The pharmacist’s personal IMPACT
Profiling Project IMPACT programs in Tennessee and Kansas
At all of the diverse Project IMPACT: Diabetes sites, pharmacists are having firsthand experience with the effectiveness of personal contact with patients. By encouraging patients to adhere to their medications, helping them navigate the tricky waters of the health care system, or simply listening to their concerns, pharmacists can make a difference just by their presence.
Since last March, Pharmacy Today has been profiling each of the 25 sites participating in the APhA Foundation’s Project IMPACT: Diabetes (see sidebar). This final installment features the pharmacists of Mountain States Health Alliance (MSHA) in Johnson City, TN, and Dillons Food Stores in Wichita, KS.
Mountain States Health Alliance: Patient care in rural Tennessee
Joy Waddell, PharmD, Pharmacist in Charge at the MSHA Northeast Tennessee Dispensary of Hope, and her team work with patients who “desperately need help,” she said. Her patients have no prescription drug coverage and earn less than 200% of the federal poverty level. Some are homeless or in transitional housing as well.
For Project IMPACT, Waddell and colleagues worked with the local Johnson City Downtown Clinic to enroll patients with glycosylated hemoglobin (A1C) greater than 7%, as well as some patients from private physicians or hospital discharges, for a total of about 120. Waddell explained that her team’s goal was to “lay the groundwork for some basic education” about diabetes, as well as to provide meal planning and target medication adherence.
“When I first came [to MSHA] about 4 years ago, it really surprised me that a lot of our patients had never had a pharmacist actually talk to them about their medications,” Waddell said. “Once we sat down with these patients, we realized that a lot of them, even if they had been to diabetes counseling in the past, they had forgotten a lot of it.”
The MSHA staff works closely with providers at the local clinic, including physicians, nurse practitioners, and specialists. Through Project IMPACT, patients were also able to enlist a local optometrist to provide eye exams. Waddell recalled one patient who, through the eye exam, discovered she had glaucoma and was able to get treatment before the condition became too severe.
The most important part of Project IMPACT, Waddell told Today, may have been simply reviewing the fundamentals of the disease. “Frankly, some of our patients just needed the encouragement and the reinforcement for us to be checking up on them … to know that someone cared enough to ask them about [their medications] at the window, ask them about their programs, and try to fix the issues that they may be having,” she said.
As a nonprofit, MSHA faces constant challenges to funding patient care. Despite that, Waddell said that she hopes to see these diabetes care programs continue. “I definitely see the need for it,” she said, noting that having patients who are enrolled and familiar with a certain program will help encourage them to keep visiting the pharmacy in the future. “They need counseling on every level possible,” Waddell concluded.
Waddell described Project IMPACT as a transformative experience—for herself and for her patients. “Project IMPACT … has truly changed me for the better,” she told Today. “And I think we’ve changed [our patients’] lives. On our scale that’s a success.”
Dillons Food Stores: Educating educators with diabetes
The Kansas supermarket chain Dillons, a division of Kroger, already provided diabetes education and care for its own employees, explained Clinical Care Coordinator C. Dean Benton, BSPharm. Through Project IMPACT, Dillons allied with Wichita Public Schools to bring that program to a new patient population. Benton noted that the school district had around 13,000 employees, about 13% of whom had diabetes—a patient population that definitely needed assistance.
To provide care to the school district employees, Benton and the Dillons team set up 25 sites in the Wichita area with pharmacist coaches for patients to visit. They also worked with the district to offer promotions to employees, including waiving copays on diabetic medications and giving IMPACT participants discounted health care premiums. In all, Dillons brought in about 180 patients to the diabetes coaching program.
These patients had access to face-to-face consultations with Dillons pharmacists, Benton explained. “The majority of them met on a monthly basis for the first 3 to 6 months, depending on the individual and where they were at in their understanding of the disease state,” he said. The pharmacists also collaborated with a dietitian, “typically a little bit later in the program—after we’ve assessed the patient’s understanding of diabetes … [the dietitian] would help with the meal-planning side of things,” Benton told Today.
Benton noted that he and his pharmacist colleagues faced a somewhat unexpected barrier. “Some of the patients really didn’t understand what their benefits structure was when it comes to their personal health care,” he explained. One patient, he said, thought that she had to choose between refilling her medications or paying for gas to drive to work. “But there were opportunities that the employer provided to help … in those particular situations,” Benton said. “We found that just getting [patients] to the right channels was helpful.”
Patients responded very enthusiastically to the program, Benton said. In a survey of the participants, 98% expressed satisfaction with the counseling and 95% said they would recommend the program to others. One respondent wrote, “My coach has motivated me and encouraged me through my diabetic struggles. … I view diabetes through different eyes.”
Benton told Today that he thinks Dillons will continue to provide these diabetes coaching programs, both at Wichita Public Schools and elsewhere. “We’re finding that as patients share with each other, it’s creating interest,” he said. “That’s the best way you can get advertising: word of mouth from a patient who has seen success in the program.”
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.
Over the past year, Pharmacy Today has profiled these Project IMPACT communities, bringing you stories of innovative and unique diabetes care programs from coast to coast. Visit the Today website at www.pharmacytoday.org for access to all the profiles of these diverse practice sites.
For more information about Project IMPACT: Diabetes, visit the APhA Foundation’s website at www.aphafoundation.org.