The IMPACT of teamwork

Schools of pharmacy use Project IMPACT: Diabetes to offer team-based care

On the campuses of Ohio State University, the University of Mississippi, and Wingate University this autumn, you’ll hear a lot about teamwork and cooperation. It won’t be just from Buckeyes, Rebels, or Bulldogs coaches on the practice fields, though. Teamwork is a hot topic in these universities’ schools of pharmacy, in part because of the APhA Foundation’s Project IMPACT: Diabetes and the need for student pharmacists and faculty pharmacists to work together with their colleagues in other health professions to improve care for patients with diabetes.

The Project IMPACT programs at all three of these universities have been able to take advantage of multidisciplinary cooperation and collaboration to provide better care for high-risk patients, including underserved patients and patients without health insurance. The faculty responsible for these diabetes care programs—Stuart Beatty, PharmD, BCPS, Assistant Professor of Clinical Pharmacy at Ohio State; Leigh Ann Ross, PharmD, BCPS, Associate Dean for Clinical Affairs and Associate Professor of Pharmacy Practice, Lauren Bloodworth, PharmD, BCPS, and Courtney Davis, PharmD, Clinical Assistant Professors of Pharmacy at Mississippi; and Delilah McCarty, PharmD, Assistant Professor of Pharmacy at Wingate—are helping develop programs for now and the future to improve patient care in their communities.

Ohio State: A model clinic for team-based care

Stuart Beatty, PharmD, BCPS, (right) teaching medical resident Omar Kahaly, MD, (left) and medical assistant Stacy Muck how to use an insulin pen.

Beatty and his colleagues have been running a diabetes clinic at Ohio State’s Martha Morehouse Internal Medicine Clinic since 2008. The clinic “is the primary site for 70 medical residents and anywhere from 10 to 12 attending physicians as well,” Beatty said. “[There’s] over 20,000 patient visits a year at the clinic; it’s a pretty busy place.”

The goal of the diabetes clinic is “to provide assistance and an educational model for the medical residents and provide better, more concentrated care,” Beatty explained. When he heard about Project IMPACT, he knew it would be a good fit. “Since we joined Project IMPACT,” Beatty noted, “we have been able to have better tracking because of the database and make sure that we get people in for follow-up.”

The patient population at the Ohio State clinic covers a wide range of races, ages, and socioeconomic groups. More than half of Beatty’s patients are black and about 40% are white, with various other groups represented as well. There’s about the same number of patients in Medicare, Medicaid, and private insurance, and about 10% have no insurance at all.

Most of the 140 Project IMPACT patients are responding very positively to the program, Beatty told Pharmacy Today. He noted that while the visits are longer than a typical clinic encounter, patients like the personal care and follow-up that they provide. “We do a lot of management in between visits,” Beatty added, including phone calls and e-mail. “We follow up and see how they’re doing with their numbers, their goals, and their diet. … I think that has as much to do with our success as anything.”

Providing a clinic on a college campus offers an important lesson for student pharmacists, Beatty said, in that they have the opportunity to see a practicing diabetes clinic for themselves. Students can see “how closely we work with physicians, how trusting the physicians are of what we want to do,” he noted. “The pharmacists are not just there to look at medicines. We’re coming up with medication plans and dosages and adjustments as much as the physicians are, if not more.”

Mississippi: Empowerment in the Delta

Courtney Davis, PharmD, (left) and 2010–11 community pharmacy resident Catherine Black, PharmD, at Diabetes Care Group.

At the University of Mississippi, Ross first heard about Project IMPACT through the school’s participation in DOTX.MED, an APhA/APhA Foundation joint initiative. “It completely aligned with our project goals,” she explained. The university works extensively with the 18-county Mississippi Delta region, an area with a great deal of medically underserved patients with a significant burden of chronic disease, as well as low literacy and high poverty rates.

