Pharmacists in Federally Qualified Health Centers: Models of Care to Improve Chronic Disease.

INTRODUCTION: Pharmacists are underused in the care of chronic disease. The primary objectives of this project were to 1) describe the factors that influence initiation of and sustainability for pharmacist-provided medication therapy management (MTM) in federally qualified health centers (FQHCs), with secondary objectives to report the number of patients receiving MTM by a pharmacist who achieve 2) hemoglobin A1c (HbA1c) control (≤9%) and 3) blood pressure control (<140/90 mm Hg). METHODS: We evaluated MTM provided by pharmacists in 10 FQHCs in Ohio through qualitative thematic analysis of semi-structured interviews with pharmacists and FQHC leadership and aggregate reporting of clinical markers. RESULTS: Facilitators of MTM included relationship building with clinicians, staff, and patients; regular verbal or electronic communication with care team members; and alignment with quality goals. Common MTM model elements included MTM provided distinct from dispensing medications, clinician referrals, and electronic health record access. Financial compensation strategies were inadequate and varied; they included 340B revenue, incident-to billing, grants, and shared positions with academic institutions. Of 1,692 enrolled patients, 60% (n = 693 of 1,153) achieved HbA1c ≤9%, and 79% (n = 758 of 959) achieved blood pressure <140/90 mm Hg. CONCLUSION: Through this statewide collaborative, access for patients in FQHCs to MTM by pharmacists increased. The factors we identified that facilitate MTM practice models can be used to enhance the models to achieve clinical goals. Collaboration among clinic staff and community partners can improve models of care and improve chronic disease outcomes.

Just Say Know to Drugs! A High School Pharmacology Enrichment Program for a Rural Population.

CONTEXT: Just Say Know to Drugs! is a summer pharmacology enrichment program for high school students. First-year osteopathic medical students serve as teachers, introducing students to pharmacology while acquiring teaching skills. OBJECTIVE: To assess the effects of a pharmacology program on high school students and to understand the effects of teaching this program on first-year osteopathic medical students. METHODS: The influence of a pharmacology STEM (science, technology, engineering, and mathematics) enrichment program on high school students' career interests and student teacher preparedness was determined by a pre- and posttest, as well as a postprogram survey. RESULTS: Data from all 37 participating high school students and 10 of 16 student teachers (medical students and undergraduate assistants) were evaluated in the study. Survey findings suggested that this STEM program increased student awareness and knowledge of pharmacology, osteopathic medicine, and scientific research. Furthermore, student teachers thought that they developed the necessary skills to communicate and educate populations with diverse science backgrounds and comprehension levels. The immersion of high school students in the scientific content significantly increased student awareness of pharmacology (paired t test, P<.0001). CONCLUSION: The Just Say Know to Drugs! program delivered benefits for both high school students and student teachers.

Inappropriate Use of Homeostasis Model Assessment Cutoff Values for Diagnosing Insulin Resistance in Pediatric Studies.

BACKGROUND: Assessing pediatric patients for insulin resistance is one way to identify those who are at a high risk of developing type 2 diabetes mellitus. The homoeostasis model assessment (HOMA) is a measure of insulin resistance based on fasting blood glucose and insulin levels. Although this measure is widely used in research, cutoff values for pediatric populations have not been established. OBJECTIVE: To assess the validity of HOMA cutoff values used in pediatric studies published in peer-reviewed journals. METHODS: Studies published from January 2010 to December 2015 were identified through MEDLINE. Initial screening of abstracts was done to select studies that were conducted in pediatric populations and used HOMA to assess insulin resistance. Subsequent full-text review narrowed the list to only those studies that used a specific HOMA score to diagnose insulin resistance. Each study was classified as using a predetermined fixed HOMA cutoff value or a cutoff that was a percentile specific to that population. For studies that used a predetermined cutoff value, the references cited to provide evidence in support of that cutoff were evaluated. RESULTS: In the 298 articles analyzed, 51 different HOMA cutoff values were used to classify patients as having insulin resistance. Two hundred fifty-five studies (85.6%) used a predetermined fixed cutoff value, but only 72 (28.2%) of those studies provided a reference that supported its use. One hundred ten studies (43%) that used a fixed cutoff either cited a study that did not mention HOMA or provided no reference at all. Tracing of citation history indicated that the most commonly used cutoff values were ultimately based on studies that did not validate their use for defining insulin resistance. CONCLUSION: Little evidence exists to support HOMA cutoff values commonly used to define insulin resistance in pediatric studies. These findings highlight the importance of validating study design elements when training medical students and novice investigators. Using available data to generate population ranges for HOMA would improve its clinical utility.

Improving Chronic Disease Outcomes Through Medication Therapy Management in Federally Qualified Health Centers.

INTRODUCTION: Appropriate management of chronic diseases, including proper use of medications, can lead to better disease control, decrease disease-related complications, and improve overall health. Pharmacists have been shown to positively affect chronic disease outcomes through medication therapy management (MTM). The primary objectives of this project are to increase the number of patients with (1) A1c in control and (2) blood pressure in control; secondary objectives are to (3) describe number and type of medication-related problems identified and resolved by pharmacists providing MTM in Federally Qualified Health Centers (FQHCs), (4) identify potential (pADEs) and actual adverse drug events (ADEs), and refer patients to diabetes self-management education classes, as needed. METHODS: This multisite, prospective, descriptive pilot study engaged three FQHC sites with distinct models of established pharmacist MTM services to care for patients with uncontrolled diabetes and/or hypertension. Data were reported in aggregate regarding primary and secondary outcomes. RESULTS: As of December 2015, 706 patients were enrolled in the project. Of the 422 with uncontrolled diabetes, 52.84% (n = 223) had an A1c <9%; 72 patients (17.06%) achieved an A1c between 8% and 9%, 19.19% (n = 81) of patients achieved an A1c <8% and ≥7%, and 16.59% (n = 70) of patients achieved an A1c <7%. The percentage of patients with blood pressure <140/90 mm Hg improved to 65.21%. CONCLUSION: Pharmacist-provided MTM can improve chronic disease intermediate outcomes for medically underserved patients in FQHCs.