Findings from a new action research study suggest that virtual reality (VR) technology can be an effective training tool that enables community pharmacists to provide continuous glucose monitoring (CGM) primary care services for patients with diabetes. The research, which used qualitative dominant action research methodology, employed semi-structured interviews, observations, and surveys to reveal that community pharmacists could benefit from scalable and accessible CGM professional development.
Diabetes is a complex, chronic disease affecting approximately 30 million diagnosed Americans and costing $412.9 billion annually in health care expenses.1 The prevalence of diabetes is growing rapidly, with 1.2 million Americans newly diagnosed each year.2Community pharmacists are uniquely positioned to help manage diabetes, as patients may visit their local pharmacy around 35 times per year compared to only a few visits to their primary care doctor.3
The American Diabetes Association updated its 2025 standards of care recommendations to include CGM usage for all patients with diabetes.4 Pharmacists also advocate for CGM use and desire to help patients as capable practitioners who can improve patient outcomes. CGM devices, combined with pharmacist interventions, have been shown to reduce hemoglobin A1c (HbA1c) levels in patients with diabetes.5HbA1c reflects the 90-day average of blood glucose levels.6 Community pharmacists can be valuable assets to diabetes patients,7 but require effective training to fulfill this role.
Purpose
The purpose of this action research study was to investigate the evolving role community pharmacists play in providing CGM services for patients with diabetes. CGM devices offer critical benefits that help people with diabetes avoid life-threatening complications.8 Community pharmacists are uniquely positioned to assist with diabetes management.3 The following research questions were used to guide this study:
- Cycle 1 Primary Research Question: What role do community pharmacists play in helping patients with diabetes use CGM devices?
- Cycle 2 Research Question: How can virtual reality become a viable training method that could be adopted by community pharmacy to drive CGM education and provide pharmacists with the confidence needed to enact primary care services for CGM?
Methods
The inclusion criteria for participants were community pharmacists currently working in a retail pharmacy setting. The 16 cycle 1 interview participants were invited to join the study through multiple channels, such as the Idaho Board of Pharmacy. Cycle 2 participation, which included 7 pharmacists who experienced the VR training, was fostered by Massachusetts pharmacists Ashly McPhillips, PharmD, RPh, and Trisha Winroth, PharmD, RPh, at CVS and Walgreens, respectively, who were instrumental during this phase of the research. Snowball sampling was used purposely to recruit 54 total survey participants who were active community pharmacists.
Interviews were recorded using Zoom and lasted approximately 30 minutes. Surveys were designed and distributed via email to participants using the Qualtrics software. In cycle 2, the researcher administered a presurvey to participants prior to a 10-minute training simulation using VR software designed and developed in collaboration with SimInsights, an award-winning VR company in California. A postsurvey was offered, which posed the same questions, 2 weeks after pharmacists experienced the training (see Figure 1).
Figure 1. Pre-Post Survey Results
Results
The cycle 1 findings indicated that community pharmacists need accessible and scalable professional development for CGM to empower them to provide better support to patients with diabetes. Although most interview participants preferred live education, the study revealed that the metric-driven pharmacy environment is not conducive to traditional training methods, such as visits from manufacturer representatives. A participant stated, “If a [representative] ever came into my store, they would be denied right away because the chain does not want [representatives].” Survey results indicate that fewer than one-third of pharmacists want to see a representative due to the time constraints they face.
The cycle 1 research also indicated that pharmacy chains are not providing the formal CGM training that pharmacists need, underscoring the demand for a new, scalable, and accessible professional development solution. When asked about formal CGM training, several participants mentioned that their employers had not provided any. “My company does not provide anything to really support me as I try to help these patients,” a participant stated. In cycle 1 surveys, approximately 60% of respondents confirmed that they need more education on CGM.Research indicates that community pharmacist-driven CGM initiatives may improve diabetes care significantly, but that more CGM education is needed for pharmacists.9
The main objective of the cycle 2 action step was to introduce an innovative concept: using VR technology to bridge training gaps in CGM education for community pharmacists. The FreeStyle Libre 3 CGM device was chosen as the product for use in the training simulation because it is a common CGM product dispensed at pharmacies. The use of VR has been proven to increase confidence by 275% using applied learning as well as decreasing distractions.10Patient simulation in pharmacy education has proven to be an effective educational tool that can bridge the gap between theory and practice.11 The goal was to pioneer the innovative concept during live sessions in community pharmacy locations to enable participants to experience the modality and provide objective feedback (see Figure 2).
