Joan Vos MacDonald

Joan Vos MacDonald is a freelance writer living in upstate New York. 

Digital health technology is transforming every aspect of pharmacy practice, whether it deploys robotics to fill prescriptions, uses analytics to track medication data, or offers access to digital therapy. Pharmacists in both the hospital and retail settings are using recently developed technology to prevent adverse drug effects, monitor the use of antibiotics, modify unhealthy behavior, and promote medication adherence.

Not only can technology make a pharmacist’s day more efficient by automating repetitive tasks, but new digital health products are providing more insight into data and the opportunity for real-time patient interaction.

One type of digital health technology that helps pharmacists monitor adherence is an at-home medication dispenser that lets them know, in real time, whether the patient is actually taking the medication.

Developed by Catalyst Healthcare and a feature of the Pack4U connected care system, spencer is a dispenser and monitor that not only reminds patients when it’s time to take medication but offers them a way to communicate concerns remotely with a pharmacist, who can then troubleshoot any required solutions. The integrated system offers several advantages in treating high-risk patients, who are often on multiple medications.

“The pharmacy in our model is usually responsible for delivering a specially packaged cartridge to the patient, and then at the patient level, we have the device that sits on the patient’s countertop, called spencer,” said Shane Bishop, founder and CEO of Catalyst Healthcare and Pack4U. “The patient can slip the cartridge into the device. We check and make sure the right patient gets the right cartridge for the right device, and then the pharmacy is connected in real time with the device on the countertop.”

When the patient takes out the medication, a question may pop up on the screen, such as “How are you?” Or the question can be customized to the particular medication or condition.

Prescriptions are packed centrally, then shipped back to pharmacies. Each step of the process is tracked, including who sent the order, where the order is, who received it, and even expiry dates. Spencer also notes adherence problems, while collecting data on medication use, that can prove valuable to research.

“You get the responses back in real time,”said Bishop.“So now you can turn that data into being proactive for that patient and even triage that information for clinicians and physicians, as well as making pharmacy very relevant in the care of the patient, because pharmacists can get access to data faster than anyone else involved in care.”

Telehealth solutions have been invaluable during the quarantine prompted by the coronavirus disease 2019 (COVID-19) epidemic, providing a link to housebound patients who require ongoing care for chronic conditions.

“Our adherence rates run at 98%, and that’s actual medication in the patient’s hand at the time they are supposed to take it,” said Bishop. “It keeps the patient safe at home and lowers the total cost of care.”

Although the system primarily works with retail pharmacies, hospitals can discharge patients with the device so a pharmacist network can remotely monitor the patient. One advantage to this technology, according to Bishop, is that pharmacists have more time to focus on patients.

“I believe there is a lot of capacity in pharmacy to do much more than they’ve been tasked with,” he said.

When it comes to behavior modification therapy, there’s now an app for that-an app that requires a prescription.

Technology-based therapy, known as digiceuticals, uses FDA-approved apps on smartphones, tablets, and other mobile devices to gather data and provide patients with real-time guidance.

Digiceuticals can be used as monotherapy or in addition to medication. Pear Therapeutics created reSET, which can be used as an adjunct to a contingency management system, to treat some forms of substance abuse. The company’s reSET-O targets opioid addiction as part of a treatment plan that also includes medication. Somryst, the company’s newest product, provides cognitive behavioral therapy for chronic insomnia.

“As these products become more and more sophisticated in relation to [their] use in conjunction with other medications, the role of the pharmacist is going to be how to use them in terms of the patient’s overall medication,” said Yuri Maricich, MD, MBA, chief medical officer and head of development at Pear Therapeutics.

A code is required to access these apps. Before dispensing the code, pharmacists need to review the patient’s profile. “With all of these [apps], the way they are dispensed is [by] the prescription [being] sent to a specialty pharmacy where a pharmacist reviews the information,” said Maricich. “A pharmacist reviews every script. If everything looks copacetic, they actually dispense and fill, providing patients with a prescription access code. The patient then goes to Google Play or the Apple apps store. They download the software, input their prescription access code from the pharmacy, and get access to that treatment for the prescription duration. If the patient wants a renewal or a refill, that can be done."

