Clinical Pharmacists in Diabetes Care: Exceptional Outcomes, Tremendous Teamwork

Clinical pharmacists have proven talents when it comes to managing patients who have diabetes. Their most successful interventions target patient self-management, patient education, and case management. For this reason, pharmacists' roles have expanded so that they can help patients set goals, and ensure that patients’ medication regimens are streamlined and appropriate.

Pharmacy practice researchers located in Ontario, Canada, work with a health care system of 95 clinics serving 280,000 patients. This health care system allocates 1 full-time equivalent pharmacist for every 10 to 12 physicians, giving physicians a half day of pharmacist clinical services each week. Pharmacists in the system see more requests for interventions for patients who have diabetes than any other condition. The authors, interested in seeing if including a pharmacist on the clinical team had improved outcomes, have conducted a review of the services.

The review, published in Canadian Journal of Diabetes, covers 10 years of experience within this health system. Their findings are interesting and serve as a model for pharmacists in the United States who wish to expand their services to cover direct care to patients with diabetes.

The authors reported that the process of referring patients to pharmacists was an important paradigm shift when they started this program. They indicated that it differs from pharmacist interventions in community pharmacies (which are unsolicited) in that physicians and other health care providers actually request the pharmacist's opinion. Pharmacists in this health care system also had access to the electronic medical record and thus had considerably more information at their disposal than pharmacists in community settings.

The authors also noted that pharmacists and dietitians often scheduled patients to see both of them on the same day, and sometimes they worked together, counseling the patient jointly.

In this health care system, pharmacists worked with the team and adjusted medications without waiting for the physician to write an order. Since the pharmacists were able to review patients’ medication regimens, they looked at the entire medication regimen and not just medications related to diabetes. This has led to improved outcomes.

After 10 years, it's clear that the level of trust among the health care providers who work in the system is high. Pharmacists have been able to build excellent relationships and share their knowledge and skills.

Reference

Gagnon A, Jin M, Malak M, et al. Pharmacists managing people with diabetes in primary care: 10 years of experience at the Hamilton Family Health Team. Can J Diabetes. 2017 Sep 18. pii: S1499-2671(17)30254-X. doi: 10.1016/j.jcjd.2017.08.240. [Epub ahead of print]