American Pharmacists Association Foundation

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Project IMPACT (IMproving America’s Communities Together): Diabetes

Locations: Birmingham, Alabama; Tucson, Arizona; Lost Hills, California; Oakwood, California; Santa Barbara, California; Kansas City, Kansas; Wichita, Kansas; Lexington, Kentucky; Essex, Maryland; Jackson, Mississippi; Dover, New Jersey; Schenectady, New York; Wingate, North Carolina; Cincinnati, Ohio; Columbus, Ohio; Oklahoma City, Oklahoma; Columbia, South Carolina; Johnson City, Tennessee; El Paso, Texas; Richmond, Virginia; Charleston, West Virginia

In this extensive project, participating pharmacists in collaboration with clinic staff and diabetes educators at 25 sites, provided patients with diabetes self-management education including medication therapy management, glucose monitoring, personal goal setting, weight management, nutrition and physical activity. More than 2,000 participants representing a cross-section of U.S. ethnic groups and including the uninsured, under-insured, homeless, those living below the poverty line and with higher rates of diabetes received care during the project period. Statistically significant improvements were measured for key indicators of diabetes, most notably for HbA1c.  Healthy behaviors also increased, including quitting smoking and getting eye and foot examinations and flu shots.

Context

This project integrated pharmacists into patient-centered, interdisciplinary care teams to provide diabetes education, medication therapy, and accountability for healthy lifestyle changes. Pharmacists are traditionally more available than primary care providers in rural areas and other areas with health care provider shortages. This high accessibility makes the pharmacist a natural point of care for patients with diabetes.  Twenty-five partner sites, including community and university-affiliated pharmacies, self-insured employers, Federally Qualified Health Centers, and free clinics were selected to integrate pharmacists into local health care teams to implement this project.

Action

Pharmacists were integrated into collaborative care teams across the 25 communities.  A patient-knowledge assessment informed the level of diabetes self-management education and medication therapy management to be provided.  Patients in every setting received clinical and referral services, one-on-one consultations and education to promote self-management, medication therapy management that included pharmacotherapy consults, and assistance with personal health goal setting.  Over 2,000 participants from the 25 partner sites received care during the project period.

Learnings

This project used pharmacists as an essential component of the diabetes care team for patients with Type 2 diabetes.  Key learnings from this project include:

  • Engaging pharmacists as integral members of the healthcare team was useful and effective in increasing access to personalized diabetes care.
  • Average HbA1c levels of participants dropped from 9.0% to 8.2%, a statistically significant decrease.
  • Collecting a minimum dataset in all communities helped standardize the care that was provided and contributed a wealth of information that helped show the efficacy of project implementation.
  • The Patient Self-Management Credential for Diabetes allowed pharmacists and other healthcare providers to customize the care they provided to meet patient-specific needs related to diabetes knowledge, skills, and performance.

Qualitative data collection and video montages for each site helped identify challenges and assets affecting patient populations, detect lessons learned through program implementation, and highlight stories of success.