A Call to Action: A Blueprint for Academic Health Sciences in the Era of Mass Incarceration

Over 100 million Americans have criminal records, and the U.S. incarcerates seven times more citizens than most developed countries. The burden of incarceration disproportionately affects people of color and ethnic minorities, and those living in poverty. While 95% of incarcerated people return to society, recidivism rates are high with nearly 75% arrested again within five years of release. Criminal records impede access to employment and other social services such as shelter and health care. Justice-involved people have higher rates of substance, mental health, and some chronic medical disorders than the general population; furthermore, the incarcerated population is rapidly aging. Only a minority of academic health science centers are engaged in health services research, workforce training, or correctional health care. This commentary provides rationale and a blueprint for engagement of academic health science institutions to harness their capabilities to tackle one of the country\u27s most vexing public health crises

IMPACT OF INTERPROFESSIONAL HEALTH FAIRS ON STUDENTS\u27 WILLINGNESS TO WORK TOGETHERON INTERPROFESSIONAL PROJECTS: IMPLICATION FOR FUTURE PRA

Objective. With increasing focus on interprofessional education, there has been an emphasis in health professions education to integrate interprofessional education throughout the curriculum. Interprofessional education is difficult given the many logistical barriers involved in coordinating the learning of several professions together. A ruralbased health fair serving a large diverse population brought together students from nine health professions for a twoday health fair where students worked side by side. The interprofessional health fair is an ideal opportunity to measure the impact of underserved health fairs on students\u27 willingness to work on interprofessional projects and future teams. Background. While the interest in promoting interprofessional is not new there have now been studies instituted by the Institute of Medicine on optimizing health care resources that demonstrate the importance of inteprofessional approach to health care. With widespread patient error becoming costly mistakes for hospital it became clear for the IOM that it was just as important how health care is delivered as what health care is delivered.11 With further studies established by the Agency for Healthcare Research and Quality in 2008 it quickly became clear that interprofessional health care would provide better team work and quality of health care. The passing of Recovery and Reinvestment act of 2009 and Patient Protection and Affordable Care Act of 2010 further emphasized the importance of improved interprofessional teamwork and team based care play for primary care approaches.11 The collaborative efforts of American Association of Medical Colleges, American Association of Colleges of Nursing, American Association of Colleges of Osteopathic Medicine, Association of School of Public Health, American Association of Colleges of Pharmacy, and American Dental Education Association resulted in the development of core competencies for interprofessional collaborative practice. The core competencies are as follows: · Values/ethics for Interprofessional Practice · Roles/Responsibilities · Interprofessional Communication · Teams and teamwork11 Values/Ethics Values of ethics focuses on the emphasizing the talent and appreciating the expertise that is inherent with each profession. The most important aspect is to place the importance of the patient and population at the center of Interprofessional health care delivery. Respect for one another is an important factor in values. Respecting the patient and the health care team is the core thought process for value and ethics core competency. Roles/Responsibilities Understanding ones role in a health care team is crucial in reducing redundancies. With growing health care cost the importance of preventing redundancies from multiple different sources can be achieved by understanding the scope of one\u27s practice. Individualizing each health care team depending on the patients need is best accomplished by understanding limitation, knowledge, and ability of each health care profession. Another important aspect is to continuously engage and provide feedback to each other to enhance team performance. Interprofessional Communication The importance of communicating with patient and other health professional in a responsive and responsible manner that supports a team approach to the maintenance of health and treatment of disease. Emphasizing the right medium for communication and having an open dialogue between health care team and patient is an important part of interprofessionalism. For effective communication having timely, sensitive feedback is important in raising performance and respect for one another. The importance of consistent communication to building a positive interprofessional working relationship is crucial in developing an efficient health professional team. Team and Teamwork Competencies The last competency ties together role and practice and communication by focusing on establishing an effective team. Integration of knowledge and establishing leadership are two major components for teamwork. As a health care team sharing accountability makes the team honest and invested. Elaborating upon the other core competencies the teamwork should be flexible and able to adapt to a variety of roles and settings. In the publishing by the Interprofessional Education Collaborative there are three steps in implementing interprofessional education; exposure, immersion, and competence.11 Exposure focuses on knowledge of each health profession and what their scope of practice is. Without exposure and understanding the second step of immersion cannot occur. With immersion comes skill in handling interprofessionalism. This step comes into play in actual clinical practice where a health professional will learn through practice how to work with and develop a health professional team. As experience levels grows competence is achieved. At this level maintaining a good relationship and continuing to foster good conflict resolution. - While institutions have invested significant effort and resource in designing interprofesional curricula, little attention ha

Identifying opportunities in EHR to improve the quality of antibiotic allergy data.

BACKGROUND: Antimicrobial resistance is a growing, global public health crisis, due in large part to the overuse and misuse of antibiotics. Understanding medication allergy data and allergy reactions that are documented in electronic health records (EHRs) can help to identify opportunities to improve the quality of documentation of beta-lactam allergies, thus potentially reducing the prescribing of alternative antibiotics. METHODS: Medication allergies and allergy reactions recorded in the EHR for 319 051 patients seen across 32 community health centers were reviewed. Patients with a beta-lactam allergy recorded in their EHR were identified. Free text, as well as standardized allergy and allergy reaction fields, were analyzed. RESULTS: Among patients, 9.1% (n = 29 095) had evidence of a beta-lactam allergy recorded in their EHR. Women, white, and non-Hispanic patients were more likely to have a documented allergy compared to men, black, and Hispanic patients. Among all patients with a documented beta-lactam allergy, 36.2% had an empty or missing allergy reaction description in their EHR. CONCLUSIONS: Findings suggest that current EHR documentation practices among the health centers reviewed do not provide enough information on allergic reactions to allow providers to discern between true allergies and common, but anticipated, drug side effects. Improved EHR documentation guidance, training that reinforces the use of standardized data and more detailed recording of allergic reactions, combined with initiatives to address patient barriers including health literacy, may help to improve the accuracy of drug allergies in patients\u27 records. These initiatives, combined with antimicrobial stewardship programs, can help to reduce inappropriate prescribing of alternative antibiotics when beta-lactam antibiotics are first-line and can be tolerated