Patient Self-Management: Diabetes

Patient Self-Management for Diabetes was designed to scale the model and successes from the Asheville Project to five different employers. The APhA Foundation’s refined structure and process model for collaborative care and provided evidence that the clinical, humanistic and economic outcomes in Asheville could be achieved with multiple employers.

Key Objectives:

1. To assess the outcomes for the first year following the initiation of a multisite community pharmacy care services (PCS) program for patients with diabetes.

2. To implement and evaluate the first year of operation of a collaborative health  management program coordinated by community pharmacists, in conjunction with other health care providers, that will improve adherence with diabetes self-management strategies and keep patients with diabetes healthy and productive on the job, which, in turn, will lower employers’ overall health care costs

3. To develop a patient self-management training and assessment program, successful completion of which will equip patients with the knowledge and skills needed to actively participate in managing their diabetes

4. To encourage employers to provide appropriate financial incentives to (a) patients (employees) to encourage their participation in the program, and (b) providers (pharmacists, physicians, certified diabetes educators, and other health care professionals) to encourage active patient participation and interaction, including treatment, education, and monitoring

The Patient Self-Management Program for Diabetes included 80 pharmacists and 256 patients seen over an 11.4 month period of time in five communities.​​​​​

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Patient Self-Management Program for Diabetes was the first project to implement the APhA's Foundation refined process of care model scaled from the Asheville Project. The methods used in the project included new components that focus on aligned incentives, collaborative care, and a Patient Self-Management Program for Diabetes (PSMP Diabetes) credentialing process. This model has continued to be refined and scaled for use in APhA Foundation's other work on diabetes - Diabetes Ten City Challenge and Project IMPACT: Diabetes.

 

Pharmacists' Patient Care Services

Patients worked with pharmacists through a structured series of visits that focused on knowledge, skills, and performance. As patients reached certain milestones in self-management of their condition, they were recognized with the PSMP Diabetes Credential. The credential is critical in patients' successful management of their diabetes.

 

Interdisciplinary Health Care Teams

Patients were referred to diabetes education centers for additional education when indicated and to their physician for changes in therapy or resolution of medication therapy problems, identified by the pharmacists.

 

Innovative Payers and Sustainability

Pharmacists were reimbursed for patient counseling services according to payment schedules negotiated with the employer by the local pharmacy network at each site

 

Aligned Incentives

Enrolled patients were offered waived copayments for diabetes-related medications and supplies or other incentives determined by the individual employers

Over the initial year of the program, improvements were shown in the clinical indicators of diabetes and standards of care. Total mean health care costs per patient were also reduced at 10.8% lower than projections for the initial year of enrollment. 
 

Clinical Outcomes

mean A1C decreased from 7.9% at initial visit to 7.1%
mean  LDL-C decreased from 113.4 mg/dL to 104.5 mg/dL
mean systolic blood pressured decreased from 136.2 mm Hg to 131.4 mm Hg.
100% of study participants had their A1C and lipid panels tested
94% of patients achieved the HEDIS A1C goal and 78% achieved lipid control of <130 mg/dL
Influenza vaccination rate increased from 52% to 77%, the eye examination rate increased from 46% to 82%, and the foot examination rate increased from 38% to 80%
 

Patient Satisfaction Outcomes

Patient satisfaction with overall diabetes care improved from 57% of responses in the highest range at baseline to 87% at this level after 6 months, and 95.7% of patients reported being very satisfied or satisfied with the diabetes care provided by their pharmacists.  

 

Read the full results in the manuscript.