Chronic diseases associated with obesity or overweight status are increasing at a rapid rate for Americans, with West Virginia one of the most-affected states. At the beginning of the grant period, according to the 2013 Behavioral Risk Factor Surveillance System (BRFSS) Report, 13.0% of adults in WV reported having diabetes, the fourth-highest ranking in the nation. At 48.3%, less than half reported having taken a diabetes education class. Diabetes self-management education (DSME) offered in community gathering places is effective in improving glycemic control for adults with type 2 diabetes (Norris et al., 2002). Studies have shown increasing the number of accredited and/or recognized DSME Programs in clinics and community settings can increase the number of people with diabetes with access to these services including pharmacies and hospitals. A 2014 review of existing databases of recognized and accredited DSME sites revealed WV had an inadequate number of DSME sites. There were only 30 DSME sites including American Association of Diabetes Educators (AADE) accredited and American Diabetes Association (ADA) recognized sites (one pharmacy). Pharmacists are the most accessible healthcare provider, especially in rural areas, thus increasing these programs in pharmacies is crucial. With fifty-five counties in the state of West Virginia forty-three of these counties are designated as rural, patient access to a diabetes self-management education (DSME) program is vital to assist with the care of diabetes patients in West Virginia.
The WV Division of Health Promotion and Chronic Disease (HPCD) recognized the promise of pharmacy-based DSME for reducing the state's diabetes burden. The Division took leadership to address this burden by developing a unique WV partnership with the West Virginia University (WVU) Wigner Institute School of Pharmacy. The Centers for Disease Control and Prevention's 1305 funding provided the fiscal resources for the Division and the Institute to collaboratively increase the number of accredited and/or recognized DSME programs over a four-year period. Collectively, the two partners engaged additional stakeholders including the WVU Office of Health Services Research (OHSR), and WV Academy of Family Physicians to develop and conduct a comprehensive implementation approach to (1) identify the needs of pharmacies to serve as DSME provider sites, (2) as well as engage and empower these sites to be effective providers. Additionally, (3) Workshop Wizard (a software platform), was implemented to enhance linkages between the patients and DSME programs. To better organize and to (4) use stakeholder-driven evaluation to assess the effectiveness of our approach. Collectively, WV accomplished the following:
Coordinated, facilitated, and executed WV AADE full day workshops to educate, inform, and recruit pharmacies yielding to increase the number of new sites and individuals who participated in training.
Developed and disseminated DSME 100+ patient referral guides to key stakeholders. These guides provided instruction/suggestions for increasing participation in DSME programs and enhancing referrals.
Provided tailored technical support and guidance to 13 pharmacies on a variety of issues such as how to bill for diabetes management education and assisted six pharmacies with application fees for AADE-accreditation.
Collaborated with public health partners in Colorado and a health system in Greenbrier County to gain information about their experiences using the Workshop Wizard platform. The lessons learned from the groups were used to finalize the decision to use Workshop Wizard to support sharing of resources and increasing referrals pertaining to DSME programs, including pharmacies, in WV.
Partnered with key stakeholders to maintain and develop up-to-date resources for dissemination to the appropriate audiences including a DSME chart of WV programs and contact information, and
Developed and disseminated a DSME guide for WV pharmacies to assist pharmacists with strategies and recommendations to implementing programs based on lessons to help improve, support, and sustain future pharmacies.
Overall, there has been an increase and improvement in DSME program access through the efforts to expand program availability into pharmacies. The patients, partners, and pharmacies in rural communities benefited from this intervention. Having a lead organization support the clinics and different community settings and partnering with AADE/ADA programs is key to the success and sustainability of DSME programs. This intervention was most successful in getting pharmacies to be AADE-accredited.
WV worked to increase the number of DSME programs established from 30 in 2014 at baseline to 39 in 2018.
This was a 30% increase of DSME programs over the funding period.
There are 28 ADA-recognized sites, 1 in a pharmacy, and 11 AADE-accredited programs, 9 of which are located in pharmacies.
WV went from 5091 DSME participants in 2012 to 5697 participants in 2017, and increase of 11.9%
For more information, contact Jessica Wright, RN, MPH, CHES, Director - West Virginia Bureau for Public Health, Division of Health Promotion and Chronic Disease (www.wvchronicdisease.org) / Jessica.G.Wright@wv.gov or 304-356-4193.
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