According to Maricich, the difference between digiceuticals and biologic medicine will eventually fade away until it will all simply be described as medicine. “This is something that can be prescribed through a telemedicine visit and filled and used MBA without ever having to physically go to a clinic,” said Maricich. “In an era where we’re moving into virtual care, it will fit more and more into models outside traditional brick-and-mortar care delivery.”

According to the CDC, between 2013 and 2016, almost half of all Americans took at least 1 prescription drug in the prior 30 days, 24% took 3 or more, and 12.6% took 5 or more, raising the risk for adverse effects (AEs). To assess risks in patients taking multiple medications, The Tabula Rasa HealthCare (TRHC) MedWise Risk Score (MRS) employs technology that identifies and aggregates markers of AEs.

“These risk factors are considered in an algorithmic approach, designed using millions of patients’ data, which creates the MedWise Risk Score,” said Robert L. Alesiani, PharmD, chief pharmacotherapy officer at TRHC. “Each patient has a dynamic risk score that changes with modification in medication therapy. We can pinpoint and act upon medication risks identified using the risk score. We also can predicate the impact of MRS, including changes in total medical spend. The MedWise system is built by pharmacists for pharmacists, incorporating the array of science we learned in pharmacy school-pharmacodynamics, pharmacokinetics, pharmacogenomics, pharmacology, and chronopharmacology.”

Rather than depend on a series of 1-to-1 drug interactions for each patient’s drug profile, the system performs a simultaneous aggregate drug interaction check that can help identify high-risk and unsafe medication regimens, overprescribing, inappropriate prescribing, overutilization, improper or suboptimal administration schedules, and drug-gene and drug-drug- gene interactions. By reducing the AE risk, the analysis also lowers the medical costs associated with treating potential health problems.

“Without a complete medication reconciliation, profile omissions represent interactions missed, increased risks of oversedation, symptoms of delirium [and] confusion, impaired gait leading to falls with injury, irregular heart rates, and, at worst, sudden death,” said Alesiani. “When a patient is taking an enzyme-inhibiting medication, it can affect so many other medications on the profile. If we don’t know about that drug, our recommendations could be useless.”

Technology can help pharmacists stay up-to-date on interactions. “When patients are on 2, 3, or more medications that are metabolized through the same drug-metabolizing enzyme, these drugs compete for the metabolism,” said Alesiani. “Pharmacists learned all about this in school, but there’s no way to memorize metabolic pathways for every drug on the market and then efficiently apply that knowledge in daily pharmacy practice.”

According to the CDC’s 2019 AR Threats Report, antibiotic-resistant bacteria and fungi cause more than 2.8 million infections and 35,000 deaths in the United States each year. To track and better steward antibiotic use, Becton, Dickinson and Company (BD) integrated new analytics into the company’s connected medication management platform. These analytics provide near real-time alerts when an inappropriate and potentially ineffective antibiotic has been prescribed.

“You have all these players–physicians, pharmacists, and nurses–trying to make sure that the right medication gets to the right patient at the right time at the right dose,” said Clint Pridgen, platform leader, MedMined Surveillance Services at BD. “It seems like that would be a pretty simple process, but every player has a different piece of information and because everyone is moving so fast, that information doesn’t always translate from person to person to person.”

Members of a health care team can receive alerts on lab results and changes in a patient’s condition, which may prompt a timely reassessment of the medication regimen. The results from the latest lab tests might, for example, suggest that a drug that was appropriate from an antimicrobial stewardship perspective when it was prescribed may no longer be the best medication.

Health systems have more data than ever before. Although useful, data can take time to process. A pharmacist who is responsible for 30 to 40 patients each day may receive a constant influx of information, which needs to be organized and prioritized. The COVID-19 pandemic clearly illustrates the need for the efficient collection and organization of data.

“Blending in technology that closes in the gaps in visibility enables you to identify patients that are infected or identify resistant organisms or to identify trends that allow health systems to get in front of pandemics and epidemics as quickly as possible,” said Pridgen.

