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R.Ph.s eat, sleep, breathe (and bill for) diabetes care

FROM: DRUG TOPICS; RxCare; February 7, 2000

by SANDRA LEVY

A little over a year ago, Jerry Meece, R.Ph., owner of Plaza Pharmacy and Wellness Center, Gainesville, Texas, came to Milpitas, Calif., for four days. Along with about 38 other pharmacists, he wore an ID bracelet, woke up at 6:00 a.m. to exercise for 30 minutes, kept track of the carbohydrates he ate, calculated his body mass index, monitored his blood pressure and blood glucose level several times a day, and examined his feet before he went to sleep. If that weren't enough, one evening at 3:00 a.m., he and some of the other pharmacists were awakened and told they were having a hypoglycemic reaction. They had to test their blood glucose level, take glucose tablets, and retest.

What was a group of healthy pharmacists doing in a place like this? Why do R.Ph.s continue to go there? It's all part of LifeScan's diabetes care certificate program, Pharmacy Partners in Diabetes Care (PPDC).

"They are living the life of a person with diabetes who is following the current American Diabetes Association [ADA] recommendations. We hope they would give these recommendations to patients," said Kim Kelly, Pharm.D., director of diabetes programs for LifeScan. Kelly oversees PPDC. More than 400 pharmacists have completed the program, which costs $1,500, since it was launched 18 months ago.

While there is no shortage of diabetes training programs, what makes PPDC unique is that pharmacists learn firsthand what it's like to have diabetes so they can help diabetes patients monitor and manage their disease state.

Meece went on to become a certified diabetes educator (C.D.E.) after completing LifeScan's program, which he dubbed "a boot camp for diabetes education." Today, he does a significant amount of diabetes counseling at his pharmacy. Consultation fees range from $50 to $125 per hour. Insurance company reimbursements range from $400 to $600 for a long-term range of care. He also gives lectures to diabetes patients. "One of the first things I tell them is, 'I've been in your shoes for only a few days and I realize how complicated your life is,' " said Meece.

Developed by Kelly with Keith Campbell, R.Ph., C.D.E., associate dean and professor of pharmacy practice at the Washington State University College of Pharmacy, the PPDC program is made up of two parts. The first part is a home study course that takes approximately a month and a half to complete and offers 30 hours of continuing education credit. The CE contains 500 pages of material in eight modules and 1,100 pages of appendices, consisting of primary literature and handouts from various organizations. An exam is administered and a score of 80% or higher is required in order to attend the second part of PPDC.

Part two provides 38 hours of credit and is usually offered the third week of each month, running from Wednesday through Saturday. There is one faculty member for every three students. "The primary component of this course is what we want pharmacists to do, and that's basically to talk to patients," said Kelly.

In order to teach pharmacists to improve their communication with diabetes patients, they are videotaped with patients in 10 counseling sessions that range from five to 20 minutes. The videotape is then critiqued by the faculty.

Pharmacists are also taught about the importance of documentation and how to bill for their services. "If we as pharmacists are ever going to be reimbursed on a regular basis, one of the truly valuable things we must learn is to document what we do and continue to document in follow-ups," said Meece.

He went on to say that LifeScan's program provided him with the confidence and knowledge to talk to insurance company case managers to get reimbursed. Noting that recent studies show pharmacists can decrease diabetes complications of blindness, kidney disease, and amputations by up to 75%, Meece said the program also instilled confidence in him to make recommendations to physicians about patients and, thereby, increase referrals from physicians.

The program also teaches R.Ph.s how to manage patients who are insulin-dependent, as well as instructing about diet and educational theory, psychosocial issues, cardiovascular disease, and the readiness of people to change. It teaches about insulin dosing and all of the devices that deliver insulin, including pens and syringes, and also about blood glucose meters. Pharmacists also learn how to administer an injection and how to mix insulins. Computer management care software programs that keep track of data for patients are also discussed.

Acknowledging that some pharmacists are anxious about what they are going to learn when they first arrive to take the program, Campbell said, "When people leave the program, they are different from when they come in. They go back, start applying this, and change their practices—and they improve the care of patients."