Pharmacist-led telehealth disease management in patients with diabetes and
Junior Investigator: Lisa B. Cohen
Senior Investigator: Paul A. Pirragilia, M.D.
Rationale: There is a high prevalence of major depression and significant depressive symptoms in
patients with diabetes mellitus (DM). Co-morbid depression in diabetes results in decreased
adherence to diabetes self-care and attenuates the effects of medical interventions. A pharmacistled diabetes case management program at the Providence VA Medical Center has improved
treatment adherence, glycemic control and cardiac risk reduction in patients with concomitant
diabetes and mental illness. However, the frequent clinic visits that are necessary to control
cardiac risk factors are cumbersome for patients and costly to the institution. We have other
preliminary data that show that depressed patients are responsive to a telehealth disease
management program, but whether this strategy could be used by clinical pharmacists to treat
patients with diabetes and depression instead of the standard individual visits has not been tested.
Objective: To determine whether a pharmacist-led telehealth disease management program is
superior to usual care in improving diabetes medication treatment adherence in patients with
concomitant diabetes and depression.
Methods: We propose to conduct a randomized, controlled pilot study of 80 patients with
concomitant diagnosis of diabetes and depression with a hemoglobin A1C > 8%. Forty patients
will be randomly assigned to receive the pharmacist-led telehealth program (experimental arm),
which will include an initial visit to learn about the technology, weekly monitoring of telehealth
data, followed by telephone calls when alerted by the telehealth system for 6 months. Another 40
patients will be allocated to usual care (control arm). The primary outcome will be the change in
diabetes and depression medication...