The cornerstone of working with patients is sharing decision-making and presenting information in a way that helps patients understand the risks and benefits of various choices.
Expanding the pharmacist's role in diabetes care can lead to improved outcomes for patients. The cornerstone of working with patients is sharing decision-making and presenting information in a way that helps patients understand the risks and benefits of various choices.
Canadian pharmacists have become involved in a publicly-funded program that reimburses them for medication review and diabetes education for patients who have type 1 or type 2 diabetes. This program, MedsCheckDiabetes, has delivered pharmaceutical care directly to more than 400,000 Ontario residents since 2010. That represents half of the population of residents who have diabetes.
Pharmacists involved in this program have published an article in the Canadian Journal of Diabetes that describes a new initiative to incorporate a decision aid for patients into their medication review and diabetes education. The authors asked for pharmacists' perceptions of the tool.
This initiative uses a decision-making tool developed by the Mayo Clinic in Rochester, Minnesota. Although the Mayo Clinic initially designed these tools for use in the physician's office with patients, the tool could be used by other clinicians.
An interesting finding was that most pharmacists had no idea what decision aids were or how they could be used. In addition, none of the pharmacists included in the study had used decision aids in their practice.
However, some pharmacists did use pictures and graphics to explain diabetes and help patients make decisions. Although these are not formal decision aids, they do help patients understand their diabetes better.
Pharmacists indicated that the decision aid presented a considerable amount of information and could help stimulate discussion. They also praised the tool's simplicity and patient-friendly language.
Pharmacists also identified the tool's limitations. They indicated that to be used best, pharmacists would need to have a good, solid understanding of diabetes and its management. They also found that for some patients, the tool would be too general and failed to address unique treatment concerns. They also indicated that the tool did not address drug interactions.
Overall, these pharmacists indicated that adding a decision aid to their consultation process could improve discussion about diabetes in general and medication selection specifically. They also indicated that the decision aid would be best used when modifying existing medications are adding new therapies.
Pharmacists can find the entire suite of Mayo Clinic shared decision-making tools at https://shareddecisions.mayoclinic.org/decision-aid-information/decision-aids-for-chronic-disease/diabetes-medication-management/. They are available in English and Spanish, and Mayo Clinic offers specific aids for HbA1c reduction, daily routine, low blood sugar, cost, daily sugar testing, and weight management.
Verweel L, Gionfriddo MR, MacCallum L, et al. Community pharmacists' perspectives of a decision aid for managing type 2 diabetes in Ontario. Can J Diabetes. 2017;41(6):587-595.