Top Ten Tips Palliative Clinicians Should Know About Rural Palliative Care in the United States.

Palliative care improves outcomes, yet rural residents often lack adequate and equitable access. This study provides practical tips to address palliative care (PC)-related challenges in rural communities. Strategies include engaging trusted community partners, addressing cultural factors, improving pediatric care, utilizing telehealth, networking with rural teams including caregivers, and expanding roles for nurses and advanced practice providers. Despite complex barriers to access, providers can tailor PC to be patient-centered, respect local values, and bridge gaps. The "Top 10" format emphasizes the relevant issues to enable clinicians to provide optimal care for people from rural areas.

Access to Palliative Care Services: Innovative Development of a Statewide Network.

In 2018, the Avera Sacred Heart Hospital and two partners were awarded a planning grant to improve palliative health care services in South Dakota (SD), United States, by assessing palliative care in rural SD communities. Through this effort, a newly formed South Dakota Palliative Care Network (SDPCN) convened statewide partners to develop a palliative care strategy for improving quality palliative care access for individuals with serious illness. Guided by a multidisciplinary governing board, the SDPCN completed needs assessments to (1) better understand the perception of palliative care in SD; (2) assess the palliative care landscape in the state; and (3) explore possible solutions to address the uneven access to palliative care. This article shares the process of network development, considers the future of the SDPCN, and provides a blueprint for improving palliative care in rural areas. The SDPCN sought first to inventory community-based palliative care resources and increase awareness of the need for services followed by addressing gaps identified through a comprehensive assessment. The SDPCN has engaged partners, captured data, and mapped a blueprint for sustaining accessible quality palliative care. Three years since its inception, the SDPCN secured additional funding to sustain the Network and to provide education on palliative care to providers and community members as a first strategic step toward improving overall palliative care in rural communities. The SDPCN currently serves rural SD patients by increasing knowledge of palliative care among health professionals (current and future), fostering Network member engagement, and maintaining an active governing board.

Impact of embedding a pharmacist in a dermatology clinic on outcomes in a specialty pharmacy.

BACKGROUND: Specialty pharmacists in a health system can help streamline medication access for patients and provide clinical support to providers. The University of Louisville (UofL) Health - UofL Hospital postgraduate year 2 (PGY-2) ambulatory care pharmacy resident implemented a new service in the UofL Health dermatology clinic in October 2020, with the goal of providing multidisciplinary care and ultimately improving patient access to specialty dermatology medications. OBJECTIVES: To describe the financial impact (dermatology prescription volume and return on investment for the UofL Hospital Specialty Pharmacy) and clinical impact (time to medication initiation, adherence, adverse events, quality of life, pharmacist interventions, and patient satisfaction) after the addition of a pharmacist to the UofL Health dermatology clinic. PRACTICE DESCRIPTION: Before this new service, the dermatology clinic team lacked a pharmacist. PRACTICE INNOVATION: A PGY-2 ambulatory care pharmacy resident spent 1 half day per week (4 hours) in the dermatology clinic from October 2020 to April 2021 and established a workflow assisting with medication selection, initiation, access, education, and monitoring. EVALUATION METHODS: Data were collected by retrospective chart review for patients who were seen in the UofL Health dermatology clinic and filled a specialty dermatology medication with the UofL Hospital Specialty Pharmacy from October 15, 2019, to October 14, 2021. RESULTS: There was a 28.87% increase in prescription volume of dermatology specialty medications sent to the UofL Hospital Specialty Pharmacy during the time period after the addition of the pharmacist (P = 0.023). The average time to initiation of medications was 13.6 days for the postintervention group and 21.3 days for the preintervention group. CONCLUSION: The addition of a pharmacist to the dermatology clinic enhanced the relationship between the providers and specialty pharmacy, leading to a positive impact on clinical and financial outcomes. Health-system specialty pharmacies can mimic this model to expand pharmacy services within dermatology.

Fear of Recurrence of Atrial Fibrillation: Translating a Cancer Fear Model to the Atrial Fibrillation Patient Experience.

