Expanding access to diabetes self-management and education programs through community pharmacy referrals: A statewide implementation evaluation

Background: Diabetes self-management education and support (DSMES) improves glycemic control but remains underutilized, particularly among underserved populations. Community pharmacy professionals offer highly accessible settings to identify and refer high-risk patients who may not be reached through traditional care pathways. Objectives: To evaluate the implementation of a statewide community pharmacy-based DSMES referral program, specifically assessing program reach, effectiveness (attendance), and implementation feasibility using the RE-AIM framework. Methods: This retrospective implementation evaluation was conducted across 19 New York pharmacies (Community Pharmacy Enhanced Services Network-New York) from May to July 2021. Adults with type 2 diabetes were screened using prescription records, health information exchange (HIE) data, and point-of-care (POC) hemoglobin A1c (A1c) testing. Standardized workflows followed ADA/ADCES guidelines to categorize referral urgency. Primary outcomes included program reach (patient demographics), 3-month DSMES attendance, and implementation feasibility (staff perceptions and workflow adherence). Results: Of 390 patients screened, 347 (89.0%) had documented A1c values, which were utilized to determine referral urgency. The analytic sample had a mean age of 61.1 years; 45.8% identified as White, 20.7% as Black, and 17.6% as Hispanic; 70.9% were publicly insured. Patients were primarily identified via prescription records (73%); A1c data were obtained via POC (50%) or HIE (17%). Pharmacists made strong/moderate referrals for 70% of patients. Among 161 patients with 3-month follow-up, 11% attended DSMES. Barriers included patient refusal (30%), scheduling (21%), and transportation (12%). Most community pharmacy professionals (94%) reported sufficient screening time, and 91% found HIE access helpful. Conclusion: Community pharmacy professionals effectively identify and refer high-risk, diverse populations to DSMES. While identification is feasible, improving attendance requires addressing patient-level barriers through supportive policy, reimbursement mechanisms, and deeper health system integration.