An Academic-Community Collaboration to Deliver Medication Therapy Management (MTM) Services to Patients Living in Rural Counties of a Southwestern State in the United States.

BACKGROUND: Patients living in rural communities often experience pronounced health disparities, have a higher prevalence of diabetes and hypertension, and poorer access to care compared to urban areas. To address these unmet healthcare service needs, an established, academic-based MTM provider created a novel, collaborative program to provide comprehensive, telephonic services to patients living in rural Arizona counties. OBJECTIVE: This study assessed the program effectiveness and described differences in health process and outcome measures (e.g., clinical outcomes, gaps in care for prescribed medications, medication-related problems) between individuals residing in different rural-urban commuting area (RUCA) groups (urban, micropolitan, and small town) in rural Arizona counties. METHODS: Subjects eligible for inclusion were 18 years or older with diabetes and/or hypertension, living in rural Arizona counties. Data were collected on: demographic characteristics, medical conditions, clinical values, gaps in care, medication-related problems (MRPs), and health promotion guidance. Subjects were analyzed using 3 intra-county RUCA levels (i.e., urban, micropolitan, and small town). RESULTS: A total of 384 patients were included from: urban (36.7%), micropolitan (19.3%) and small town (44.0%) areas. Positive trends were observed for clinical values, gaps in care, and MRPs between initial and follow-up consultations. Urban dwellers had significantly lower average SBP values at follow-up than those from small towns (p < 0.05). A total of 192 MRPs were identified; 75.0% were resolved immediately or referred to providers and 16.7% were accepted by prescribers. CONCLUSION: This academic-community partnership highlights the benefits of innovative collaborative programs, such as this, for individuals living in underserved, rural areas.

Considerations for the Care of Transgender Individuals.

Transgender individuals are at an increased risk of experiencing health inequalities, such as anxiety, depression, and HIV. It is important that providers and staff in the health care setting are prepared to care for this population to ensure best patient outcomes. An understanding of transgender terminology and the experience of gender dysphoria is key. In addition, a transinclusive environment should be created to reduce the likelihood of transgender-related discrimination. Developing an understanding of potential gender-affirming treatments and surgeries also optimizes patient care. Improving the quality care will reduce health disparities commonly faced by the transgender population.

Bridging the Gap of Mental Health Inequalities in the Transgender Population: The Role of Nursing Education.

The transgender population experience mental health disparities as a result of numerous environmental, sociocultural and personal factors. Health care-related discrimination plays an unfortunate role in these disparities. The institutional and informational erasure of transgender individuals in health care actively contributes to this discrimination. The lack of preparation of health care professionals to care for this population is a significant factor. There is an absence of education on transgender topics in nursing school and a lack of nursing research on this population. An awareness through education of culturally competent transgender terminology is crucial to ensure a transinclusive environment is created. The creation of a transinclusive environment in the mental health care setting will ultimately lead to improved patient outcomes.

An Overview of Munchausen Syndrome and Munchausen Syndrome by Proxy.

Munchausen syndrome and Munchausen syndrome by proxy are complex diseases that are difficult to diagnose and treat. To assist in this process, an overview of diagnostic criteria with common characteristics and red flags are discussed, with case studies illustrating identification and diagnosis of these disorders. Treatment options are addressed within the context of each of these complex syndromes. The provider's knowledge of diagnostic criteria and treatment options for Munchausen syndrome and Munchausen syndrome by proxy promotes better outcomes for patients. Without an early diagnosis and intervention, the patient is at high risk for severe complications, including organ failure and mortality.