Pharmaceutical care coaches improve outcomes for people with diabetes

Pharmaceutical care coaches improve outcomes for people with diabetes

Care Coach offers a comprehensive range of pharmacy and counseling services for patients struggling to manage their diabetes.

Melissa Almeida struggled for years to control her diabetes. After being diagnosed with type 2 diabetes at age 16, Almeida experienced frequent hypoglycemia as a result of her medications, and for years thereafter tried to manage her diabetes through diet alone.

Unable to keep her blood sugar steady with this approach, at age 18 she lost her job in a photography shop because she wasn’t able to maintain the energy she needed to work. Almeida did not start taking the drug again until after she became pregnant at the age of 22.

But even with a new drive to stick to a strict diabetes care plan, Almeida—as a full-time working mother—and a mother of four—had great difficulty carving out the time to effectively manage her disease.

Acknowledging everything she was messing around with, Almeida endocrinologist Dr. Richard Haas of UMass Memorial Health’s Diabetes Center of Excellence (DCOE) referred her to the Diabetes Care Coach Program, an extension of and managed by UMass Memorial Health’s Specialty Pharmacy Program. Shields Health SolutionsSpecialist pharmacy accelerator.

Care Coach offers a comprehensive suite of pharmacy and counseling services for patients struggling to manage their diabetes and is available to DCOE patients with a sustainable HbA1C score above 9.0%. Although a level of 6.5% or higher indicates diabetes, the target for most people with diabetes is an HbA1c of less than 7.0%.

Launched in 2021, the program offers high-touch specialty pharmacy services that manage pre-licensing and patient financial assistance, as well as nutrition and lifestyle counseling, medication management, diabetes technology assistance, motivational support, and referrals to local organizations for challenges. outside the clinic. Coaches work as an integral part of the DCOE care team and help ensure that the patient’s care plan and individual goals are fully achieved.

Hinal Sharma, PharmD, CSP, one of two care coaches assigned to the clinic, began working with Almeida in June 2021. Overwhelmed in her attempts to manage her diabetes, Almeida was taking only 1 of 3 prescribed medications and had many questions about these recipes.

As a clinical pharmacist, Sharma was able to answer these questions, explain the benefits of each drug, and create a weekly plan for Alameda to improve her adherence to the progressive regimen. Sharma has also worked with Almeida to make major changes to her diet, including adding more protein to his carb-heavy meals, keeping Almeida motivated on days of high frustration, and arranging her continuous glucose monitor to be delivered through the UMass Memorial Health specialty pharmacy. After 11 years of A1C levels above 9.0%, Almeida’s A1C is now down to 6.2%.

“The combination of professional pharmacist support and regular guidance on how to effectively self-manage diabetes has played a key role in the success of the program,” Haas said. “By offering both to patients, we are removing the silos of care they no longer have to navigate.”

The complexity of treating and managing diabetes appropriately can be a serious challenge for patients, but the Care Coach program is designed to address it. Most people with diabetes have two or more chronic conditions in addition to diabetes.

On top of having to administer multiple medications, patients must constantly monitor their blood sugar, maintain a healthy diet and exercise, undergo annual foot and eye exams, and maintain positive mental health and a strong motivation, among other commitments. Frequently, patients have to work with more than one pharmacy or a permanent medical equipment supplier to obtain all of their medications and supplies, as each of these demands poses increasing challenges to the effective management of diabetes.

By offering a dependable, one-stop pharmacy resource for diabetics, as well as a coach who can assist with a wide range of chronic disease management needs, the program has had a remarkable impact on patient outcomes. Patients who participated in the program for 6 months or more experienced a mean decrease in HbA1C of 2.4%. The average patient enters the Care Coach program with an A1C score of 10.4%.

The program also had a marked effect on drug adherence rates, another major challenge among diabetics nationwide. Since the program’s inception, Care Coach patients have, on average, maintained a proportion of days included with a medication adherence rate of 95%, well above the national adherence estimates for US diabetes patients, which tend to hover around 65%.

The UMass Memorial Health Diabetes team attributes this to the high frequency of coach-patient interactions, not to mention the financial assistance services the program provides to keep patient co-payments at an average of $5.

“Many of our diabetes patients face challenges on multiple fronts whether it is being able to afford medications, understanding and sticking to a healthy diet or appropriately monitoring blood sugar trends,” said Dr. Rushali Shah, who clinically oversees the Care Coach program with Haas. “Having someone like a care coach who stays in regular contact with our patients and works alongside them to achieve week after week, the additional goals have helped patients feel strong. This has truly been a game changer in our clinic.”

The high-frequency hotspots provided by the Care Coach program were exactly what Balram Santram needed after years of blood sugar levels in the 300 and 400. After being diagnosed with type 2 diabetes in his late thirties and prescribing several medications to treat it, Santram struggled to survive Stick to these medications and follow a healthy diet. Over time, he developed chronic pain in his legs as well as fatigue that affected his ability to be an engaged member of the family, a priority for him as a grandfather of two children.

Santram joined the Care Coach program in July 2021 and with Sharma’s help, he was able to raise his A1C level from 9.1% to 7.7% by stopping him from medications that were causing adverse effects and reducing his intake of high-carb foods, such as pasta and candy. Its even today, albeit in moderation.

Having Sharma there to help him overcome diabetes self-management challenges, including making him pay less for his medications, was a game changer for Balram.

“This is the best I’ve ever done with this disease. I feel healthier, have more energy, can think more clearly, and as a result I’m a more engaged husband, father and grandfather.”

While still in its experimental phase and already serving more than 170 patients, UMass Memorial Health and Shields hopes to offer the Care Coach program to more UMass Memorial clinics and hospitals in the future with the goal of improving clinical outcomes, reducing the cost of care, and enhancing patient and provider satisfaction.

“We believe this program addresses a real need in the diabetes field,” said Bill McKelnia, vice president of population health at Shields Health Solutions. “Patients are demanding better access and simplification of care, and the Care Coach program has made significant progress in achieving both.”

About the author

Bill McKelnia is Vice President of Population Health at Shields Health Solutions.

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