HOW IT WORKS
Siscare-DT2 aims to improve medication adherence of patients with type 2 diabetes through interprofessional collaboration, care coordination, and therapeutic support. Patients are eligible for the program if they are undergoing treatment with at least one chronic oral antidiabetic drug. Pharmacists make the final decision about eligibility, but the patient's general practitioner (GP) must also approve the treatment. OFAC, a professional cooperative society of Swiss pharmacists that offers its members administrative, billing and information technology services, recruits pharmacies for the program. Pharmacists are responsible for program intake, conducting assessments, and taking medical histories. They are trained as patient navigators and receive communication training regarding appropriate patient contact. Data are stored on a secure web platform and can be shared with the GP if patients give consent. Data are collected for research purposes and for operational management at the pharmacy level.
The program, which admitted its first patient in 2016, now enrolls 212 patients from 29 pharmacies. The concept is currently under review to demonstrate wider implementation and efficiency in primary care settings. Evaluation metrics follow the Triple Aim. A research study will examine before and after data, with results available in 2019.
Pharmacists are largely responsible for patient care within the program, which is delivered in a primary care setting (a community pharmacy). A GP’s degree of involvement depends on the patient’s wishes and consent - if consent is given, the pharmacist can contact the GP and share data. Primary care remains the GP’s responsibility. The program involves a new staffing model that consists of a pharmacist and pharmacy technician. Providers cooperate as a team, although pharmacists and pharmacy technicians are only involved in “coordination of service” for operational matters and do not discuss patients.
Patient engagement is a strong component. Patient-defined care goals are recorded and used to develop individualized care plans. While to some degree, the program promotes patient self-efficacy and empowerment, it offers no formal support or training in processes that promote self-management. Patients can decide whether they want to involve caregivers in their care, for example by bringing them into meetings.
Implementation is supervised by an advisory board composed of key stakeholders. Among them is Sispha SA, an OFAC company specializing in coordinated care and the developer of the Siscare-DT2 program. Other stakeholders include PharmaSuisse, the Swiss pharmacist association, MFE, the Swiss association for family medicine physicians, an insurance company, participating pharmacies, and the Federal Office of Public Health (FOPH), which is responsible for supervising and monitoring the project. This kind of structure is unique to the program.
The pilot project was funded by FOPH in response to an effort by the Swiss federal legislature to strengthen the clinical role of the pharmacists in Switzerland.