Digital health care technology makes it easier to derive insight from an over-abundance of information.

“Technology is going to continue to be a driver,” said Pridgen. “But the key is that it’s got to provide actual intelligence. One of the real challenges is visibility because there is so much information, but it’s so hard to pull all those pieces together in an effective mechanism. What you’re going to find with technology solutions is a desire for a mechanism to close the gaps and connect the dots.”

Pharmacy practice will continue to evolve along with the latest technology, which may help pharmacists spend more time interacting with patients.

“I think that pharmacists have al- ways wanted to participate more clinically and drive patient outcomes,” said Pridgen. “I think the technology that’s available now allows for pharmacies to do that.”

Articles

New digital health products are providing more insight into data and the opportunity for real-time patient interaction.

Technology Innovations Transforming Pharmacy Practice

Pharmacist-led home infusion centers are making it easier for patients to access long-term therapy without enduring protracted hospital stays. Not only does it enable patients to more quickly resume their normal activities, but home infusion can be more cost effective than a long hospital stay and reduce the risk of hospital-acquired infections.

“The push is to get patients home and not be in the hospital so someone has to provide a service for them when they are home,” said Ryan McFerrin, PharmD and co-owner of Druid City Vital Care, Northport, Alabama. “What happens on the other days that you used to be in the hospital? Keeping people out of the hospital is our main goal. We want you to get therapy, but if you ask me, I’d rather get therapy at home on my couch than in a hospital bed.”

The National Home Infusion Association (NHIA) estimates that there are currently 1500 US pharmacies offering infusion therapies. “The industry has experienced rapid growth in the last decade,” said Connie Sullivan, RPh, NHIA president and chief executive officer. “We think that the growth is going to continue.”

According to the Department of Health and Human Services, home infusion is one of the fastest growing sectors of home health care. One reason for projecting growth is that the numberof patients estimated to need such therapy is expected to increase. The American Hospital Association estimates that approximately 133 million Americans currently have at least 1 chronic illness. That figure is forecasted to reach 170 million by 2030, with many of those patients requiring medication that needs to be infused or injected, including the growing number of biologics.

Unlike retail or independent pharmacies, infusion centers are basically closed-door pharmacies that not only compound prescriptions for patients but can administer therapy-via needle or catheter-and monitor a patient’s treatment.

“We don’t have customers walking in to fill a prescription,” said Sullivan. “An infusion center operates essentially in collaboration with home health care agencies and companies, such as durable medical equipment companies, to provide acute and chronic clinical oversight and sterile products to patients who need extended infusion therapy. They’re facilities that offer sterile compounding services, primarily to make IV solutions, and provide the clinical oversight of these patients, which can be quite acute.”

Infusion centers provide ongoing therapy for conditions such as congestive heart failure, cancer, multiple sclerosis, rheumatoid arthritis, inflammatory bowel disease, psoriasis, and pain treatment, as well as nutrition and hydration problems.

“Anti-infectivesarethemostcommon therapies for home infusion, such as van-comycin, cefazolin, ceftriaxone, ertape- nem, [and] micafungin,” said Binh Ngo, PharmD, pharmacy manager at University of California San Diego Pharmacy Infusion Services. “Other therapies that are often provided in the home are total parenteral nutrition, inotrope for CHF, chemotherapy, hydration, and factor replacement for hemophilia.”

Although very few retail pharmacies currently offer infusion therapy, Sullivan said it’s possible for a retail pharmacy to expand and diversify into home infusion if they understand the care model and the facility requirements for the sterile compounding component.

“We are creating a hospital level environment in a home setting for those patients [who] want to or need to continue their IV treatments after they are dis- charged from the hospital,” said Sullivan.

A home infusion center setup requires an office area for staff and patient care management, as well as sufficient space for equipment and inventory. Some centers have an on-site, ambulatory infusion suite for specialty infusion therapy. An essential requirement of any home infusion center is a sterile compounding facility.

