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This is a framework for community pharmacists to start a diabetes education program
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Role of Community Pharmacists in Diabetes Management
Anas Bahnassi PhD CDM CDE
Strengths of community pharmacist
• A pharmacist is one of few medical professionals in the world to whom a patient or anyone else can go for a consultation or advice without an appointment.
• They are knowledgeable about a myriad of aspects concerning patients and their medication.
• It is thus of the utmost importance to take these skills into consideration when it comes to diabetic education.
• Pharmacists have long-term relationships with most of their chronic patients, which sets a good foundation for mutual trust and respect and better patient compliance.
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Pharmacy is a dynamic, information driven, patient-orientated profession
Advisor on the safe and rational use
of meds
Provider of essential
care services
Provider of healthcare education
Provider of pharma-
ceutical care
Provider of cost-
effective therapy
Formulator, distributor,
and compounder
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Diabetes and disease state management
• Disease state management (DSM) approaches focus on intensive management of type 2 diabetes involving regular monitoring, follow-up, and continuity
of care.
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• An escalating epidemic with predictions of worldwide prevalence exceeding three million by 2030.
• Strict control of type 2 diabetes can delay the onset of the complications of this disease is cost-effective, and brings about improvements in overall quality of life.
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Pharmacist’s role in diabetes DSM
Pharmacists are ideally placed to contribute to DSM programs and assist in the detection, education and referral of individuals at risk of diabetes.
• Provide targeted education • Monitor blood pressure, weight
and lipids • Remind patients of the
importance of regular exams • A disease management educator
and tutor
• Support of self blood glucose monitoring (SBGM) • Monitor & promote patient adherence • Identify and resolving drug-related problems
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Study circles
A small group of people interested in the same subject invite lecturers, and had discussions. The aim is to gain knowledge that does not only include facts but change ones existence. Knowledge should be sought by group members in texts as well as from their own experiences. The long-term goal of an SC for diabetes should be to develop a diabetes education program to teach glucose control and help participants cope with their diabetes.
The pharmacy is a good setting since it is a widely distributed service.
Clifford RM et al.Int J Pharm Pract 2002;10:85–9. 11/15/2013 6
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Pharmacist as a SC facilitator
Pharmacists should be trained to promote learning and be able to handle conflict that might arise out of group discussions. For some it can be hard in the beginning to abstain from lecturing and let the group do the work and it is therefore imperative that some knowledge of group dynamics is present.
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Effective disease state management
The key to effective diabetes management is the adoption of a systematic approach of: • Collecting • Interpreting, and • Acting on blood glucose data.
Berringer R. et al. J Am Pharm Assoc 1999;39:791–7. 11/15/2013 8
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Collection
Glucose profiling has consistently been associated with improved glycemic control, whether evaluated as part of an intensive insulin management strategy or as a component of management of patients not treated with insulin.
Intensive insulin therapy guided by SMBG performed at least four times per day was associated with a > 2.0% reduction in HbA1c. Similar findings were observed in patients with type-2 diabetes
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Interpretation • Handwritten logbooks can be incomplete, inaccurate, and
illegible faulty analyses of BG trends • The use of data-management software may help both
patients and health care professionals manage these profiles and achieve glycaemic control.
This may: • help in the management of patients’ diabetes • increase their knowledge of diabetes • increase SMBG frequency • improve overall glycaemic control • increase patients’ satisfaction with their care • be cost effective http://software.ascencia.com
• A free online software provides text and graphic presentations of downloaded data.
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Action • Base on systematic approach of pre- and postmeal targets
• Management plan can be reassessed depending on changing glucose readings
• Recognizing patterns and implement changes is critical.
• Systematic use of glucose profiles improves glycaemic control
• SMBG data be accurately obtained and reviewed.
• Patient education may facilitate adherence to appropriate treatment regimens and improveoutcomes.
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Ideal diabetes care program
• Based on national standards for diabetes self-management education programs-Life with Diabetes
• Pharmaceutical care + Education + Nutrition
• Multidisciplinary program/ Dietitian
• Advisory Board that oversees the Program
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Ideal educational sessions ideas
Overview of Diabetes
Monitoring
Complications
Medications
Foot, Skin, and Dental Care
Coping with Diabetes
Nutrition and Exercise
Conclusion/ Wrap-up
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Session 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
Krass I. et al. Diabet Med 2007;24:677–83. 11/15/2013 14
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Challenges
• Breaking new grounds
• Slow Process
– Recognition Process
– Reimbursement
– Pharmacist Training
– Marketing
Krass I. et al. Diabet Med 2007;24:677–83. 11/15/2013 15
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Sum-up
• Pharmacists could, in fact, play a more active role in quality diabetes care.
• Systematically educated pharmacists could perform group education for diabetes patients, thus easing the burden on the primary health care centers and giving participants the time they need.
• Mutual respect between medical professionals and the pharmacist for each other’s competence could lead to a well functioning system for all parties involved.
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The Community Pharmacist’s Role in Diabetes Management CE program for pharmacists
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Anas Bahnassi PhD CDM CDE
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