7/18/2017. Jasmine Gonzalvo PharmD, BCPS, BC-ADM,CDE, LDE Clinical Associate Professor College of Pharmacy Purdue University

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1 Jasmine Gonzalvo PharmD, BCPS, BC-ADM,CDE, LDE Clinical Associate Professor College of Pharmacy Purdue University Clinical Pharmacy Specialist, Primary Care Eskenazi Health Indianapolis, IN Sheryl Traficano MBA, CAE CEO National Certification Board for Diabetes Educators Arlington Heights, IL CDE Pharmacists in the United States Disclosure to Participants tice of Requirements For Successful Completion Please refer to learning goals and objectives Learners must attend the full activity and complete the evaluation in order to claim continuing education credit/hours Conflict of Interest (COI) and Financial Relationship Disclosures: Presenter: Jasmine Gonzalvo, PharmD, BCPS, BC-ADM, CDE, LDE U-500 Advisory Board: Lilly Presenter: Sheryl Traficano, MBA, CAE COI/Financial Relationship to disclose n-endorsement of Products: Accredited status does not imply endorsement by AADE, ANCC, ACPE or CDR of any commercial products displayed in conjunction with this educational activity Off-Label Use: Participants will be notified by speakers to any product used for a purpose other than for which it was approved by the Food and Drug Administration. Learning Objectives Recognize the role of in the provision of Diabetes Self-Management Education (DSME) Identify the specific practice settings of CDE Discuss the implications of a greater number of obtaining diabetes credentials 1

2 7/18/2017 Pharmacists and DSME Instructors in accredited or recognized DSME programs Role of Pharmacists in DSME Established in 1986 NCBDE Establishes eligibility requirements and provides a written examination for initial certification; identifies renewal eligibility requirements and renewal pathways. Health professionals holding any number of different disciplines can become certified. Pass Rate Pharmacists vs. RNs and RDs/RDNs Number of Pharmacist CDEs Number of CDEs Jan-00 Jan-05 Jan-10 Jan-15 Jan-16 Jan-17 As of 5/15/2017 Pharmacist CDEs Volunteer Leadership 85% 79% 78% 77% 77% 77% 75% 75% 72% 70% 70% st Exam 10/18/1986 Accredited in March 2016 by the National Commission on Certifying Agencies (NCCA) 65% Several relevant credentials for practicing DSME Growth of CDEs and Pharmacist CDEs Promotes the interests of diabetes educators and the public at large by granting certification to qualified health care professionals involved in teaching persons with diabetes 80% Collaborative practice agreements 70% 62% 56% 61% 63% 71% 69% 67% 66% 67% 67% 59% 57% 62% Current pharmacist CDE : There has been a pharmacist CDE seat on the Board since its inception. A new pharmacist CDE will be elected this year to serve beginning Tommy Johnson, PharmD, CDE, BC-ADM, FAADE. He was elected to serve as Board Chair for % Spring 2012 Fall 2012 Pharmacists Spring 2013 Nurses Fall 2013 Spring 2014 Dietitians Fall 2014 Average All Spring 2015 Fall 2015 Linear (Pharmacists) 2

3 Pharmacist CDEs Volunteer Leadership NCBDE works to include at least one pharmacist CDE on committees and task forces Some current volunteer pharmacist CDEs include Nancy Letassy and Chris Lopez Examination Committee Jasmine Gonzalvo ( ) Credentials Committee Melisa Sigley Outreach Committee Thoughts on Pharmacists Tommy s thoughts: "It Takes Two campaign idea Pharmacists are most accessible health care professionals with 90% of U.S. population living within 5 miles of a community pharmacy Pharmacists can identify 1-2 persons each day that are picking up prescription medication for diabetes Start a conversation blood glucose values, latest lab results, monitor blood pressure, inquiry at immunizations and then move into education. Thoughts on Pharmacists "It Takes Two campaign idea (continued) One pharmacist could provide diabetes education to over 500 people with diabetes per year If only half of the 200,000 in community pharmacies have 1-2 interactions/day, over 50,000,000 a year pharmacist to person with diabetes conversations could be generated! Practice Settings of CDE Pharmacists What a significant impact these conversations could have on improving the health of those with diabetes! In what settings do CDE practice? Pilot study in Indiana focus on community (1) Less than 1% of Indiana community surveyed hold the CDE or BC-ADM credentials (2) Community believe that advanced diabetes credentials allow for a stronger impact on patient care and increase diabetes knowledge (3) Major barriers to obtaining advanced diabetes credentials are limited time and money Region n (%) West 122 (26.3%) Southwest 49 (10.5%) Midwest 96 (20.6%) Southeast 112 (24.1%) rtheast 81 (17.4%) 5 (1.1%) Nationwide study sought to identify specific practice settings for CDE J Am Pharm Assoc. 2016; 56(3):