“A sterile compounding facility that is compliant with USP 797 and 800 is a must for home infusion services,” said Ngo. “There must be training and competencies on aseptic technique, process validation for the pharmacists and technicians, handhygiene, and garbing. Equipment for sterile compounding such as automated compounding devices will be needed for TPN and compounding.”

A home infusion center generally dispenses a 7-to-14 day supply of compounded sterile medication to the patient with laboratory tests typically done at least weekly. Pharmacists need to coordinate the blood draw and track laboratory test results before the next shipment is due, so the results can be reviewed before the drug is shipped out. This can be challenging if a patient does not keep appointments.

“Certain drugs require more clinical oversight, such as those that require PK monitoring, TPN, inotrope, or chemotherapy,” said Ngo.

Environmental monitoring of the sterile room is mandatory, including temperature and humidity monitoring. The room needs to receive clean room certification every 6 months. The frequency of end-product testing may differ from state to state, depending on what the board of pharmacy requires.

Not only should staff be knowledgeable about how to use home infusion equipment, but the office will require a staff member who knows how to bill such services since insurance considerations can differ from those encountered by a retail pharmacy. Infusion pharmacies must comply with licensing and other regulatory requirements imposed by state pharmacy boards, as well as accreditation standards required by third-party payers.

Some pharmacists, such as McFerrin, opt to franchise their home infusion center, because the company provides contracts and deals with billing.

“They provide a lot of clinical support and billing support, but mainly it’s the access,” said McFerrin. “If I don’t have access to insurance contracts or products, it’s very difficult for me to be successful.”

Staffing requirements at infusion centers differ from those of a retail pharmacy. An infusion center requires a team of health care professionals that is likely to include a pharmacist who is well-rounded in managing various disease states and therapies; a care transition nurse; an infusion nurse; and, for patients receiving clinical nutrition, a dietitian.

“The home-infusion practice is a multidisciplinary practice and requires someone [who] is team oriented and enjoys speaking to internal and external customers,”saidNgo.“Thepharmacist would be working with an RN [registered nurse], RD [registered dietician], intake [department representative], billing [department representative], pharmacy technicians, [and] physicians. There is quite a bit of coordination of care that takes place when a patient is on board to be discharged. Once a referral is confirmed for the start of care, the intake specialist will inform the pharmacist. Nursing may be staffed by your own nurses, or it can be outsourced to a home health agency, depending on the insurance and whether there are other needs required, such as PT [physical therapy], OT [occupational therapy], ST [speech therapy], or wound care.”

At a home infusion center, the pharmacist reviews and processes the order, including infusion supplies, then consults with the patient and arranges a delivery time. As part of the consultation, the pharmacist determines how the drug is going to be administered- IV push, elastomeric device, gravity, or mechanical pump-and assesses whether the patient or caregiver is able to learn to self-administer, the type of IV access, and home environment before deciding on the setup.

The nurse or home health agency should be informed when the medica- tion and supplies will be delivered, as well as when the first set of laboratory tests should be done.

“The pharmacist speaks with the patient periodically to assess [adverse] effects of the medication and to make recommendations for changing the therapy, should a patient need the change,” said Sullivan. “If the patient is not responding or developing some sort of adverse effect, that needs to be assessed.”

One important consideration before starting any home infusion center is that it will not be a Monday to Friday workweek.

“It’s a very demanding profession in the sense that when a patient needs a drug, they need a drug, and you need to do what’s required to make sure the patient doesn’t miss a dose, so there’s no interruption in therapy,” said Sullivan.

McFerrin agrees that the schedule can be demanding; however, he enjoys visiting patients at home and getting to know them. Interacting with patients was what he liked most about his previous retail pharmacy job, but offering infusion services provides new challenges and a chance to deliver an essential service to his community.

“You’re basically on call 24/7, 365 days a year. That’s the biggest word of caution I would offer to someone considering this. But at the same time, the biggest reward I get is seeing sick people get better. You see people that have a festering wound and they’re not able to walk around and then 6 weeks later- because you coached them through with IV antibiotics and fielded calls in the middle of the night-they’re back to their normal life and they stayed at home through the entire process.”

