SHOPPERS DRUG MART SUSTAINABLE SOLUTIONS REPORT: PHARMACIST INTERVENTIONS IN DIABETES

Transcription

1 Sustainable Solutions Report: Pharmacist Interventions in Diabetes March 2015

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3 TABLE OF CONTENTS Summary 2 About Shoppers Drug Mart s Sustainable Solutions Reports 5 Why Diabetes? 6 Opportunity for Pharmacist Support 7 Diabetes Support Program Details 8 Diabetes Support Program Results 10 Infographic: Why Pharmacist Interventions Can Make a Real Difference in Diabetes Care. 12 Supporting Research on the Benefits of Pharmacist Interventions in Diabetes Management 13 Discussion 14 Recommendations 16 About Shoppers Drug Mart Corporation and Great-West Life 19 References 20 1

4 Summary More than ever, pharmacist interventions are improving the health of Canadians. As medication experts, pharmacists have the ability to play an even greater role both in preventative care and in helping individuals manage their chronic diseases. By extension, better disease management can save the health care system money through fewer trips to the emergency room. It can also positively impact the Canadian economy by reducing absenteeism and short- and long-term disability claims. The following Sustainable Solutions Report presents the results of a case study of Shoppers Drug Mart and Great-West Life s Diabetes Support Program. This initiative demonstrates the positive outcomes that can be obtained through pharmacist interventions when their knowledge and expertise are used to their full potential to help individuals manage chronic illnesses. When fully integrated in to a patient s health care team, specially trained pharmacists can make a significant difference in patient care when it comes to treatment of those with diabetes. The need for this care is more urgent than ever: The population of individuals with diabetes is growing, with an estimated 2.7 million Canadians living with diabetes in That number is expected to rise to 4.2 million by The cost associated with treating diabetics is also significant the estimated cost in 2010 was $12.2 billion, and that is projected to rise to $16.9 billion by Individuals with diabetes are three times more likely to be hospitalized at least once a year, and on average, once admitted, they spend more days in the hospital than non-diabetics. 3 Private drug plans spend approximately four times more per capita on prescription drugs for plan members with type 2 diabetes compared to all other claimants. 4 Drug costs for people living with type 2 diabetes are also higher, due in part to the other conditions these patients are more likely to have. Per capita spending on co-morbidities among plan members with type 2 diabetes was six times higher than for all other non-diabetic plan members. In fact, of the direct disability costs associated with type 2 diabetes, the majority were due to co-morbidities rather than diabetes itself. 5 Complications from diabetes account for more than 80% of the associated costs for the disease. When pharmacists trained in diabetes management are part of the care team, their interventions can help to prevent or at least delay those complications. 6 Physicians face enormous challenges with the management of diabetes and pharmacists can offer additional support. Shoppers Drug Mart collaborated with Great-West Life, one of Canada s leading insurers, to offer the Diabetes Support Program to nearly 68,000 Great-West Life plan members and their families at no cost to the employers or participants. Of those, 457 plan members participated in at least one visit as part of the voluntary program. The goal was to help individuals living with type 2 diabetes better manage their condition and help avoid future complications that would significantly diminish their quality of life and place an additional burden on the health care system. 2

5 Summary One of the key benefits of the Diabetes Support Program is that it can help increase a participant s access to diabetes-related services. Currently, provincial diabetes programs and clinics across Canada provide varying levels of access and support. Some provincial programs and clinics require a physician referral while others charge a fee, and not all offer convenient scheduling outside of standard business hours. The Diabetes Support Program provided services that a participant might not otherwise have had easy access to. As part of the Diabetes Support Program, eligible plan members and their families were offered the opportunity to receive an A1C test administered by a local Shoppers Drug Mart pharmacist trained in diabetes management. This was followed by lifestyle counselling, medication therapy recommendations and, where necessary, physician referrals. The A1C test at the pharmacy uses a blood sample taken from a simple finger prick. The test takes only five minutes to complete, and reflects a person s average blood glucose level over a period of two to three months. The target A1C level for most diabetics is less than 7%, and a higher level can indicate poor blood glucose (sugar) control. By discussing their A1C results with a pharmacist trained in diabetes management, patients can better understand how well their condition is being controlled. The test also provides patients with another point of access to their health care team, where pharmacist and physician interventions can motivate patients to modify their medications, lifestyle, diet and other behaviours. In addition to administering the A1C test, pharmacists informed the patient s physician of the A1C result and, if warranted, provided recommendations for a change in therapy (dose, amount, medication, addition/ discontinuation of a medication). A1C Improvements: Program Results 1. The number of patients that reached A1C target TRIPLED AFTER THE FIRST APPOINTMENT with a Shoppers Drug Mart pharmacist. 2. Approximately HALF of all patients with a follow-up appointment had a clinically significant reduction in A1C. Physician Collaboration: 3. The number of patients that met A1C target increased FOURFOLD after the pharmacist consulted with their physician. 4. Of patients who were not initially at target and received a diabetes-related therapy change, HALF successfully reached target by their follow-up appointment. 3