4 7/18/2017 Year CDE First Obtained Participant Demographics Sex n (%) Male Female 122 (26.2%) 335 (72%) 8 (1.7%) Terminal pharmacy degree graduation year n (%) (present) 69 (14.8%) (39.6%) (26.3%) Before (17.6%) 8 (1.7%) a includes multiple includes combined b c Professional pharmacy degree n (%) BPharm 73 (15.7%) PharmD 263 (56.6%) BPharm and PharmD 111 (23.9%) PharmD Dual degree 5 (1.1%) Othera 9 (1.9%) 4 (0.9%) % % Current Practice Setting Consultant/Long-term Care 3% Managed Care 7% Informatics 1% Nuclear Other 0% 4% Community pharmacy 14% Hospital-based/Healthsystem including ambulatory care 52% Academia 17% % Current Practice Setting Current practice settingb Community pharmacy Hospital-based/Healthsystem including ambulatory cared Academia Industry Nuclear Consultant/Long-term Care Informatics Managed Care Othere Preceptor to IPPE/APPE students or residents 337 (72.5%) 123 (26.5%) 5 (1.1%) Affiliated with residency program or academic practice site 306 (65.8%) 156 (33.5%) 3 (0.6%) Residency program director 28 (9.2%) 277(90.5%) 1 (0.3%) t applicable Time in current practice setting (y) (29.0%) (26.2%) (30.5%) (12.7%) > 50 1 (0.2%) 6 (1.3%) Characteristics of Diabetes Patient Care Services Deliver structured diabetes patient care services 408 (87.7%) 51 (11.0%) 6 (1.3%) Accredited or recognized DSME program 151 (32.5%) 306 (65.8%) 8 (1.7%) Time program has been accredited/recognized (y) (31.8%) (33.1%) (15.2%) (9.3%) >20 8 (5.3%) 8 (5.3%) t applicable 314 Plans to offer diabetes patient care services in the next 12 months 168 (53.5%) 132 (42.0%) 14 (4.5%) t applicable % % Completed formal post graduate trainingb ne 158 PGY1 residency 247 PGY2 residency 55 Fellowship 14 Graduate school (non- 17 dual degree) Otherc 18 BCGP (board certified geriatric pharmacist); BCPS; BD MS pharm PharmD; BPharm, PhD; BS Pharm and MS Pharm; MS; PharmD and BS Psychology options could be selected ambulatory care training before residencies in this area were established/accredited, BCACP, in the process of obtaining a post-baccalaureate PharmD, MS/hospital residency, partially completed residency, on the job experience, MBA, naturopathic medical school, certificate course Industry 2% 2% Before % b multiple options could be selected U.S. Department of Veterans Affairs and Federally Qualified Health Centers includes Government setting including Indian Health Services, Military, Correctional, and Regulatory, pharmacist who work outside the traditional healthcare setting, Mail Order etc. d includes e Influential factors Factors that influenced decision to obtain CDEb Self-motivation/professional drive Mentor that holds CDE Participated in diabetes certification program Employer paid cost Wanted career change to focus in diabetes Employer provided protected time to accrue DSME hours in practice setting Received additional diabetes specific education Otherf Employer provided protected time to study for exam Employer provided protected time to accrue DSME hours outside practice setting b multiple options could be selected family member with diabetes, mentor, bonus or raise, wanted to improve quality of care delivered, etc f includes 4