1. National Home Infusion Association. www.nhia.org/faqs.cfm. Accessed March 3, 2020.
	2. Department of Health and Human Services, Office of Inspector General. Medicare Home Infusion Therapy. https://oig.hhs.gov/oei/reports/oei-02-92-00420.pdf. Published September 1993. Accessed March 3, 2020.
	3. American Hospital Association. Health for Life. www.aha.org/system/files/content/00-10/071204_H4L_FocusonWellness.pdf. Accessed February 21, 2020.

“You’re basically on call 24/7, 365 days a year. That’s the biggest word of caution I would offer to someone considering this. But at the same time, the biggest reward I get is seeing sick people get better."

Home Infusion Therapy: What Pharmacists Should Know

According to the CDC, approximately 30.3 million people in the United States have diabetes.

 Pharmacies that offer ongoing diabetes care and counseling do more than deliver a valuable service; providing such services makes sound business sense. 

“Patients need help navigating their care and managing the disease,” said Dorinda Martin, PharmD, RPh, FACA, FASAP. “Diabetic patients fill more prescriptions and visit the pharmacy more often than most of our other patients. The more services and products we offer, the more patients we will see. It's the ‘build it and they will come’ story. Offering individualized patient care and not just prescriptions increases patient trust, dedication and loyalty.”

One common way pharmacists help patients with diabetes is by showing them how to properly use prescribed devices. Although basic instruction in the self-monitoring of blood glucose levels is the set-up and demonstration of the device, pharmacists can use the opportunity to present information on glycemic goals. What should glucose levels be during fasting, before meals, after meals, and bedtime? What are the signs/symptoms/treatment of high and low glucose values and how often should I test?

Answering the simplest questions can be a game changer. “Interestingly, ‘How often should I test my blood glucose?’ is repeatedly asked-patients often state they have never been told how often or when to check glucose levels so this is an excellent opportunity for pharmacists,” said Jennifer Smith, PharmD, BCACP, BCADM, CDE. 

“My one question I always ask takes 2 seconds. ‘Where do you inject your insulin?’ You would be amazed at the responses received (ie calf, breast, back, forearm). This becomes the easiest diabetes education moment that will profoundly impact absorption that takes less than 10 seconds to complete. Even the busiest pharmacist can spare 10 seconds.”

Monitoring medication use and adherence may be a more time-consuming task, but it’s something pharmacists are uniquely positioned to do. Pharmacists can recognize when medications are not optimized, if another medication is recommended for comorbid diseases, but not prescribed, and note any adverse or intolerable effects. 

Ideally, counseling on the importance of medication adherence, plus the risks of the newly-diagnosed disease, should begin when a patient first shows up at the pharmacy with a new prescription for diabetes.

“If they don't have time at that moment of POS, then promise to call them the next day and outline what services the pharmacy offers, such as 1-on-1 diabetic counseling,” Martin said. “Create a summary and a template sheet for each pharmacist to create a plan for each of these patients, then place in ticker to ensure a follow-up call to monitor the patient every few months. This follow-up could include taking their weight and blood pressure as well as A1c and checking on their immunization records.”

Whether diabetes care and counseling happens in an independent pharmacy or at a nationwide pharmacy chain, systems that monitor patient adherence are an essential tool. At Walgreens pharmacies, pharmacists use a program with predictive analytics to identify patients most likely to become nonadherent to their maintenance medications, including those with diabetes, then provide personalized recommendations.

“By providing patient specific solutions to help them effectively manage their chronic condition, lifestyle modifications and medication regimen, diabetes patients can be empowered to meet their health goals,” said Alexandra Broadus, PharmD, director, Patient Outcomes Performance for Walgreens. 

Prominently displaying diabetes products and services in the pharmacy is a good way to let customers know what you offer, but pharmacists can also help spread the word in the community “Outside of our stores, it’s important that pharmacists are participating in local community events and organizations to raise awareness of the care and services they can provide,” said Broadus. “Our pharmacists participate in community outreach programs. As part of these, we offer presentations on diabetes care and solutions.”

