The impact of a pharmacist-run diabetes self-management program on patient self-management activation and healthy behavior in an underserved patient population

Purpose: The Transtheoretical Model stages of change have been used as outcome measures to predict self-care behavior change in a variety of medical conditions.  The Patient Activation Measure (PAM) is a reliable and valid tool to assess stage of change through patient self-reported knowledge, skill, and confidence for self-management.  Few studies have assessed patient activation in diabetes.  The aims of this study were to investigate the impact of a pharmacist-run diabetes self-management education program on patient activation and healthy behavior towards glycemic control in an underserved patient population.

Methods: The diabetes self-management program included five monthly pharmacist-run sessions, designed to meet the American Association of Diabetes Educators (AADE) standards and AADE7 Self-Care Behaviors framework.   Each session included a didactic lecture and a break-out support group activity.  Follow up support group activities were held at 6 and 12 months.  The primary outcome was the PAM score.  Secondary outcomes included change in HbA1c, change in healthy behavior, and patient satisfaction.  All outcome measures were collected at baseline, 6 and 12 months.  This program was funded by the ACCP Ambulatory Care PRN Seed Grant Program.

Results: A total of 21 patients were enrolled into the program.  Upon enrollment, 46.7% of patients were at the highest level of activation, indicating they have made most of the necessary behavior changes, but may have difficulty maintaining behaviors over time or during times of stress.  Most patients maintained or improved their level of activation at 6 and 12 months.  Patients were highly satisfied with the program, but no significant change in HbA1c or healthy behaviors were observed.

Conclusion: Despite referral of all eligible patients, the program attracted those who were already heading toward self-management.  The pharmacist-run diabetes self-management program was effective at maintaining patient activation, glycemic control, and healthy behaviors in motivated diabetic patients.