Coach patients with diabetes to reach their goals

Empower patients to engage in self-care

In brief:

• Taking medications properly is one important part of managing diabetes
• But healthy eating, physical activity and other behaviors are also important
• A key to managing diabetes is for patients to engage in self-care
• Pharmacists can coach patients on self-care, leading to better outcomes

Helping patients with diabetes with self-care

You may already be helping patients with diabetes by:

• Consulting providers to ensure patients are on the best medication for them
• Synchronizing refills to improve adherence
• Counseling patients on their meds and on testing their blood

But many patients with diabetes can do more self-care to manage their disease.

Taking medications and monitoring blood sugar are only two of seven self-care behaviors recommended by the American Association of Diabetes Educators. These behaviors are healthy eating, being physically active, monitoring blood sugar, taking medications, problem-solving, reducing risks and healthy coping.¹

1. Ask the right questions

Patients with diabetes can be overwhelmed, especially just after being diagnosed. Instead of asking, “Do you have any questions?” check for understanding.²

These questions uncover what a patient understands about their disease and medications, heading off problems with adherence. Also, patients who are not experiencing symptoms or aren’t prepared for side effects are unlikely to follow a care plan or take medications as prescribed.

At refill time, ask, “What kind of problems are you having?” Without that prompt, a patient may not mention anything. Even asking, “Are you having any problems?” may not draw out information.

2. Become a coach

Lifestyle coaching can improve glycemic control and reduce the risk of prediabetes.³

Effective coaches don’t dump information on patients. They conduct behavioral interviews to get to know patients and motivate behavior change.

To coach patients, get to know them — not just their medications and A1C levels, but what is important to them. Know patients’:

• Values
• Daily routines
• Stressors

By knowing patients, you can help them set goals (see below) and coach them in achieving these goals.

Resources to assist you in becoming a coach for patients with diabetes include:

• Health Mart University℠ courses on motivating patients and behavioral interviewing.
• Training to become a lifestyle coach from the National Diabetes Prevention Program (DPP). Technicians and residents can become lifestyle coaches⁴. (Note: Trained lifestyle coaches can receive payment through Medicare Part B.⁵)

3. Set SMART goals

Work with patients to establish SMART self-care goals.

• Specific
• Measurable
• Achievable
• Relevant
• Time-bound

A goal of “improving adherence” isn’t SMART. It may be relevant but isn’t specific, measurable or time-bound.

A SMART goal for a patient with diabetes might be achieving an A1C level below 7% within six months. This goal is specific, measurable and time-bound. It is obviously relevant. A key question is whether it is achievable.

A good coach works with patients to set goals that are embraced by the patient. You can help a patient set a goal, but the patient must take ownership; it is THEIR goal, not yours.

After a patient sets a SMART goal:

• Develop a plan with specific steps to achieve the goal. Define the steps, such as taking meds each day and walking for 10 minutes. Make sure the patient’s tasks are clear and define how you will support them.
• Measure progress. Since a SMART goal is measurable, measure progress along the way.
• Adjust the goal if necessary. Goals don’t need to be fixed. If necessary, modify the goal or the timing. The journey and constant progress are often more important than the destination.

In setting goals and coaching patients to achieve them, form a partnership with patients. Be supportive and encouraging. Provide resources to assist patients. Identify barriers and help patients overcome them. Setting and achieving self-care goals is a collaborative process.

4. Communicate effectively

In coaching patients:

• Make written communications simple. Keep in mind: more than 33% of Americans read below a 7th-grade level. Make communication simple, clear, understandable.⁶
• Practice conversations. Use role-playing exercises to have staff practice talking with patients.
• Try text messages. One study found a daily text message from a pharmacist about medication adherence and exercise improved outcomes.⁷ A text is less of an interruption than a phone call and more likely to be read than email.
• Combine in-person and online support. A hybrid of personal, individual coaching and online and group support can be effective.⁸

Also, develop a plan to communicate about each self-care behavior. This might be through Facebook or blog posts, a monthly text or short conversations at med sync pick-up about a self-care behavior.

5. Address the whole patient

The patient you are coaching is more than simply “a diabetic.”

Work with others in your community to surround patients with holistic support. For example, a registered dietitian can consult patients about their diet and a personal trainer can create fitness programs for patients.

Taken together, these five steps provide a framework for your pharmacy to empower patients with diabetes to engage in self-care. These steps will improve adherence and outcomes, with your pharmacy at the center of patients’ diabetes self-care.

¹ AADE7 Self-Care Behaviors, American Association of Diabetes Educators, Oct. 2, 2019.
² “Patient Counseling Approaches to Enhance Medication Adherence,” Cortney M. Mospan, U.S. Pharmacist, June 18, 2019.
³ “Why Refer to a CDC-Recognized Lifestyle Change Program?” Centers for Disease Control and Prevention, Oct. 30, 2018.
⁴ “AADE National Diabetes Prevention Program (DPP) Lifestyle Coach Trainings,” American Association of Diabetes Educators.
⁵ “Launching a Diabetes Prevention Program within a Community Pharmacy,” Nicole Pezzino, Pharmacy Today, Nov. 2018.
⁶ “Patient Counseling Approaches to Enhance Medication Adherence,” Cortney M. Mospan, U.S. Pharmacist, June 18, 2019.
⁷ “Text Messages May Improve Adherence in Diabetes,” Jeannette Y. Wick, Pharmacy Times, April 15, 2019.
⁸ “Outcomes of a Digital Health Program with Human Coaching for Diabetes Risk Reduction in a Medicare Population,” Cynthia Castro Sweet et al., Journal of Aging and Health, Jan. 24, 2017.