Project IMPACT: Diabetes
Jefferson County Department of Health
Jefferson County Department of Health (JCDH) has a stated mission to prevent disease and assure access to quality health care, promote a healthy lifestyle and a healthy environment, and protect against public health threats. JCDH provides outpatient health care for Jefferson County’s underinsured and uninsured residents at six health centers located throughout Jefferson County, Alabama. In some cases at these clinics, physicians and pharmacists visit with patients together and work as a team to develop health goals and care plans.
Project IMPACT: Diabetes was integrated into three pharmacist-run diabetes clinics in JCDH health centers. Patients with diabetes benefit from in-depth coaching and education provided through a pharmacist-run diabetes clinic. The clinic has a five visit protocol which the patients experience at different visits four to six weeks apart.
JCDH has partnered with Samford University McWhorter School of Pharmacy and Cooper Green Mercy Hospital through Project IMPACT: Diabetes to provide enhanced care to diabetes patients.
B. DeeAnn Dugan, PharmD, BCACP
Patients consist of individuals who enter the program with uncontrolled diabetes. Most of the patients that are seen at the site have baseline A1Cs greater than 9%. The patient population is largely uninsured and unemployed, and many are poverty-stricken. Health literacy is also a concern with these patients.
Pharmacists’ Role on the Collaborative Care Team
Pharmacists participate directly with other healthcare providers during patient visits, performing medication histories, collaborating in decision making and discussions, and educating patients. Patients are enrolled in the diabetes clinic upon identification by the team during provider visits, by provider referral, or identification by the pharmacist team using EMR reporting. Once patients are identified, an appointment is made with the pharmacist-run diabetes clinic to initiate the 5-session program.
- During the initial session, patients meet with a pharmacist to take the knowledge assessment and are then provided basic pharmacist-led diabetes education. Blood glucose meters are provided to the patients who are then instructed on the use of the devices.
- The second session continues more advanced diabetes education on diet, exercise, and medications.
- Sessions three and four continue the education, as well as initial discussion of psychosocial issues.
- Finally, session five is a follow-up protocol. As part of this session, patient self-management credential components are further completed to confirm self-management skills, and counseling and education are further individualized. In addition, as the need arises, patients may be contacted and consulted via telephone to provide continued patient care.
Throughout this process, patients continue to see their primary provider for diabetes and other health-related concerns. Communication among the healthcare team is ongoing.
Relevant Statistics – Community Level
According to the CDC, Alabama Department of Public Health, and Dugan B, Fisher K, Hannings A, et al.1-3:
- In 2010, Alabama ranked as having the 2nd highest age-adjusted prevalence of diabetes among adults in the U.S. (estimated at 11.3%)
- The death rate for diabetes in Alabama is 26.1 per 100,000 individuals. This rate is variable based on race, for White individuals the death rate is 23.4 per 100,000 and for Black or individuals of other races, the rate is 32.4 per 100,000 individuals
- JCDH reports that 89% of their patients at the diabetes clinics are African American and the average income per individual is $9,4000 per year
- Based on data from 2010, JDCH reports that 22% of patients have A1Cs greater than 9%
- Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. Increasing prevalence of diagnosed diabetes - United States and Puerto Rico, 1995-2010. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6145a4.htm. Accessed July 2, 2013.
- Alabama Department of Public Health. Alabama vital statistics: 2011. Available at: http://www.adph.org/healthstats/assets/AVS2011.pdf. Accessed on July 3, 2013.
- Dugan B, Fisher K, Hannings A, et al. Improving diabetes care through an interdisciplinary, patient-incentivized model in a public health department population: A Project IMPACT: Diabetes community’s results. Poster session presented at: 2013 APhA Annual Meeting & Exposition. 2013 Mar 2-4; Los Angeles, California
- 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.