How Pharmacies Can Transform Diabetes Care with 5-Minute A1C Testing

This special Diabetes Alert Day episode of the Quality Corner Show focuses on how pharmacy teams can move beyond dispensing to become proactive leaders in chronic disease management.

Host Ashley Ramer, MSN,RN, is joined by Terilyn St. Pierre, BSN, RN, to discuss the critical role of Hemoglobin A1C testing in the pharmacy setting. With 1 in 10 U.S. adults living with diabetes, and many unaware of their status, the pharmacy serves as a frequent and accessible touchpoint for closing essential care gaps.

In this episode, we cover the power of immediacy, clinical essentials, EQUIPP resources and a step by step demonstration. 

Transcript

00:00:05:07 - 00:00:12:24

Ashley Ramer

All right. And where do pharmacies have the greatest opportunity to close diabetes related gaps?

00:00:13:01 - 00:00:17:09

Terilyn St. Pierre

Pharmacies see patients far more frequently than most health care settings.

00:00:17:09 - 00:00:25:23

Terilyn St. Pierre

Many patients visit monthly, but may only see their primary care a few times a year if that. This frequency creates opportunity.

00:00:26:00 - 00:00:41:16

Terilyn St. Pierre

Pharmacies can identify patients overdue for A1 c testing those with uncontrolled diabetes or those struggling with adherence. Offering point of care testing removes barriers like scheduling delays and transportation issues.

00:00:41:18 - 00:00:59:07

Terilyn St. Pierre

Instead of telling a patient to schedule a lab draw, which in their busy schedules might not fit in, we can say let's check it today. That immediacy closes gaps before they become complications.

00:00:59:09 - 00:01:00:15

Voiceover

Welcome to the Pharmacy

00:01:00:18 - 00:01:09:13

Voiceover

Quality Solutions Quality Corner Show. Buckle up and put your thinking cap on. The Quality Corner show starts now.

00:01:09:15 - 00:01:19:06

Ashley Ramer

Welcome, everyone to the pharmacy Quality Solutions Quality Corner Show. I'm your host for today, Ashley Ramer, clinical transformation consultant, pharmacy at PQS by Innovaccer.

00:01:19:08 - 00:01:24:20

Ashley Ramer

And this is a special episode that is meaningful because we are releasing it on Diabetes Alert day.

00:01:24:23 - 00:01:38:13

Ashley Ramer

We're talking about how pharmacies can transform diabetes care through hemoglobin A1C testing, closing care gaps, improving quality performance, and using EQUIPP along with EQUIPP Academy to capture and sustain impact.

00:01:38:15 - 00:01:59:16

Ashley Ramer

Did you know that 1 in 10 adults in the U.S. have diabetes and nearly one third don't even know it? That means millions of people are at risk for serious complications every day, and many of them walk right into your pharmacy. Today on Diabetes Alert Day, we're talking about how pharmacists can set up, close care gaps, and make a real, measurable difference in patients lives.

00:01:59:21 - 00:02:20:20

Ashley Ramer

Starting with something as simple as a five minute A1C test. Before we dive deeper into our topic today, let's take a moment to introduce our guest and fellow PQS by Innovaccer Associate Terilyn St. Pierre, BSN, RN. Terilyn joins us with the diverse clinical background, beginning her career as a paramedic before transitioning to emergency nursing.

00:02:20:22 - 00:02:44:18

Ashley Ramer

She has focused her expertise on home health and value based care, providing her with practical understanding of the patient journey across different care settings. In addition to her work with us, Terilyn remains active in nursing education as a clinical instructor at the nursing school she attended. Her combination of frontline experience and commitment to the next generation of clinicians makes her a perfect fit for our discussion today.

00:02:44:20 - 00:02:47:16

Ashley Ramer

Terilyn, welcome to the show.

00:02:47:18 - 00:02:53:06

Terilyn St. Pierre

Thank you so much, Ashley. I'm really excited to be here today, especially on Diabetes Awareness Day.

