Effect of the Pharmacist-managed Cardiovascular Risk Reduction Services (CVRRS) on the Diabetic Retinopathy Outcome Measures

poster abstractIndianapolis Diabetes mellitus is affecting many people throughout the world. Diabetic retinopathy (DR) is a long-term complication of diabetes associated with impaired vision. If left untreated DR may eventually lead to blindness. DR is caused by a damage to the small blood vessels in the retina. According to the American Academy of Ophthalmology, 5-10 % of the diabetic patients with normal retinal exams will develop DR within a year of their last retinal exam. The diabetic individuals who currently have DR are similarly susceptible to developing more severe retinopathy. Unfortunately many individuals with diabetes fail to receive education about maintaining glycemic control, medication management and recommended frequency of tests to monitor diabetic complications such as DR. Several studies have shown that the disease management services are effective in improving the quality of care for persons with diabetes. An increasing number of disease management programs utilize pharmacists to assist in the disease management of diabetic individuals. For this clinical study we evaluated the effect of pharmacistmanaged CVRRs on the development of DR in over 100 diabetic individuals. The patient records were assessed for demographics (e.g. age, sex etc.), metabolic parameters (lipid profile, HbA1c) along with number of pharmacist appointments and ophthalmology records. We observed that 95% of the patients who have had pharmacist intervention have been able to keep their retinopathy from getting worse or have improved it. Our studies suggest that there is a correlation supporting the theory that pharmacist intervention helps manage or reduce the severity of DR. Further studies can be conducted in the area to find potential ways to help decrease the severity of DR in patients with diabetes and maybe even prevent diabetic patients from developing DR

Effect of the Pharmacist-managed Cardiovascular Risk Reduction Services (CVRRS) on the Diabetic Retinopathy Outcome Measures

poster abstractIndianapolis Diabetes mellitus is affecting many people throughout the world. Diabetic retinopathy (DR) is a long-term complication of diabetes associated with impaired vision. If left untreated DR may eventually lead to blindness. DR is caused by a damage to the small blood vessels in the retina. According to the American Academy of Ophthalmology, 5-10 % of the diabetic patients with normal retinal exams will develop DR within a year of their last retinal exam. The diabetic individuals who currently have DR are similarly susceptible to developing more severe retinopathy. Unfortunately many individuals with diabetes fail to receive education about maintaining glycemic control, medication management and recommended frequency of tests to monitor diabetic complications such as DR. Several studies have shown that the disease management services are effective in improving the quality of care for persons with diabetes. An increasing number of disease management programs utilize pharmacists to assist in the disease management of diabetic individuals. For this clinical study we evaluated the effect of pharmacistmanaged CVRRs on the development of DR in over 100 diabetic individuals. The patient records were assessed for demographics (e.g. age, sex etc.), metabolic parameters (lipid profile, HbA1c) along with number of pharmacist appointments and ophthalmology records. We observed that 95% of the patients who have had pharmacist intervention have been able to keep their retinopathy from getting worse or have improved it. Our studies suggest that there is a correlation supporting the theory that pharmacist intervention helps manage or reduce the severity of DR. Further studies can be conducted in the area to find potential ways to help decrease the severity of DR in patients with diabetes and maybe even prevent diabetic patients from developing DR

Survey of Pharmacist-Managed Primary Care Clinics Using Healthcare Failure Mode and Effect Analysis (HFMEA)

Objectives: The primary objective was to expand upon results of a previously piloted patient perception survey with Healthcare Failure Mode and Effect Analysis (HFMEA), to identify areas within pharmacist-managed clinics needing improvement.Methods: The survey was adapted for use in pharmacist-managed clinics. Patients completed the survey following regularly scheduled pharmacist appointments.  Data were analyzed with a method adapted from HFMEA.  Product scores could range from five to 25. A product of five indicates that pharmacists are doing a good job on the items that patients place the most value on, while a product score of 25 indicates that pharmacists are doing a poor job.  A score greater than or equal to ten was used to identify areas for improvement. Results: Seventy-one patients completed surveys. Thirteen components were assessed and no item achieved a mean product greater than or equal to ten. The survey item with the highest mean product pertained to discussion of potential medication side effects (mean: 7.06; interquartile range: 5-10). Analysis of each survey item found that all survey items had multiple individual responses that provided a product score of greater than or equal to ten. The survey items most frequently listed in the overall population as being most valued were “Told you the name of each of your medicines and what they are used for”, “Answered your questions fully,” and “Explained what your medicines do”.Conclusions: Educational components provided during pharmacist-managed clinic appointments are aligned with patients’ needs and are successfully incorporating the components that patients value highly in a patient-healthcare provider interaction. The HFMEA model can be an important teaching tool to identify specific processes in need of improvement and to help enhance pharmacists’ self-efficacy, which may further improve patient care