Through Project IMPACT, the pharmacists began providing care to patients at Diabetes Care Group, a diabetes specialty clinic in Jackson, MS. “We say we provide diabetes care, but we look at the whole patient,” Ross said. “We’re targeting the high-risk patients with diabetes, but we’re doing more than just diabetes management,” including cholesterol and blood pressure screenings and immunizations.

The university engaged 71 patients in Project IMPACT. Empowering these patients is crucial, noted Davis, the pharmacist on site. “We can’t go home with the patients,” she told Today. “So helping them feel empowered and able to manage their diabetes to a certain extent at home is what ultimately helps patients who do succeed get to their goals.”

Davis described one patient in particular who was an empowerment success story. When he first enrolled in Project IMPACT, his glycosylated hemoglobin (A1C) was more than 9%, and he’d been struggling to control the disease for a while. At his first follow-up visit, he had started working out and making lifestyle changes, but Davis wouldn’t see him for another 3 months. “I was a little worried,” she recalled, “because it had been 3 months since our last visit, and patients who start off real strong, sometimes they fizzle out. I was hoping he wouldn’t.”

Not only had the patient kept up with his medications and lifestyle changes, he had lowered his A1C so much that Davis and her colleagues were able to let him manage his diabetes without any medications, purely with his lifestyle changes. “He really made himself in control of his disease. … It’s rewarding for me to see patients do that,” Davis said. “They’re so proud of themselves, and it’s a big accomplishment.

Wingate: Community partnerships

Delilah McCarty, PharmD

For Project IMPACT, Wingate recruited patients from independent community pharmacies Med Care Pharmacy, Franklin Street Pharmacy, and Faulkner’s Drugs as well as the Matthews Free Medical Clinic and HealthQuest Pharmacy, which cater to underserved patients in the university’s North Carolina community. In all, 80 patients were engaged.

McCarty told Today that the program has been “really helpful” so far. “The patients … comment that no one has told them this aspect about a medication before, or no one’s showed them how to carb count their meals before,” she said. She noted that at a clinic or physician’s office without a clinical pharmacist or a diabetes educator, “a lot of the education just gets lost due to a lack of time.”

One challenge McCarty and her Wingate colleagues faced in Project IMPACT was the cultural obstacle of the Southern diet. “Being from the South … we definitely have a unique way of living and eating down here,” McCarty explained. “People have been brought up with recipes that have been handed down through generations, and [you can] really show patients that you can make these healthier. You can cook them in a different way and still get that same taste from it.” McCarty uses examples from her own life; she shares her mother’s own low-sodium recipes to help patients eat healthier.

One of McCarty’s long-term goals for Project IMPACT at Wingate is to obtain pharmacoeconomic data that she and her colleagues can use to demonstrate the cost effectiveness and practicality of clinical pharmacy programs for patients with diabetes. “I thought there was a big void in pharmacy and clinical pharmacy … there’s a big market for more education to be done,” she explained. “We’re trying to see if it’ll be feasible for [a pharmacy] to hire a clinical ambulatory care pharmacist. … That’s where I really want to focus my efforts in the future, to see if we can make this a sustainable practice of pharmacy.”

The value of teamwork

The Project IMPACT pharmacists at all three of these schools understand the importance of teamwork. For McCarty, it’s a matter of just going down the hall—the physician assistant program at Wingate shares a building with the school of pharmacy. “I’ve been able to utilize the doctors within that setting to come and provide physical exams for the patients,” she explained. “They get an aspect of that multidisciplinary care approach.”

Davis told Today that Mississippi’s program truly relies upon a team-based approach. “It’s important to establish relationships with other people involved on the health care team,” she said. “I think that’s probably the best way to get their buy-in and their help, which is a big asset when you’re trying to recruit patients and set up a program like this.”

At Ohio State, pharmacists working side by side with other health professionals set the stage for the future. As Kelli Barnes, one of Beatty’s pharmacy residents, said, a key aspect of Project IMPACT is giving pharmacists and students “the opportunity to work with other health professionals and show what we can do.”


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 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 what pharmacists at Fink’s Pharmacy in Maryland and Zufall Health Center in New Jersey have done through the program.

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