Assessing the accessibility and accuracy of pharmacist counseling for continuous glucose monitoring: A secret shopper study of community pharmacies

Abstract

Background

Continuous glucose monitors (CGMs) have many benefits in diabetes care and have grown in popularity. CGMs are often dispensed in community pharmacies, placing a growing responsibility on community pharmacists to provide patient education. Limited time and resources may result in suboptimal, or even absent, patient counseling.

Objectives

To assess the accessibility and accuracy of CGM counseling offered by community pharmacists in Austin, TX.

Methods

All community pharmacies in Austin, TX (N = 125) were visited in person in 2 phases by trained auditors, simulating a patient requesting pharmacist counseling on a CGM device. The devices for counseling were Freestyle Libre 3 (Abbott Diabetes Care) in phase one and Dexcom G7 (Dexcom, Inc.) in phase 2. Competency outcomes measured included glycemic targets, description of components, placement technique, checking/assessing glucose, and other tips for successful use. All responses were recorded immediately following the encounter using an 8-item online form.

Results

Data were obtained from 114 (91.2%) community pharmacies in both phases. Counseling was provided more often for Freestyle Libre versus Dexcom (88.6% vs. 71.1%, P < 0.01). A small proportion declined to counsel due to lack of time, limited product comfort, or a combination of the 2. Competency outcomes frequently met for Freestyle Libre and Dexcom included: sensor placement (91.5% vs. 88.7%), CGM components (80.3% vs. 70.4%), and application technique (78.9% vs. 56.3%, P < 0.01). Competency outcomes rarely met included glycemic targets (1.4% vs. 0.0%), alarms and alerts (1.4% vs. 2.8%), when a fingerstick is needed (0.0% vs. 7.0%), and how to interpret glucose/arrows (18.3% vs. 12.7%).

Conclusion

Pharmacists remain accessible health care providers for individuals with diabetes, but deficits in CGM counseling and patient education in community pharmacies exist. Barriers may include low pharmacist comfort with CGM devices and potential lack of familiarity based on the type of device a patient is using.