5 Reasons you decided to obtain the CDE Reason you decided to obtain CDE credential b Personal satisfaction 332 More strongly impact patient care 294 Respect or recognition from other healthcare providers 280 Professional practice role/responsibilities 261 Increase knowledge about diabetes 253 Position self for other professional opportunities 224 Need in community 131 Personal connection to diabetes 124 Receive reimbursement for services 94 Receive bonus or raise 32 Other g 12 Requirement of current job or position 25 Receive a promotion 6 g includes left community pharmacy for diabetes education, needed credential to teach ADA classes, to assist with responsibilities of employment, raise that was no longer offered, etc Plan to renew CDE credential 440 (94.6%) 20 (4.3%) 5 (1.1%) Renewal Plans Reasons for NOT renewing credential b Will retire before renewal/currently retired 8 benefits to having credential 4 Changed careers and credential is no longer 4 applicable Expensive to maintain 3 Other 3 Insufficient hours to meet the practice requirement 2 Inability to accrue CE hour requirements 2 Do not receive reimbursement for credential 2 Insufficient time to study to retake renewal exam 1 Community Pharmacists with CDE credential vs. All other respondents Likert Item It is important for all community to attain the CDE credential. It is necessary for all community to attain the CDE credential. Attainment of the CDE credential is important for all community delivering DSME services. Attainment of the CDE credential is necessary for all community delivering DSME services. It is difficult for community to attain the CDE credential. Community are too busy to pursue the CDE credential. Community All other Significance Pharmacist with Pharmacist with CDE (n=81) CDE (n=454) 3.20 (1.30) 3.27 (1.08) (1.07) 3.70 (1.03) (1.19) 1.97 (0.95) (1.34) 2.38 (1.137) (1.16) 2.31 (1.15) (1.35) 2.76 (1.12) * For all items, means were reported using the five point Likert scale of 1 = Strongly agree 5 = Strongly disagree. For comparisons of means α = Barriers Barriers experienced b Potential barriers for other b barriers 205 Insufficient practice hours with patients with 355 Insufficient time to prepare/study for 96 the exam diabetes Employers do not encourage pursuing 246 Did not need credential for my 95 diabetes credential practice site Do not need credential for my practice site 223 Insufficient practice hours with patients with diabetes 80 Insufficient time to prepare/study for the exam 205 Too expensive (exam or CE credits or 63 exam preparation materials) Uncertainty about how to go about with credentialing 170 Employer did not encourage 60 Do not value CDE credential 167 pursuing diabetes credential Too expensive (exam or CE credits or exam 140 Uncertainty about how to go about 28 preparation materials) with credentialing barriers 32 Other h 19 Other i 21 h including application difficulty and audits, difficulty in obtaining hours including the need to change jobs, other certification more valued/more appropriate, etc i including access to mentors, confusion between different diabetes credentials, no increase in benefits/compensation, inability to obtain hours in the community setting, etc Benefits experienced b Personal satisfaction 382 Respect from healthcare 336 professionals More strongly impact patient 287 care Increased diabetes 265 knowledge Qualified for other positions 104 Requirement of my current 41 job Bonus or raise 38 Other j 17 Promotion 9 benefit 5 Benefits j including increased professional satisfaction, increased credibility to payers and patients, etc k including potential for billing and reimbursement Potential benefits for other b More strongly impact patient 328 care Respect from healthcare 323 professionals Personal satisfaction 315 To increase diabetes 314 knowledge To qualify for another 204 positions Requirement of job 108 Bonus or raise 98 Promotion 92 benefit 13 Other k 8 Employer or mentor support Inadequate reimbursement Qualitative Analysis Barriers: difficulty with hours Motivating Factors Professional opportunities/growth or credential valued (positive and negative) Residency Training Perceptions of Community Pharmacist CDEs Increase in Knowledge Exam Prep Interdisciplinary Relationships (positive and negative) 5

6 Spreading the Word to Pharmacists Implications of More Pharmacists with Credentials NCBDE reaches out to via: Presence at American Association of Colleges of Pharmacy (AACP) Annual Meeting exhibit or sponsorships Presence at American Pharmacists Association (APhA) exhibits Communication with professors of schools of pharmacy who attend AACP Communication with new regarding the certification Initial certification presentation at AADE Annual Meeting Implications Conclusions Greater impact for people with diabetes Personal satisfaction Potential for increased recognition among other healthcare providers Others? There has been a steady increase of pharmacist CDEs over the last 30 years The majority of who sit for the exam, successfully pass the exam All agree that it is difficult for community to attain the CDE credential Most CDE Conclusions Practice in a hospital/ambulatory care setting, followed by academia and community pharmacies Participate in training of other healthcare professionals Deliver structured diabetes patient care services in unaccredited/unrecognized DSME programs Are influenced to obtain the CDE by their own motivation or professional drive Most CDE Conclusions Do not encounter barriers in obtaining the CDE Perceive insufficient contact hours with people with diabetes to be a barrier to obtaining the CDE Decided to obtain the CDE for personal satisfaction, to more strongly impact patient care, and for more respect from other healthcare professionals 6

7 Contact Information Jasmine D. Gonzalvo, PharmD, BCPS, BC-ADM, CDE, LDE Clinical Associate Professor College of Pharmacy, Purdue University Clinical Pharmacy Specialist, Primary Care Eskenazi Health 7