00:02:53:08 - 00:03:14:14

Terilyn St. Pierre

This is such an important topic. I love the opportunity to share practical strategies and tools that pharmacists can use to make a real difference for patients with diabetes. I'm looking forward to walking through everything from agency testing to how EQUIPP Academy can help the team implement these services efficiently and confidently.

00:03:14:16 - 00:03:25:11

Ashley Ramer

All right, Tara Lynn, let's start at the foundation here. What is hemoglobin A1C and why does it matter so much?

00:03:25:13 - 00:03:54:17

Terilyn St. Pierre

Hemoglobin A1C is a measurement that reflects the patient's average blood glucose levels over the past three months. Unlike a single glucose reading that captures that moment, A1C provides a long term picture of diabetes control. It's used to diagnose diabetes, monitor treatment effectiveness, and guides therapy adjustments. Elevated A1 C levels increase risks for complications like neuropathy, kidney disease, vision loss, and cardiovascular events.

00:03:54:19 - 00:04:12:15

Terilyn St. Pierre

Many patients don't fully understand their A1. C number means when pharmacies take the time to explain it and connect that number for real life health outcomes. We empower patients to take control of their health and empowered patients to make better decisions.

00:04:12:17 - 00:04:20:09

Ashley Ramer

All right. And where do pharmacies have the greatest opportunity to close diabetes related gaps?

00:04:20:11 - 00:04:24:19

Terilyn St. Pierre

Pharmacies see patients far more frequently than most health care settings.

00:04:24:19 - 00:04:33:08

Terilyn St. Pierre

Many patients visit monthly, but may only see their primary care a few times a year if that. This frequency creates opportunity.

00:04:33:10 - 00:04:49:01

Terilyn St. Pierre

Pharmacies can identify patients overdue for A1 c testing those with uncontrolled diabetes or those struggling with adherence. Offering point of care testing removes barriers like scheduling delays and transportation issues.

00:04:49:03 - 00:05:02:06

Terilyn St. Pierre

Instead of telling a patient to schedule a lab draw, which in their busy schedules might not fit in, we can say let's check it today. That immediacy closes gaps before they become complications.

00:05:02:08 - 00:05:07:02

Ashley Ramer

And then how does this connect to quality measures and performance?

00:05:07:04 - 00:05:15:07

Terilyn St. Pierre

A1C control directly influences quality metrics, including CMS star ratings and value based care programs.

00:05:15:09 - 00:05:36:12

Terilyn St. Pierre

Maintaining control to A1 C levels reflects effective medication management and monitoring for pharmacies, and value based initiatives. Improved outcomes strengthen both performance and reimbursement. Clinical care and quality performance are aligned when we improve outcomes. Performance follows.

00:05:36:14 - 00:05:47:13

Ashley Ramer

So let's take this all now and tie this into EQUIPP. So if it's not documented it doesn't count. How does EQUIPP support this work?

00:05:47:15 - 00:06:21:14

Terilyn St. Pierre

EQUIPP provides visibility into care gaps and performance trends when pharmacies perform an A1 C test. EQUIPP allows that service to be documented in alignment with enhanced services programs by entering the A1C result. Documenting, counseling, and outlining follow up plans, pharmacies ensure their work is measurable. EQUIPP transforms daily patient and patient care into structured reportable impact, giving weight and dollars to the work you're already doing.

00:06:21:16 - 00:06:40:15

Ashley Ramer

So I know I believe there's something new coming that might be a little A1C playbook that you guys are going to be able to provide pharmacies with. So before we move into the demonstration part, I want to highlight the EQUIPP Academy section in that A1C playbook. So Terilyn, tell us a little bit more about the hemoglobin A1C playbook that's coming soon.

00:06:40:17 - 00:06:45:22

Ashley Ramer

and the EQUIPP Academy module that is available.

00:06:45:24 - 00:07:14:21

Terilyn St. Pierre

I'm super excited about this playbook. Inside the EQUIPP Academy we are working on creating a comprehensive A1C playbook and step by step guide, for implementation. It covers understanding the clinical importance of A1C, identifying patients, integrating testing into workflow, documenting in EQUIPP, and establishing follow up protocols. It's practical, actionable and designed for busy pharmacy teams.