Indiana community health workers: challenges and opportunities for workforce development

Background: An interest in, and the need for, Community Health Workers (CHWs) in the United States is growing exponentially. CHWs possess a unique ability to relate to and build trust with communities in order to improve clinical outcomes, while building individual and community capacity. Given their critical role in addressing social determinants of health, expanding the CHW workforce is crucial. However, creating CHW jobs, facilitating training and certification, and establishing sustainable financing models to support this workforce has been challenging. Methods: A mixed-methods study consisting of an online survey and focus group discussions assessed the strengths, practices, and challenges to CHW workforce sustainability and expansion in the state of Indiana, including perspectives from both CHWs and employers. Results: Across 8 topics, mixed data analysis revealed 28 findings that were both complementary and unique across focus group and survey results. Results highlighted CHW skills and attributes, illustrated the recruitment and hiring process, and provided insight into measuring outcomes and outputs. Findings also indicated a need to build position validation, professional development, and billing and reimbursement capacity. Conclusion: Building and sustaining the CHW workforce will require creating an evidence base of roles and impact, increasing awareness of existing reimbursement mechanisms, and sharing best practices across employer organizations to promote optimal recruitment, training, supervision, career development, and funding strategies

Assessment of Clinical Inertia in People with Diabetes Within Primary Care

Rationale, aims and objectives Clinical inertia, defined as a delay in treatment intensification, is prevalent in people with diabetes. Treatment intensification rates are as low as 37.1% in people with haemoglobin A1c (HbA1c) values \u3e7%. Intensification by addition of medication therapy may take 1.6 to more than 7 years. Clinical inertia increases the risk of cardiovascular events. The primary objective was to evaluate rates of clinical inertia in people whose diabetes is managed by both pharmacists and primary care providers (PCPs). Secondary objectives included characterizing types of treatment intensification, HbA1c reduction, and time between treatment intensifications. Method Retrospective chart review of persons with diabetes managed by pharmacists at an academic, safety‐net institution. Eligible subjects were referred to a pharmacist‐managed cardiovascular risk reduction clinic while continuing to see their PCP between October 1, 2016 and June 30, 2018. All progress notes were evaluated for treatment intensification, HbA1c value, and type of medication intensification. Results Three hundred sixty‐three eligible patients were identified; baseline HbA1c 9.6% (7.9, 11.6) (median interquartile range [IQR]). One thousand one hundred ninety‐two pharmacist and 1739 PCP visits were included in data analysis. Therapy was intensified at 60.5% (n = 721) pharmacist visits and 39.3% (n = 684) PCP visits (P \u3c .001). The median (IQR) time between interventions was 49 (28, 92) days for pharmacists and 105 (38, 182) days for PCPs (P \u3c .001). Pharmacists more frequently intensified treatment with glucagon‐like peptide‐1 agonists and sodium glucose cotransporter‐2 inhibitors. Conclusion Pharmacist involvement in diabetes management may reduce the clinical inertia patients may otherwise experience in the primary care setting