6 Summary The Diabetes Support Program was made possible through the collaborative efforts of Shoppers Drug Mart and Great-West Life, and the program was supported by the Canadian Diabetes Association and Bayer Healthcare Canada. These types of collaborations hold great promise for helping patients better manage their health conditions. This report also highlights the findings of a complementary study conducted at Shoppers Drug Mart pharmacies across the country, which also found that, among those tested, a majority (59.1%) had A1C levels that were above 7%. This study documents the types of pharmacist interventions in diabetes care that were offered based on A1C screening results. This Sustainable Solutions Report concludes with a set of recommendations on how to build on initiatives like the Diabetes Support Program by having pharmacists play a greater role in the health care team supporting individuals with diabetes. These recommendations are: 1. Expand collaborative opportunities for pharmacists to assess patients risk of developing diabetes; 2. Increase scope of practice to allow pharmacists in all provinces to conduct A1C tests for eligible patients and to access test results; 3. Enable pharmacists to structure and support a plan for patients to self-manage their care through the use of A1C test results and other diabetes assessment tools; 4. Increase scope of practice to allow pharmacists in all provinces to adapt prescriptions to help improve patient outcomes; and 5. Strengthen opportunities for pharmacist-physician communication and collaboration to better support patients in obtaining health outcome goals. Diabetes management is just one more part of health care where pharmacists can make a significant difference. By working together, we can develop sustainable solutions that will have positive impacts on the health of Canadians, all while improving the value delivered by our health care system. Mike Motz President Shoppers Drug Mart Stefan Kristjanson Executive Vice-President, Group Great-West Life 4

7 About Shoppers Drug Mart s Sustainable Solutions Reports This Sustainable Solutions Report: Pharmacist Interventions in Diabetes is the fourth in a series of reports issued by Shoppers Drug Mart. These reports explore different ways pharmacists can contribute to transforming our health care system by improving the health of Canadians, increasing patient satisfaction, expanding health care access and delivering better value for health care dollars. This report presents a case study on the Diabetes Support Program conducted by Shoppers Drug Mart and Great-West Life, supported by the Canadian Diabetes Association and Bayer Healthcare Canada. Participants of the program included 457 individuals who participated in a first appointment, 82 of whom participated in a follow-up appointment. The findings from the appointments were recorded and tracked by pharmacists in the Shoppers Drug Mart online Patient Scheduler electronic system. In addition, the report also includes the results of a patient satisfaction survey that was conducted with participants of the program. There were 132 surveys completed from individuals across the country. Where provincial policies permit, respondents were offered 8,000 bonus Shoppers Optimum Points (total value approximately $10) for completing the survey. 5

8 Why Diabetes? In Canada, diabetes affected an estimated 2.7 million individuals, or 7.6% of the population, and this number is expected to increase to 10.8% of the population, or 4.2 million Canadians, by Diabetes is a chronic and serious disease that can damage blood vessels, organs and nerves when not managed properly. 8 Type 2 diabetes is the most common type and it affects the way the body turns food into energy. It occurs when the pancreas does not produce enough insulin or the body s cells do not respond appropriately to insulin. When this happens, the cells do not absorb glucose (sugar) to convert it into energy. This can lead to excessive glucose in the blood instead of in the body s cells and can result in serious complications, such as blindness, non-traumatic amputation and end stage renal disease. 9 Cardiovascular disease also occurs two to four times more often in individuals with diabetes and is the leading cause of death in people with diabetes. 10 The management of diabetes involves keeping blood glucose levels within a healthy range. 11 Complications of diabetes account for 80% of the associated health care costs, and those costs are significant. 12 In 2010, the estimated cost of diabetes was $12.2 billion and it is estimated to rise to $16.9 billion by The annual per capita health care cost for those living with diabetes is estimated to be three to four times higher than the cost for the general population. 14 The good news is that the risk of developing these complications can be reduced with appropriate interventions and treatment. 6

