Table of Contents
Background
This business plan involves incorporating a pharmacist into the outpatient Diabetes Management Center at Wake Forest Baptist in order to provide support at clinic visits and to provide diabetes management through monthly DSME classes. Incorporating pharmacists into the management of diabetes through medication management and patient education is an effective approach to better control micro and macrovascular complications associated with uncontrolled diabetes. This can be done through medication optimization, medication adherence, improved patient education, and a decrease in overall healthcare costs.
According to a meta-analysis of 25 studies conducted by Wang et al, pharmacist-led services, as opposed to usual care, produced a cost-savings of up to $85,000 per year, while also costing an average of approximately $89,000 to prevent any diabetes-related micro or macrovascular event. A pharmacist involvement in diabetes management can be done through any stage of diabetes management from screenings to the ongoing disease state management. Research shows that a pharmacist’s involvement in the management of diabetes have been shown to improve the patient’s knowledge of their disease state and its corresponding complications, both pharmacological and non-pharmacological interventions, as well as self-monitoring of the disease. which will better help reduce barriers to the access of care while improving the quality of care being delivered to these patients.
Current trends of pharmacist involvement in the management of diabetes is based off the positive contributions to the clinical, economic and humanistic outcomes in those with diabetes. With this data, it would be effective to have a pharmacist involved in the Wake Forest Baptist Diabetes Clinic in order to provide these medication optimization and education services. Not only would this lead to improved outcomes as well as decreased healthcare costs, but the Wake Forest Baptist Health System would benefit overall in having decreased costs and diabetes-associated complications.
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Furthermore, this initiative complements the vision of WFBH in creating and sustaining a culture of positive health and well-being to improve the overall health in the community. In managing this chronic disease state, our clinic will serve as a resource for our patients as well as utilize a holistic approach in order to ensure those affected by diabetes are achieving targeted outcomes through innovative care.
This initiative also aligns with the mission of the Diabetes Center to provide high quality, team-based, and comprehensive care to manage diabetes and prevent further complications through patient education, professional training, and medical treatment. Our values of (excellence, compassion, service, integrity, diversity, collegiality, and innovation) honesty, dedication, integrity, professionalism, respect, and compassion will allow us to reach the most patients obtaining the healthiest of lives.
Establish the Need and Opportunity
In 2012, the annual economic cost of diagnosed diabetes in the United States was $245 billion, with the average medical expenditures of people with diabetes was $13,700 per year. These trends are comparable to those observed in Guilford County and the state of North Carolina. According the Center for disease Control (CDC) the number of people with diabetes is increasing each year. There is a total of 30.3 million people with diabetes, approximately 9.5% of the total US population, with 23.3 millions of those people who have been formally diagnosed as having diabetes, and 7.2 million people who remain undiagnosed.
Furthermore, there are an additional 84.1 million adults who have prediabetes. In 2014 alone, there were a total of 7.2 million hospital discharges were reported with diabetes listed as any diagnosis among US adults. In having such a large and rapidly growing diabetic population, it is evident that there is an increased need for access for diabetes management. Our pharmacists will be equipped and trained to counsel on lifestyle modifications, assessing and interpreting self-monitoring blood glucose levels, and assessing overall health status attributable to further interventions.
Concept for Providing Service
The facility will utilize a multidisciplinary approach of team-based care to manage diabetes and prevent further diabetes-related complications. Our staff will include physician oversight, an eye care provider, a podiatrist, a registered dietician, and clinical pharmacists. The pharmacists will work under a collaborative practice agreement with the physician in order to provide the best treatment plans by means of integrating all modes of diabetes specialties into a team model of care. Under the collaborative practice agreement, the pharmacist(s) will be able to evaluate diabetes therapy as outlined by the American Diabetes Association Standards of Medical Care in Diabetes 2018 Guidelines and other nationally recognized standards of care.
Pharmacists will have the authority to authorize the continuation or therapeutic modification in the treatment of diabetes which may include, but are not limited to the following classes of medications: biguanides, sulfonylureas, meglitinide derivatives, alpha-glucosidase inhibitors, thiazolidinediones, glucagon-like-peptide-a (GLP-1) agonists, dipeptidyl peptidase IV (DPP-4) inhibitors, selective sodium-glucose transporter-2 (SGLT-2) inhibitors, insulins, amylinomimetics, bile acid sequestrants, and/or dopamine agonists.