00:07:14:23 - 00:07:45:08

Terilyn St. Pierre

We are pleased to say that is coming very soon. There's also a dedicated hemoglobin A1C module that breaks the content of documenting into manageable, on demand lessons. Teams can learn at their own pace, building both clinical competence and operational clarity. The playbook bridges knowledge and exclusion paired with EQUIPP documentation. Pharmacies don't just provide the service they sustain it and measure its impact.

00:07:45:10 - 00:07:53:24

Terilyn St. Pierre

All right. So let's talk about accessibility. What is a CLIA waiver.

00:07:54:01 - 00:08:22:24

Terilyn St. Pierre

All right so a CLIA waiver allows pharmacies to perform simple low risk lab tests including point of care A1C testing. The CLIA waiver needs to be in hand in the pharmacy before a test can be performed. With this, pharmacies can perform a quick fingerstick and get results within minutes, enabling real time clinical conversations and elevating the pharmacy to proactive care setting.

00:08:23:01 - 00:08:30:00

Ashley Ramer

All right, so what I gathered from that is get your CLIA waiver before you perform a fingerstick.

00:08:30:02 - 00:08:32:15

Terilyn St. Pierre

That is Correct.

00:08:32:17 - 00:08:45:01

Ashley Ramer

Let's walk through how simple the task really is. So tell it. Are you able to describe it by step by step just for the listeners? And then I believe we are actually going to be showing a little bit of a demonstration here as well.

00:08:45:03 - 00:08:52:21

Ashley Ramer

So those of you who are listening, she'll describe what she's doing step by step, and then those of you who are watching you will be able to see it done.

00:08:52:23 - 00:09:04:20

Terilyn St. Pierre

All right. So first you're going to want to gather your supplies. And their supplies include, of course your PPE. So some gloves you're going to need the analyzer.

00:09:04:22 - 00:09:31:21

Terilyn St. Pierre

Kit. You're going to need the, packages that come within the kit. We have a bandage for care. Afterwards. We have alcohol prep and then a cotton swab, to help, with the blood after we do the finger poke. So to perform a fingerstick, You're going to put on my gloves here.

00:09:31:23 - 00:09:35:24

Terilyn St. Pierre

That sound we're all familiar with...

00:09:36:01 - 00:09:55:04

Terilyn St. Pierre

All right, so we've got our gloves on, and then we're going to take the patient's finger, and we're going to clean it with the alcohol. We're going to allow that to dry completely before we do anything with it. While that's happening, we can open up our test kit inside

00:09:55:07 - 00:10:02:05

Terilyn St. Pierre

the kit, they include a lancet so we don't have to get our own.

00:10:02:07 - 00:10:14:14

Terilyn St. Pierre

Though with the lancet. It's better to poke the patient on the side of the finger if you're poking it right in the middle. They're going to be touching that all day long.

00:10:14:16 - 00:10:39:19

Terilyn St. Pierre

So we're going to poke on the side and then we're going to squeeze. To get our drop of blood in our kit is a small clear collection device. And you're going to just touch it to the blood drop. We're going to take that cotton ball, and we're going to give it to our patient so that they can hold.

00:10:40:00 - 00:10:58:22

Terilyn St. Pierre

We can also give them the bandage so that they can or we can place the bandage to control bleeding. So now in our kit, there's a another little tube like device. We're going to take our collection device and pop it into the tube.

00:10:58:24 - 00:11:07:22

Terilyn St. Pierre

And that sends the blood in here. We're going to rotate it a couple times.

00:11:07:24 - 00:11:43:17

Terilyn St. Pierre

And then we're going to grab our step two kit. And when we open that up it's our test cartridge. We're making sure the numbers align on the cartridge in the device. When we put that in. It tells you to wait. The cartridge into the device. It tells you to wait. Now it's saying sample. So we're going to take the bottom of the tube off and press it into the cartridge.

