Partnerships are the key to success in public health. Partners extend your reach, leverage precious resources, and help you achieve your objectives such as increasing enrollment in diabetes self-management education and support (DSMES) services and the National Diabetes Prevention Program (National DPP) lifestyle change program. This article describes benefits and opportunities to establish diabetes programming and provides examples of state health departments working with pharmacists to improve diabetes prevention and control.

Community Pharmacists

Pharmacists are members of the diabetes healthcare team in many settings, including hospitals, clinics, and extended care facilities. And unlike other providers, pharmacists also practice and are easily accessible in community pharmacies where they have ongoing relationships with the patients they serve. Community pharmacists make connections with patients because they often live in the same neighborhood, may speak the same language, and frequently take care of the patients’ family and friends, especially in rural areas. A few years ago, Pharmacy Times asked pharmacists to describe what they loved about their profession. “As a pharmacist, I am in the perfect position to strengthen the healthcare message by tailoring my recommendations to patients,” said one respondent. Another said, “Community pharmacists are unique among healthcare professionals, as our accessibility naturally allows us … to become problem-solvers, confidants, and friends… Our interactions with patients can truly change and save lives.”

One of pharmacists’ vital contributions is their capacity to support diabetes management education and prevention in the community. Pharmacists are able to provide information about prediabetes and diabetes; screen patients using the paper risk test and recommend a doctor visit for those with a high score; refer patients to DSMES or National DPP, or deliver the program services and benefits.

Challenge of Sustainable Business Models

Sustainable payment models for pharmacist-delivered services are critical to valuable patient care programs being continued long-term and positively impacting patient outcomes. Diabetes Accreditation Standards-Practical Applications (DASPA) is a program designed to expand patient access to DSMES while offering community pharmacists a path to payment for services delivered. DASPA is offered through a joint collaboration of the National Community Pharmacy Association and the American Association of Diabetes Educators (AADE). DASPA is a 1 ½ day training that directs community pharmacists on how to achieve DSMES site accreditation, support patient diabetes self-management, and bill for education and services delivered. “Pharmacists are one of the most trusted and visible health care providers and often the only healthcare provider in many communities; it just makes sense to develop diabetes education programs within pharmacies”, said Leslie Kolb, RN, BSN, MBA, Vice President of Science and Practice of the American Association of Diabetes Educators. To be eligible to bill Medicare, community pharmacies must apply for AADE accreditation or American Diabetes Association recognition. DASPA may consider adding similar training to support National DPP lifestyle change programs. Learn more about DASPA.

Here are a few examples of the ways state health departments work with pharmacists:

Colorado
The Colorado Department of Public Health and Environment uses a systems approach to build capacity.

• Equipped fourth-year pharmacy students with skills to provide chronic disease self-management services, including training in motivational interviewing and health equity and rotations in rural communities providing chronic disease self-management services
• Developed an infrastructure for community pharmacists to use claims data to identify clients who might benefit from pharmacist-led interventions like medication management and disease education
• Shared data on the services they provide to other clinicians and health systems. This data exchange is important to support long-term integration and sustainability of care, particularly for DSMES and the National DPP lifestyle change program

For more information, contact Tara Trujillo or visit the website and look for their Pharmacy Survey, Pharmacy Toolkit and information on the Pharmacy and Medicaid Accountable Care Organization Project.

Missouri
The Missouri Department of Health and Senior Services works with the Missouri Pharmacy Association to expand the availability of DSME programs and to include pharmacists in health center team-based care efforts.

• Partnered with the Missouri Primary Care Association (MPCA) and a diverse group of community health centers representing a mix of urban, suburban, and rural settings to engage patients in self-management of their diabetes or hypertension with pharmacist assistance. MPCA acts as the facilitator for group training, technical assistance, and reporting.
• Supported DASPA training to enable pharmacies to provide and bill for services such as DSME and medication therapy services and to cover the AADE accreditation fee for getting pharmacies up and running as new program sites.
• Supported a consultant and use of an online platform to facilitate movement of pharmacies through the 10 standards of the AADE accreditation process to full DSMES program implementation; this enables programs to meet the requirements established by the Centers for Medicare & Medicaid Services.

For more information, contact Jennifer Hunter.

Wisconsin
The Wisconsin Department of Health and Human Services partners with pharmacists to advance DSMES and the National DPP lifestyle change program as well as initiatives focused on heart disease prevention and community health workers.

• Conducted a continuing education webinar for pharmacists through the Pharmacy Society of Wisconsin (PSW) which focused on the National DPP lifestyle change program. It is archived for pharmacists to access, view, and apply for continuing education credits over the next year.
• Presented at the Wisconsin PSW Annual Meeting about the National DPP and introduced the program, evidence, and information on upcoming coverage and local impact.
• Partnered with a community pharmacy in Milwaukee to train pharmacists to serve as National DPP lifestyle coaches.  The pharmacy is AADE-accredited to offer DSMES and is also providing the Stanford diabetes self-management program (DSMP). 

For more information, contact Pam Geis.