Background: Atrial fibrillation occurs when rapid and disorganized electrical signals cause the atria in the heart to beat irregularly and is associated with an increased risk for stroke. Despite medical advancements, first and second line atrial fibrillation treatments exhibit significant recurrence rates. Because of this, atrial fibrillation patients often experience disease-specific fears that are not routinely assessed and targeted in clinical management. Fear of recurrence models in cancer research and other cardiac-specific fears have paved the way for a patient-centric approach to disease intervention. Purpose: Clinical assessment focused solely on the taxonomy of anxiety disorders may miss key components unique to the atrial fibrillation patient experience. An anxiety disorder diagnosis in the presence of an arrhythmia could be misleading and ultimately fail to address patient needs. Modeled from the cancer literature, providers may benefit from a broader disease specific conceptualization for AF patients that differs from a general DSM-5 diagnosis. Aims: The objectives of this paper are: (1) to review the medical aspects of atrial fibrillation, (2) to examine the comparability of fear of recurrence concept from cancer literature to the atrial fibrillation patient, and (3) to suggest considerations of these novel concepts in patient care. Future Directions: Increased understanding of fear of recurrence among atrial fibrillation patients aims to define and assess fear of recurrence components, determine treatment targets, and ultimately improve patient outcomes.

Patients and Partners in Research: Patient and Caregiver Perceptions of Research Engagement and the Role of Their Psychosocial States in Participation.

Multiple sclerosis (MS) is one of the most common, nontraumatic, disabling diseases diagnosed in adults. Self-empowered patients and families are valued members of the MS research team. The objective of this study was to explore patient and family perceptions of the influence of psychosocial state on their willingness to be research partners. Researchers conducted 5 focus groups with MS patients and family from the Upper Midwest Chapter of the National Multiple Sclerosis Society. The researchers asked questions addressing psychosocial factors influencing ability and willingness to work with MS researchers as partners. Relevant themes were identified including comfort level of individuals in formulating research questions, comfort level engaging in research, understanding of the meaning of research and self-perception about skills, research training, and knowledge needs. The findings of this study support the role of MS patients' perspectives about MS, their understanding of the science of MS, and role of their psychosocial states as all these factors were patient identified as being key to their ability to be active, engaged and willing research participants.

Evaluation of an Interprofessional Academic-Practice Partnership in End of Life Care.

Introduction: The purpose of this mixed-methods study was to evaluate an interprofessional academic-practice partnership in end of life care by examining patient medication outcomes, the contributions of student pharmacists and a pharmacy preceptor to care teams, and student learning experiences. Methods: Retrospective chart review assessed polypharmacy differences in hospice patients with a primary terminal diagnosis of non-Alzheimer's dementia between two patient groups; Group 1 managed on interprofessional care teams within the pharmacy partnership, and Group 2, managed on teams without a pharmacist. Team members who interacted with student pharmacists and the pharmacy preceptor participated in semi-structured key informant interviews to document perceptions of pharmacy contributions to care teams and the organization. At the end of their APPE, students completed reflective writings regarding their learning. Results: Patients in Group 1 were on statistically significant fewer medications than Group 2 at both week 4 and weeks 7-12 following admission. Five conceptual themes emerged from interviews: pharmacists as team medication experts, improved patient outcomes, interprofessional collaboration, patient/caregiver trust in medication regimens, and desire for sustainability. Student reflections included the following learning themes: teamwork, respect, value, and patient-centered care. Conclusions: The addition of a pharmacist on interprofessional care teams decreased the average number of medications in the non-Alzheimer's end of life patient population. Team members identified value-added contributions of student pharmacists and the pharmacy preceptor that enhanced team efficiency and patient care. Student pharmacists recognized these contributions and the experience served as an exemplar of interprofessional practice.

Perceptions of Palliative Care: Voices From Rural South Dakota.

