A Clinical Pharmacist in Telehealth Team Care for Rural Patients with Diabetes

The prevalence of diabetes in eastern North Carolina is higher than the state average (12.8% vs. 10.3%) [1]. The American Diabetes Association and the chronic care model recommend using a team-based approach to optimize care for patients with diabetes [2, 3]. However, primary care clinics in rural areas often do not have the patient demand or resources to have interprofessional teams on site. Telemedicine can bring interprofessional team-based care to patients in rural health care practices by utilizing remote electronic communication. From 2013-2016, a diabetes telemedicine program funded by the Health Resources & Services Administration and Kate B. Reynolds Charitable Trust was offered in 13 sites in eastern North Carolina, including federally funded Community Health Clinics. A telemedicine team offered interdisciplinary care in the primary care provider's (PCP's) office without the patient needing to travel. The interdisciplinary team included a clinical pharmacist, dietician, behavioral therapist, and physician specializing in diabetes. The PCP referred the patient to 1 or more disciplines depending on the patient's needs. The program targeted underserved rural adults with uncontrolled type 2 diabetes. Patients were frequently challenged by comorbid distress, depression, behavioral/lifestyle challenges, finances, and limited local care. More than 70% of patients had incomes at or below 200% of the federal poverty level. The interdisciplinary team included 3 part-time pharmacists. At each patient's first appointment the pharmacist took a medication history. Then he/she assessed adherence, knowledge of medications for diabetes, and injection technique. The pharmacist reviewed the patients' blood glucose logs to identify trends and provide…