T2DM: Fit the coaching to the patient

When coaching diabetes patients to take their medications as prescribed, pharmacists have two choices: Fit the patient into the world of medicine, or fit the medicine into the world of the patient. Susan Cornell, PharmD, CDE, FAPhA, FAADE, knows which approach is best. The priority is to understand the patient’s daily challenges, and she adjusts her advice to meet his or her needs.

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Susan Cornell“We have to fit medication-taking and lifestyle change into a patient’s life using appropriate communication skills,” Cornell said at the recent annual meeting of the American Pharmacists Association (APhA) in San Diego. Instead of focusing on everything they’re doing wrong, the way so many family members and physicians do, said Cornell, associate director of Experiential Education and associate professor of Pharmacy Practice at Midwestern University Chicago College of Pharmacy, “we have to be cheerleaders for our patients.”

Jerry MeeceThere are, of course, plenty of reasons for loved ones to nag. Many of the estimated 21 million diabetes patients in the United States fail to take their medications properly or treat their illness with proper diet, exercise, and stress reduction.

Fortunately, “what we bring to the table as pharmacists is access, more than any other providers in the country,” said Jerry Meece, RPh, CDE, FACA, FAADE, owner and director of clinical services at Plaza Pharmacy and Wellness Center in Gainesville, Texas. “Nonadherence costs a lot of money. If we use a patient-centered approach, we can change the face of diabetes in this country.”

In an August 2012 study in Health Affairs (http://bit.ly/healthaffairs812), it was estimated that improved medication adherence among diabetes patients could lead to $8.3 billion in annual savings in the United States, with almost $5 billion savings in hospitals alone. Among the study’s sample, a quarter of diabetes patients failed to take their medications properly. 

What to do?

According to Cornell, it is crucial to get to know patients and create a sense of trust, allowing them to feel comfortable talking about obstacles to optimal diabetes care.

See also: Treating two: Effective management of gestational diabetes

In one case, she said, a patient’s diabetes progressed even though she was eating healthy foods. Cornell explained that insulin is a “very good drug” that’s natural and healthful and finally coached the truth out of the patient. Cornell discovered that her patient was a recovering drug addict and did not want to threaten her recovery by taking an injectable medication.

“Here the doctor is writing the prescription over and over again, but she won’t take it, and she has a valid reason,” Cornell said. The truth only came out after some detective work.

In other cases, pharmacists can play a role in helping patients to “do the wrong thing right,” she said. For example, patients may want to go on a vacation and take a break from healthy diets and difficult medication routines.

But medical emergencies can occur during patients’ hiatus from hassles. “We have to work with them on how to handle the situation and prepare for it,” she said, by doing things like making sure patients have the tools they need to handle a medical crisis.

The right tool

David PopeDavid Pope, PharmD, CDM, CDE, of Barney’s Pharmacy in Augusta, Ga., and the Creative Pharmacist patient awareness/education program (https://creativepharmacist.com/), echoed Cornell, urging APhA attendees to find the right tool at the right time for the right patient.

For example, Pope helped a patient order an insulin pump to gain better control of her diabetes. When it arrived, the patient was shocked to find that it required her to prick her skin.

“I have a fear of needles unlike any you would ever see,” said the patient, who’d fabricated her blood sugar readings in order to get a pump. “I thought being put on the pump I wouldn’t have to use needles. Now you tell me I’ve got to use a needle, and I’m not going to do it.”

Pope worked with the patient to help her start checking her blood sugar levels, and she’s now doing well without a pump.

“You need to jump into their world for just a brief moment,” he said, “and see what kind of structure they have in their life.”

Randy Dotinga is a medical writer based in San Diego, Calif.