Strategies for Pharmacists in the Implementation of Diabetes Mellitus Management Programs: New Roles in Primary and Collaborative Care

Pharmacists are in an ideal position to assess, monitor and treat adherence-related problems that can adversely affect patients' health outcomes. To accomplish these goals, pharmacists must accept the responsibilities and challenges of a primary care provider. They also must assume an interdisciplinary role in collaborative drug therapy management. Strategies to monitor and improve adherence are key components of pharmaceutical care plans, especially for patients with chronic diseases, such as hypertension, diabetes mellitus and atherosclerotic heart disease. This article gives an overview of guidelines, recommendations, current practices and related issues in the management of patients with diabetes mellitus. It also reviews the behavioral and social factors that influence adherence to therapeutic and lifestyle regimens, and highlights special needs in selected high-risk populations. Finally, best practice strategies that could serve as appropriate models for pharmaceutical care services are discussed. The overall goal is to enhance pharmacists' professional abilities to coordinate pharmaceutical care services targeted for major modifiable behavioral and biological risk factors. Pharmacists can overcome their apprehension about undertaking a primary care role in diabetes management through adequate preparation (including training and certification). The primary care functions that have been evaluated to date in the care of patients with diabetes mellitus by pharmacists show successful patient outcomes in terms of cost, quality of life and reduction of complications.