Figure 2. Pharmacists Experiencing the VR Training on CGM Usage.
These are photographs of 5 of the 7 participants during the VR training simulation. The participants gave permission to be photographed for this research project. Participants included Nina Ahmadi Lashkendari, PharmD, RPh (bottom left), and Pui Yee Chan, PharmD, RPh (top left).
Finding 1: VR Training Increases CGM Primary Care
One outcome of this study was that pharmacists were truly empowered to engage in primary care services after experiencing the training intervention using VR as a modality for CGM. Figure 1 shows the results from the pre-post survey that was administered to measure the efficacy of the training. Prior to the training, participants lacked confidence in their ability to counsel patients on the glucose reporting functions of the device, and they were unlikely to provide CGM primary care services for patients with diabetes. Additionally, pre-intervention, pharmacists were not even sure of what was in the device’s box. However, after experiencing the fully simulated VR training, participants reported statistically significant increases in product knowledge, application, data reporting, confidence, and likelihood of providing CGM primary care services to patients.
One participant stated that pharmacists are more likely to provide primary care services to patients for CGM once that they have experienced the VR training, saying, “Yes, I’d be more likely to proactively seek out a patient who I know is picking up either the sensors or the reader for the first time and address them proactively to answer any questions they might have or show them the product versus letting them pick it up and take it home without any explanation. I feel like it increased our confidence level with the product.” Another participant asserted, “I definitely feel more comfortable providing primary care services.”
Finding 2: Pharmacists Believe VR is an Effective Learning Tool
This research found that pharmacists believe VR to be an effective modality for CGM training. The training that was delivered taught pharmacists vital knowledge about the device that is needed to counsel patients. “We have the opportunity to make a larger impact during our consultation with them if we have something like this [VR training].” Participants were trained in the VR simulation on key topics such as the device components, sensor application, the iPhone app, and the glucose data reports that are critical to understand. These CGM topics are vital to a pharmacist’s knowledge and directly affect their abilities to counsel patients effectively.
This study also found that pharmacists do not know what is inside the box, as they do not get a chance to open the CGM devices. “We can’t open the packages in the store, so rarely are we handling it. I have no personal experience with it,” one participant said. The VR simulation was effective because it allowed the participants to simulate opening the reader and sensor boxes. “Because I’ve been able to at least virtually see and touch it, I’ll be more confident,” another participant stated.
Finding 3: Implementation of VR Must be Well Planned
Another relevant finding was that pharmacists are not familiar with VR, and the participants in the study had never used the technology before. Most participants made similar comments, such as, “It was my first time actually using virtual reality. I heard about the device, but I’ve never actually used it.” From putting the headset on properly to holding the hand paddles correctly, there are some things that are intuitive and some that may not be so easy to figure out without clear instructions. There should be a plan in place to deliver the training seamlessly.
Conclusions
The VR training intervention has been proven to increase CGM awareness and competence levels of pharmacists in understanding a CGM device, its components, application process, and critical glucose data reports. Further, results showed statistical significance was achieved in confidence counseling patients and likelihood of providing CGM primary care services to diabetes patients. The literature supports the finding that VR technology has the power and accessibility to become the standard in pharmacy education.12 When it comes to teaching pharmacists—which is the underpinning of this action research study—researchers Al-Worafi et al. tell us, “The use of patient simulation in pharmacy education has been growing in popularity in recent years, and it has become an essential tool in training the next generation of pharmacists.”11
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Foto: Gorodenkoff – stock.adobe.com