Patient perceptions of pharmacist-managed clinics: a qualitative analysis

Background: Pharmacist-managed clinics have consistently demonstrated improvement in patient outcomes. Quantitative research offers the benefit of objective outcomes to track progress toward therapeutic goals at pharmacist-managed clinics. While quantitative studies are readily available in the literature, there is a paucity of qualitative studies to capture the patients\u27 perspectives of pharmacy services. Objective: To assess through the use of qualitative research methods patient perceptions of pharmacist-managed services within ambulatory care clinics that operate under a collaborative practice agreement. Methods: A semi-structured interview questionnaire was developed, pilot tested, and revised using a focus group of clinical pharmacists. The questionnaire was used to conduct face-to-face patient interviews at 6 pharmacist-managed clinics in central Indiana. English-speaking patients with a minimum of 2 visits with the clinical pharmacist were included in this study. Pharmacist-managed clinics without established collaborative practice agreements were excluded. Patient interviews were conducted by a trained research assistant, audio-recorded, and transcribed verbatim. The interview transcripts were analyzed to identify cross-cutting themes without predetermined definitions via inductive qualitative analysis. Four study investigators independently identified themes using a sample of the transcripts. Additional themes were identified and defined in a series of independent reviews and investigator meetings using the remaining transcripts until theme saturation. All themes were assigned to segments of the interview transcripts according to the consensus definitions. Results: A total of 30 interviews were conducted across the clinics. Ten themes from the interview transcripts emerged, including disease state management expertise, patient alliance, practice novelty, accessibility, increased sense of patient well-being, and compassion. Conclusions: Patient perceptions from qualitative interviews revealed that pharmacists are viewed as medication experts who provide patient-centered care. This study highlights unique in-depth perspectives from the patient that further support maintenance and expansion of pharmacist-managed services

Changes in clinical markers observed from pharmacist-managed cardiovascular risk reduction clinics in federally qualified health centers: A retrospective cohort study

Background Reductions in hemoglobin A1c (HbA1C) have been associated with improved cardiovascular outcomes and savings in medical expenditures. One public health approach has involved pharmacists within primary care settings. The objective was to assess change in HbA1C from baseline after 3–5 months of follow up in pharmacist-managed cardiovascular risk reduction (CVRR) clinics. Methods This retrospective cohort chart review occurred in eight pharmacist-managed CVRR federally qualified health clinics (FQHC) in Indiana, United States. Data were collected from patients seen by a CVRR pharmacist within the timeframe of January 1, 2015 through February 28, 2020. Data collected include: demographic characteristics and clinical markers between baseline and follow-up. HbA1C from baseline after 3 to 5 months was assessed with pared t-tests analysis. Other clinical variables were assessed and additional analysis were performed at 6–8 months. Additional results are reported between 9 months and 36 months of follow up. Results The primary outcome evaluation included 445 patients. Over 36 months of evaluation, 3,803 encounters were described. Compared to baseline, HbA1C was reduced by 1.6% (95%CI -1.8, -1.4, pConclusions Our study augments the existing literature by demonstrating the health improvement of pharmacist-managed CVRR clinics. The great proportion of loss to follow-up is a limitation of this study to be considered. Additional studies exploring the expansion of similar models may amplify the public health impact of pharmacist-managed CVRR services in primary care sites

Pharmacist-Led Implementation of Brief Tobacco Cessation Interventions during Mobile Health Access Events

To address gaps in care for individuals from under-resourced communities disproportionately affected by tobacco use, this pharmacist-led demonstration project evaluated the feasibility of implementing tobacco use screening and brief cessation interventions during mobile health access events. A brief tobacco use survey was administered verbally during events at two food pantries and one homeless shelter in Indiana to assess the interest and potential demand for tobacco cessation assistance. Individuals currently using tobacco were advised to quit, assessed for their readiness to quit, and, if interested, offered a tobacco quitline card. Data were logged prospectively, analyzed using descriptive statistics, and group differences were assessed by site type (pantry versus shelter). Across 11 events (7 at food pantries and 4 at the homeless shelter), 639 individuals were assessed for tobacco use (n = 552 at food pantries; n = 87 at the homeless shelter). Among these, 189 self-reported current use (29.6%); 23.7% at food pantries, and 66.7% at the homeless shelter (p < 0.0001). About half indicated readiness to quit within 2 months; of these, 9 out of 10 accepted a tobacco quitline card. The results suggest that pharmacist-led health events at sites serving populations that are under-resourced afford unique opportunities to interface with and provide brief interventions for people who use tobacco