David Prater, CFts, had been dispensing diabetic footwear and inserts in
Fulton, Ky., for 8 years when he decided he needed more credibility with his
patients and their physicians.
He became one of a growing number of Kentuckians to become ABC-certified
fitters of therapeutic shoes. But Prater is apparently a rarity among holders
of the CFts credential anywhere.
He is a pharmacist. “A pharmacist who is also a certified fitter
seemed like the way to go for me,” Prater said. “Pharmacy is
considered to be one of the most ethical professions in America. Most people
trust their pharmacists.”
Prater is a staff pharmacist at Evans Drug Co. and at Parkway Regional
Hospital, both in Fulton, an historic old railroad town that shares the state
line with South Fulton, Tenn. He is owner of Evans Total Care LLC, a durable
medical equipment company next door to the drug store.
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| David Prater predicts Medicare will require people who dispense diabetic shoes to be certified. |
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| Image: Craig B, O&P Business News. |
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He founded the DME business in 2002 with his former partner and Evans
Drug Co. owner, David Woolf. “It was an easy spin off from the drug store,
which has been open since around 1905,” Prater said. “David Woolf
suggested we keep the Evans name which gave us instant credibility.”
Prater added that when he started out with Evans Total Care, he
“had no background in shoes and really only a minimal background in
medical equipment. But I knew about diabetes and the importance of footwear in
preventing amputation.”
Searching for certification
Prater had earned expert fitter certificates from some of the companies
whose shoes and inserts he provided his patients. “But I wanted
more.”
So he surfed the internet.
“I found ABCOP. It is the gold standard of the industry — the
Cadillac or Mercedes Benz. The certified fitter-therapeutic shoes credential
seemed right for me.”
He got certified in 2010. “I also thought it was a good idea
because sooner or later, Medicare will probably require people who dispense
diabetic shoes to be certified.”
He said Evans Drug Co. and Evans Total Care offer one-stop shopping for
patients with diabetes. “People can go next door for their meds, and they
can come to us for their diabetic supplies.”
Like many, if not most, certified fitters and pedorthists, Prater says
shoe fitting is both art and science. “You measure their feet, but you
also know your lines. You know what shoes are going to work best with different
types of feet.”
Besides shoes, Prater dispenses heat-moldable, over-the-counter
orthotics.
“As a pharmacist, I know what my scope of practice is and follow
it. I do the same thing as a certified fitter. If somebody comes in needing
custom orthotics, I refer them to a full-blown orthotics and prosthetics
facility. You always want to do what’s best for the patient.”
He said all of his patients are doctor referrals. “But sometimes,
if a person comes in for diabetic supplies, we ask them if they have ever had a
pair of diabetic shoes. We have a great rapport with our local physicians who
can then refer them to us for shoes.”
Prater stresses he does not run a shoe store. “We have a large
selection of sample shoes. People come in, we fit them, and we order the shoes.
We can have the shoes in a couple of days.”
Occasionally, he does sell diabetic footwear to people who just want a
comfortable pair of shoes. “But the retail side of the business is very
small. This is a cash-poor area.”
But Prater said diabetic footwear is not just for people with diabetes.
“I wear the shoes myself. It also gives me good rapport with my patients.
They are glad to see that I am wearing the shoes they might be wanting.”
Prater said he is not a “fashionista.” Yet he said many of his
diabetes patients want shoes that are stylish and not just supportive.
“When I started in the business, some of these shoes were really ugly. But
that’s changed. You get more compliance when the shoes are a quality
product that looks great.”
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Education solution
He said compliance can be a problem. Education, he added, is the
solution. “It depends on the patient. Sometimes I joke with them. Other
times, you have to be blunt. Diabetes is a disease that can cause you to lose
toes or your foot.
“I tell patients that it doesn’t matter how old you are, you
still have life left and you’re going to have a harder time getting around
on a prosthesis. Once they start amputating toes and feet, things start to go
downhill.”
Neuropathy usually precedes amputation. As a result, many people with
diabetes want tightly-fitting shoes so they can feel them. “That of
course, decreases the circulation and makes things worse. So I explain to them
why diabetic shoes are best – how a wider toe box, for example, helps
increase circulation.”
Prater confessed that not all patients heed him. “You get it as a
pharmacist, too. When I try to explain to people about their prescriptions,
they sometimes say ‘My doctor knows best, just count the pills, put them
in the bottle and give them to me.’ They won’t talk to their doctor
that way, but they will to the pharmacist because they just want their
prescription filled so they can be on their way. But I’m big on counseling
whether I am filling prescriptions or fitting shoes.”
Use psychology
Shoe fitting sometimes requires psychology, too, he said, especially
when trying to coax a patient into a larger size shoe.
“Mrs. Smith comes in and says she wears a size 5. You measure her
as an 8½. ‘Oh, no,’ she says, ‘I’m a 5.’ I
won’t order a 5. But I will order a 7½ and an 8½. Then I try
both pairs on her. She says the 7½ is a little tight, but the 8½
feels great. Then I tell her it doesn’t look like she’s got a water
ski on.”
Prater the pharmacist-certified-fitter-psychologist is proud of what he
does. Fulton, population of about 2,800, never had a DME company.
“People here never had the option of getting diabetic shoes in
town. I really enjoy this. I feel like we are doing everything we can to
accommodate our patients.”
