The Mississippi Delta Health Collaborative Medication Therapy Management Model: Public Health and Pharmacy Working Together to Improve Population Health in the Mississippi Delta.

INTRODUCTION: The Mississippi Delta has high rates of chronic disease and is known for its poor health outcomes and health disparities. The University of Mississippi School of Pharmacy (UMSOP) and the Mississippi State Department of Health partnered in 2009 through the Mississippi Delta Health Collaborative to reduce health disparities and improve clinical outcomes by expanding the UMSOP's evidence-based medication therapy management (MTM) initiative, focused in Mississippi's 18-county Delta region, to federally qualified health centers (FQHCs) in 4 of those counties. METHODS: Between January 2009 and August 2018, the MTM initiative targeted FQHC patients aged 18 years or older with a diagnosis of diabetes, hypertension, and/or dyslipidemia. Pharmacists initially met face-to-face with patients to review all medications, provide education about chronic diseases, identify and resolve drug therapy problems, and take appropriate actions to help improve the effectiveness of medication therapies. Clinical parameters evaluated were systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, and hemoglobin A1c (HbA1c). RESULTS: The analysis included 335 patients with hypertension (n = 287), dyslipidemia (n = 131), and/or diabetes (n = 331). Significant mean reductions occurred in the following metrics: SBP (7.1 mm Hg), DBP (6.3 mm Hg), LDL cholesterol (24.9 mg/dL), triglycerides (45.5 mg/dL), total cholesterol (37.7 mg/dL), and HbA1c (1.6% [baseline ≥6%] and 1.9% [baseline ≥9%]). CONCLUSION: Despite the cultural and environmental disadvantages present in the Mississippi Delta, the integrated MTM treatment program demonstrated significant health improvements across 3 chronic diseases: hypertension, dyslipidemia, and diabetes. This model demonstrates that a partnership between public health and pharmacy is a successful and innovative approach to care.

Pharmacist linkage in care transitions: From academic medical center to community.

OBJECTIVES: To improve the care of patients discharged from the University of Mississippi Medical Center (UMMC) after treatment for acute myocardial infarction, heart failure, pneumonia, and chronic obstructive pulmonary disease; reduce preventable hospital readmissions; and inform future care transition collaborations between hospital teams and community pharmacies. SETTING: Study was conducted at UMMC, UMMC outpatient pharmacies, and targeted community pharmacies. PRACTICE DESCRIPTION: UMMC is the state's only academic health science center, providing all levels of care. Participants were at UMMC's 722-bed hospital in Jackson, MS. Participating pharmacies included 2 UMMC outpatient pharmacies and community pharmacy research partner sites within 60 miles of UMMC. PRACTICE INNOVATION: A pharmacist transitions coordinator (PTC) worked with inpatient and community-based pharmacists to provide predischarge medication reconciliation and 30 days of medications on discharge. The PTC with access to inpatient and outpatient records facilitated communication among settings/providers. Community pharmacists provided telephonic and face-to-face medication therapy management (MTM). EVALUATION: The project was structured as a prospective, randomized controlled trial of pharmacist-led care coordination during transition from inpatient to community setting, with follow-up MTM by community pharmacists. In this intention-to-treat analysis, readmission rates were assessed with propensity adjustment. Drug therapy problems (DTPs) identified/resolved were assessed and reported through descriptive statistics. RESULTS: Ninety-six patients were enrolled. Positive outcomes in overall reduced readmission rates were observed in the intervention group at 30, 60, 90, and 180 days, although statistical significance was not achieved because of limited enrollment. Approximately 60% participated in MTM postdischarge, with 453 interventions and 169 DTPs identified and addressed (98% > 1 DTP; 20% > 5 DTPs). Implementation experience includes PTC successes, new partnerships, and connectivity among all providers, as well as enrollment challenges, follow-up, and service delivery timeframe. CONCLUSION: With access to patient records, pharmacists have the potential to positively affect patient outcomes through medication management during care transitions.

First Responder knowledge, perception and confidence in administering naloxone: Impact of a pharmacist-provided educational program in rural Mississippi.

OBJECTIVE: In July 2017, Mississippi passed House Bill 996, which permitted first responders to carry naloxone and required training before administration. There is no standard training offered in Mississippi for first responders. The purpose was to evaluate the change in first responder knowledge, perceptions, and confidence in administering naloxone after pharmacist training. SETTING: The study was conducted at an independent community pharmacy in Holly Springs, Mississippi, with a longstanding presence in Marshall county. Participants included firefighters and law enforcement. PRACTICE DESCRIPTION: Participants provided informed consent and attended a 1-hour training class taught by a pharmacist. Participants were recruited by telephone to the local police and fire chiefs, who agreed to have their departments trained by the pharmacy. PRACTICE EVALUATION: The survey consisted of 12 questions and covered topics including, knowledge and perception of the opioid crisis, overdose symptoms, reversal agents, and confidence to perform correct administration. The first outcome was change in participants' knowledge of opioid overdose symptoms and was gathered with multiple choice questions. The second and third outcomes included change in perception and confidence in ability to administer reversal agents and were measured using a Likert-type scale ranging from strongly disagree to strongly agree. Fifty-seven participants completed the training, and the majority had more than 21 years of experience. The pre- and post-training survey responses demonstrated a statistically significant change in the first outcome where the average score of the knowledge assessment increased from 35% to 56% (P < 0.001). The perception and confidence outcomes had a statistically significant improvement in 5 of the 8 questions. CONCLUSION: Providing opioid education to law enforcement and firefighters increased their knowledge of overdose symptoms and improved administration technique, perception, and confidence to administer naloxone correctly.

