Multidisciplinary pharmacist-led diabetes clinic developed in a U.S. rural setting

Many people living in rural settings do not have access to a primary care provider. Rural populations also experience a higher degree of burden from chronic diseases compared to urban-dwellers. For example, with lack of primary care, diabetes can go undiagnosed and undertreated. To address these care gaps, a multidisciplinary pharmacist-led diabetes clinic was developed at a large, rural family medicine practice in western North Carolina.The diabetes management clinic was developed in 2018 at the Mountain Area Health Education Center (MAHEC), a large family medicine practice in Asheville, North Carolina that serves 16 counties in the state. The interdisciplinary clinic is led by pharmacy residents and incorporates nutrition and pharmacy learners to provide patient care in an office setting and by telehealth. The clinic has facilitated meaningful learning opportunities for students and residents and helped patients manage their diabetes using a multifaceted approach. An explanation of the clinic was presented at MAHEC’s Annual Research Day. With greater awareness of the clinic, physicians began referring more patients to the pharmacy team. Primary care providers can give patients a description of pharmacy services, so they know what to expect prior to their diabetes management clinic appointment. The clinic is organized into distinct time slots that allow for a 40-minute appointment (in-person or telehealth) per patient. Under a collaborative practice agreement, pharmacists can order lab tests, as well as prescribe and change medications relating to patients’ diabetes care. They can also bill insurance companies for services provided via phone or video chat platforms. Nutrition services have also been incorporated into the clinic workflow. By integrating dietary recommendations into the clinic, the care team can address blood glucose control in a multifactorial manner that is convenient for the patient. Typically, a nutritionist or nutrition intern joins the pharmacist in a co-visit model.A retrospective, cross-sectional study was undertaken to evaluate diabetes-related outcomes for 80 patients seen in the diabetes management clinic during a 12-month period. The primary outcome measure was change in A1C from baseline. Results showed a mean reduction in A1C by 0.79% from baseline among patients with a follow-up A1C during the study period (n=64). A mean reduction from baseline in A1C of 1.42% was seen in those with a second follow-up A1C (n=32). The authors conclude that the utilization of pharmacy residents as part of an interdisciplinary diabetes management clinic can extend access to care for underserved patients. They believe their model may serve as an example for others developing pharmacy resident-led clinics for rural patient populations. The clinic also serves as a structured teaching clinic for interdisciplinary learners, and it has contributed to positive clinical outcomes, stronger interprofessional collaboration, and expansion of experiential education opportunities. The development of this pharmacist-led diabetes clinic builds upon previous literature showcasing the positive impact of pharmacists in diabetes management. It also adds to other studies demonstrating successful pharmacy resident-led patient care initiatives.Reference:Williams E, Simkins H, Hale A, et al. Implementation of an interprofessional diabetes management clinic in the rural primary care setting. Innov Pharm 2024;15(2). doi: 10.24926/iip.v15i2.5773.

Multidisciplinary pharmacist-led diabetes clinic developed in a U.S. rural setting

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