Carl Dean Benton, RPh, explains how pharmacists can contribute to improvements in patient care through counseling programs. With the provisions of the Affordable Care Act, many insurers may begin to recognize the benefits of pharmacist-driven counseling initiatives, and integrate these programs to help improve outcomes for patients with type 2 diabetes.
From a community pharmacy perspective, the Affordable Care Act (ACA) will provide pharmacists increased opportunities to deliver patient care in the community practice setting through cost-saving programs. Pharmacists are considered the most easily and readily accessible healthcare professionals (HCPs), and the increasing number of community pharmacies that now offer dedicated consultation areas highlights the positive shift that emphasizes the unique role of pharmacists in the patient care delivery model—one that allows pharmacists to become more deeply involved in coordinated care with other HCPs while reducing overall costs. In addition, not only do these counseling programs allow patients to retrieve information quickly and effectively, they foster relationships between pharmacist and patient, which strengthens the sense of community and ultimately improves the quality of care.
To improve the availability and quality of time spent by pharmacists, patients must schedule appointments to meet with a pharmacist, pharmacies/employers must provide a private counseling area, and pharmacists, in the case of diabetes management, must be certified for counseling in diabetes management. While the incentives for pharmacies and employers to implement these counseling programs include cost savings and improved care quality and delivery, patients with diabetes may be incentivized to seek pharmacist counseling with reductions in copays and overall costs. Research has shown that a reduction in copays resulted in a 58.2% increase in patient adherence to medication therapies. Furthermore, pharmacists can improve patient access to medications by directing patients to affordable, low-cost glucose monitoring equipment and supplies, such as glucose testing machines and test strips.
Diabetes coaching and medication therapy management (MTM) through pharmacist counseling sessions require 30 to 60 minutes per face-to-face visit, and action plans are specifically designed to American Diabetes Association (ADA) and American Association of Diabetes Educators (AADE)-7 standards of care. During the first visit, patient quality of life (QOL) is evaluated, depression surveys are administered, the medical history is collected, and realistic treatment goals are set. The goals must be SMART—specific, measurable, attainable, relevant, and timely. This compilation of information is then entered into the pharmacy data system and travels with the patient between pharmacy locations.
During the second visit, which typically occurs 4 to 6 weeks later, pharmacist diabetes educators measure the weight and blood pressure, conduct a foot exam, review records of blood sugar readings from the glucometer, and assess meter function to ensure proper operation. They also determine if patients are administering medications correctly, evaluate the patient’s nutritional quality, and provide educational handouts that are specific to the patient’s needs. In conjunction, dieticians may also visit the pharmacist to counsel patients with diabetes and to educate them on the importance of maintaining a healthier diet. Subsequent visits to the pharmacist diabetes educators occur at 4 to 6 week intervals and involve a reassessment of treatment goals and a review of SF-36 and depression surveys for any changes or improvements.
A 2012 diabetes coaching pilot study conducted in the Wichita, Kansas, public school district found that the average baseline A1C had dropped from 7.3% to 6.9% by the end of the study, and that markers of blood pressure, cholesterol, and other cardiovascular measures had demonstrated positive changes. Surveys showed that patients were highly satisfied with the diabetes coaching program, with 98% satisfied with the counseling provided by pharmacists, 99% satisfied with the convenience and scheduling flexibility of the program, 87% expressing that they had made progress in improving their condition, and 95% stating that they would recommend the diabetes counseling program to others. However, while satisfaction among patients was high, 65% of patients did also indicate the need for continued support.
As the community’s source of healthcare information, advisors for medication therapy, navigators of insurance coverage and cost-effective treatments, and monitors for patient progress, pharmacists will continue to play an increasingly important role in patient care. With the ongoing healthcare reform implemented by the ACA, payers may begin to truly acknowledge the benefits of pharmacist-driven counseling and monitoring programs, and as an increasing number of pharmacies and employers integrate certification and patient-care programs, there will be a positive and progressive shift in management paradigms and outcomes for diabetes.