OBJECTIVES: This study aimed to explore health professional, patient, family, and caregiver perceptions of palliative care, availability of palliative care services to patients across South Dakota, and consistency and quality of palliative care delivery. METHODS: Six focus groups were conducted over two months. Participants included interprofessional healthcare team members, patients, family members of patients, and caregivers. Individuals with palliative care experiences or interest in palliative care were invited to participate. Recruitment strategies included emails, flyers, and direct contact by members of the Network. Snowball sampling was used to recruit participants. RESULTS: Forty-six participants included patients, family members, caregivers and interprofessional health care team members. Most participants were Caucasian (93.3%) and female (80%). Six primary themes emerged: Need for guidance toward the development of a holistic statewide palliative care model; Poor conceptual understanding and awareness; Insufficient resources to implement complete care in all South Dakota communities; Disparities in the availability and provision of care services in rural SD communities; Need for relationship and connection with palliative care team; and Secondary effects of palliative care on patients/family/caregivers and interprofessional healthcare team members. Significance of Results: Disproportionate access is a principle problem identified for palliative care in rural South Dakota. Palliative care is poorly understood by providers and recipients of care. Service reach is also tempered by lack of resources and payer reimbursement constraints. A model for palliative care in these rural communities requires concerted attention to their unique needs and design of services suited for the rural residents.

"Girl, just pray ": Factors That Influence Breast and Cervical Cancer Screening Among Black Women in Rochester, MN.

BACKGROUND: Black women in Minnesota and beyond have a greater burden of death due to some cancers than their White counterparts. Delayed screening and treatment may explain these disparate statistics. The purpose of this study was to work in collaboration with a local Black faith-based organization to gain an updated understanding of Black women's knowledge, attitudes, and behaviors related to breast and cervical cancer, and determine to what extent known factors persist as barriers to accessing cancer screening among Black women in Rochester, MN. We also sought to identify unique barriers for Black women residing in a particularly health resource rich community. METHODS: Using a community-based participatory research approach, two academic institutes worked in collaboration with a local Black faith-based organization to conduct focus groups. Focus groups were utilized to identify factors that may limit Black women's access to cancer screening and health care. RESULTS: Forty-five eligible participants attended one of eight focus group sessions. All participants self-identified as Black women and most were born in the United States. Content analysis of participant responses suggested that Black women's health-seeking behaviors related to breast and cervical cancer screening continue to be very much influenced by known factors that serve as barriers to screening services. Four primary themes pertaining to these influential factors emerged from participants' focus group discussions: 1) knowledge of cancer, risk factors, and screening options; and 2) socioeconomic factors, 3) psycho-social factors, including lack of trust of doctors specifically involved in clinical research, and 4) cultural factors, including reliance on religious practice in place of medical intervention. CONCLUSION: Black women face real and perceived barriers to cancer screening even where health resources are abundant. Results reiterate an on going need for culturally appropriate interventions to improve Black women's breast and cervical cancer screening participation by minimizing barriers and engaging entire communities - including Black women, religious leaders, and health care providers.

Survivorship Care Plans: Health Actions Taken and Satisfaction After Use.

OBJECTIVES: To examine the use of and assess patient satisfaction with survivorship care plans (SCPs). SAMPLE & SETTING: 189 cancer survivors recruited from five cancer treatment center locations (Avera Cancer Institute in Aberdeen, Mitchell, Sioux Falls, and Yankton; Sanford Cancer Center in Sioux Falls) and one auxiliary specialty center (Urology Specialists in Sioux Falls), all in South Dakota. METHODS & VARIABLES: A written survey was completed by participants before and three months after receiving an SCP. Associations between demographics and cancer-related characteristics and use of the SCP were evaluated using chi-square tests. Logistic regression was used to determine factors associated with any use of the SCP, health actions attributable to the SCP, and satisfaction with the SCP. RESULTS: The most frequently reported uses of the SCP were to share with spouse or partner, inform about symptoms, and ask physician or nurse about concerns. SCP use, health actions taken, and satisfaction with the SCP were associated with gender, marital status, and main cancer type. IMPLICATIONS FOR NURSING: Nurses should promote SCPs because they are valued and used by survivors for follow-up care.

Pharmacy Practice in the South Dakota Correctional System: Discovery of an Unconventional Experiential Practice Site.

