Advanced practice pharmacists in the field of diabetes work
collaboratively with patients’ medical providers, often in primary care
settings or in close proximity to the providers’ practices. They help to
integrate the pharmaceutical, medical, education/ counseling, and
direct patient care activities necessary to meet patients’ individual
self-management and diabetes care needs.
Patient
education and self-management behavioral change are underpinnings of
pharmaceutical care, and not only as they directly relate to the use of
medications. Pharmacists, especially those who are certified diabetes
educators (CDEs), frequently provide diabetes patients with education
not only on medications, but also on the overall disease state,
nutrition, physical activity, decision-making skills, psychosocial
adaptation, complication prevention, goal setting, barrier resolution,
and cost issues.
In addition to these substantial
education responsibilities, advanced practice pharmacists who are Board
Certified–Advanced Diabetes Managers (BC-ADMs) play an expanded role
that encompasses disease state management. This includes performing
clinical assessments and limited physical examinations; recognizing the
need for additional care; making referrals as needed; ordering and
interpreting specific laboratory tests; integrating their pharmacy
patient care plans into patients’ total medical care plans; and entering
notes on patient charts or carrying out other forms of written
communication with patients’ medical care providers. Depending on state
regulations and physician-based protocols, some advanced practice
pharmacists can prescribe and adjust medications independently or after
consultation with prescribing clinicians.
Case History:
Her medical history includes atrial fibrillation with cardioversion, anemia, knee replacement, and multiple emergency room (ER) admissions for asthma.
B.L.’s diabetes is currently being treated with a premixed preparation of 75% insulin lispro protamine suspension with 25% insulin lispro preparation (Humalog 75/25), 33 units before breakfast and 23 units before supper. She says she occasionally “takes a little more” insulin when she notes high blood glucose readings, but she has not been instructed on the use of an insulin adjustment algorithm.