Boosting Revenue
Sonya Collins
Pharmacists at UNC Eshelman School of Pharmacy demonstrated the value and efficacy of a pharmacist-led continuous glucose monitoring (CGM) clinic in a March 23, 2024, JAPhA article. The program, run at a local primary care practice under a CPA with the physician, helped lower patients’ A1C, generated revenue for the pharmacy, and resulted in patient satisfaction.
“This is another example of how pharmacy services can be leveraged to ease the primary care workload, while adding value and extra care,” said lead author Lindsey Miller, PharmD, a clinical assistant professor at the University of Mississippi School of Pharmacy.
“We’ve also demonstrated how community pharmacy residents can be utilized to expand the services that pharmacies offer, while allowing them to explore additional clinical areas.”
As a PGY-1 resident, Miller ran the CGM clinic described in the JAPhA paper through a partnership between UNC’s community pharmacy residency at Moose Pharmacy in Concord, NC, and Family Care Associates in Troy, NC.
Pharmacist-run CGM clinic in a primary care practice
Moose Pharmacy, an independent community pharmacy, established a CPA agreement with Family Care Associates to allow PGY-1 residents to provide care under the general supervision of the pharmacist. Adult patients with T2D, an A1C over 7%, and insurance coverage for CGM were offered the clinical service. The program included 3 months of appointments with the pharmacist for CGM application, interpretation of readings, diabetes education, and lifestyle counseling.
In-person appointments took place at the primary care clinic during the 1 day per week that the community pharmacy resident dedicated to chronic care management. Some follow-up took place by phone while the resident was at the pharmacy.
When the program began, 7 of 18 patients had an A1C over 10%. After 3 months, patients had lowered their A1C by a mean 1.2%. Only 2 of the 12 patients, whose final A1C Miller captured, were over 10%.
The program generated $3,671.40 for the clinic. Most patients who completed the survey were satisfied with the service and were willing to continue using the device, as well as receive counseling and education from a pharmacist.
Provider collaboration
Pharmacists’ scope of practice and provider status vary from one state to another. In North Carolina, it was the relationship with physician and study co-author John Goodyear, MD, that allowed for a pharmacy resident to provide these clinical services.
The care had to take place in the physician’s office under his general supervision in order for the resident to bill for the services. The type of services, however, could also be provided in a community pharmacy consultation room in states where that would not impact pharmacists’ authority to administer the care and bill for it.
That said, seeing patients in the supervising physician’s clinic facilitated communication, too. “In this program, the pharmacist’s knowledge is critical, but you want the patient connected to their primary care provider,” said Laura Rhodes, PharmD, an assistant professor at UNC Eshelman School of Pharmacy and co-author of the study. “You want charting and the flow of communication to be bidirectional between the providers and the patient. That’s an infrastructure piece to think about—how to keep everyone connected.”
Real-time feedback empowers patients
After patients at Family Care Associates started to see the real-time impact of their food choices on their blood glucose, Miller said they were more motivated to make changes.
For instance, one patient in the program, Miller said, was on multiple doses of insulin each day and consistently got blood glucose readings over 300 when he was referred for CGM. His numbers were lower by his first follow-up visit.
“He was pretty excited because he could tell pretty quickly how each thing he ate impacted his blood sugar,” Miller recalled. “We talk a lot about what to choose and what to avoid, but when patients could actually see as soon as they ate something what it did to their blood sugar, they reported feeling empowered to make better decisions.”
While some patients were lost to follow-up, struggled to use the device correctly, or could not keep the sensor in place, most patients’ experiences, according to Miller, were positive. “CGM made them more aware of the decisions they were making throughout the day.” ■