9 Opportunity for Pharmacist Support The Diabetes Support Program facilitated access to services for Great-West Life plan members living with diabetes, in light of the fact that current provincial diabetes programs and clinics across Canada provide varying levels of access and support. Some of the challenges of current provincial programs include: Lack of Standardization Provincial programs and clinics are not standardized across Canada, providing different levels of support depending on where a person lives. Costs Some programs have a cost associated with them and require the patient to pay out of pocket. This could deter individuals from taking full advantage of these programs. Physician and Lab Referral Many programs require a referral from a physician and require the patient to make a separate visit to a lab for A1C testing. This added layer of going to a lab could deter some patients. Opportunity to Increase Focus on Medication Advice Most diabetes programs in Canada involve a consultation with a nurse and include a focused discussion on diet, nutrition, exercise, and insulin if applicable. Pharmacist interventions can include these and more, including greater focus on managing diabetes through oral medications. Variable Access and Convenience Convenient and timely access to health care professionals offering diabetes support programs is not always available. For instance, many provincial programs only operate during standard business hours, and individuals may not have the flexibility to book an appointment at a time that works best for them. Pharmacists can help to address each of these challenges. As pharmacists scope of practice continues to expand for instance empowering pharmacists to order lab tests or adapt prescriptions there are greater opportunities for pharmacists to make a difference in patients management of their diabetes by providing accessible, expert service. 7

10 Diabetes Support Program Details Collaboration The Diabetes Support Program shows what we can learn when a number of partners collaborate on finding a solution to a common problem. Central to the program s success was collaboration among the following partners: Pharmacy Community Shoppers Drug Mart leveraged its large national network of stores and pharmacists as health care experts to provide diabetes consultations. Insurers Great-West Life made the program available to its employer clients and their plan members at no cost. The program has demonstrated its value in helping many participants better manage their condition through medication changes, improved monitoring of blood glucose levels and increased medication adherence, which may help in lowering their risk of future complications. Patient Advocacy Groups Canadian Diabetes Association supported the program and provided its educational material to be shared with program participants. Pharmaceutical Industry Bayer Healthcare Canada provided the A1C tests that were administered at each appointment. The company also provided educational materials for program participants. Physicians were informed of A1C test results where appropriate and consulted for medication adjustments and/or new therapies to manage patient outcomes in collaboration with pharmacists. In addition, government programs were also leveraged depending on the province and the program rules, such as the MedsCheck for Diabetes program in Ontario. 8

11 Diabetes Support Program Details Eligibility The Diabetes Support Program was offered to eligible Great-West Life plan members and/or their eligible dependants living with diabetes. Eligibility was determined based on their employer s voluntary participation, as well as an individual s history of using either medication to treat diabetes or a blood glucose meter (a device used for patients with diabetes to self-monitor their blood glucose levels). Physician referral was not required to access the service. It was completely voluntary and offered to eligible Great-West Life members at no cost. Recruitment Nearly 68,000 eligible Great-West Life plan members were sent a letter notifying them about the program. Follow-up calls were also conducted and information was provided to eligible Shoppers Drug Mart patients when picking up their prescriptions. Great-West Life also promoted the program by providing information to benefit plan consultants and account representatives for dissemination to employers. Appointment Logistics Eligible patients were able to book a 30-minute appointment online, over the phone or at their participating local Shoppers Drug Mart. Appointments were available in the mornings, afternoons, evenings and on weekends at all participating Shoppers Drug Mart pharmacies across Canada (excluding Quebec). At the appointment, individuals met with a pharmacist who was either a Certified Diabetes Educator or specifically trained in diabetes management. The appointment started with an A1C test to determine whether or not the participant s diabetes was well controlled (the target for most people with diabetes is considered a reading of 7% or lower). An A1C result that is not at target indicates action should be taken to better control diabetes. Monitoring the A1C level is an important part of optimal diabetes management. According to the Canadian Diabetes Association, maintaining people s A1C at target reduces their chances of serious diabetesrelated complications. 15 Following the A1C test, the pharmacist discussed the A1C results and provided recommendations related to current medications, medication adherence, diet, exercise, blood glucose monitoring, hypoglycemia and physician referral. In Alberta, where pharmacists are able to adapt prescriptions (i.e., make appropriate modifications to the dose of a medication), if a change in therapy was recommended, the pharmacist would initiate the change and notify the patient s physician of the change. In provinces where pharmacists are not permitted to do this, they contacted the patients physician to notify them of the A1C test result and recommend the therapy change. Patients were also provided with educational material related to lifestyle management and blood glucose monitoring. The materials outlined specific, practical steps the patients could take to modify behaviours, diet and lifestyle to help manage their diabetes. Finally, a follow-up appointment was offered to plan members approximately three months after their initial appointment. 9