The Impact of Clinical Pharmacist Integration on a Collaborative Interdisciplinary Diabetes Management Team.

OBJECTIVE: The national initiative, Project IMProving America's Communities Together (IMPACT): Diabetes, was intended to scale a proven American Pharmacists Association (APhA) Foundation process model, which integrates pharmacists on the collaborative health-care team, in communities greatly affected by diabetes to improve key indicators of diabetes. This article discusses the results from 1 community in Mississippi. METHODS: This national prospective study followed patients with a hemoglobin A1c (HbA1c) >7% from September 2011 to January 2013. Pharmacists collaborated with providers and other health-care professionals to provide medication therapy management services for a minimum of 3 visits. Outcome measures included HbA1c, systolic and diastolic blood pressure (SBP and DBP), fasting cholesterol panel, body mass index (BMI), influenza vaccine and smoking status, and foot and eye examination dates. RESULTS: At this site, there were statistically significant outcomes including mean HbA1c decrease of 1.2% in SBP and DBP of 8.3 mm Hg and 3.5 mm Hg, respectively, and reduction in low-density lipoprotein of 16.6 mg/dL, all of which were greater improvements compared to overall results from combined sites. CONCLUSION: Patients in this community who received care from the collaborative team, including a pharmacist, had improvement in most key indicators of diabetes, with a clinically significant reduction in HbA1c.

Impact of a residency interest group on students applying for residency.

OBJECTIVE: To determine the impact of a faculty-directed, residency interest group on the knowledge, confidence, and preparedness about residency-related topics of third-year (P3) and fourth-year (P4) pharmacy students. DESIGN: Faculty members implemented residency interest group sessions on residency and career preparation for P3 and P4 students. Group meetings consisted of four 2- to 3-hour sessions that covered topics such as residency timeline and resources, letter of intent and CV development, proper interview techniques, and navigating the midyear clinical meeting. Residency directors throughout Mississippi, current pharmacy residents, P3 and P4 students, and other faculty members were invited to attend these sessions. ASSESSMENT: Surveys were administered prior to and after completion of the interest group sessions. Students who attended the sessions demonstrated increased knowledge, confidence, and preparedness on residency-related topics. However, non-attendees also demonstrated increased knowledge, confidence, and preparedness from baseline. CONCLUSION: The majority of students who accepted a residency position had attended at least 1 residency interest group session, suggesting this program had a positive influence.

A multipreceptor approach to ambulatory care topic discussions.

OBJECTIVE: To assess the impact of a multipreceptor approach to facilitating topic discussions on students' knowledge and confidence in clinical decision-making during an ambulatory care advanced pharmacy practice experiences (APPEs). DESIGN: Faculty members with relevant expertise and experience facilitated discussions with fourth-year doctor of pharmacy (PharmD) students regarding 7 ambulatory care topics. A student self-assessment survey and knowledge-assessment instrument was administered before and after discussions. ASSESSMENT: Students' examination scores increased significantly from 59.1% ± 13.9% at baseline to 76.5% ± 12.6% at the end of the 5-week experience (p<0.001). The majority of participants were comfortable making therapeutic decisions regarding medication use as it related to all discussion topics except heart failure. CONCLUSIONS: Participation in topic discussions led by faculty members with expertise and experience for each ambulatory care topic was associated with a significant improvement in knowledge-assessment scores.

Health information technology use in a rural clinic: the pharmacist's perspective.

Poor communication of medical information during care transitions can lead to medication errors, adverse drug events, and increased health care costs. The crucial pharmacist's role sometimes requires efforts to improve documentation. Here, we describe our experience integrating a pharmacist into a medical team at a federally qualified health center.

Patient-centered health care using pharmacist-delivered medication therapy management in rural Mississippi.

OBJECTIVE: To describe and provide preliminary clinical and economic outcomes from a pharmacist-delivered patient-centered health care (PCHC) model implemented in the Mississippi Delta. SETTING: Mississippi between July 2008 and June 2010. PRACTICE DESCRIPTION: 13 community pharmacies in nine Mississippi Delta counties. PRACTICE INNOVATION: This PCHC model implements a comprehensive medication therapy management (MTM) program with pharmacist training, individualized patient encounters and group education, provider outreach, integration of pharmacists into health information technology, and on-site support in community pharmacies in a medically underserved region with a large burden of chronic disease and health disparities. The program also expands on traditional MTM services through initiatives in health literacy/cultural competency and efforts to increase the provider network and improve access to care. MAIN OUTCOME MEASURES: Criteria-based clinical outcomes, quality indicator reports, cost avoidance. RESULTS: PCHC services have been implemented in 13 pharmacies in nine counties in this underserved region, and 78 pharmacists and 177 students have completed the American Pharmacists Association's MTM Certificate Training Program. Preliminary data from 468 patients showed 681 encounters in which 1,471 drug therapy problems were identified and resolved. Preliminary data for clinical indicators and economic outcome measures are trending in a positive direction. CONCLUSION: Preliminary data analyses suggest that pharmacist-provided PCHC is beneficial and has the potential to be replicated in similar rural communities that are plagued with chronic disease and traditional primary care provider shortages. This effort aligns with national priorities to reduce medication errors, improve health outcomes, and reduce health care costs in underserved communities.