Editor's Note: The Pharmacist and Diabetes Care

Mr. Eckel is professor and director of the Office of Practice Development and Education at the School of Pharmacy, University of North Carolina at Chapel Hill.

Over 10 years ago, this editor, working with a small group of dedicated pharmacists, was involved in developing a pharmacistbased diabetes management program. This project became known internationally as the Asheville Project and has become a symbol for a new pharmacy practice model. The original Asheville Project continues today, having expanded to include more diseases, more patients, and more pharmacists. Perhaps the most significant outcome is that the positive results seen initially have been sustained. Improvement in the patients' clinical indicators continues while the cost of care continues to be less than projected cost increases would suggest.

Our group never dreamed of the impact this project would have on pharmacy practice today. Our focus was on helping patients. We did this by working with an employer who was willing to do a little "out of the box" thinking about helping employees do a better job of taking care of themselves.

Rather than practice in isolation, these pharmacists coordinated their activities with other health professionals caring for that patient. They kept the patient's physician informed by faxing to the office a copy of the pharmacist's record of the visit.

The employer used a "carrot and stick" approach to keep employees involved. Copayments were waived for patients in the program. If they decided to get out of the program, they had to start paying the copayments again. This often became the encouragement to keep the patient involved.

Although some disease management programs selectively focus on the most complex patient, the Asheville Project was open to anyone with diabetes. Many of us who were involved believe that the success we have seen is due to the fact that we got patients with diabetes in self-management early in the disease process. That kept many of those patients from developing complications or at least delayed their onset.

These early risk-takers have had a much greater impact than they imagined possible. Isn't that the way things happen, however? When we put the needs of others first, the rewards are often much greater and more sustained. Isn't that why we became pharmacists so that we could give back to our community by serving people?