12 Diabetes Support Program Results Initial Appointment In total, 293 Shoppers Drug Mart locations in all provinces except Quebec had patients who participated in the program. There were 457 individuals with diabetes who had an initial appointment and received a consultation with the pharmacist and an A1C test. These patients had an average A1C of 7.8%, which is considerably higher than the optimal A1C target for most people with diabetes of 7%. Only 37% (169/457) of these patients were at their target A1C level. Follow-up Appointment Of the 457 patients who participated in the initial appointment, 82 returned for a follow-up appointment. These individuals in particular provide a helpful snapshot of the positive impact a pharmacist intervention can have by showing how their health was impacted following the first consultation. The proportion of patients that met target A1C increased from 9% (7/82) at their first appointment to 26% (21/82) at their follow-up appointment. In other words, the number of patients that reached A1C target tripled after only a 30-minute consultation with a Shoppers Drug Mart pharmacist (Figure 1). Figure 1: Analysis of the 82 patients who participated in a second appointment and their corresponding A1C results before and after pharmacist interventions. First Appointment 9% 91% Second Appointment 26% 74% At Target Not At Target 0% 20% 40% 60% 80% 100% Almost half of those who participated in the follow-up consultation (45%) had a clinically significant reduction (i.e., a reduction of 0.5% or more) in their A1C levels, and of those the average reduction achieved was 1.5%. 10

13 Diabetes Support Program Results As for assessing the impact of specific pharmacist recommendations and interactions, below is a breakdown of key discussion points among the 82 follow-up patients, and the result the recommendations had on A1C levels: 49% decrease in A1C level at follow up 46% decrease in A1C level at follow up 48% decrease in A1C level at follow up 48% decrease in A1C level at follow up Diet Of the 67 patients who were not initially at target and discussed diet changes, 49% had a clinically significant decrease in their A1C level at their follow-up. Medication Adherence Of the 41 patients not at target who discussed medication adherence, 46% had a clinically significant A1C decrease. Exercise Among the 61 patients not at target who received recommendations related to exercise, 48% had a clinically significant A1C decrease. Physician Consultation Of the 33 patients not at target whose pharmacist consulted with their physician following the initial appointment, 48% had a clinically significant A1C decrease. Notably, the number of patients that met A1C target increased fourfold after the pharmacist consulted with their physician. Patient Satisfaction Survey The patient satisfaction survey was filled out by 132 participants following their appointment with the pharmacist. The results show overwhelming support for the services provided by the pharmacist and the value the patients received from the interaction. The following is a summary of some of the key findings from the survey: Survey Question Strongly Agree/Agree You were able to find a convenient appointment time. 95% 90% You found the assistance/consultation you had with the pharmacist very valuable in managing your diabetes. You received information that would help you better manage your condition. 89% 91% You will discuss the appointment results with your doctor or other health care provider 11

