Pharmacy Check-in: Meet Susie Jin
Susie Jin, RPh, CDE, CRE (she/her)
Susie Jin is a community pharmacist, Certified Diabetes Educator, Certified Fitter of Compression Therapy and Certified Respiratory Educator. She serves on several Diabetes Canada committees, including as a chapter author and member of the Dissemination and Implementation Committee of Diabetes Canada Clinical Practice Guidelines, Editorial Board volunteer for the Diabetes Communicator and Professional Conference Co-Chair. Other national and provincial contributions include Wounds Canada board member, co-author of Wounds Canada Best Practice Recommendations and member of the Ontario Immunization Advisory Committee.
Susie takes great pleasure in collaborating with colleagues and people in her care as evidenced by the prestigious national awards awarded to her: She is the 2020 Charles H. Best Award recipient, given to a health-care professional who has made a significant difference across Canada towards improving the quality of life of individuals living with diabetes; and the 2021 Diabetes Canada Educator of the Year.
Q&A with Susie
We caught up with Susie ahead of Diabetes Awareness Month to chat about pharmacists' role in diabetes care.
What is the #1 thing pharmacists can do to help people affected by diabetes?
It’s hard to choose just one thing because I think there’s such a vast opportunity for pharmacists to improve clinical outcomes of people affected by diabetes: from recognizing people who are at risk of diabetes and supporting early prevention, to facilitating care of people living with diabetes and therein reducing their risk of diabetes complications, to helping people balance “living” with everything else that may be happening in their lives beyond diabetes. But, if I had to choose the #1 thing that we can do to support people in their diabetes management, it would be to advocate for people affected by diabetes. Advocating involves listening to people and understanding what they need to support them in improving their own health outcomes. It involves shared decision-making and supporting self-management so that people can make their own informed choice, while increasing access to equitable care.
Why is it important for pharmacists to be involved? What role can pharmacists play in supporting individuals with diabetes?
Sadly, the reason why it’s so important for pharmacists to be involved is because there is such a high NEED. People affected by diabetes NEED (and deserve) better care and the health-care system itself needs care. During my over twenty-five years of practice, I have worked in a variety of health-care settings including at the local hospital Diabetes Education Program, at the local Community Health Centre Diabetes Education Program, in family physician offices and at my community pharmacy. What I noticed is that despite providing the same level of care in each of these settings, when I met with people in my community pharmacy, they generally appeared highly motivated to learn from me. In other words, people were often in a more “readied” state of change (i.e., rather than pre-contemplative or contemplative, people tended to be in preparation or action), which made the time that I spent with them very effective in facilitating improved health outcomes. I believe this is because the inherent nature of the relationship between a community pharmacist and an individual involves the individual having the choice of community pharmacist. This right to choose empowers the individual, and perhaps this sense of empowerment confers autonomy and a more determined level of individual engagement in their own self-care. It is my experience that the time that I invest in supporting a person’s self-care through interactions at a community pharmacy is very effective.
Can you describe a situation that makes you particularly proud of what you do?
Similar to all of my pharmacy colleagues, I have been blessed to support people in my community and have made a significant impact in improving health outcomes, generally supporting care through an established a management plan. However, a few situations that have made me feel particularly proud involved my support of people improving their health outcomes through the use of one image, “Targets for Glycemic Control” on page 2 of the Diabetes Canada Quick Reference Guide. In each of these particular situations, the person was an older adult with a mild degree of frailty with an A1C that had been stable at about 7.8%. According to this table, with frailty involved, an A1C of 7.8% would be considered quite acceptable. However, this same table also tells us that if we can keep the person’s risk of hypoglycemia low (or nonexistent), then an A1C of less than or equal to 6.5% could further reduce the risk of chronic kidney disease, a comorbidity which is quite common in the older adult. In these situations, I took it upon myself to engage the older adult and/or caregiver in informed shared decision-making. I let them know of the possibility of reducing their risk of progression of kidney disease (which could lead to renal dialysis, increased frailty, and even death), as well as other diabetes complications, through improved glycemic target achievement, while keeping the risk of hypoglycemia low, and cardiorenal medications. This situation made me particularly proud because rather than going with the flow of supporting an existing medical plan, I engaged the older adult and set a management plan to keep the person safe while improving their clinical outcomes. Then I collaborated with the person’s diabetes health-care team to implement and follow-up the care plan.
How did you grow your practice?
I found that when I communicated effectively (i.e., sent faxes) with all members of the person’s diabetes health-care team, the other providers appreciated my efforts and confidence in my care and word-of-mouth grew. The fax had to be concise (maximum of 1 or 2 pages). Where I was simply providing a summary of my interaction, I would write at the top of the fax “FYI only, No action required”; whereas if I required their input, on the fax I would circle the word “Request” with a clear sentence of my recommendation. I would also ask the person “who is on [their] diabetes health-care team, for example, “When last did you last meet with the Diabetes Education Program and/or any specialists,” and, with the person’s permission, I would send the fax to all affected and active diabetes health-care team members. I would then scan the document into the person’s profile at my pharmacy, and not needing the original anymore, I would give the original to the person for their files to engage them in their own care and hold them responsible for ensuring follow up.
Any words of advice for a pharmacist interested in building their diabetes care practice?
Two things: First, Over my twenty-five plus years in the practice of pharmacy and actively supporting people with diabetes, I think the best advice I can give to my colleagues is to make sure you don’t waste your time trying to help someone the way you think they should be helped. Rather, make sure your actions align with the person’s health-care wishes and needs.
And second, in order for you to be able to provide the care you want, you need to have an efficient and organized practice. Build your pharmacy team. Your dispensary staff can explain to people how the pharmacist can help them and book appointments for people to meet with the pharmacist at specific times, for example, when you have overlapping staff; and pharmacy technicians can help with demonstrating devices like how to start a glucose sensor and how to do a subcutaneous injection with an injection pen.
If a pharmacist reading this were to be inspired to increase diabetes care in their practice, can you give one practical idea as to how to get started?
Start by running a report to determine which individuals in your care have had prescriptions filled for a sulfonylurea (like gliclazide or glyburide) and/or a DPP-4i (like linagliptin, saxagliptin, or sitagliptin) in the past three months. Have a dispensary staff call them to let them know that, “We continue to learn more about the management of diabetes. We have identified that there may be better ways to manage your diabetes than the medications you are currently taking. Would you like me to book you an appointment to meet with the pharmacist who can review your medications, your recent bloodwork and your overall diabetes care?” Then, during the appointment, assess the person’s healthcare goals, determine if the person would benefit from stopping the sulfonylurea and/or DPP-4i and replacing it with a GLP-1 RA and/or SGLT2i, supported by health behaviours, which would confer cardiorenal protection in certain populations, support glycemic target achievement and weight loss/management. With the person’s permission, send a fax to the person’s health-care team detailing your recommendation; and be sure to provide follow-up care. In applying this care in your practice, beyond improving clinical outcomes for people affected by diabetes, pharmacists would be realizing cost-savings to the health-care system through supporting health behaviours, reducing hypoglycemia and choosing medications that support weight loss support in addition to having blood glucose lowering effects.
Any final words?
Don’t be afraid to care and to get involved. Learn and improve your ability to provide care through actually caring for people. Each time I did something new, like when I did my first insulin start, I told the person… “This is my first time, are you ok to have me help you? Or I could refer you to a diabetes clinic.” I was grateful for their trust and it was so meaningful that a person would share their life with me and we could learn from each other and grow together.
PLEASE NOTE: This information is provided for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. Please speak with a trusted health-care provider if you have questions or concerns.