PPA Educational Foundation

2010 Grant Recipient Report

Assessment of Patient Attitudes and Willingness to Participate in a Community Pharmacy Centered Comprehensive Diabetes Education Program

The following report was written by Amelia Arnold, PharmD, who served as a Community Practice resident with Wilkes University and Hartzell’s Pharmacy in Catasauqua, PA in 2009-2010. Amelia was one of four successful recipients of the Foundation’s first-ever mini-grant program. She collaborated on the project with Kristen M Hartzell, Pharm.D, Vincent A Hartzell, Pharm.D, and Justin Boland, M.S. She utilized her $500 funding, along with other monies, to do the following program. The ongoing success of the Grant Funding Program is incumbent on the contributions to our PPA Educational Foundation.

Summary Report

Diabetes self-management education (DSME), the ongoing process of facilitating the knowledge, skill and ability necessary for diabetes self-care, has been consistently shown to improve patient outcomes1-3. The overall goals of DSME are to aid an individual patient in making informed decisions regarding their own health care to improve clinical outcomes, overall health status and quality of life4. To promote quality education for persons with diabetes, the American Diabetes Association endorses National Standards for Diabetes Self-Management Education to guide development and delivery of such education programs. Pharmacists in the community setting have the potential through their knowledge and skills to provide such services to educate patients. The aim of this study was to conduct exploratory research assessing patient attitudes and willingness to participate in a community pharmacy centered diabetes education program. This was done with the intention that survey results would be used to explore the potential of implementing and marketing such services within a community pharmacy setting.

Information was collected regarding patient attitudes toward a pharmacist providing diabetes education by a surveywhich focused on four themes: past patient experience with diabetes education, attitudes toward pharmacist provided diabetes education, factors influencing participation in a diabetes education program, and patient demographic information. The survey was developed and then piloted by patients and pharmacy staff for clarity of content. Chain and independent pharmacies within Lehigh and Northampton counties were then approached and asked to serve as distribution sites for the surveys. Initially 18 pharmacies expressed interest in serving as distribution sites for the surveys representing a range of urban, suburban and rural pharmacies. Each distribution site was given a packet of surveys and staff was educated on procedures. The collection period ran from February 7th, 2010 to April 3rd, 2010. A patient was considered eligible to take the survey if they were diagnosed diabetes or prediabetes and over the age of 18 years old. To ensure patients were randomly included, eligible patients were identified by the pharmacy staff during a four hour block of time each week during the 8 week collection period.

Over the eight week collection period eleven independent pharmacies collected a total of 69 surveys and two chain pharmacies collected a total of 7 surveys. The number of surveys collected per site ranged from one to eleven. Overall, 76 surveys were collected during the 8 week collection period. While not all survey participants had answered every question, all information gathered on the survey was included in the statistical analysis and used for decision making regarding potential program implementation.

Of the 76 survey respondents, 56% indicated they had received prior formal diabetes education and 44% indicated they had not. The most common reasons cited for not receiving prior education were not feeling it was needed, not enough time, and not knowing it was offered.

Promising results regarding patient views on pharmacist provided diabetes education were collected. The survey asked patients on a scale of 1 to 5 (1=strongly disagree to 5=strongly agree) their opinion if they felt a pharmacist was qualified to provide them education over seven different items: General diabetes information, help selecting healthy foods to eat, information on their medicines, information on monitoring their disease, how to set and achieve goals for their diabetes, information on complications from diabetes and how to prevent and treatment complications. The results for all 7 of these items were skewed positively to show statistical significance that patients favorably viewed pharmacist provided education and believe pharmacists are sources for diabetes related information.

The results of this survey also revealed potential obstacles toward implementing such a program in a community pharmacy setting. In particular, patients overwhelmingly indicated they would not be willing to pay for these services. While Medicare does cover the cost of providing these services for patients, as well as some private insurance plans, this does represent a significant obstacle to overcome. Other areas where there were less than supportive results included the distance patients were willing to travel and whether a patient would be willing to visit a pharmacy other than where they normally fill their prescriptions.

It was concluded that the results suggest patients view pharmacist as a potential source of education for a variety of diabetes-related topics. This suggests that there is potential for implementing a program centered in a community pharmacy. However, the results also suggest that any potential program would need a payor source established prior to implementation. Additionally, further market analysis toward specific subgroups of individuals based on age, race, sex, education level and income status would be needed to draw conclusions regarding any need in specific demographic groups.

References:

  1. Norris SL, Engelgau MM, Naranyan KMV: Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care 24:561-587,2001.
  2. Renders CM, Valk GD, Griffin SJ, Wagner EH, Eijk van JThM, Assendelft WJJ: Interventions to improve the management of diabetes in primary care, outpatient, and community settings: a systematic review. Diabetes Care 24:1821-1833, 2001.
  3. Deakin T, McShane CE, Cade JE, et al. Review: group based education in self-management strategies improves outcomes in type 2 diabetes mellitus. Cochrane Database Syst Rev (2): CD003417, 2005
  4. Funnell MM, Brown TL, Childs BP, et al. National standards for diabetes self-management education. Diabetes Care 2009 Jan;32 Suppl 1:S87-94.