14 Why Pharmacist Interventions Can Make a Real Difference in Diabetes Care Diabetes Rates Are Increasing IN 2010, THERE WERE AN ESTIMATED BY IN 2020, 2010, THAT THERE NUMBER WERE AN IS EXPECTED ESTIMATEDTO CANADIANS LIVING RISE CANADIANS TO LIVING WITH DIABETES 2.7 M WITH DIABETES RIS 2.7 M 4.2 M ii BY 2020, T Associated Costs Are On The Rise Too ESTIMATED COSTS FOR TREATING DIABETES IS PROJECTED TO RISE FROM $12.2 B IN 2010 TO iii $16.9 B BY 2020 DIABETICS ARE 3XTHAN NON-DIABETICS MORE LIKELY TO BE HOSPITALIZED iv PRIVATE DRUG PLANS SPEND 4X MORE ON EMPLOYEES WITH TYPE 2 DIABETES THAN FOR ALL v OTHER CLAIMANTS The Proven Power of Pharmacist Interventions The Shoppers Drug Mart and Great-West Life Diabetes Support Program showed how a 30-minute pharmacist intervention can make a significant impact. Following a pharmacist-administered A1C test to determine the patient s average blood sugar level, pharmacists provided patients with advice on how to control their illness, and modify their lifestyle, diet and other behaviors and in some cases, referred them to a physician. 5 MIN Positive Patient Outcomes PATIENTS THAT REACHED THE TARGET A1C LEVEL TRIPLED AFTER THE FIRST INTERVENTION WITH A PHARMACIST 45% OF PARTICIPANTS HAD A CLINICALLY SIGNIFICANT REDUCTION IN THEIR A1C LEVELS i Canadian Diabetes Association and Diabète Québec (2011). Diabetes: Canada at the Tipping Point Charting a New Path. Retrieved from II Ibid. III Cheng, A (2013). Introduction, Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Canadian Journal of Diabetes, 37 (Supplement 1), S1 S3. iv Canadian Diabetes Association and Diabète Québec (2011). Diabetes: Canada at the Tipping Point Charting 12a New Path. Retrieved from v AstraZeneca, Great-West Life, Cubic (2014). Burden of SHOPPERS Illness for Type DRUG 2 MART Diabetes SUSTAINABLE from a Canadian SOLUTIONS Employer REPORT: Perspective. PHARMACIST INTERVENTIONS IN DIABETES

15 Supporting Research on the Benefits of Pharmacist Interventions in Diabetes Management Complementing the findings of the Diabetes Support Program is a recent national study entitled, Community Pharmacy-Based A1C Screening A Canadian Model for Diabetes Care. This involved the A1C screening of 1,111 patients (871 of which were included in the analysis) in over 1,200 Shoppers Drug Mart pharmacies across Canada. Like the Diabetes Support Program, it found the majority of participants did not have their blood glucose levels optimally controlled. In fact 59.1% had A1C levels above the target of 7%. 16 In terms of pharmacist interventions overall, there was an average of two interventions per person conducted as part of the study. The three most common interventions were lifestyle counselling (29% of all interventions), referral of patients to their doctor for follow-up (16.5%), and discussion of the A1C result with the pharmacist (13.7%). The study also found that as individuals A1C levels increased, meaning they had poorer glycemic control, they required more physician-directed interventions (e.g., referral of patients to their doctor or pharmacist contacting the doctor directly on the patients behalf) as opposed to pharmacist-directed interventions (e.g., lifestyle counselling). This is important because it shows that pharmacists can make an impact by addressing basic concerns for those whose diabetes is moderately uncontrolled, and they can also help those whose diabetes is more seriously uncontrolled to get urgent help from their physician. The following chart shows the types of interventions provided to patients, based on their A1C results: No Intervention Lifestyle Counselling Discussion of Results Device Training Book Follow-Up with Pharmacist Referral to Dietitian Contact Physician Referral to Physician 0% 20% 40% 60% 80% 100% A1C 7.0% A1C >7.0% and <9.0% A1C > 9.0% > 13

16 Discussion The results of the Diabetes Support Program demonstrate the health benefits that can result when pharmacists trained in diabetes management play a greater role in a patient s health care team. Of the 457 patients that participated in the initial appointment, a staggering 63% were not at their target A1C level. Furthermore, the average A1C reading among these patients was found to be 7.8% almost a full point higher than most patients target of 7% or less. Community pharmacists have proved that they can be an invaluable resource for patients with diabetes by providing point-of-care testing and medication management support as well as patient education. Breakdown of A1C Results at Initial Appointment n=457 63% 37% At Target Not At Target This standardized program was implemented into the existing workflow for pharmacists in approximately a quarter of all Shoppers Drug Marts across Canada (excluding Quebec). It demonstrated the impact of pharmacist interventions in the community setting: the proportion of patients that achieved target A1C within approximately three months tripled after only a 30-minute intervention with a Shoppers Drug Mart pharmacist. Additionally, 45% of patients that returned for a follow-up appointment had a clinically significant reduction (i.e., 0.5% or greater) in their A1C level. In fact, in these patients, the average A1C reduction was 1.5%. One shortcoming of this study is the selection bias in those who returned for a second consultation versus those who did not which likely skewed the results of the satisfaction survey in a positive direction. Interestingly, the initial A1C result for those who returned for a second consultation was 8.5%, compared to 7.7% for those who did not. Those returning were therefore, on average, in greater need of help. Further study of this issue would benefit from a rigorous methodology that accounts for this selection bias and produces a larger sample of patients who return for a second consultation. 14

