the Asheville Project: Pharmacists Providing Diabetes Care

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Case Study:
Diabetes and the Asheville Project
Diabetes Management
Two employers, the City of Asheville and Mission-St. Joseph's Health System, (In North Carolina) participated in 2 initiatives targeting asthma and diabetes. A total of 194 employees met the criteria for participation in the diabetes program. The study assessed both clinical and economic outcomes for up to 5 years.1
Program Components:
· Pharmacy care services by trained community pharmacists
· Diabetes education center, staffed by certified diabetes educators
· Patient participation incentives
· Free home blood glucose monitor
· Waiver of copayment for all diabetes drugs and related supplies such as lancets and test strips
Asheville Project (2001); Mean Cost Per Patient Per Year (USD)

Program Outcomes:
· The mean insurance cost per-patient-per-year (PPPY) decreased by $2,704, $3,609, $3,908, $5,480, and $6,502 in the first through fifth follow-up years, respectively.
· Prescription costs increased. But total mean direct medical costs PPPY decreased every year compared to the baseline.
· For one employer group, sick days were reduced for 5 consecutive years. Increased productivity value was estimated at $18,000.
· Prescription costs increased every year compared to the baseline. For the first through fifth years, increases of $656, $1,487, $1,932, $1,942, and $2,188 PPPY, respectively, were observed.
· Mean hemoglobin A1c (HbA1c) levels decreased (improved) at every follow-up.
· HbA1c levels compared to baseline for enrolled patients improved at each follow-up visit in 57.7% to 81.8% of patients.
· Mean HDL-C levels increased (improved) at every follow-up with 53.3% to 75% of patients.

1. Cranor CW, Bunting BA, Christensen DB. The Asheville project: long-term clinical and economic outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc. 2003;43(2):173-184.

Pharmacy Times

The Asheville Project: Taking a Fresh Look at the Pharmacy Practice Model
by Barry Bunting, PharmD, and Bill Horton, RPh

Our message needs to be: “It is broken.
Pharmacy can help fix it.” We need to teach physicians that we have information they need and convince them we can and will help them manage their patient’s illness.

Community pharmacists in particular have information that primary care physicians need. Physicians need to know if their patient filled the prescription they wrote (nearly 15% of patients don’t); they need to know if they are taking it (about 13% of patients don’t, even if they get the prescription filled); they need to know if the medication is working; and they need to know if the medication is causing their patient any problems that need to be resolved, especially if those problems have caused the patient to stop taking the medication.

Most important, the physician needs to know these things before the patient’s next appointment, which is months away.

The Initial Consultation
Once a patient has been matched up with a pharmacist, the pharmacist calls the patient to arrange for a counseling session time that is convenient for both. The initial sessions take about 60 minutes on average.

If the client is not familiar with the service being provided, help him or her understand what you hope to accomplish together. Take a detailed history using standard forms provided for that purpose.

Help the person set goals regarding lifestyle changes he or she would like to make. To many people, just knowing that they are going to be monitored is an incentive. Let them know that this is a team approach and that they are the most important members of the team.

Provide any necessary training, such as how to use a glucose meter or how to mix insulin.

Record and document everything in a standard format.

Plan follow-up visits.
These should take place at least once a month, and in our experience they average 20 to 30 minutes per patient per month.