Pharmacist Involvement in Management of Challenging Diabetes Patients in a Rural Clinic Group

Objectives:

Diabetes mellitus is a chronic disease which is common, especially in rural United States.  Drug therapies required to treat DM are often complex.  Multidisciplinary team health care has clearly been shown to enhance outcomes in diabetes treatment.  The incidence of diabetes is high in many rural populations where team health care is less available to the patient.  This project demonstrates a model of team health care for diabetes in rural West Virginia which has had a high rate of success. 

Methods:

The pharmacist member of the team contributes to the patient’s care with at least three core elements:  basic diet counseling, glucose monitoring instructions and collaborative medication adjustments.  Communication between pharmacist and physician, as well as other health care personnel, occurs through the electronic health record, by telephone and in person.  The health care organization has multiple clinic locations within a 25 minute radius, each of which refers diabetic patients to the clinical pharmacist located at the central clinic.  Patients are scheduled for consultation visits with the pharmacist with number and frequency of the visits being determined by therapy needs of the patient.  The patient continues meeting with the pharmacist until two primary therapeutic purposes are met:  achievement of HbA1c as low as possible without the occurrence of hypoglycemic events.  

Results:

 Between August 2010 and August 2011, 32 patients completed the program.  Each of these patients improved with an average beginning HbA1c of 10.64% and average ending HbA1c of 7.72%. 

Conclusion:

This clinical pharmacist program for the management of difficult-to-manage diabetics involves not only diabetes education, but also collaborative medication adjustment with a high rate of success with rural patients being referred from affiliated clinics in the area.