSK. He says that the scale-up of the program (which traces back to the Asheville Project of the 1990s) gives it national relevance. GSK is going on to set up a similar program just for the city of New Orleans (which was to have been in the study, but the Katrina hurricane disrupted that). APhA Foundation, meanwhile, is looking to conduct a similar study for depression patients.