Motivating patients with diabetes

Shelly Rosser, PharmD, helps coach patients through their diabetes

 

One of the most important things a pharmacist can do for patients with diabetes, believes Shelly Rosser, PharmD, Patient Care Manager with Kroger Pharmacy in Blue Ash, OH, is motivation and behavior modification.

“When people think about a health coaching program, they think you’re doing medication review,” Rosser told Pharmacy Today. “But so much of [the diabetes coaching] program is not necessarily dealing with the medications … so much of it has to do with behavior modification.”

Rosser explained that she and her colleagues work to help patients set smart goals, encourage them when they meet their goals, and ensure that they concentrate on one step at a time. “A lot of patients, if they don’t have a coach, will set goals … that sometimes might be unrealistic. They’re setting themselves up for failure,” she said. “But if they have someone [who] can help coach them along and motivate them—that helps.”

Taking time to help out

Rosser knows what she’s talking about when it comes to patients with diabetes. The Blue Ash Kroger Pharmacy offers two programs for these patients: a Diabetes Self-Management Education (DSME) program accredited by the American Diabetes Association as well as a diabetes coaching program offered through the city of Cincinnati based on the APhA Foundation’s Asheville Project model. The partnership with Cincinnati has been going on for more than 5 years and now boasts more than a thousand patients enrolled.

Kroger’s programs in the Cincinnati area have been well received by patients on annual satisfaction surveys, Rosser told Today. “They really appreciate that we take the time to help them out,” she said.

“A lot of patients say that this is information they know that their doctor would want them to know, but they just don’t have time,” Rosser noted. “That’s just our health care system. But we have the time to go over it.”

Teaching self-sufficiency

The DSME program at Kroger consists of an initial assessment followed by four classes: the pathophysiology of diabetes, basic nutrition, advanced nutrition, and acute and chronic complications. “It’s basically teaching self-management of the disease state, being proactive, preventing complications, and knowing what to do if something happens,” Rosser said.

Joining the DSME program requires a physician referral, and although most insurance companies cover the program, patients usually receive it in hospital settings, Rosser said. She and her Kroger colleagues have been working with physicians in the area to encourage them to take advantage of their DSME program as well. It’s sometimes easier for physicians to refer patients to the hospital because of the way electronic medical record programs are set up, Rosser explained.

“Most often, we recruit patients and then obtain referrals for them,” Rosser said. “We haven’t had a physician say no!”

‘A big difference’

Given the Blue Ash Kroger’s range of diabetes care programs, it was natural for it to participate in the DOTX.MED (Discussions on Taking Medications) Diabetes Pilot Program on pharmacist interventions on patients with diabetes (see sidebar). “It was similar to what we do,” Rosser said, “just in an abbreviated form and specifically dealing with medications.”

One major difference in the DOTX.MED interventions, however, was the insurance status of patients. “The majority of our patient population is insured, and all of the patients in our coaching programs are too,” Rosser explained. “But the majority of the patients in DOTX.MED were uninsured. That gave us the opportunity to provide them with resources to help pay for their medicines … because cost was one of the primary concerns through all of our patients.”

All the interventions performed by Rosser and her colleagues rely on patient interactions—from DSME to patient coaching to DOTX.MED to the APhA Foundation’s Project IMPACT: Diabetes, which recently kicked off (see page 60 for more on this initiative). Even the smallest interactions are worthwhile, Rosser noted, saying, “Little, simple things … that you could do in a short period of time can really make a big difference.”


 

The DOTX.MED study

The Kroger Pharmacy in Blue Ash, OH, is just 1 of 10 sites where the DOTX.MED (Discussions on Taking Medications) study team measured the effectiveness of pharmacist interventions on patients with diabetes. This 6-month study, supported by an educational grant from sanofi-aventis, enrolled more than 200 patients with diabetes at sites all over the country; findings were published in the Journal of the American Pharmacists Association in December.

According to the study’s synopsis, “Structured communication interventions delivered through motivational interviewing techniques resulted in a modest improvement in patient adherence to diabetes medication therapy. Improvements also were noted in pharmacists’ confidence in using motivational interviewing techniques, knowledge of diabetes care, and amount of time spent with patients. Satisfaction results with the program were positive. The DOTX.MED Diabetes Pilot Program leverages the proven role of behavioral interventions in modifying health behaviors and the involvement of a traditionally trusted health partner (the pharmacist) to improve medication adherence and satisfaction measures.”

The full text of this article is available online at www.japha.org. Keep reading Pharmacy Today for more information about this and other practice-based projects.