Role of the Pharmacist in Diabetes Care: A Community Pharmacy Experience

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Role of the Pharmacist in Diabetes Care A
Community Pharmacy Experience

• Magaly Rodriguez de Bittner, Pharm.D., BCPS, CDE
• Associate Professor
• University of Maryland School of Pharmacy
• and
• Program Coordinator, Giant Pharmacy Diabetes Care
  Outpatient Education Program

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Objectives

• Provide an overview of the need for pharmacist
  involvement in diabetes management and education.
• Describe the Diabetes Care Program at Giant
  Pharmacy
• Describe the challenges facing pharmacies and
  pharmacists in diabetes management and education
• Describe the role of the pharmacist in DSME
  programs

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Background

• Incidence of Diabetes is increasing at an
  alarming rate- Epidemic Proportions
• 18 million Americans
• 6-8 million have diabetes but have not been
  diagnosed
• Complications of Diabetes
• Treatment Complexity
• Diabetes education is instrumental in reducing
  complications and decreasing overall health care
  costs
• Prevention

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Background

• Pharmacists are knowledgeable about the treatment
  and management of many chronic illnesses
• Pharmacists are accessible
• Pharmacist managed diabetes programs have
  increased dramatically over the last five years
• Payment for these services have been a challenge

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Pharmacists RoleDiabetes Care

• Variety of settings
• Variety of roles
• Direct providers of care
• Members of the Interdisciplinary Team
• Providers of education (400 CDE RPh/12, 390
  CDEs)
• Providers of Pharmaceutical care
• Providers of Products
• Consultants

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Diabetes Self-Management Education

• What is it?
• A structured and comprehensive educational
  process
• Assess instructional needs
• Develop educational plan
• Use a variety of instructional methods
• Teach self-management skills
• Evaluate outcomes

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A Diabetes Care Program in a Food-Drug Chain
Pharmacy
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Background

• Joint venture between the University of Maryland
  School of Pharmacy and Giant Pharmacy
• Offers the convenience of the community pharmacy
  and the expertise of an academic center

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Setting

• Giant Food Inc.
• Food-drug chain store
• 137 pharmacies in 4 states and D.C.
• Employs 600 pharmacists
• Strong interest in health and wellness- Healthy
  Ideas Program
• Excellent reputation and client base

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Patient Care Centers

• Counseling rooms
• Located at Two stores Annandale, Virginia and
  Baltimore, Maryland
• Large Prescription Volume
• Mixed socioeconomic population

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Patient Care Centers

• One-on-one counseling with pharmacist
• By Appointment only
• Physician participation
• To date out-of-pocket payment
• Pharmacist with additional training
• Equipment to performed a variety of tests
• Patient Education Materials

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Diabetes Care Program

• An ADA Recognized Program The first chain
  pharmacy diabetes education program to be
  recognized in the nation
• Provides diabetes education with a personal touch
• Comprehensive education tailored to the patients
  needs
• Conveniently located in the pharmacy
• Work in collaboration with the patients doctor
  and family members
• Provides patients with free glucose monitors and
  monofilaments

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Diabetes Care Program

• Obtain patient information
• Confidentiality/Informed consent
• Measurement of the Patients
• knowledge
• quality of life
• satisfaction
• short/long term goals

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Diabetes Care Program

• Teaching Sessions- Four or Eight
• Based on ADA standards for diabetes
  self-management education programs-Life with
  Diabetes
• Pharmaceutical care Education Nutrition
• Multidisciplinary program/ Dietitian
• Advisory Board that oversees the Program

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Educational Sessions

• Overview of Diabetes
• Monitoring
• Complications
• Medications
• Foot, Skin, and Dental Care
• Coping with Diabetes
• Nutrition and Exercise
• Conclusion/ Wrap-up

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Marketing and Recruitment

• Marketing of program
• Brochure distributed at store level
• All patients receiving prescription for diabetes
  medication speak with pharmacist
• Recruitment
• Free 15 minute consultation
• Program overview

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Program Evaluation

• Throughout, 3, and 6 months after completion of
  program

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Outcomes

• Improvement in Clinical Markers
• Blood glucose, HbA1c, BP, weight, etc.
• Improvement in patients quality of life
• Improvement in patients knowledge of the disease
• Patients satisfaction with the services
• Decrease in overall health care cost,
  hospitalizations, ER visits and complications of
  diabetes

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Challenges

• Breaking new grounds
• Slow Process
• Recognition Process
• Reimbursement
• Pharmacist Training
• Marketing
• Medicare Provider Number

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Patient Testimonials

• Giants Diabetes Program
• Where have you been?
• I have been to group programs before that were
  covered by my insurance and they just went too
  fast and didnt give me a chance to ask
  questions.
• Having my prescription filled at this Giant was
  the best thing I could have done.
• No one has ever taken the time to explain my
  condition to me and I have had diabetes for 11
  years.

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In the Future...

• Expansion of the Diabetes Care Program to other
  sites
• Giant employees program
• Secure Reimbursement from Insurance Companies
• Medicare Billing
• Expanding to other diseases like Asthma,
  Cholesterol, Weight Management and Osteoporosis

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Medicare

• Balanced Budget Act of 1997
• Expanded coverage (effective 7/1/98)
• Outpatient diabetes self-management training by
  certified providers
• Blood glucose monitors, test strips, and other
  monitoring supplies
• Interim program rules published 2/99
• Final program rules 12/29/00
• Effective date February 27, 2001

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Medicare

• Eligibility (Conditions of Coverage)
• Physicians (practitioners) order
• Comprehensive educational plan
• Content, number, frequency, and duration
• Individual training permitted under special
  circumstances
• Reasonable and necessary
• Signed by the physician

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ADA Recognition Process

• Required by Medicare for provider eligibility
• Recently changed in May 2000
• New process for application and review
• New personnel requirements

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Application for ADA Recognition

• 6th edition will only be accepted online via the
  ADAs web site. Form must be filled
  electronically
• There is not a Meeting the Standards manual with
  this application
• http//www.diabetes.org/recognition/Education/appl
  ication.asp
• Fee 850.00 includes one site, additional sites
  50.00/site
• Data period 6 months, must be submitted with the
  application to the ADA within 3 months of the end
  of the data period
• Do not need to send documentation, just fill the
  application. Documents will be review on the site
  visit
• If the program is re-applying it can submit the
  application two months before the current
  recognition expires
• Score is Pass or Fail
• Certificate of recognition good for 3 years
• Annual Status Report must be completed and
  returned to the ADA

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State / Local Issues

• State Mandated Coverage
• Majority of states mandate coverage for diabetes
  education and supplies
• Eligibility and provider requirements vary
  significantly
• Some states have developed own credentialing
  process (i.e. NJ, RI)

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Conclusions

• Community-based pharmaceutical care is feasible
  even in large volume chains
• Pharmacists have a significant role in diabetes
  care
• Patients find value in these services
• Must find creative ways to secure reimbursement
  for these services and capture their economic,
  humanistic and clinical impact in patients
  outcomes
• There is a need to have more pharmacists
  involved!