Walgreens recently launched the “Missing Therapy–Statin Use” program to help identify patients with diabetes who are not currently taking a statin and provide education and physician outreach around the heart health benefits of statins. “The American Diabetes Association (ADA) recommends that diabetes patients over the age of 40 include a statin as part of their drug therapy to lower their risk for heart disease,” Broadus said. “Yet, many patients with diabetes have never been offered a statin.” 

CVS launched its Transform Diabetes Care program in 2017 and expanded it in 2019 to focus on prevention and early identification of diabetes, as well as hypertension, a common comorbidity of diabetes. The program helps pharmacy benefit manager (PBM) members control their diabetes through a combination of personalized support and coaching focused on improving medication adherence and better control of HbA1c. 

“More than 50% of members with uncontrolled diabetes who enrolled in the program have moved to a controlled status and, on average, members have improved HbA1c by 1.2 percentage points,” said Peter Simmons, RPh, vice president of Chronic Care Optimization at CVS. 

Personalized coaching and support for healthy lifestyle behaviors can be delivered at the pharmacy or by phone. Members can also receive diabetes monitoring at MinuteClinic locations at no out-of-pocket cost, including A1C checks.

“In addition, members are offered a connected glucometer, which shares their blood glucose levels with a pharmacist-led team via a health cloud, enabling the team to identify potential issues and intervene with 1-on-1 coaching,” said Simmons.

Patients have the option of not only getting refill reminders by text but can also text their requests for refills.

“Patients commonly convey that they’re frustrated, and that they find their diabetes to be challenging, inconvenient, and difficult to manage,” Simmons said. “Our expanded program is designed to make it easier for a broader range of patients to keep their diabetes under control, prevent complications, and manage related conditions like high blood pressure in a coordinated way.”

As well as counseling patients already diagnosed with diabetes, pharmacists can screen those who may be at risk.

“Per the American Diabetes Association (ADA) Standards of Medical Care in Diabetes, an informal assessment of risk factors for [type 2 diabetes mellitus] or the use of a validated tool should be used in asymptomatic adults,” Smith said. “The ADA Risk Test is readily available on page S21 of the 2020 guideline and is a good tool for pharmacists to review with patients.”

Screenings can provide an opportunity for pharmacists to suggest preventive steps that can reduce an individual’s risk, such as healthy eating habits and exercise. 

“Often, pharmacists feel they need to be a Certified Diabetes Educator (CDE) in order to effectively provide diabetes education to patients, which is inaccurate,” Smith said.

Many health care professionals hold the title of diabetes educator while working toward the hours of hands-on education required before the CDE exam. 

“Ideally, pharmacists should have basic knowledge of counseling tips for available diabetes medications, basic diet information for patients living with diabetes, an understanding of guideline recommendations for glycemic goals and pharmacologic treatment, and the ability to recognize glucose patterns from home monitoring,” Smith said. “These are all covered in the APhA Diabetes Certificate Training Program which offers online modules for learning at a self-set pace and a hands-on live seminar for application of the material covered in the modules.” 

As pharmacy schools offer more diabetes management education, newer graduates may need less additional training, but there are multiple options should training be needed.

“I wanted to be sure my pharmacists were knowledgeable,” said Martin of her Texas-based pharmacy Martin’s Wellness Dripping Springs Pharmacy. “So I sent 4 of us to a certified diabetes education class (20 hours of CE) at a local college of pharmacy. This allowed a confidence level that benefited the pharmacists and our patients."

1. New CDC report: More than 100 million Americans have diabetes or prediabetes [news release]. CDC’s website. 

https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html

Creating a place where patients seek diabetes care and counseling.

How To Turn Into A ‘Diabetes Pharmacy’

The most effective way to manage a patient’s diabetes, according to the American Diabetes Association (ADA), is with a team-based approach-and that team may be most effective if it includes a pharmacist. A 2018 study, published in the Journal of Managed Care and Specialty Pharmacy, found that adding pharmacists to diabetes care teams not only improves patient outcomes, but can help prevent complications and reduce costs.

