Pharmacists As Diabetes Educators Can Improve Care in Underserved Communities

NEW ORLEANS — Pharmacists who are certified diabetes educators (CDEs) can play a much greater role in helping patients with diabetes manage their medications and become more successful at self-management, according to two speakers at AADE 2015, the annual meeting of the American Association of Diabetes Educators. 

The two speakers — Geoffrey Twigg, PharmD, BACP, CDE, and John Motsko, RPh, CDE — have developed a program they call “CORE Clinical Care,” which has its own physician medical director and nurse practitioner. In just the past couple of years, this program has become a reference point for diabetes education in one local community. The developers say it is a program that could help underserved communities across the country.

“Certified diabetes educators, who are pharmacists, can add a different perspective to education vs. the traditional registered dietitian or RN program. The pharmacist has the training to offer comprehensive medication management,” Twigg, who is a clinical pharmacist at Apple Discount Drugs in Salisbury, Maryland, said.

“Not only can the pharmacist monitor if a patient is adherent on a given medication regimen, but they can also help the prescribers make sure that patients are on guideline-based therapy that takes into account comorbid conditions.”

Twigg and Motsko, who is also a pharmacist, co-presented a session on the roles that pharmacists can play in diabetes care at AADE 2015.

The average patient coming into their pharmacy is on more than eight medications from multiple prescribers, Twigg and Motsko noted. The pharmacist CDE is uniquely poised to help the patient by offering not only education but also management of both real and perceived adverse drug events, medications costs and drug interactions. Twigg pointed out that most patients are comfortable visiting the pharmacy and many already do it several times a month.

Twigg and Motsko presented an interactive session, highlighting what is happening at their community pharmacy in rural Maryland and how it can be adopted in other communities in an effort to improve diabetes outcomes. They found that the potential of the community pharmacist cannot be overstated.

To set up this program, Apple Discount Drugs and the Apple Diabetes Center formed a new corporation to house their clinical services. The Apple Diabetes Center serves an area that has been traditionally underserved in regards to health care. The area lacks primary care providers and diabetes specialists, and has only two endocrinologists serving the entire three-county area. 

In addition, the incidence of diabetes in the area exceeds 17%, according to Twigg. 

Patients with diabetes in this area who need immediate care for complex diabetes issues have been forced to travel to surrounding metropolitan areas, often at a distance of 120 to 150 miles. This area of Maryland also has many residents over the age of 65 (approximately 24%) and high poverty rates. Motsko said these factors present significant barriers to accessible and affordable health care as well as the management of chronic diseases such as diabetes.

“A pharmacy-based program is extremely user-friendly for patients. While we have formal appointments and classes, the ability to do one-stop shopping for their diabetes needs has resulted in a strong, comfortable patient interactive education system,” Motsko told Endocrinology Advisor. 

“Not having to go to a clinic or hospital for services has improved patient involvement in their care. Pharmacists are one of the most accessible health care professionals and this constant contact encourages confidence and compliance.”

This innovative pharmacy program allows for monitoring of blood pressure, blood glucose, BMI and weight. The results are recorded directly into the pharmacy dispensing software and can be sent to prescribers. The site also offers cholesterol and HbA1c testing.

Twigg said the facility has been providing diabetes services since 2009 and was AADE-accredited in January 2011. The program provides individual assessment, instruction by appointment and multiple monthly group classes (3-hour sessions). The follow-up to goal setting is conducted by phone or by personal visit at 1-, 3- and 6-month intervals based on the goal setting schedule.

Motsko, the coordinator of the diabetes center, said the program helped 77 patients in 2013. Patients experienced a mean reduction in HbA1c levels from 8.39% to 7.37% and a significant drop in mean weight (232.4 lb to 212.07 lb). 

In 2014, 90 patients were treated and the mean HbA1c reduction was similar (8.19% to 7.17%) and weight loss was also significantly improved (216 lb to 196 lb).

Despite these significant improvements, there are still many barriers to setting up similar programs in other communities. Part of the problem is that it has been difficult to get third-party payers to discuss reimbursement for diabetes education provided by pharmacists, and there are also issues related to time and space. Many pharmacies are not conducive to private counseling, Twigg said.

In their community, Motsko said the initial perception of the pharmacist CDE by the medical community was not a positive one. However, CORE has since become a reference point for diabetes education in their local community, and some of the physicians who initially gave the most pushback are now the largest referral sources.

Furthermore, Twigg said some local health care systems have asked CORE Clinical Care to take over their diabetes education services.

Reference

1. Twigg G, Motsko J. S08 – Community Pharmacy: Exploring a New Frontier. Presented at: AADE 2015; Aug. 5-8, 2015; New Orleans.