Study Examines Barriers to Diabetes Care in the Pharmacy

Pharmacists are the most accessible health care professionals and have critical roles in managing patients’ chronic diseases. Diabetes is a top 5 chronic disease nationwide, and medication therapy management is vital in the prevention and delay of microvascular and macrovascular complications.

Pharmacists in Ontario, Canada have participated in the MedsCheck Diabetes (MCD) program, which delivers medication review services to patients with diabetes, since 2010.¹ Since its implementation, nearly 50% of patients with diabetes received an initial medication review. Follow-up, on the other hand, declined substantially to only 17.5% of patients receiving assessment.

The journal Research in Social and Administrative Pharmacy published results from a survey completed by community pharmacists in its April 2020 issue. It identified the most substantial barriers to routine monitoring and follow-up for diabetes patients.

Altogether, 7270 Canadian pharmacists were invited to complete a survey using the Theoretical Domains Framework Version 2 (TDF v2), and 346 of those pharmacists completed it.

The TDF found both positive and negative influences affecting delivery of routine monitoring and follow-up for patients with diabetes.

Positively influencing domains consisted of:

• beliefs about consequences for people with diabetes
• pharmacist knowledge
• pharmacist skills
• social influences
• optimism

Negatively influencing domains consisted of:

• lack of reinforcement
• environmental context and resources

Other themes that pharmacists described as potential barriers included time and competing priorities, reimbursement, patient engagement, workflow and human resources, access to labs and clinical information, information technology, and support from the owner/manager.

Pharmacists’ concerns for the patient population with diabetes—along with their skills, knowledge, and belief in their roles for management—were apparent in the responses. Positive mindsets are key to advancing pharmacists’ benefit in monitoring diabetes and providing follow-up of care. Yet, despite these positive influencing factors, several factors remain as barriers and explain the substantial decline in follow-up for this patient population.

From basic education about the scope and role of pharmacy to more complex workplace strategy, changes are needed to optimize the pharmacist role in managing patients with diabetes. Whether it be new reimbursement strategies, expanding certified pharmacy technicians’ tasks, or increased staffing, the changes and patient benefits will not happen overnight. Trial and error will need to occur to optimize diabetic patient short- and long-term health goals.

REFERENCE

MacCallum L, Mathers A, Kellar J, et al. Pharmacists report lack of reinforcement and the work environment as the biggest barriers to routine monitoring and follow-up for people with diabetes: A survey of community pharmacists [published online ahead of print, 2020 Apr 9]. Res Social Adm Pharm. 2020;S1551-7411(19)31114-3. doi:10.1016/j.sapharm.2020.04.004