“Whether it’s a member of the rounding team in the hospital or a member of the patient-centered medical home team in the ambulatory care setting, pharmacists are an integral part of the team that cares for each patient,” Sarah L. Anderson, PharmD, FCCP, BCPS, BCACP, associate professor at the University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, said. “Being present allows pharmacists to voice their recommendations and educate the medical team on the evidence that supports it.”

As part of a team, pharmacists can help guide treatment decisions.

“With the ever-growing armamentarium of diabetes medications, pharmacists play a huge role in helping select medications that maximize efficacy, minimize side effects, benefit other concurrent disease states (eg, kidney or cardiovascular disease), and minimize costs,” Anderson said. “The ADA algorithm for treatment of diabetes is somewhat of a ‘choose your own adventure’ path, and pharmacists are key for helping both patients and providers choose the right medication(s) for the patient’s individual situation.”

Knowing how the health system’s formulary works means pharmacists are in a position to help contain costs while still recommending guideline-based medication therapy.

“Pharmacists have a keen understanding of balancing not only benefit versus risk when recommending a medication, but also whether the medication is cost-effective,” Anderson said.

Pharmacists also play an important role in medication adherence, which is more likely when patients know what the medication is expected to do, how to take it, what adverse effects (AEs) to possibly expect, and whether those AEs may be temporary.

“Health system pharmacists help to encourage medication adherence by discussing each patient’s medications with them so that the patient is educated on why they are prescribed each medication,” Anderson said.

It’s easy for a patient to feel overwhelmed when diagnosed with diabetes, since the diagnosis often requires learning how to administer insulin, monitor insulin levels, and make lifestyle changes. A patient may benefit from access to a health system pharmacist who can answer questions, help set up glucose monitors, and make practical recommendations.

“Pharmacists can also help with recommending and assisting the patient in obtaining a pill box and educating the patient on apps or use of alarms on their phones to assist with medication reminders,” Anderson said.

In a hospital setting, clinical pharmacists help monitor patients’ A1C blood sugar levels and markers for other conditions, such as high cholesterol and high blood pressure. Their help can also make it easier for patients to leave the hospital after treatment.

“Pharmacists in the hospital are also great bridges to pharmacists in the ambulatory and community settings and can assist in ‘warm handoffs’ to ensure seamless transitions, as the patient transitions from the hospital back to the ambulatory setting,” Anderson said.

A recent report by the CDC estimates that more than 100 million US adults are now living with diabetes or prediabetes. Diabetes is the seventh leading cause of death in the United States and places individuals at an increased risk of health complications such as vision loss, heart disease, stroke, and kidney failure, as well as amputation of toes, feet, or legs.

“The pharmacist’s role in diabetes management is more important than ever before given the number of patients with diabetes and the number of options available for treating them,” Anderson said.

As more new diabetes medications come to market, health system pharmacists can aid in the decision-making process to ensure that the medication is necessary and cost-effective.

“Newer doesn’t necessarily always mean better,” Anderson said. “Pharmacists can help with cost containment by stepping in with an alternate recommendation if that which is recommended is expensive yet yields little benefit to the patient.”

1. Benedict AW, Spence MM, Sie JL, et al. Evaluation of a pharmacist-managed diabetes program in a primary care setting within an integrated health care system. 

Journal of Managed Care & Specialty Pharmacy.

https://doi.org/10.18553/jmcp.2018.24.2.114

2. New CDC report: More than 100 million Americans have diabetes or prediabetes [news release]. CDC’s website. 

The pharmacist’s role in diabetes management is more important than ever before, given the number of patients with diabetes and the number of options available for treating them.

Author | Joan Vos MacDonald

Articles

Technology Innovations Transforming Pharmacy Practice

Home Infusion Therapy: What Pharmacists Should Know

How To Turn Into A ‘Diabetes Pharmacy’

Pharmacists Play An Essential Role In A Diabetes Care Team