A Utah Model for Diabetes Education in the Community

Submission Date: August 2015

Entry Type: Case Study

State/Territory Submitted on the Behalf of: Utah

States/Territories Involved: Utah

Funding Source: CDC

CDC Funding:

Yes

CDC Funding (Specified):

(1305) State Public Health

Domain Addressed:

Community-Clinical Linkages

Public Health Issue:

Diabetes self-management education is proven to help people with diabetes learn how to control their blood sugar and stay well. To ensure its quality, experts created program certifications based on national standards, such as the American Association of Diabetes Educators (AADE) certification.

Diabetes education programs in Utah were closing their doors due to a loss of grant funding or because they weren’t billing enough to sustain the program. Many rural parts of the state had no program sites.

Since people with diabetes regularly need to get prescriptions filled and purchase supplies such as test strips, community pharmacists have many opportunities to interact with them.

To take advantage of this patient interaction, Santaquin Pharmacy’s founder & pharmacist, Jim Webster, BSPharm, CDE, established diabetes self-management education classes and attended a National Community Pharmacists Association, Diabetes Accreditation Standards-Practical Applications (DASPA) meeting to learn more about sustaining an accredited program.

The pharmacy’s program achieved the desirable AADE certification but the completion rate for people starting the classes was a dismal 10% and classes could only be offered during hours when the pharmacy was closed for business.

Project Objectives:

To increase completion rates of DSME among patients with diabetes

Program Action:

The Santaquin Pharmacy & Diabetes Center, as it’s now known, has a growing education program of group classes and individual consultations in both Spanish and English, drawing participants from rural and central Utah, up to 80 miles away. An experienced pharmacist, Andrea Lowry, PharmD, guides the program and she, along with University of Utah pharmacy students, provides the education. Ms. Lowry also reaches out to physicians to describe the patient benefits and encourage physicians to refer their patients and is working toward her CDE credential.

To make the program more responsive to patient needs by addressing the barriers local diabetes education participants had to joining and completing classes, the UDOH completed key informant interviews as part of a quality improvement (QI) project. Patients said they “loved the classes” and were “comfortable in the pharmacy” but the class schedule was not convenient.

In the second phase of the QI project, Santaquin implemented a group class schedule change to address one of the barriers patients had to completing the prescribed course. The schedule changed from weekly 1-hour classes provided over seven weeks to two, 3-hour blocks provided over 2 weeks. They also created a student workbook for use in class and later at home. Classes are now offered on weeknights and Saturday mornings to give patients even more scheduling choice.

A key piece of this work is making the program self-sustaining. Santaquin began billing Medicare but this was difficult to sustain using paper claims since the response rate from the Medicare Administrative Contractor was poor. Now they partner with an electronic data interchange to reconcile payments and submit claims, requiring about 5 hours per week in administrative costs.

Data/Other Information Collected:

The UDOH quality improvement project at Santaquin Pharmacy and Diabetes Center reported on 274 unique participants, of which 146 participated in group classes. The Center logged 909 total education hours, which included both group instruction and individual appointments.

Impact/Accomplishments:

This first pharmacy-run program in Utah makes diabetes self-management education available in a very rural part of the state. The combination of education and community pharmacy supports the ongoing needs of patients who make critical health-related decisions many times a day. A Payson pharmacy site recently became a satellite location for the Santaquin Diabetes Center.

Regular referrals are now coming from a group of physicians, some of whom hadn’t previously referred patients.

As a result of the QI Project, the class completion rate rose dramatically from an initial 10% of people who started the classes to a 95% completion rate when classes were grouped into two, three-hour blocks. Of all those who ever signed up to take a class, at least 75% actually completed all classes.

For all diabetes education patients – both individual consultations as well as group class participants – A1C improved from an average pre-education level of 9.49 to a post-class level of 8.07.

As of August 2015, the pharmacy has 160 patients in active or follow-up status. An additional 420 patients have completed classes and follow-up. All of these people with diabetes would not otherwise have had access to a local DSME program.

A new conference space and media center on site provides a more comfortable and private place to hold classes and patient consultations, replacing the dedicated corner nook in the store where classes were previously held.

Challenges/Lessons Learned:

Meeting certification requirements – need experiential hours and a mentor

Pharmacists don’t use E&M codes like physicians

Getting physicians to refer patients to any form of diabetes education & sustaining their interest in referring patients

Diabetes education is part of the standard of care for payers today but there’s an administrative “boondoggle” because few payers are set up to reimburse out-of-network providers

Next Steps:

Form larger class groups to spread costs over a larger base

Streamline administrative and billing costs

The Utah Department of Health will support other pharmacists in establishing accredited diabetes education programs.Thirty-four pharmacists received financial support to attend the DASPA training and when they complete all AADE requirements they will receive financial support for their first 4 year AADE accreditation.

Program Areas:

Diabetes

State Contact Information:

Utah
Jim Webster
Santaquin Pharmacy and Diabetes Center
801-609-2300
jwebbie89@yahoo.com

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