Exploring the value of clinical pharmacy services for patients with diabetes in safety net settings.

Background: The role of the pharmacist in safety net settings has not been well studied, specifically in meeting unmet needs of vulnerable patients with diabetes.

Objectives: To identify unmet management and medication-related needs of patients with diabetes who are receiving care in two distinct underserved practices in Pittsburgh, PA.

Methods: Individual, semi-structured interviews with patients from a free clinic (FC) and a federally qualified community health center (FQHC) in Pittsburgh were conducted. Inclusion criteria included: adults at least 18 years old with uncontrolled diabetes (A1C > 7%) who received health care services from either the FC or the FQHC. Participants completed a short demographic survey and answered questions about their perceptions and attitudes in four thematic areas: (1) self-management of diabetes; (2) medication-related needs; (3) the role of the pharmacist in their care; and (4) how pharmacists can be better integrated in their diabetes management. Transcripts were analyzed using principles of Grounded Theory.

Results: Twenty-nine interviews were conducted: 15 participants were from the FC, and 14 were from the FQHC. Five main themes emerged from each site including: patients experience challenges managing their diabetes, patients identify the emotional struggle associated with living with diabetes, patients feel that they are "on their own" to care for their diabetes, patients desire a personal and caring relationship with their pharmacist, and patients value a pharmacist who is knowledgeable about diabetes care.

Conclusions: These results will help provide guidance to pharmacists working in safety net settings who are interested in expanding clinical pharmacy services for patients with diabetes.