Project IMPACT: Diabetes

Zufall Health Center


Program Overview

The pharmacist at Zufall Health Center meets with patients individually, completes the Patient Self-management Credential with them, reviews their health conditions and their medications, and explains in easy-to-understand language how patients can best take care of themselves. Patients are not charged for visits with the clinical pharmacist to make it affordable and accessible. Medication and lab costs are also covered as needed.

Program Partners

Zufall Health Center is a Federally Qualified Health Center serving northwestern New Jersey’s underserved population as a medical and dental home.  Zufall’s bilingual staff includes the pharmacist, pharmacy students, certified medical assistants, Licensed Certified Social Workers, patient navigators, physicians, dentists, and nurse practitioners. Health care is offered to residents of Morris, Sussex, Hunterdon, and Warren counties. All patients are welcome, regardless of income or insurance status. The services provided are patient-centered and culturally sensitive. 

Community Champion:

Rina Ramirez, M.D., and Teresita Lawson, RPh, CDE

Patient Profile

The patients served through Project IMPACT: Diabetes in northwestern New Jersey are often uninsured or underinsured and working multiple jobs. Patients are indentified as high risk according to evidence based guidelines for their condition(s), in addition to meeting criteria that increases their risk for  adverse drug events.  These criteria include 5 or more medications, multiple conditions, and multiple providers. Preventable care is not a choice for many patients who live 200% below the poverty level.  They are unfortunately and frequently  forced to choose between buying food or buying their medication. With approximately a 65% Hispanic patient-population, language and culture are main barriers to care as well as their level of health literacy. Many patients do not comprehend why medications are necessary to control their disease. Providing a continuum of care can be difficult with patients in transient living situations and phone numbers often continually change.

Pharmacists’ Role on the Collaborative Care Team

Providers refer eligible patients for participation in Project IMPACT: Diabetes. The pharmacist meets with each patient individually for a minimum of 30 minutes per visit. During the visit, the pharmacist reviews the patient’s condition and medications. Diabetes management is explained to each patient in a language comfortable to the patient, and the pharmacist assesses each patient for comprehension of the information supplied, adherence, and compliance. Barriers to diabetes care are also uncovered during individualized sessions. After the appointment, the pharmacist and other health care providers work collaboratively to generate a health care plan for each patient. Through the individualized appointments, the pharmacist partners with the patient. Trust is built and nurtured. The pharmacist is viewed as a resource for the physicians and the patients.

Relevant Statistics – Community Level

According to the Mississippi State Department of Health1:

  • 596,000 (8.3%) of New Jersey adults were diagnosed with diabetes as of 2010

Learn more about Zufall Health Center from its profile in Pharmacy Today.

View a video to learn more about this community and its patients before Project IMPACT: Diabetes.



  1. Centers for Disease Control and Prevention. Diabetes Data & Trends: New Jersey. Available at: Accessed July 30, 2013.
  2. 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.
  3. American Diabetes Association. Fast Facts Data and Statistics About Diabetes. Available at: Accessed June 12, 2013.