Pharmacists can help manage diabetes care

Op-ed: pharmacists can bridge a gap in delivery of care for those with diabetes.

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 continues 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 type 1 or 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.

Natalie D. Eddington is professor and dean of the University of Maryland School of Pharmacy in Baltimore. She can be reached at neddingt@rx.umaryland.edu.

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