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

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Describe the Diabetes Care Program at Giant Pharmacy Describe the challenges facing pharmacies and pharmacists in diabetes management and education Describe the ... – PowerPoint PPT presentation

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


1
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

2
Objectives
  1. Provide an overview of the need for pharmacist
    involvement in diabetes management and education.
  2. Describe the Diabetes Care Program at Giant
    Pharmacy
  3. Describe the challenges facing pharmacies and
    pharmacists in diabetes management and education
  4. Describe the role of the pharmacist in DSME
    programs

3
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

4
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

5
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

6
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

7
A Diabetes Care Program in a Food-Drug Chain
Pharmacy
8
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

9
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

10
Patient Care Centers
  • Counseling rooms
  • Located at Two stores Annandale, Virginia and
    Baltimore, Maryland
  • Large Prescription Volume
  • Mixed socioeconomic population

11
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

12
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

13
Diabetes Care Program
  • Obtain patient information
  • Confidentiality/Informed consent
  • Measurement of the Patients
  • knowledge
  • quality of life
  • satisfaction
  • short/long term goals

14
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

15
Educational Sessions
  • Overview of Diabetes
  • Monitoring
  • Complications
  • Medications
  • Foot, Skin, and Dental Care
  • Coping with Diabetes
  • Nutrition and Exercise
  • Conclusion/ Wrap-up

16
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

17
Program Evaluation
  • Throughout, 3, and 6 months after completion of
    program

18
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

19
Challenges
  • Breaking new grounds
  • Slow Process
  • Recognition Process
  • Reimbursement
  • Pharmacist Training
  • Marketing
  • Medicare Provider Number

20
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.

21
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

22
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

23
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

24
ADA Recognition Process
  • Required by Medicare for provider eligibility
  • Recently changed in May 2000
  • New process for application and review
  • New personnel requirements

25
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

26
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)

27
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!
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