“We Knew No One Else Had Our Back except Us”: Recommendations for Creating an Accountability Care Framework with Sex Workers in Eastern Canada

The authors report findings from a 15-month project that focused on the experiences of sex workers who live and work in an Eastern Canadian province. As part of a larger multi-phased study, 15 adults who identified as women, transgender, or non-binary, and received money or goods for sexual services, participated in photo-elicitation interviews. Drawing on a critical framing analysis, findings indicated supports—as identified and experienced by sex workers—encompassed three categories of care: self, community, and collective. These categories are described, with a particular focus on the latter two. Continuing with the care-based framework, recommendations to structure interventions draw on the role of accountability care in identifying how best to operationalize policies that promote health, well-being, and dignity of Canadian sex workers. The paper begins with a brief overview of the Canadian context and the role of supports. It follows with a discussion on the materials and methods and the results. It concludes with recommendations, limitations, and future considerations.

Implementation of a self-measured blood pressure program in a community pharmacy: A pilot study.

BACKGROUND: Hypertension is a leading cause of cardiovascular disease in the United States and is costing the health care system billions of dollars annually. A health program that combines education, empowerment, and monitoring has shown to improve clinical outcomes and decrease overall health care costs. OBJECTIVE: To describe the implementation and effectiveness of a self-measured blood pressure (SMBP) program in a community pharmacy. PRACTICE DESCRIPTION: An independent community pharmacy located within rural Southeast Missouri. On-site community pharmacists provide medication therapy management, adherence monitoring, immunizations, and reimbursed clinical services. PRACTICE INNOVATION: Patients were eligible if they were older than 18 years of age and fell into one of the following categories: self-reported a new hypertension diagnosis, self-reported a desire to SMBP, were referred by a provider, or had a medication change within the 3 months before enrollment. The program consisted of 4 patient sessions. The first session obtained an initial blood pressure and provided patient education and behavior counseling. Follow-up sessions obtained average SMBP readings and reinforced previously learned concepts. EVALUATION METHODS: Implementation was evaluated using time and patient satisfaction. Effectiveness was evaluated using number and type of clinical problems identified, BP measurements, and test scores. RESULTS: A total of 20 patients enrolled and completed the study. The program took 63 minutes (SD ± 18) of staff time per patient for recruitment, sessions, reminder calls, and documentation. All patients received education and monitoring and 11 additional clinical problems were documented. Systolic BP decreased an average of 17 mm Hg (P = 0.002), and diastolic BP decreased an average of 12 mm Hg (P < 0.001). Patient confidence scores increased by 14%, and 7 more patients correctly answered the post-test knowledge question. All patients reported overall satisfaction with the program as "satisfied" or "very satisfied." CONCLUSION: This standardized SMBP program effectively improved hypertension control and patient confidence in managing BP.