17 Discussion The Diabetes Support Program incorporated discussions around diet, medication adherence and exercise, all of which were found to be effective in helping patients reach their A1C targets. At each appointment, the pharmacist evaluated the needs of each patient and determined which topic(s) would be appropriate to discuss. The results of the program showed that each discussion (diet, medication adherence and exercise) as well as consulting physicians for possible medication adjustments resulted in approximately 50% of patients having a clinically significant decrease in their A1C level. Other studies have found the benefit of pharmacist-led diabetes counselling in a similar patient sample size, which produced similar results in terms of decreasing A1C values, but each of these studies involved multiple intensive patient education sessions. 17,18 Likewise, the complementary Community Pharmacy-Based A1C Screening A Canadian Model for Diabetes Care study conducted at Shoppers Drug Mart showed that pharmacists with training in diabetes management were able to provide patients with a range of interventions that escalated depending on the severity of the A1C test results. By referring patients with the poorest glycemic control to a physician or adjusting their medication, pharmacists can play a valuable role in an integrated health care team. Pharmacists are ideally positioned to help patients manage their diabetes and they can ultimately help to reduce the risk of diabetic complications. The results of the Diabetes Support Program differ from those of other studies in that they show that a meaningful intervention can occur with as little as a 30-minute structured pharmacist consultation. Moreover, this program can be successfully implemented into the current workflow by all pharmacists with diabetes management training. While pharmacist-administered A1C screening results can be used to inform appropriate interventions, the A1C test offers additional promise to patients who are underserved and have complex health care needs. Further studies could look at the benefits of greater access to A1C testing administered by pharmacists trained in diabetes management. 15

18 Recommendations The results of the Diabetes Support Program are consistent with results of similar studies and demonstrate that pharmacist interventions in diabetes management can have a significant impact on patient health outcomes and patient satisfaction. Building on these results, there is a tremendous opportunity to help more Canadians living with diabetes benefit from these services. Based on the role specially trained pharmacists can play to help people manage diabetes as part of their health care team, we recommend action on the following recommendations: 1Expand collaborative opportunities for pharmacists to assess patients risk of developing diabetes. Pharmacists can play a greater role in helping to prevent and manage diabetes. New collaborations can be developed to support outreach to employees and the public to enhance the early assessment of chronic disease. Existing diabetes programs could be expanded to include pharmacists in the care team in order to provide screening and appropriate interventions. 2Increase scope of practice to allow pharmacists in all provinces to conduct A1C tests for eligible patients and to access test results. Pharmacists in Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia and PEI, either currently or in the near future, will have the ability to order lab tests, including A1C tests. Expanding this scope of practice in other provinces would allow even more patients with diabetes to benefit from greater access to health care. Pharmacists with training in diabetes management are also uniquely positioned to offer accessible and convenient A1C testing and interpretation to patients. Pharmacists should also have the ability to access lab results from A1C tests ordered by physicians to enhance patient care and to avoid duplication. 3Enable pharmacists to structure and support a plan for patients to self-manage their care through the use of A1C test results and other diabetes assessment tools. When paired with expert pharmacist advice, funding for pharmacist-administered A1C testing can go a long way toward motivating necessary improvements in diabetes management. In addition to administering and/or discussing A1C results, pharmacists should be further supported with funding to provide people with diabetes with counselling related to diet, exercise, current medications, medication adherence, blood glucose monitoring, and hypoglycemia. This counselling can supplement the plan of care put in place by a physician. 16

19 Recommendations 4Increase scope of practice to allow pharmacists in all provinces to adapt prescriptions in order to help improve patient outcomes. As medication experts, pharmacists have the knowledge to adjust dosing or drug therapies to better meet patient health needs. Enabling equitable access to prescription adaptation by pharmacists across the country would make it easier to assist patients with the management of diabetes and other conditions by eliminating unnecessary delays when patients are required to go back to their physician to get medication alterations made. 5Strengthen opportunities for pharmacist-physician communication and collaboration to better support patients in attaining health outcome goals. Patients experienced greater health improvements after the pharmacist consulted with the physician on their plan of care and any changes in their diabetes-related therapy. We need to make it easier for physicians and pharmacists to work together to support a patient s plan of care. 17

