Collaboration creates an IMPACT

Diabetes care for the underserved at Zufall Health Center and Fink's Pharmacy

The pharmacist–physician relationship is a hot topic in the health care world these days. As concepts like provider status and collaborative practice agreements gain momentum and acceptance, pharmacists have a golden opportunity to prove their worth in patient care. Zufall Health Center in Dover, NJ, and Fink’s Pharmacy in Essex, MD, are using Project IMPACT: Diabetes to do just that.

Collaboration between pharmacists and physicians, as well as other health professionals, is essential to patient care at both of these locations. As the first and only Maryland pharmacy with a collaborative practice agreement, Fink’s is on the cutting edge of practice in its state. Zufall makes the most of a close working relationship between Teresita Lawson, BSPharm, CDE, and Chief Medical Officer Rina Ramirez, MD, FACP, as well as rest of the medical staff.

Challenging patient populations

Both Fink’s Pharmacy and Zufall Health Center reach often underserved patients. Fink’s Pharmacy, located in a suburb of Baltimore, reaches mostly working and retired blue-collar patients, said Christine Lee, PharmD. In addition to economic barriers, few patients in this working-class population have more than a high school education, and their work schedules can present scheduling conflicts.

Christine Lee, PharmD (left) and Kristen Fink, PharmD (right)

Project IMPACT at Fink’s involves approximately 40 patients who take both group and individual classes, Lee told Pharmacy Today. “When patients come into the pharmacy to pick up their medications, they have been asking additional questions not only about their medications, but also about diabetes and other chronic conditions,” she noted. “They have developed self-motivation skills to improve their lives.”

Empowerment is a big part of Project IMPACT at Fink’s. Lee educates patients about what to expect at primary care visits. “I almost know every time a patient of ours goes to the doctor, because within the next couple of days we’ll get a referral,” she said.

As a federally qualified health center, Zufall focuses on safety net care. The center serves more than 15,000 patients, mostly uninsured, who made more than 45,000 visits last year, Ramirez said. More than 70% of patients are Latino, and about half need translation services.

Rina Ramirez, MD, FACP, (left) and Tersita Lawson, BSPharm (right)

Zufall initially enrolled more than 100 patients in IMPACT. Lawson works with these patients individually, reviewing their electronic medical records during each encounter. “I implant the diabetic education by doing chart reviews and lab reviews with the patients so that they understand what the labs are telling them,” she explained.

One challenge at Zufall, given its predominantly Latino patient population, was implementing the Patient Self-Management Credential knowledge assessment test. “I sat down with [patients] and asked them the questions on a one to one basis,” Lawson said. “If I see that the patient feels uncomfortable or is just not able to read the questions, I’ll ask them the questions.”

Ramirez noted that the assessment test helped in two ways. “One is to help the patient learn, understand, and begin the self-management process,” she told Today. “But another very important one is that … whoever is working with that person really understands where that patient is and how to communicate to that patient.”

Collaborations are key

Dialogue with providers as well as patient is key to Zufall’s success, Lawson and Ramirez agreed. “[Lawson] interacts every day with the physicians on the floor, the nurse practitioners, and the care coordinators,” Ramirez said. “Once they understood what [she] can do for the patient and how she can help … now she doesn’t have a space in her schedule.”

Lawson noted that her position allows her to spend more time with difficult patients than physicians may have, leading to “more positive outcomes in difficult patients.” She explained, “I look at my service here as a way of closing the loop for patient care.”

For Kristen Fink, PharmD, Clinical Pharmacy Specialist at Fink’s and daughter of Phil Fink, the pharmacy’s founder and owner, pharmacist–physician cooperation has always been a fact of life. The first physician whom she enlisted in a collaborative practice agreement in 2007 had known her father for more than 30 years. “He gave me his hardest patients whom he had not been able to do anything with,” she told Today. “I started working with them, and we got their blood glucose down, so he started referring more and more. … It was a matter of proving what I can do. Once he saw it, the practice just grew.”

To help promote their services, Fink’s has obtained American Association of Diabetes Educators accreditation and is pursuing Medicare approval for reimbursement. Since Fink’s first collaboration, the pharmacy has signed agreements with four more physicians.

Looking to the future

Fink and Lee see the creation of a “replicable business model for independent community pharmacies” as their objective, Lee said. “Our next goal is to get [reimbursement] figured out,” Fink said. “If it’s sustainable, then other pharmacists will want to pick it up as well.”

Advancing the pharmacist’s standard of practice also keeps Lawson and Ramirez going. Ramirez told Today that Zufall wants to offer more clinical pharmacy services, but the lack of reimbursement remains a barrier. “Even though it does not save us money, since most of our patients are uninsured, it saves the system money,” she explained. “But more importantly, it improves the quality of life of our patients.”

“One of the greatest things that you can get is not in all of the data,” Ramirez said. “It’s what the patients tell us, how grateful they are, how grateful their families are. Even if you just touch one life … it makes your whole day. It makes it all worthwhile.”

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 United States. 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 over the coming months, bringing you stories of innovative and unique diabetes care programs from coast to coast. Read next month’s issue to find out about Project IMPACT at the Mountain States Health Alliance in Tenn essee and Virginia and Oklahoma’s Variety Care.

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