Phar­ma­cists can help man­age di­a­betes care

Baltimore Sun - - COMMENTARY - By Natalie D. Ed­ding­ton Natalie D. Ed­ding­ton is pro­fes­sor and dean of the Univer­sity of Mary­land School of Phar­macy in Baltimore. She can be reached at ned­dingt@rx.umary­

In spite of the enor­mous amount of money spent on manag­ing di­a­betes, and lost pro­duc­tiv­ity of those who suffer from types of the dis­ease, the rates of peo­ple de­vel­op­ing di­a­betes con­tinue to climb. Di­a­betes of­ten im­pacts those in their prime years, lim­it­ing their health and eco­nomic prospects.

There is an ur­gent need to call on phar­ma­cists to bridge a gap in de­liv­ery of care for those in need of med­i­ca­tions and life­style mod­i­fi­ca­tions to man­age their di­a­betes. As one of the na­tion’s most ac­ces­si­ble health care providers, phar­ma­cists can de­velop and di­rect prac­tice mod­els that en­sure the safe and ef­fec­tive use of med­i­ca­tions. Drug in­ter­ven­tions have demon­strated that at least three classes of oral an­tidi­a­betic med­i­ca­tions are ef­fec­tive in de­lay­ing the on­set of Type 2 di­a­betes and re­duc­ing the in­ci­dence of di­a­betes com­pli­ca­tions. More­over, in­ten­sive blood sugar man­age­ment can de­lay on­set of di­a­betic blindness and on­set of neu­ro­pathic and car­dio­vas­cu­lar com­pli­ca­tions in pa­tients with ei­ther Type1or Type 2 di­a­betes. And the ben­e­fits of early in­ten­sive treat­ment per­sist over time.

A re­cently pub­lished study in the Jour­nal of the Amer­i­can Phar­ma­cists As­so­ci­a­tion by Ma­galy Ro­driguez de Bit­tner and Fa­dia T. Shaya and their team of re­searchers and clin­i­cians at the Univer­sity of Mary­land School of Phar­macy fol­lowed 600 pa­tients with di­a­betes over five years who were en­rolled in an em­ployer-based health pro­gram. Through the pro­gram, pa­tients met reg­u­larly with their phar­ma­cist, who re­viewed their med­i­ca­tions, ex­plained what side ef­fects they might ex­pe­ri­ence, mon­i­tored for med­i­ca­tion in­ter­ac­tions, and ex­plained the im­por­tance of tak­ing each med­i­ca­tion as pre­scribed. Most im­por­tantly, the phar­ma­cist was avail­able to an­swer ques­tions and con­cerns from both the pa­tient and his or her physi­cian, act­ing as a nec­es­sary bridge in the con­ti­nu­ity of care.

Our re­searchers and clin­i­cians found that pa­tients in this pro­gram, be­ing cared for by a phar­ma­cist in be­tween physi­cian’s vis­its, saw a 50 per­cent drop in their blood sugar and sig­nif­i­cant re­duc­tions in lipid and blood pres­sure lev­els. There was also a large cost sav­ings to the pa­tient’s em­ployer, with to­tal an­nual health care costs de­clin­ing by $1,031 per em­ployee, largely due to fewer emer­gency room vis­its and hos­pi­tal­iza­tions.

These re­sults show that it is time for new treat­ment mod­els to be in­tro­duced into pri­mary care and com­mu­nity prac­tice set­tings. Mary­land Med­i­caid is do­ing much to com­bat the grow­ing bur­den of di­a­betes, but I en­cour­age them to con­sider phar­ma­cist-di­rected chronic care man­age­ment mod­els. These cost-ef­fec­tive op­tions would im­prove health out­comes for pa­tients with di­a­betes and achieve the Af­ford­able Care Act’s triple aim of bet­ter care, bet­ter health and lower costs.

To­day, 38 states rec­og­nize phar­ma­cists as health care providers through state statute or in their Med­i­caid Provider Man­ual. If Mary­land Med­i­caid or the Mary­land Gen­eral Assem­bly named phar­ma­cists as providers, phar­ma­cists could be of­fer­ing ser­vices to many more pa­tients.

Just imag­ine the sav­ings to the state, the re­duc­tion in avoid­able hos­pi­tal­iza­tions and read­mis­sions and the public health im­pact. Presently, only one in three adults main­tains ad­e­quate di­a­betes con­trol and med­i­ca­tion ad­her­ence, mean­ing that we as a sys­tem fail to serve more than 60 per­cent of the pa­tient pop­u­la­tion. The sit­u­a­tion is es­pe­cially trou­bling for women, par­tic­u­larly African-Amer­i­can women, who are much more likely to have el­e­vated blood sugar, blood pres­sure and choles­terol lev­els.

While life­style mod­i­fi­ca­tion, diet and ex­er­cise can help re­duce the risk of de­vel­op­ing di­a­betes and can be tools for manag­ing the dis­ease, bet­ter use of med­i­ca­tions can move us closer to­ward achiev­ing bet­ter out­comes for our pa­tients. Phar­ma­cists stand ready to help.

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