(1242) Utilizing Community Pharmacy Care to Improve Diabetes Population Health: Sustainability Case Study

Objectives: Each day additional patients are diagnosed with diabetes and pre-diabetes. Community pharmacists are a highly accessible and trusted healthcare resource, which provide an opportunity to optimize access to population health interventions. To combat the diabetes epidemic in the country, the Community-based Value-driven Care Initiative (CVCI) identified and created innovative community pharmacy care delivery models targeting chronic disease states, including diabetes. The aim of the project was to explore the feasibility and effectiveness of three patient-centered, quality-driven care interventions to advance population health. This case report focuses on the diabetes management implementation in a North Carolina pharmacy and the ongoing journey towards accessible and sustainable diabetes interventions.

Methods: This is a case report documenting the journey community pharmacies took from the training to implementation phase to create sustainable services for diabetes patients. The CVCI project utilized a top-down, bottom-up methodology to support sustainability. By working top-down and bottom-up, the aim was to meet in the middle in eastern North Carolina (NC) and create a diabetes intervention that was fiscally sustainable and clinically feasible. The CVCI team conducted pharmacy interviews (bottom-up) to explore previous clinical service implementations. The team also conducted a NC population health environmental scan to provide insights into establishing payer-pharmacy collaborations at the local level (top-down). Combing the results of the top-down, bottom-up methodology, the team was able to identify a need for improved diabetes care in NC and convened stakeholders at the state level to facilitate a pathway to sustainability.

Results: For the diabetes intervention arm, two pharmacy organizations completed the implementation in 1 to 5 pharmacy sites in North Carolina and South Carolina. The community pharmacy organization in NC is the focus of this case study and is a regional independent pharmacy chain with 16 locations in eastern NC. The pharmacy team completed a 3-month planning phase followed by a 12-month implementation phase. A key aspect to the intervention implementation was identifying eligible patients, which was successful through utilizing current partnerships with an ACO (also allowing for financial sustainability and local provider referrals). Patients with diabetes not at A1c goal completed the full program which included six health education sessions and diabetes adherence. The stakeholder meeting connected key persons with aligned interest and uncovered the opportunity for community pharmacy to address gaps in care for diabetes patients. These discussions led to the formation of a pharmacy advisory committee and formal project to launch a statewide community pharmacy services network, beginning with the diabetes intervention. The next phase of the sustainability journey is building a community pharmacy clinical services network across NC (in collaboration with a regional payer).

Conclusions: The lessons learned from the community pharmacy-ACO research was key to the foundational step toward sustainability. Some critical success factors from the initial statewide expansion which would be relevant for other pharmacies wanting to replicate would be:
• Funding for training and coaching to support integration of new patient care services into pharmacy workflows
• Identifying relevant quality metrics which pharmacists can influence and build into the intervention evaluation
• Having patient identification and reporting data/outcomes available from third party payers
• Integrating documentation into workflow allowing clear communication on a regular basis with third party payers