20 Recommendations Looking to the Future By adopting these recommendations, there is a real opportunity to make a difference in the lives of Canadians who are living with diabetes, while also providing better value for our health dollars, not to mention the benefits to employers through reduced absenteeism and short-term and long-term disability claims. Diabetes is just one important area where pharmacists can make a significant difference. There are numerous other chronic conditions such as hypertension, arthritis, COPD and asthma where pharmacists expanded scope of practice will enable better disease management if their skills are leveraged to the maximum potential. Collaboration is the key to success pharmacists, government, patient groups, employers, insurers, and drug manufacturers need to keep working together to learn from new programs, to review their effectiveness and to come up with new solutions to target affected patients. This will result in more Canadians benefiting from the full expertise of pharmacists, who can provide accessible and personalized care. 18

21 About Shoppers Drug Mart Corporation and Great-West Life Shoppers Drug Mart Corporation is one of the most recognized and trusted names in Canadian retailing. The Company is the licensor of full-service retail drug stores operating under the name Shoppers Drug Mart (Pharmaprix in Québec). With more than 1,253 Shoppers Drug Mart and Pharmaprix stores operating in prime locations in each province and two territories, the Company is one of the most convenient retailers in Canada. The Company also licenses or owns 56 medical clinic pharmacies operating under the name Shoppers Simply Pharmacy (Pharmaprix Simplement Santé in Québec) and six luxury beauty destinations operating as Murale. As well, the Company owns and operates 62 Shoppers Home Health Care stores, making it the largest Canadian retailer of home health care products and services. In addition to its retail store network, the Company owns Shoppers Drug Mart Specialty Health Network Inc., a provider of specialty drug distribution, pharmacy and comprehensive patient support services, and MediSystem Technologies Inc., a provider of pharmaceutical products and services to long-term care facilities. Shoppers Drug Mart is a unique and independent operating division of Loblaw Companies Limited. Founded in Winnipeg in 1891, Great-West Life has long been a leader in the group benefits marketplace. The company has established this position over many decades, through its commitment to superior customer service and through a comprehensive selection of costeffective benefits plans. Great-West Life offers effective benefit solutions for employee groups of any size. The company serves the needs of more than 30,000 plan sponsors and their plan members, and handles approximately 50 million group health and dental claims transactions for its plan members and their dependants each year. We are developing targeted programs to assist plan members in the effective management of chronic conditions. Working with Shoppers Drug Mart Canada s largest pharmacy chain we introduced a diabetes management program in 2013 to help eligible plan members better manage their condition through monitoring, medication reviews and counselling. With a broad focus on supporting health and wellness, the goal is to help lower plan members risks of complications and achieve better overall health outcomes for them, with lower cost to the members, their employers, and the Canadian health system. 19

22 References 1 Canadian Diabetes Association. Diabetes: Canada at the Tipping Point Charting a New Path Available at: 2 Cheng AY. Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Introduction. Can J Diabetes Apr, 37 Suppl 1: S Ibid. 4 AstraZeneca, Great-West Life, Cubic. Burden of Illness for Type 2 Diabetes from a Canadian Employer Perspective Ibid. 6 Canadian Diabetes Association. Diabetes: Canada at the Tipping Point Charting a New Path Available at: 7 Ibid. 8 Ibid. 9 Cheng AY. Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Introduction. Can J Diabetes Apr, 37 Suppl 1: S Ibid. 11 Ibid. 12 Canadian Diabetes Association. Diabetes: Canada at the Tipping Point Charting a New Path Available at: 13 Cheng AY. Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Introduction. Can J Diabetes Apr, 37 Suppl 1: S Op. Cit. 15 Op. Cit. 16 Papastergiou J, Folkins C, Li W (2014). Community pharmacist-based A1C screening a Canadian model for diabetes care. 17 Mehuys E, Van Bortel L, De Bolle L, Van Tongelen I, et al. Effectiveness of a Community Pharmacist Intervention in Diabetes Care: A Randomized Controlled Trial. J Clin Pharm Ther Oct, 36(5): Johnson KA, Chen S, Cheng IN, Lou M, et al. The Impact of Clinical Pharmacy Services Integrated into Medical Homes on Diabetes- Related Clinical Outcomes. Ann Pharmacother Dec, 44(12):

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