1. Role of the Pharmacist in Diabetes Care: A Community Pharmacy Experience
Magaly Rodriguez de Bittner, Pharm.D., BCPS, CDE
Associate Professor
University of Maryland School of Pharmacy
and
Program Coordinator, Giant Pharmacy Diabetes Care Outpatient Education Program

2. Objectives
Provide an overview of the need for pharmacist involvement in diabetes management and education.
Describe the Diabetes Care Program at Giant Pharmacy
Describe the challenges facing pharmacies and pharmacists in diabetes management and education
Describe the role of the pharmacist in DSME programs

3. Background
Incidence of Diabetes is increasing at an alarming rate- Epidemic Proportions
18 million Americans
6-8 million have diabetes but have not been diagnosed
Complications of Diabetes
Treatment Complexity
Diabetes education is instrumental in reducing complications and decreasing overall health care costs
Prevention

4. Background
Pharmacists are knowledgeable about the treatment and management of many chronic illnesses
Pharmacists are accessible
Pharmacist managed diabetes programs have increased dramatically over the last five years
Payment for these services have been a challenge

5. Pharmacists’ Role Diabetes Care
Variety of settings
Variety of roles
Direct providers of care
Members of the Interdisciplinary Team
Providers of education (400 CDE RPh/12, 390 CDE’s)
Providers of Pharmaceutical care
Providers of Products
Consultants

6. Diabetes Self-Management Education
What is it?
A structured and comprehensive educational process
Assess instructional needs
Develop educational plan
Use a variety of instructional methods
Teach self-management skills
Evaluate outcomes

7. A Diabetes Care Program in a Food-Drug Chain Pharmacy

8. Background
Joint venture between the University of Maryland School of Pharmacy and Giant Pharmacy
Offers the convenience of the community pharmacy and the expertise of an academic center

9. Setting Giant Food Inc. Food-drug chain store
137 pharmacies in 4 states and D.C.
Employs ~600 pharmacists
Strong interest in health and wellness- Healthy Ideas Program
Excellent reputation and client base

10. Patient Care Centers Counseling rooms
Located at Two stores –Annandale, Virginia and Baltimore, Maryland
Large Prescription Volume
Mixed socioeconomic population

11. Patient Care Centers One-on-one counseling with pharmacist
By Appointment only
Physician participation
To date: out-of-pocket payment
Pharmacist with additional training
Equipment to performed a variety of tests
Patient Education Materials

12. Diabetes Care Program
An ADA Recognized Program: The first chain pharmacy diabetes education program to be recognized in the nation
Provides diabetes education with a personal touch
Comprehensive education tailored to the patients’ needs
Conveniently located in the pharmacy
Work in collaboration with the patient’s doctor and family members
Provides patients with free glucose monitors and monofilaments

13. Diabetes Care Program Obtain patient information
Confidentiality/Informed consent
Measurement of the Patients’
knowledge
quality of life
satisfaction
short/long term goals

14. Diabetes Care Program Teaching Sessions- Four or Eight
Based on ADA standards for diabetes self-management education programs-Life with Diabetes
Pharmaceutical care + Education + Nutrition
Multidisciplinary program/ Dietitian
Advisory Board that oversees the Program

15. Educational Sessions Overview of Diabetes Monitoring Complications
Medications
Foot, Skin, and Dental Care
Coping with Diabetes
Nutrition and Exercise
Conclusion/ Wrap-up

16. Marketing and Recruitment
Marketing of program:
Brochure distributed at store level
All patients receiving prescription for diabetes medication speak with pharmacist
Recruitment:
Free 15 minute consultation
Program overview

17. Program Evaluation
Throughout, 3, and 6 months after completion of program

18. Outcomes Improvement in Clinical Markers
Blood glucose, HbA1c, BP, weight, etc.
Improvement in patient’s quality of life
Improvement in patient’s knowledge of the disease
Patient’s satisfaction with the services
Decrease in overall health care cost, hospitalizations, ER visits and complications of diabetes

19. Challenges Breaking new grounds Slow Process Recognition Process
Reimbursement
Pharmacist Training
Marketing
Medicare Provider Number

20. Patient Testimonials Giant’s Diabetes Program “Where have you been?”
“ I have been to group programs before that were covered by my insurance and they just went too fast and didn’t give me a chance to ask questions.”
“Having my prescription filled at this Giant was the best thing I could have done.”
“No one has ever taken the time to explain my condition to me and I have had diabetes for 11 years.”
Educate consumers (and your pharmacists and other staff ) -- Survey after survey shows one of the key things that consumers want relative to healthcare is information.
A recent Readers Digest Survey (telephone interviews of 1200 adults >18 years old) showed the growth of managed care, aging of the population, increased volume of healthcare advertising and widespread availability of alternative remedies and treatments are dramatically changing consumers needs and interests in healthcare information and their desire to take more control of their health, their interaction with doctors, and pharmacists, and their purchase decisions.
91% of consumers surveyed in the Readers Digest Survey said they are interested in learning more about health and 60% say the need will increase in the next few years. Most want to learn more about health conditions like high blood pressure, stress/anxiety, arthritis and high cholesterol.
The retailer who acts as an information source will give the shopper a reason to make a repeat visit and build loyalty.
Fulfill this need via the pharmacist and your HABA personnel to help build loyal customers.

21. In the Future... Expansion of the Diabetes Care Program to other sites
Giant employees program
Secure Reimbursement from Insurance Companies
Medicare Billing
Expanding to other diseases like Asthma, Cholesterol, Weight Management and Osteoporosis

22. Medicare Balanced Budget Act of 1997
Expanded coverage (effective 7/1/98)
Outpatient diabetes self-management training by “certified” providers
Blood glucose monitors, test strips, and other monitoring supplies
Interim program rules published 2/99
Final program rules 12/29/00
Effective date February 27, 2001

23. Medicare Eligibility (Conditions of Coverage)
Physician’s (practitioner’s) order
Comprehensive educational plan
Content, number, frequency, and duration
Individual training permitted under special circumstances
Reasonable and necessary
Signed by the physician

24. ADA Recognition Process
Required by Medicare for provider eligibility
Recently changed in May 2000
New process for application and review
New personnel requirements

25. Application for ADA Recognition
6th edition will only be accepted online via the ADA’s web site. Form must be filled electronically
There is not a Meeting the Standards manual with this application
Fee: $ includes one site, additional sites $50.00/site
Data period: 6 months, must be submitted with the application to the ADA within 3 months of the end of the data period
Do not need to send documentation, just fill the application. Documents will be review on the site visit
If the program is re-applying it can submit the application two months before the current recognition expires
Score is Pass or Fail
Certificate of recognition good for 3 years
Annual Status Report must be completed and returned to the ADA

26. State / Local Issues State Mandated Coverage
Majority of states mandate coverage for diabetes education and supplies
Eligibility and provider requirements vary significantly
Some states have developed own credentialing process (i.e. NJ, RI)

27. Conclusions
Community-based pharmaceutical care is feasible even in large volume chains
Pharmacists have a significant role in diabetes care
Patients find value in these services
Must find creative ways to secure reimbursement for these services and capture their economic, humanistic and clinical impact in patients outcomes
There is a need to have more pharmacists involved!