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When primary care providers are strapped for time, they could turn to an underutilized resource to help patients manage their diabetes: Pharmacists. Clinical pharmacists could be the key difference in helping patients manage their diabetes and maintain better control of their blood glucose levels.

Some Value-Based Care Models Incorporate Pharmacists

A group of researchers recently found that a pharmacist-managed group achieved statistically significant reductions in glycated hemoglobin (A1c) in a cohort of patients with type 2 diabetes over a 12-month period. 

As part of the study, which was published in the Journal of Primary Care & Community Health, clinical pharmacists hired and trained by a retail pharmacy then operated within a value-based primary clinic under a collaborative practice agreement. The pharmacist served as the first point of contact for patients via in-person and telehealth visits.

“We’re not replacing physicians here,” said Sashi Moodley, MD, MBA, chief medical officer of Walgreens and a co-author of the study. “We’re supporting or augmenting.”

A number of other studies have also shown that pharmacist-led programs or interventions can help patients with type 2 diabetes achieve statistically significant reductions in A1C and make improvements in glycemic control.

Jodie Pepin, PharmD, a clinical pharmacist with Harbor Health in Austin, Texas, explained that pharmacists are well-suited for this role. Pharmacists are not diagnosticians, but they are experts in medication management and therapeutic use of medications.

“Pharmacists know the medications, and they can save you a lot of time,” she said.

Plus, pharmacists are also familiar with nonprescription medications and supplements that many people take and can provide guidance about potential interactions, added Leslie Helou, PharmD, senior vice president of Health Outcomes Strategy at MOBE.

The Gift of Time

Time is a precious resource in primary care. A 2022 study in the Journal of General Internal Medicine estimated that primary care providers would need roughly 27 hours per day to provide all the guideline-recommended care required by their patients, but team-based care could help.

In fact, advocates say time is a key advantage offered by a model that incorporates pharmacists into the management of patients with diabetes. The pharmacist usually has the ability to spend more time with patients than the average primary care physician (PCP).

As Pepin put it, “I’m not bound to seeing 25 patients per day or whatever quotas people are placed on.”

“What the pharmacist does is have more frequent touchpoints,” Moodley said. “It’s a higher-touch model.”

Erika Horstmann, PharmD, head of Clinical Operations at Scriptology Health, agreed that patients with diabetes benefit from more frequent contact with healthcare professionals who can guide them. Many of them also suffer from other comorbidities, which may also require medications and management, and it can all feel overwhelming.

“People are just lost in the process,” said Horstmann.

With more frequent patient contact, the model can improve patient adherence.

According to Jodi Loyles, PharmD, executive director of Clinical Pharmacy and Quality at Kaiser Permanente. Kaiser Permanente includes clinical pharmacists in its care model, using a collaborative practice agreement. With prescriptive authority and expertise in medication management, pharmacists can manage medications for patients with diabetes, ensuring appropriate dosing and adherence to evidence-based guidelines.

Based on their own internal analyses, Kaiser Permanente has patient adherence rates to diabetes medications that are 20% higher than average, said Loyles.

Explaining the Collaboration to Patients

Patients might initially be puzzled when they learn they’ll be meeting with a clinical pharmacist to help manage their diabetes. Both primary care providers and pharmacists should explain the process and expectations to them at the outset.

“Then we have established a relationship, and they feel like they have an advocate to help them navigate the system a bit,” said Horstmann.

According to Daphne Smith Marsh, PharmD, a clinical assistant professor in UIC’s Retzky College of Pharmacy, Chicago, patients typically respond positively to the opportunity to have frequent phone and in-person visits with a pharmacist to review their glucose measurements and get assistance with medication adjustments. Plus, some patients need some encouragement to make necessary lifestyle modifications.

“Person with diabetes value empowering language and support, particularly as daily management of diabetes is challenging,” she said.

Loyles also referred to positive feedback from patients.

“When I was working as a front-line pharmacist in a primary care clinic, I had many patients come back to me after our time together was done and they had achieved their care goals and tell me how much it changed their personal life and how they were able to manage their disease,” she said.

Pepin noted that she does both in-person and telehealth visits with her patients with diabetes. She can spend 40 minutes with them if they need that much time, and patients really seem to value the chance to have more time with a healthcare professional who can help them achieve their goals.

“Isn’t that what everyone wants?” she said.

Hurdles to Overcome

Moodley maintained that pharmacists are often underutilized. They could play a greater role in chronic disease management, working alongside PCPs and bringing their medication expertise to the table.

“We really need to start thinking more about how we incorporate pharmacists into our healthcare space,” he said, adding that reimbursement should also be a fundamental part of the discussion.

Currently, some primary care practices are set up as value-based care organizations that allow them to collaborate with a clinical pharmacist to help manage patients with diabetes. Value-based care practices are becoming increasingly common, however.

According to Lydia Nesemann, PharmD, senior vice president of Medication Therapy Management at Monogram Health, hiring a pharmacist to oversee medication therapy management is a feasible model for a value-based organization — and one that can be “an immense value-add for patients and providers alike.”

However, it will require making sure that the appropriate credentials and agreements are in place, as well as convincing leadership of the benefits.

“In general, organizations need to make a strong business case for this in-house function or role to exist,” said Nesemann.

And pharmacists can be expensive team members to add, said Horstmann.

She suggested that primary care practice leaders approach local independent pharmacies to discuss the possibility of a partnership, since they may have some flexibility. State pharmacy associations could also be potential resources for finding a partner, she added.

“Overall, the benefits go beyond just patients,” said Helou. “Providing clinical pharmacy services to your patients will not only benefit them by helping them achieve outcomes and more tightly manage their medication experiences … but it’s also an added benefit to their providers and can help them improve their quality of life.”