Pharmacists must be prepared to care for populations where health disparities are greatest and their services can best impact public health needs. Such preparation requires that students have access to practice experiences in underserved environments where pharmacy practice, cultural competence and knowledge of population health are experienced simultaneously. The correctional facility is such a place. The American Society of Health-System Pharmacists recommends that students receive preceptorship opportunities within the correctional system. The occasional collaboration or experiential opportunity, like Kingston's early model, has occurred between health professional schools and correctional facilities. However, to date, the correctional facility-experiential site remains an untapped opportunity, at least in a complete, coordinated, pharmaceutical care, patient management framework. Consequently, a short research study asked: To what extent is there potential for correctional facilities to serve as experiential practice sites for pharmacy students? The research objective was to identify pharmaceutical practices within South Dakota correctional system and compare those practices to the guidelines established by the Association of American College of Pharmacy's as optimal for student training. To understand medical and pharmaceutical practices in SDPS, three South Dakota Adult prison facilities were included in the exploratory study. Data was collected through a mixed methods approach designed to obtain perspectives about the SDPS health care system from individuals representing the numerous job levels and roles that exist within the health care continuum. Interviews and a web-based surveys were used to collect data. A review of a 36-page transcript along with 498 freeform survey comments revealed that while exact themes from the Exemplary Practice Framework may not have been evident, related words or synonyms for patient-centered care, informatics, public health, medication therapy management, and quality improvement appeared with great frequency.

Communication Strategies Must Be Tailored to a Medication's Targeted Population: Lessons from the Case of BiDil.

BACKGROUND: The American population's diversity continues to grow, and its racial and ethnic mixes are changing. The US healthcare system must confront this changing reality. The introduction of isosorbide dinitrate/hydralazine hydrochloride (BiDil) to the US marketplace was a move toward recognizing these changing consumer needs. BiDil was approved specifically as a secondary treatment for heart failure in African-American patients. It remains the first and only drug approved by the US Food and Drug Administration for a race-based indication. To ensure commercial success, a drug must be made "visible" to healthcare providers and to consumers. OBJECTIVES: To describe and analyze the case of BiDil and its potential implications for drugs developed for targeted populations to help them avoid a similar fate of market withdrawal because of commercial considerations. METHOD: This analysis is based on 12 comprehensive interviews with 5 clinical investigators, 1 minority healthcare provider, and 5 pharmaceutical representatives, as well as a review of the literature. Overall, 12 one-hour semistructured interviews were conducted. Of the 11 interviewees, 10 were interviewed once and 1 was interviewed once early in the process and then had a second interview by the end of the study. When the 12 scheduled interviews were completed, the recordings were transcribed and subjected to analysis through the use of a readily available computer software package, using concepts and themes collected from the literature and the interviewees' responses. RESULTS: The interviewees lacked consensus regarding the unique nature of BiDil. The clinical researchers considered it innovative in identifying that taking the 2 drugs together produced the greatest clinical effect in African-American patients with heart failure. For them, BiDil represented an innovation in the emerging field of personalized medicine. However, they were dismayed to see that these beliefs were challenged by the medical community and their physician colleagues. They reported that practicing, mainly primary care physicians considered the development of a branded medication that combined 2 older drugs to be superfluous, because the same effect could be achieved by administering each agent individually at the same time. Obtaining a patent for BiDil, therefore, was seen simply as a desire for commercial gain. During the approval hearings, representatives of the sponsored company attributed these concerns to "misinformed physicians" and "uninformed patients." CONCLUSION: The case of BiDil demonstrates that a marketing strategy for a population with unique health issues requires an understanding of underlying cultural, social, and economic underpinnings. Ignorance of these dynamics within the African-American community was blatantly reflected at the launch of the drug. Although BiDil remains a treatment option, there is no marketing effort to promote its use. The failure to capture the targeted market for the drug has important implications for the future of commercial considerations in the development of race-based medications.

The effect of topiramate plasma concentration on linguistic behavior, verbal recall and working memory.

This is the first study of the effect of topiramate on linguistic behavior and verbal recall using a computational linguistics system for automated language and speech analysis to detect and quantify drug-induced changes in speech recorded during discourse-level tasks. Healthy volunteers were administered a single, 100-mg oral dose of topiramate in two double-blind, randomized, placebo-controlled, crossover studies. Subjects' topiramate plasma levels ranged from 0.23 to 2.81 µg/mL. We found a significant association between topiramate levels and impairment on measures of verbal fluency elicited during a picture description task, correct number of words recalled on a paragraph recall test, and reaction time recorded during a working memory task. Using the tools of clinical pharmacology and computational linguistics, we elucidated the relationship between the determinants of a drug's disposition as reflected in plasma concentrations and their impact on cognitive functioning as reflected in spoken language discourse.