APhA hails success of 10-city diabetes tour

SAN DIEGO —Clinically trained pharmacists working directly with patients, and in collaboration with other members of those patients’ healthcare teams, can have a significant impact on the rising diabetes epidemic and its enormous financial costs, an ongoing experiment in pharmacist intervention reveals.

That experiment actually is a major disease-management project undertaken by community pharmacists and sponsored by the American Pharmacists Association Foundation and pharmaceutical giant GlaxoSmithKline. Now in its fourth year, the APhA Foundation’s Diabetes Ten City Challenge is an an employer-funded collaborative health management program in which participants are empowered, by community pharmacist “coaches,” to self-manage their diabetes.

The foundation unveiled the initial results of the program at APhA’s 2008 Annual Meeting here March 16. Those results show clear improvement for “patients with diabetes who actively work to improve glycemic control,” including “fewer complications from co-morbidities such as heart disease, stroke and renal disease,” according to the group.

“The interim report on the Diabetes Ten City Challenge shows that the collaborative practice model utilizing community-based pharmacist coaching, application of evidence-based diabetes care guidelines and self-management strategies can play a key role in helping patients to successfully manage chronic disease,” said Toni Fera, director of patient self-management programs for the APhA Foundation. A total of 29 employers are participating in the DTCC through contracts for patient care services in 10 geographic locations: Charleston, S.C.; Chicago; Colorado Springs, Colo.; Cumberland, Md.; Honolulu; Milwaukee; northwest Georgia; Los Angeles and Tampa, Fla.

The interim results reported by Fera and colleagues involved 914 patients with diabetes, each of whom received three or more months of pharmacist care. Improvements in key clinical measures were seen, including glycosylated hemoglobin (A1C) levels. Other improvements included a lowering of LDL cholesterol levels and systolic blood pressure, and a rise in the number of patients who had foot exams and flu shots. Patients enrolled in the program also took better charge of their own health, with self-management goals for nutrition, exercise and weight reduction.

“Participant satisfaction with pharmacist-provided diabetes care improved markedly from baseline to one year,” APhA reported. “Patients rating their overall care as 9 or 10 (excellent) increased from 39 percent to 87 percent, and the final survey results indicated that 97.5 percent of patients were satisfied or very satisfied with the care they received from their pharmacist coach.”

Fera and other APhA leaders said the promising interim results of the 10-city diabetes initiative are in line with the successes demonstrated by a longer-running and better-known patient-care initiative in collaborative care—the Asheville Project in North Carolina, now ongoing for a decade. “DTCC exemplifies how a successful pilot project was used as a launching pad to form a quasi–pharmacy, practice–based research network,” APhA noted in its findings. “The Asheville Project has demonstrated that pharmacist intervention in a broad population resulted in employer savings of between $1,622 and $3,356 per patient annually.

“The long-term clinical and financial benefits demonstrated in the Asheville Project provide convincing evidence to employers and other purchasers of health services that return on investment is likely from programs that include medication therapy management services and other disease management approaches. In similar fashion, Fera and colleagues expect the positive trends observed in their interim DTCC analysis to drive down total direct medical costs over the long term.”

William Ellis, executive director and chief executive officer of the APhA Foundation, pointed out how DTCC and the Asheville Project highlight the role of pharmacists in assisting with drug therapy decisions, providing patient education and monitoring adherence and efficacy.

Employers will be able to evaluate the economic impact of the program for total health care during the next DTCC reporting phase. Fera said in San Diego that those findings will be disseminated by APhA in late 2008 or early 2009.