Project IMPACT: Diabetes
The Daily Planet
The Daily Planet provides comprehensive interdisciplinary diabetes outreach, screening, and diabetes management programs to the homeless and those at-risk of becoming homeless. The interdisciplinary team in the patient-centered medical home includes physicians, pharmacists, nurse practitioners, nurses, medical assistants, dietitians, social workers (case managers), and behavioral health therapists. The physician and pharmacist work collaboratively through the medical exam process, setting treatment goals, reviewing key concepts of diabetes self-management, and providing education and skills training for each patient.
The Daily Planet and Virginia Commonwealth University (VCU) School of Pharmacy are partners in providing patient care through Project IMPACT: Diabetes. The Daily Planet is a nonprofit, 501(c) 3 charitable organization that serves as part of Homeward’s Greater Richmond Homeless Continuum of Care and provides a wide scope of health and human welfare services to the population. The Daily Planet operates the only free-standing federally-qualified health care center in the area providing primary medical, behavioral health, vision, and dental care to the homeless, uninsured, and underinsured regardless of their ability to pay. The VCU School of Pharmacy has an extensive history of community engagement modeled by several pharmacist faculty who practice in multiple ambulatory, community, and long-term care settings with a focus on medically underserved populations. In 2005, The Daily Planet and VCU School of Pharmacy established an Academic-Community Partnership to enhance medication-related health outcomes among the homeless in the Richmond community through patient care, education, and research initiatives.
Jean-Venable (Kelly) Goode, PharmD
The patients served through Project IMPACT: Diabetes are homeless, at risk for homelessness, or in transient living situations in Richmond, VA. Many of their meals come from soup kitchens, churches, and food banks, which often serve low-cost foods, such as pasta and sandwiches. Patients often do not have their own mode of transportation and travel mostly on foot. Therefore, transportation to a doctor or a pharmacy presents a barrier to managing their diabetes and to their overall health. Health care is not a priority because patients do not have insurance, and they lack the resources to pay for health care, transportation, and preventative care. Many patients postpone seeking care until symptoms become more serious and often more difficult to reverse. In the United States, 61% of men and 51% of women report exposure to at least one traumatic event in their lifetime, with many reporting more than one. For individuals with mental illnesses or substance use disorders, traumatic life events are the rule rather than the exception. These adverse life experiences have been found to be a risk factor for a variety of serious health conditions and are likely to contribute to an individual's avoidance of and discomfort with medical procedures in primary and specialty care.
Pharmacists’ Role on the Collaborative Care Team
The health care team meets each patient in their environment to help plan successful diabetes management strategies. They tour stores that patients visit, such as Krogers and McDonald’s, and demonstrate how to make healthy food choices. The transportation barrier was identified, and patients receive bus tickets to come to clinic visits. Memberships to the YMCA are given to promote a healthy lifestyle. A holistic, collaborative approach is taken with the pharmacist and health care provider meeting each patient together. Patients are not simply given instructions to care for their diabetes; the health care team takes the time to explain the reasoning behind each decision and patients are included in the decision-making process. High expectations are set for patients, and because patients know they are cared for, they meet or surpass those expectations. As a population that is often ignored in the health care system, Daily Planet patients feel worthwhile because the health care team is there for them. This health care team is proud of their synergy and cannot imagine practicing without the skills and expertise of each other. They hope other providers will see their success and implement similar programs with their at-risk diabetes patients.
Relevant Statistics – Community Level
According to the CDC and Virginia Department of Health1,2:
- 508,000 (8.1%) of Virginia adults were diagnosed with diabetes as of 2010
- 13.5% of Black, non-Hispanic Virginians were diagnosed with diabetes as of 2010
- 10.9% of Richmond, Virginia adults were diagnosed with diabetes as of 2009
- Centers for Disease Control and Prevention. Diabetes Data & Trends: Virginia. Available at: http://apps.nccd.cdc.gov/DDTSTRS/StatePage.aspx?state=Virginia. Accessed July 18, 2013.
- Virginia Department of Health. Prevalence of Diabetes in VA. Available at: http://www.vdh.virginia.gov/ofhs/prevention/diabetes/documents/2011/pdf/factsheets/Diabetes%20Prevalence/Prevalence%20of%20Diabetes%20in%20VA.pdf. Accessed July 18, 2013.
- Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.
- American Diabetes Association. Fast Facts Data and Statistics About Diabetes. Available at: http://professional.diabetes.org/admin/UserFiles/0%20-%20Sean/FastFacts%20March%202013.pdf. Accessed June 12, 2013.