Abstract and Introduction
Introduction: Even though evidence-based diabetes prevention interventions exist, more than 1 in 3 Americans have prediabetes; the use of pharmacies has been explored as a way to reach and care for this population. The objective of this study was to analyze factors that influence adoption of type 2 diabetes prevention programs by community pharmacies.
Methods: We conducted 21 semistructured interviews in 2018 with decision makers from 11 independent pharmacies in 6 US states and the District of Columbia and from 10 chain pharmacies operating in 1 state, multiple states, and nationwide. We identified participants by using purposive sampling. We used qualitative methods to analyze data and conducted interviews until we reached saturation.
Results: Multiple themes emerged: 1) initiation of services is more likely if initial financial support is received; 2) patient demand for services, actual or perceived, is paramount; 3) diabetes prevention services often fit within the existing operations of a pharmacy and allow maximum use of resources; 4) customer loyalty is a clearly articulated advantage against competition; and 5) engagement in diabetes prevention affirms an expanded role and the value of pharmacies to serve communities.
Conclusion: Pharmacies are well situated to deliver diabetes prevention programs to communities. Although considerable opportunity exists for pharmacies to address diabetes prevention, more could be done to reduce barriers to their use.
Diabetes imposes a societal and public health burden. More than 100 million Americans live with diabetes or prediabetes. Developing type 2 diabetes is a gradual but preventable process. In a 2019 study, nearly 1 in 5 adolescents aged 12 to 18 and 1 in 4 young adults aged 19 to 34 were living with prediabetes.
For people with prediabetes, reducing body weight and exercising can prevent or delay onset of type 2 diabetes. Studies demonstrated that such modifications resulted in a 30% to 60% reduction in diabetes incidence; these studies influenced the creation of the Centers for Disease Control and Prevention's (CDC's) National Diabetes Prevention Program (National DPP). This program offers evidence-based, cost effective interventions to prevent diabetes. The National DPP, a lifestyle-change intervention, is offered by programs that meet quality standards through its recognition program (Table 1).
Several commercial and government payers provide coverage for the National DPP lifestyle-change intervention (Table 2). Expanding coverage is important to reach eligible participants and reduce financial burdens. Increases in the number of partnerships and access points are needed to prevent diabetes. Pharmacies are well-positioned to support this effort. CDC has promoted collaboration with pharmacies and pharmacists since its release of a guide supporting such action.
The current transformative health care landscape provides an opportunity to look beyond traditional models of care to increase access, reduce costs, and improve health outcomes. Despite mounting evidence on the value of pharmacists as patient care providers, legal, policy, and reimbursement frameworks have not kept pace nor adequately recognized pharmacists as providers.
Our study considers community pharmacies as a health care destination for diabetes prevention programs. Few studies have explored how pharmacies can affect diabetes prevention, and no study has considered factors that influence the decision making of pharmacy executives. The objective of our study was to identify factors that enable or hinder pharmacy adoption of diabetes prevention programs.
Prev Chronic Dis. 2020;17(8):e90 © 2020 Centers for Disease Control and Prevention (CDC)