The clinical pharmacist must have a PharmD degrees from an accredited university as well as some experience in both medication therapy management (MTM) services as well as diabetes management. Board certification in ambulatory care services is preferred but not required. Once the pharmacist is appointed to the position, he/she will undergo training to become a certified diabetes educator per National Certification Board for Diabetes Educators (NCBDE) who can then provide individual and group counseling sessions to our patients.
Furthermore, The American Pharmacists Association (APhA) offers a certificate training program for pharmacists titled, The Pharmacist and Patient-Centered Diabetes Care Certificate, which is designed to provide pharmacists with knowledge and skills required to provide successful evidence-based diabetes care. This is a comprehensive program that incorporates case-based scenarios as well as hands-on training to be able to confidently approach any scenario that may be encountered in the community and other practice settings.
Our patients in the outpatient diabetes center will require a referral from their primary care physician. These patients may include newly diagnosed type-1 and type2 diabetes mellitus patients, recently hospitalized due to diabetes-related complications, poorly controlled diabetic patients, and poly-pharmacy diabetic patients. The first appointment with new patients will include a comprehensive review and consultation with a clinical pharmacist.
Prior to this visit, the pharmacist will review the medical charts faxed over from the PCP. The pharmacist will identify any medication-related problems including the appropriateness of the medications, optimization of medication doses, the effectiveness of each medication, the adherence to each medication, any potential safety concerns relative to each medication, and the overall optimization of the medication regimen. After the pharmacist reviews the medication profile and overall health of each patient, he/she may refer or consult with the podiatrist, eye care provider, and/or registered dietician as necessary.
Strategic Fit
Although the {Center for Diabetes Management and Prevention} has taken the necessary steps in addressing the complexity of diabetes management, there are still many subsets of patients that are experiencing hospitalizations due to uncontrolled diabetes, which incurs great costs for our health system. Diabetes is the single most expensive chronic disease, accounting for $174 billion in US health care costs in 2007. The costs of diabetes related hospital stays totaled $58.3 billion in 2007. This data proves the increased need for continuous follow-up and monitoring that is essential throughout the course of a diabetes diagnosis, to ensure adequate medication regimens and medication adherence is being prescribed.
To this degree, the integration of a pharmacist as an essential entity of the healthcare team at the {Center for Diabetes} will allow for improvements in both patient care and health outcomes. Since pharmacists are the most accessible healthcare provider, they may play a unique role in the lifelong management of this chronic disease. Since each case of diabetes is a unique entity, pharmacists can help patients by selecting and manipulating a unique medication regimen on an individual basis. Pharmacists are also able to counsel on appropriate diet and exercise routines to compliment the medication management.
This model of integrating a pharmacist into the disease state management of diabetes is unique and especially useful in areas where diabetes prevalence remains elevated and prospering. Additionally, with the growing number of antidiabetic medications climbing, pharmacists may arguably be one of the best suited healthcare professionals to facilitate the fundamentals and intricacies involved in the medication management best suited for them. Pharmacists may also help facilitate the understanding of associated adverse effects, monitoring and proper usage associated with these complex regimens.
The integration of pharmacists in the chronic disease management of diabetes will allow for prompt diagnosis, proper lifestyle changes, and appropriate pharmacotherapy such that allows patients to minimize and prevent the complications that are associated with uncontrolled diabetes.
Furthermore, the addition of a pharmacist in the management of diabetes will align with many of the strategic goals set forth by the Wake Forest Baptist Health System. In congruence with commitment to employ interventions from our multidisciplinary team, we will help patients get the best care they need. Our goal is for every patient is to manage his/her diabetes and prevent the associated complications from this disease.
Implementation of this clinical service is projected to cost $XX,XXX at the end of fiscal year 1 with expenditures rising to $xx,xxx by year 5. While these costs may be a significant burden on the forefront, the long-term benefits, reduced hospitalizations, and decreased overall health costs will generate the cost-savings revenue within the first year of implementation
