Broadening pharmacy’s IMPACT

Project IMPACT: Diabetes at Ball's Food Stores in Kansas City, MO, and Price Chopper Pharmacies in upstate New York

The dozens of pharmacies, clinics, and health centers participating in Project IMPACT: Diabetes have taken unique routes to helping patients with diabetes in their communities. Some have developed completely new programs to reach underserved patients. Other sites, like the two profiled this month, have expanded or rethought previously existing initiatives to allow their pharmacists to care for entirely new patient populations.

At Ball’s Food Stores in Kansas City, MO, Nikki Schwartze, PharmD, Beth Eickman, PharmD, and John Witt, PharmD, expanded the grocery store chain’s employee patient care program to employees of a self-insured local waste management company. In upstate New York, Price Chopper pharmacists Alisha I. Roberts, PharmD, AE-C, and Kimberly Houser, PharmD, expanded their in-store program into the community and to a local nonprofit health center.

Ball’s Food Stores: Expanding an employee program

Employees at Ball’s Food Stores have had access to pharmacist-led patient care and medication therapy management (MTM) for years. The self-insured company, which operates 28 grocery stores in the Kansas City area, modeled its patient care program after the APhA Foundation’s Asheville Project, so expanding this project through Project IMPACT was a natural next step. The Foundation helped connect Ball’s with Deffenbaugh Industries, Inc., a local self-insured company, for this expansion.

Deffenbaugh employees with diabetes were all given the opportunity to enroll in Project IMPACT, Schwartze said. “Many of them hadn’t engaged with a health care provider for their chronic conditions in years,” she noted. “We spent our first 6 months just getting them to reengage in the system.”

While the patient population had been underserved, they were enthusiastic to participate in Project IMPACT—about 90% of eligible Deffenbaugh employees signed up for the program. “90% participation is just staggering to me. It is a testament to how dedicated we all were to making this program work and providing more consistent care to this population,” Schwartze told Pharmacy Today. “They’re so appreciative; they really understand the disease management opportunity we’re offering them.”

Schwartze explained that six to eight patient visits per year was the goal for Deffenbaugh employees. The schedule and format for these visits depends on each patient’s progress on the Patient Self-Management Credential assessments, as well as their glycosylated hemoglobin, blood pressure, and cholesterol levels. “We’re figuring out what their baseline knowledge and skills are … and how to supplement that current knowledge or skill so that … they’re able to go home and more confidently interpret information or apply their skills for self-management,” Schwartze said.

Ensuring that this whole process works efficiently is Witt’s responsibility. “One of the challenges we’ve seen in trying to make this financially responsible is that pharmacists’ time costs money,” he explained. “How do we maximize their time so it’s spent … sitting down face to face with the patient, developing that relationship, getting the patient to understand their disease state and how to care for themselves?”

“When we went into Project IMPACT, we said, this is our foray into the financial feasibility of this model,” Witt told Today. “Like any new business that opens, you know you may not turn a profit for a while—but you’re going into it with that model set up.”

The early returns have been positive enough to secure a renewal of the Deffenbaugh agreement for 2013. “This year, we’re expanding services to include prediabetes management education and offering these services to employees living outside the Kansas City metropolitan area” as well, Witt said. They’re also hoping to expand the project to patients with cardiovascular disease—an “exciting new venture,” Schwartze said.

Price Chopper Supermarket: Two patient populations

Roberts and Houser first heard about Project IMPACT through an article in Today, just in time to call into an APhA Foundation conference call that day. “It was perfect timing,” Roberts recalled.

Price Chopper already has its own program for patients with diabetes—Diabetes AdvantEdge—and looked to Project IMPACT to expand this free medication and education offering. The chain brought Project IMPACT to patients at Whitney M. Young Jr. Health Services, a federally qualified health center (FQHC), and members of the Capital District Physicians’ Health Plan at its own supermarket locations in Albany and Schenectady.

At Whitney Young, Price Chopper has a pharmacy and counseling room located within the health center. The pharmacists schedule patients to come in when they see their primary care physician to maximize efficiency. “We meet with them first, provide information and an updated medication list, and then they see the physician,” Houser explained. “It works really well and it’s very coordinated.”

Since Whitney Young is an FQHC, it targets an underserved patient population. The patients don’t have health insurance, and Houser noted that “their biggest barrier is getting to the appointment itself.” Price Chopper pharmacists have developed an effective working relationship with the Whitney Young physicians, Houser added. “We were able to meet with the team early on, explain the project, and work together to come up with a process that was going to work for us and for the existing health care team.”

For patients enrolled at Price Chopper locations, pharmacists can meet with them when they come to the supermarket for grocery shopping or regular pharmacy visits. The pharmacies have private counseling rooms within the supermarket for patient counseling.

Wherever the patient interventions occur, the process involves pharmacists as well as diabetes educators and registered dietitians. The dietitians engage in a series of three visits—an assessment, an education session, and a food tour in the patient’s local Price Chopper. Dietitians integrate the NuVal Nutritional Scoring System, developed at Yale/Griffin Hospital, with medical nutrition therapy and shopping tours. The system rates foods on a 100-point scale, with higher scores representing more overall nutrition. “NuVal has been a tremendous tool, helping to educate patients about nutrition quality and making healthier choices easier,” Roberts said.

Project IMPACT has been a great learning experience for Price Chopper, Houser told Today. “We have learned so much through the program—we’ve never really worked with a truly underserved population before,” she said. Price Chopper plans to continue its diabetes education program and expand into MTM and further education for underserved patients with diabetes.

“We’ve learned what works and what doesn’t work to make programs better for next year,” Houser said. “The underserved population has very unique challenges, and we’ve had to be really flexible and help meet their barriers to make them successful.”


 

APhA Foundation making an IMPACT

Project IMPACT (Improving America’s Communities Together): Diabetes is a national initiative of the APhA Foundation that aims to improve care for patients with diabetes through community-based interdisciplinary teams that include pharmacists.

This project scales previous Foundation initiatives such as the Asheville Project, Patient Self-Management Program for Diabetes, and the Diabetes Ten City Challenge into 25 communities across the country. As part of the program, the Foundation provides communities with tools, resources, guidance, and support to facilitate their success.

Pharmacy Today will continue to profile these Project IMPACT communities, bringing you stories of innovative and unique diabetes care programs from coast to coast. Next month, in the final installment of our series, we will feature the Mountain States Health Alliance and Wichita Public Schools.

For more information about Project IMPACT: Diabetes, visit the APhA Foundation’s website at www.aphafoundation.org.