00:11:43:19 - 00:12:01:09

Terilyn St. Pierre

Now the cartridge is displaying run. So that will run. It takes about five minutes for that test to run. And then we'll have our results. It'll show right up on the monitor.

00:12:01:11 - 00:12:07:21

Terilyn St. Pierre

All right. We're going to wash our hands and put our, sharps and sharp and clean up.

00:12:07:23 - 00:12:11:13

Ashley Ramer

Seems like the hands on work. Part of it takes less than two minutes.

00:12:11:13 - 00:12:19:01

Ashley Ramer

So besides the results, it's almost like that takes longer than actually doing it. So I'd say that's simple and effective and pretty easy to integrate.

00:12:19:04 - 00:12:20:02

Terilyn St. Pierre

Yes.

00:12:20:04 - 00:12:20:17

Terilyn St. Pierre

00:12:20:17 - 00:12:27:11

Ashley Ramer

So, Terilyn, what do you recommend that pharmacies do while this analyzer is running now for these five minutes?

00:12:27:13 - 00:12:48:17

Terilyn St. Pierre

So a good practice would be to log in to EQUIPP, navigate to the patient profile and document the A1C in the Enhanced Service section, including the date, the counseling, and follow up. By the time the result is ready, you can fill it in and the other documentation is complete. So it'll be efficient and impactful.

00:12:48:19 - 00:13:00:08

Ashley Ramer

So while doing this, I know you walked through everything you were doing, do you have any though like practical tips for the pharmacy, teams on taking A1C?

00:13:00:10 - 00:13:20:20

Terilyn St. Pierre

Again, making sure that the hands are warm, using the side of the finger so that they're not touching that all day, avoiding, excessive squeezing as that can cause some bruising and discomfort to the patient. Check the cartridge, storage and expiration date, making sure everything within, proper use, mostly,

00:13:20:22 - 00:13:29:09

Terilyn St. Pierre

Most importantly, use the results as a teaching opportunity that conversation drives change.

00:13:29:11 - 00:13:38:03

Ashley Ramer

All right. So if a pharmacy wants to take immediate action on this, what would you recommend that they do? How do they get started?

00:13:38:05 - 00:13:49:13

Terilyn St. Pierre

The big thing is that CLIA waiver, starting with that. The process, is fairly quick. And it's all online automated now.

00:13:49:13 - 00:14:06:20

Terilyn St. Pierre

So you used to have to send in payment, and that took a while. But to designate a diabetes service champion and use that EQUIPP weekly to identify eligible patients, small steps create lasting, momentum.

00:14:06:22 - 00:14:08:06

Ashley Ramer

All right, so on this

00:14:08:08 - 00:14:09:07

Ashley Ramer

Diabetes

00:14:09:09 - 00:14:09:18

Ashley Ramer

Alert

00:14:09:18 - 00:14:09:24

Ashley Ramer

Day,

00:14:10:01 - 00:14:17:16

Ashley Ramer

here's the message that we are going to leave you with, somewhere today, a patient walks into a pharmacy, not fully understanding their A1C.

00:14:17:18 - 00:14:43:00

Ashley Ramer

They might not know their risk or that small changes could prevent life altering complications for themselves so that patient may walk in to your pharmacy. Pharmacies are no longer just dispensing medications. You are monitoring chronic disease, closing care gaps, educating patients, and preventing complications before they happen. So a five minute test, immediate documentation, a conversation that changes a life, that's impact.

00:14:43:02 - 00:15:05:19

Ashley Ramer

That's leadership. And that's the role pharmacists play in diabetes care. So Terilyn, thank you for sharing your expertise today and the little demonstration for pharmacists to be able to see how quick and simple it really is. And thank you to all the pharmacy teams listening for the work you do every day to improve patient lives. We'll see you on the next episode of the Quality Corner Show.

00:15:05:21 - 00:15:28:21

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00:15:28:23 - 00:15:48:09

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00:15:48:09 - 00:15:51:13

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