The pharmacist role in the development and implementation of a naloxone prescription program in Alabama.

OBJECTIVE: The purpose of this report is to describe the development and implementation of a pharmacist-led naloxone-training and prescription service at a county health department. SETTING: Jefferson County Department of Health, Birmingham, Alabama. PRACTICE DESCRIPTION: This service was developed in response to the overwhelming heroin and opioid epidemic that is currently affecting the entire nation and which is highly prevalent in the state of Alabama. Because of this epidemic, new state laws have been established regarding prescriptive authority, liability, and possession of naloxone. PRACTICE INNOVATION: Through a collaborative protocol, pharmacists at the Jefferson County Department of Health were responsible for prescribing and educating the public about naloxone. EVALUATION: Between 2014 and 2015 the Jefferson County Coroner reported a 131% increase in opioid prescription-related deaths indicating the continued need for the naloxone prescription program. RESULTS: In total, 83 clients were trained and 150 naloxone kits were distributed among heroin and opioid users, concerned family members or friends, and those who work closely with users. CONCLUSION: This service and its extending arms were developed in response to the need for naloxone education among heroin and opioid users, their family members, civil servants who work with users, and family practice physicians who prescribe opioids.

Urban Park Development and Pediatric Obesity Rates: A Quasi-Experiment Using Electronic Health Record Data.

INTRODUCTION: Childhood obesity affects ~20% of children in the United States. Environmental influences, such as parks, are linked with increased physical activity (PA). OBJECTIVE: To examine whether changes in Body Mass Index (BMI) z-score were associated with construction of a new park. METHODS: A quasi-experimental design was used to determine whether living in proximity of a park was associated with a reduction in BMI z-score. Children were selected from health clinics within an 11 mile radius of the park. A repeated-measure ANOVA was employed for analysis of the relationship between exposure (new park) and BMI z-score. RESULTS: Participants were 1443 (median age 10.3 range (2-17.9 years), BMI: z-score 0.84 ± 1.09) African American (77.4%) adolescents. Change in BMI z-score was not statistically different for children living at different distances from the park after controlling for age, gender, race, ethnicity, or payer type (p = 0.4482). We did observe a small 0.03 increase in BMI z-score from pre- to post-park (p = 0.0007). There was a significant positive association between child's baseline age and BMI z-score (p < 0.001). CONCLUSIONS: This study found proximity to a park was not associated with reductions in BMI z-score. Additional efforts to understand the complex relationship between park proximity, access, and PA are warranted.

Are physician productivity and quality of care related?

This study examines the relationship between clinical quality of care and physician productivity in the public sector clinical setting. This longitudinal study takes place in Jefferson County, Alabama using data from six public sector clinics. Data representing 21 physicians across 13 consecutive quarters representing 44,765 person observations were analyzed. Four variables were selected to represent quality of care for this pediatric patient population; two of which pertained to antibiotic use and two pertained to asthma care. Findings from multivariate analyses examining each quality of care measure and controlling for other visit and practice characteristics indicate that three of the four quality measures were significantly related to productivity. Specifically, the percent of asthma patients with documented asthma severity classification was negatively related to physician productivity (ß = -.24, p = .04), although the magnitude of this relationship was small. The percent of asthma patients prescribed an inhaled corticosteroid who also had a severity classification was negatively related to physician productivity (ß = -.23, p = .03) and the percent of patients prescribed oral antibiotics was marginally negatively related to physician productivity (ß = -.09, p = .09). In general, findings suggest that a relationship exists between quality of healthcare and physician productivity. Future research should continue to examine this relationship across other disciplines and healthcare settings.

Changes in use of county public health services following implementation of Alabama's immigration law.

Several states have enacted legislation restricting undocumented immigrants' access to publicly funded health benefits not protected by federal law. Using electronic health records from 140,856 county health department visits, we assessed the monthly change in Latino patients' visits compared to non-Latinos 12 months before and after implementation of Alabama's immigration law. We used ICD-9 diagnosis codes to determine whether visits included services exempt under the law: immunizations, testing and treatment for sexually transmitted infections (STIs) and communicable diseases, and family planning. Differences between groups in the mean percent change were assessed with t-tests. Among children younger than 18 years, there were no significant differences by ethnicity. Visits among Latino adults decreased by 28% for communicable diseases, 25% for STIs, and 13% for family planning; this was significantly different from changes among non-Latino adults (p <.05). State-level legislation may reduce immigrants' access to protected benefits, which could adversely affect the broader public's health.

Relationship between food safety and critical violations on restaurant inspections: an empirical investigation of bacterial pathogen content.

While various safety control measures exist within the U.S. food system, foodborne illness remains a costly and persistent problem. The purpose of the study described here was to examine the relationship between violations of critical restaurant inspection items ("critical items") and food safety as measured by the bacterial load of illness-causing pathogens. Specifically, the authors' study looked at bacterial pathogens present in foods of two groups of restaurants, those that consistently scored poorly on critical items as compared to restaurants that performed superiorly in the same types of evaluation in Jefferson County, Alabama. Laboratory analyses indicated that 35.7% of the foods tested had detectable levels of Staphylococcus aureus, but no difference occurred between the two groups of restaurants. No other bacterial pathogens were found in any of the tested samples. A total of 45.2% of the food samples were received outside of recommended temperatures. Findings draw attention to the ongoing need to improve temperature control and hygienic practices, specifically handwashing practices, in restaurants.

Initiation of a pediatric mock code program at a children's hospital.

BACKGROUND: Pediatric cardiopulmonary arrests are rare. Mock codes were instituted to bridge the gap between opportunity and reality. AIM: The goal was to improve medical caregivers' skills in pediatric resuscitation. METHODS: All pediatric and internal medicine/pediatric (med/peds) residents were anonymously surveyed pre- and post-intervention about confidence level about codes and code skills. Twenty mock codes were conducted during the 1 year intervention period. Statistical comparisons were made between each resident pre- and post-survey, graduating third-year residents (PGY3s) prior to intervention versus PGY3s with mock codes and pediatric versus med/peds residents. RESULTS: All residents significantly improved in their perception of overall skill level during the study (p < 0.0001). PGY3s were significantly more confident in their skills than PGY2s or PGY1s and PGY2s were significantly more confident than PGY1s both pre- and post-mock codes (p < 0.0001). Med/peds residents were significantly more confident in their skills than pediatric residents both pre- (p = 0.041) and post-intervention (p = 0.016). The two skills with the lowest score post-intervention were the ability to place an interosseous line and the ability to manage cardiac dysrhythmias. CONCLUSIONS: Pediatric mock codes can improve resident confidence and self-assessment of their resuscitation skills. Data from surveys such as this can be used to design future skill-based educational initiatives.