IMPACT across the country

Project IMPACT sites in Ohio, West Virginia use diabetes care tools in divergent settings


Pharmacists provide patient care in a wide range of settings, a range that is reflected in the 25 communities participating in Project IMPACT: Diabetes. Interventions to help patients with diabetes can be a powerful tool at almost any practice site, a fact reflected in the similarities and differences of the experiences of Kroger Pharmacy’s Cincinnati/Dayton (OH) Division and West Virginia Health Right.

When Kroger’s Clinical Pharmacist and Residency Director Stacey Frede, PharmD, CDE, first heard about Project IMPACT, she told Pharmacy Today, “I actually questioned whether or not we would be eligible, because we already had a program in place … very much modeled after the Asheville Project and what the APhA Foundation has done.” She realized, however, that “we were seeing a lot of the well-controlled patients, and not necessarily reaching those uncontrolled patients. I saw that was one of the aims that the Foundation was looking for as well. It was a great fit.”

At West Virginia Health Right, on the other hand, the attractive element of Project IMPACT was the integration of the clinical pharmacist, explained Program Coordinator Keith Settle. “We have a large diabetes population here in West Virginia,” he told Today, “and we had been educating our patients through diabetes management classes. But we have not been able to have the clinical pharmacist meet with them one on one. So when we found out about the program, we were excited to incorporate that in our care.”

Kroger: Reaching a new population

As Frede explained, Kroger’s objective was expanding its successful diabetes care program to reach the patients who needed the care but weren’t getting it. James Kirby, PharmD, BCPS, CDE, Clinical Coordinator and Project IMPACT Community Champion, explained that Kroger contracts with the City of Cincinnati to provide diabetes as well as cardiovascular coaching programs free to city employees.

“What we have found with our City of Cincinnati patients is that we’re only engaging about 20% of the eligible population,” Kirby said. “And our baseline A1C [glycosylated hemoglobin] was not all that bad. … What we needed to do was reach the people who are very uncontrolled, whose complications may be costing a lot of money, who may be utilizing the health care system more than other participants, who might not have a primary care physician, or who aren’t—or may not know how to be—engaged in their health.”

With Project IMPACT, Kroger had the opportunity to “engage in some innovative marketing strategies and engagement strategies” to reach more patients, Kirby explained. Kroger partnered with Tri-Health, which is a large hospital system in Cincinnati that administers the city’s wellness program, to drive referrals through physicians’ offices and employee benefit programs. Kroger and Tri-Health jointly developed marketing materials for area physicians’ offices to encourage city employees to ask the medical assistant about Kroger’s program. Tri-Health is also introducing new functionality within its electronic medical records so that medical assistants can automatically generate referral notes for the patients’ physician.

Another unique marketing initiative undertaken by Kroger is a member referral reward program, which builds on patients’ enthusiasm for the coaching they receive from their pharmacists. Patients who refer their coworkers to the program will be able to receive credits on their Kroger Plus card for groceries when a coworker enrolls in the program. A patient testimonial video is also available on the city’s website and is broadcast on the local cable channel.

The early returns on these initiatives are positive, Kirby said. “We have 149 people engaged, which is greater than our target. And though we’re not officially enrolling them in the study, our numbers continue to grow because these marketing tactics aren’t stopping. We’re trying to bring more patients into the coaching program,” he added.

Health Right: Incorporating clinical pharmacists

The challenge for Health Right certainly wasn’t getting patients in the door; Settle told Today that the clinic sees about 85,000 visits per year and is the largest free clinic in West Virginia.

“We have a big population of uninsured—approximately 400,000 in West Virginia,” Settle explained. “We have people come from 2 hours away to get to our health clinic.” Health Right has a few dozen employees, but most patient care services, from internal medicine to dental and eye care and pharmacy services, are provided by volunteer health professionals.

With so many patients to draw from, it’s no surprise that Health Right has engaged more patients than any other Project IMPACT site; 275 West Virginians are signed up for the study. “We already had this program going, other than the clinical pharmacist one on one,” Settle explained.

“Patients were really happy to find out about [Project IMPACT],” Settle continued, “because they hadn’t really thought of the role of the pharmacist as being key in their care before. They were used to going to the clinic where they would see the [physician] or the nurse practitioner, and they would get their medications in the pharmacy, but they had never connected that the clinical pharmacist could be an asset to help them understand their medications and improve their care.”

Settle noted that getting patients to come into the Health Right clinic for the Project IMPACT sessions was made easier by the clinic’s practice of distributing free diabetes supplies to patients each month. “When they come, they get their education in the class, and then at the end of the class they get their supplies,” Settle noted.

Making progress

Both Health Right and Kroger are pleased with their progress so far, and both sites have already taken steps to leverage the lessons learned from Project IMPACT.

“We’ve had such good response to providers and health educators on [the diabetes knowledge assessment tool] … that we implemented it across the board,” explained Health Right Executive Director and Community Champion Patricia White, MPH, MPA. “Any patient with diabetes who walks through our front door, whether this is their first visit or they’ve been a patient of ours for 10 years, is given the knowledge test [of the Patient Self-Management Credential].”

Health Right staff share the results of the test with the rest of the clinic so that every health professional who interacts with a patient knows “where the patient’s weaknesses are, if they don’t understand their medicine, or they don’t understand the benefit of exercise, or they don’t know how to eat,” White explained. “It helps them focus, when they’re one on one with the patient, on what they need to do.”

Because Kroger pharmacies are located within grocery stores, Project IMPACT has shed a light on the importance of helping patients with diabetes eat healthy. Frede said that Kroger can help offer patients lower cost options for healthy food, “as well as just educating people—because there are a lot of ways to eat health and be cost effective.” Kroger also involves a network of dietitians to counsel patients with diabetes, helping them set up and stick to meal plans.

Spreading clinical pharmacy across the country

Project IMPACT sites are making progress in changing the way pharmacists treat patients with diabetes, from Ohio to West Virginia, and from a California pistachio farm (March Today, page 71) to a federally qualified health center in South Carolina (April Today, page 60).

White plans to speak about the Project IMPACT program at the 2012 National Association of Free Clinics Annual Summit in San Antonio this October. “Having a reliable tool that can assess a patient’s level of understanding of their diabetes is really important,” she said. “It’s the first time that we’ve seen that sort of a tool, and it’s really beneficial.”