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Australian Journal of Pharmacy : July 2005
diabetes Intervention target: diabetes support Despite howls of complaint from the Australian Medical Association that the government should resist attempts from pharmacists to deliver disease support services, evidence here and overseas demonstrates the health and financial value of community pharmacy intervention to improved outcomes for people with diabetes. LISA OFFORD reports HILE increasing evidence sup- ports the case for pharmacy to extend its role in the community-based, multi-disciplinary care of people with diabetes, there are of course many phar- macists who are already providing valu- able services for diabetes patients. The AJP spoke to a number of phar- macists who offer disease state manage- ment services for people with diabetes. The three pharmacists featured—Albert Regoli, Louise Dixon and Phil Davies— all have a special interest in diabetes. As well as acting as National Diabetes Services Scheme Sub-Agents, each has experienced the delivery of specialised diabetes care services as participants in research projects run by the Faculty of Pharmacy at Sydney University. Critical elements of these projects include patient education, support and monitoring to facilitate self-management and medication regimen review in those with established disease. For those at risk of diabetes, the focus was on case detec- tion, education and referral. W The pharmacists received formal train- ing in areas such as the management of diabetes therapy and care, diet, exercise and use of blood glucose monitoring equipment. Interventions included con- ducting medical checks; reviewing self- care techniques, lifestyle issues, and med- ication adherence; and providing diabetes education was documented and patient goals set. The trials also provided the opportu- nity for these pharmacists to work closely with other health professionals—GPs, spe- cialists and diabetes educators—establish- ing a more formal role in patient-cen- tered, multi-disciplinary team approach to optimise diabetes treatment. And they also experienced first hand, the amount of time and effort required to offer a structured diabetes care service and be paid for it. Although their part in the faculty’s recent large scale project—The Phar- macy Diabetes Care program—has con- cluded, the three pharmacists featured have taken advantage of the skills they have acquired and continue to deliver aspects of the services covered. Albert Regoli, who runs a pharmacy in Marayong, in western Sydney summed up their present position. ‘The level of knowledge required to be involved in one of those university studies is a lot more than the knowledge you have 534 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 JULY 2005 from pharmacy training,’ he said. ‘And because you are put in contact with spe- cialists and other clinicians, you develop more of a sense of what you can achieve and you also start gearing up to being able to do some of those things. ‘Participating in these trials allows you to start re-thinking your pharmacy—you start to see what is possible. You see the things that you could apply right away and you throw them in when it suits,’ Mr Regoli said. Education The diabetes care service Mr Regoli delivers revolves around applying his knowledge and counselling patients. He says people diagnosed with diabetes are often confused and seeking advice. ‘They walk into the doctors surgery one day and he or she says: “your blood sugar is a little high, we’ll get that tested”.’ ‘Next time the doctor sees them they say—“You are diabetic”—and then they are sent off to the diabetic counsellor, or the specialist, or the eye guy and they are inundated with a huge volume of infor- mation and a lot of stress because they are really not sure what having diabetes means,’ he said.