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Australian Journal of Pharmacy : March 2005
pharmacy pro pharmacy professional updates Specialising in diabetes Diabetes has been identified as a disease state that pharmacy can expect to play a greater role in identification and ongoing management support. In recognition of this, US pharmacist and diabetes specialist,JERRY MEECE,has been invited to speak at the Australian Professional Pharmacy (APP) conference about his experiences in supporting people with diabetes to better manage their condition. A CCORDING to Jerry Meece, two important principles underpin his work: understanding that diabetes is a complex chronic progressive cardiovas- cular disease that requires that all care be patient-centred; and that diabetes is a self-management disease whose success- ful control rests in the patient’s hands 95 per cent of the time. ‘The idea is to educate our patient and at the same time empower them to self- manage their own disease,’ Mr Meece told the AJP. ‘One of the first things con- ferred to the patient when we first meet with them is that they have the control and will be the one who takes care of their diabetes. What we have all found as clini- cians is that the authoritative paternalistic approach to treating diabetes does not result in effective outcomes.’ Mr Meece’s team from Plaza Phar- macy and Wellness Centre in Gainesville, Texas, works closely with patients’ physi- cians as part of the diabetes care team, keeping them informed of changes in the condition or offering advice about how to achieve the goals identified for the patient. He said the good working relationships his pharmacy has with GP’s was under- pinned via regular contact over general prescription care of patients. As an aside, Mr Meece believed that pharmacists did not take enough advantage of the trust physicians had in pharmacists. ‘We work from the standpoint that care of the patient is much more than adjust- ing medication. But that’s only one leg of the stool,’ Mr Meece said. ‘Medication has to be balanced with activity and a good understanding of nutrition to achieve good outcomes. If you mix this concept in with the idea that we will work with a nurse, a dietitian, a general practi- tioner and possibly even an endocrinolo- gist, you see how complicated care can get if everybody is not sending the same mes- sage to the patient.’ Mr Meece’s team also follows standard national guidelines set up by the American Diabetes Association (ADA) and the Amer- ican Association of Clinical Endocrinolo- gists (AACE), thus ensuring a standardised way of taking care of the patient. Mr Meece says his Plaza Pharmacy and Wellness Centre looks like a lot of other professional community pharmacies, with an over-the-counter section and a waiting area for patients where educational tapes or medical shows are viewed while wait- ing on prescriptions to be filled. What is different is that there is a pri- vate office for consulting with patients one-on-one, a semi-private area for downloading blood glucose meters, tak- ing blood pressures and meeting with patients informally, and a conference room to allow for group diabetes self- management training sessions. Besides himself, there are two pharma- cists—one who is a Certified Diabetes Educator (CDE) who sees patients as well as filling prescriptions, and another who fills prescriptions and undertakes spe- cialised compounding of prescriptions. ‘About 95 per cent of what I do in my daily work has to do with diabetes care, either working with patients, visiting with physicians, or marketing our services in the surrounding area,’ said Mr Meece. Features of the diabetes service offered by Plaza Pharmacy and Wellness Centre include one-on-one and group self-man- agement training on everything from meter training, to coping skills, to how insulin works in conjunction with carbo- hydrates consumed. ‘We do medication management as well as insulin initiation, which includes 158 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL 86 MARCH 2005 Jerry Meece attending to a diabetes patient in his Plaza Pharmacy and Wellness Centre in Gainesville, Texas training the patient how to properly inject as well as use insulin pens that have been prescribed. We also start patients on insulin pumps, taking the time to calculate and adjust doses along with all the train- ing and follow up that is needed for their use,’ Mr Meece said. ‘We also adjust insulin according to pattern management and titrate the dose using guidelines agreed upon in collaboration with the patient’s physician. We also do foot screens, blood pressures, as well as overall comprehensive management of the patient in some cases.’ As well as his speaking engagement at the APP conference, Roche and Guild Gold Cross Products have arranged for Jerry Meece to speak with pharmacists in Sydney (6.30pm on 1 March at the Westin Hotel) and Melbourne (6.30pm on 2 March at the Park Hyatt Hotel). Those wishing to attend this complimen- tary presentation should contact Gold Cross on (02) 6270 1860. ¦ ? ?