Pharmacists Improve Outcomes for Underserved Diabetes Patients

Interim results from Project IMPACT: Diabetes, an APhA Foundation program, suggest that pharmacists working as part of a multidisciplinary team helped improve a range of outcomes for diabetes patients.

Pharmacists working in teams with other health care professionals as part of the American Pharmacists Association (APhA) Foundation’s Project IMPACT: Diabetes helped to significantly improve blood sugar control, cholesterol, blood pressure, and body mass index (BMI) in underserved diabetes patients, according to interim clinical results announced on October 24, 2013.

The project was developed in partnership with the Bristol-Myers Squibb Foundation’s Together on Diabetes Initiative. After learning about the success of other APhA Foundation diabetes programs, including the Diabetes Ten City Challenge and the Patient Self-Management Program for Diabetes, the Bristol-Myers Squibb Foundation contacted Benjamin Bluml, RPh, senior vice president for research and innovation at the APhA Foundation, to propose designing similar programs for patients with limited access to care.

“The phone rang, and it was them and they were essentially interested in whether or not we might consider a partnership,” Bluml said in a recent interview with Pharmacy Times. “We were selected as one of the 4 first partners in the Together on Diabetes initiative.”

Since its launch in 2010, the program has connected more than 2000 uninsured, underinsured, and homeless diabetic patients with interdisciplinary teams of health care professionals in 25 communities disproportionately affected by diabetes. Each participating site operates differently, depending on the needs of its patients and the resources available to the community. However, to participate, each location must implement a collaborative care program including pharmacists, regularly submit datasets to the APhA Foundation, and adhere to additional guidelines.

Patients who enroll in the program first take a knowledge assessment designed by the APhA Foundation that helps pharmacists “understand where the patient’s knowledge strengths and weaknesses are and helps them to customize a process of care for the patient that’s specifically tailored for them,” Bluml said. Pharmacists then review medications and medical history and work with patients to set shared goals for the patient to work toward before their next visit. At follow-up appointments, the pharmacists continue to monitor A1C, blood pressure, cholesterol, and BMI, and counsel patients on nutrition, exercise, and other lifestyle changes. Patients typically visit their pharmacist frequently: approximately 6 times during the first year of the program and 4 times per year after that, Bluml said.

The pharmacists also work with physicians, diabetes educators, and other health care professionals to better manage care and provide patients with resources and incentives to improve their health. “When we implement the program, we encourage the team to make sure they are aware of the other resources that are available to them in their local community and use that to the maximum advantage possible,” Bluml said.

Aggregated data from all 25 project sites indicates that the interdisciplinary approach has been successful in improving patient outcomes. A1C, LDL cholesterol, systolic blood pressure, and BMI were all significantly improved from the start of the program through July 31, 2012. “The results clearly demonstrate how pharmacists play an important role in diabetes care, particularly in underserved and highly affected populations, by really empowering patients to understand and manage their diabetes,” Bluml said.

Not only does the interim data show the success of the program, but participant feedback reveals patient, physician, and pharmacist satisfaction with the project as well. “Patients say to us, ‘My pharmacist cares about me,’” Bluml said. “The other thing that patients frequently say is that the pharmacist in their visits usually starts out by listening to the patient and asking them to provide feedback.”

The success of Project IMPACT: Diabetes has inspired the APhA Foundation to consider pursuing similar programs when the current project ends in December 2013, Bluml said. “We’re definitely exploring all kinds of opportunities to try and figure out how we can spread more of this good that’s being done all over the country.”