Improving efficiency through workflow optimization in a pharmacist-run diabetes clinic.

PURPOSE: To evaluate the impact of hiring nonclinical support staff on pharmacist productivity and diabetes control outcomes in internal medicine clinics of an integrated healthcare system. METHODS: A retrospective, longitudinal cohort study was conducted. Patients were included if they were contacted by telephone for a diabetes consultation with a clinical pharmacist from July 1, 2015, through June 30, 2017. Nonclinical support staff were hired in July 2016 to schedule patient appointments with the clinical pharmacists. The primary outcome was the average rate of completed telephone encounters per month before and after hiring of nonclinical support staff. The secondary outcome was the mean change in glycated hemoglobin (HbA1c) level in patients who had a laboratory assay completed within 90 days of clinical pharmacist outreach. The tertiary outcome was the call completion rate for scheduled appointments vs unscheduled calls. RESULTS: In total, 6,709 patients were included; their average age was 55 years. After the intervention, the mean (SD) rate of completed telephone encounters increased from 61% (3.8%) to 77% (3.5%) (P < 0.001). Small improvements were noted in glycemic control, as measured by the mean (SD) percentage of patients with an HbA1c concentration of <8%, which increased from 31% (5.2%) to 42% (3.0%) (P < 0.001), and the mean (SD) change in average HbA1c concentration, which increased from 8.9% (0.2%) to 8.5% (0.1%) (P < 0.001). Throughout the study, scheduled calls were more likely to be completed than unscheduled calls (mean [SD] completion rate, 66% [9.0%] vs 74% [6.0%]; P < 0.001). CONCLUSION: Hiring nonclinical support staff led to greater efficiency among the clinical pharmacist team, yielding a higher volume of telephone interactions, a modest overall decrease in HbA1c values, and an increased likelihood of reaching patients by phone.

Impact of Physician-Pharmacist Covisits at a Primary Care Clinic in Patients With Uncontrolled Diabetes.

PURPOSE: A popular method for enhancing medication management within a patient-centered medical home (PCMH) is the physician-pharmacist collaborative management (PPCM) model. To improve efficiency of health-care delivery within 4 federally qualified health centers (FQHCs), the PPCM model was implemented through coordinated physician-pharmacist covisits. OBJECTIVE: To evaluate the impact of physician-pharmacist covisits on clinical outcomes among patients with uncontrolled diabetes. METHODOLOGY: This was a retrospective multicenter cohort study including adults (≥18 years old) with uncontrolled type 1 or type 2 diabetes (hemoglobin A1c [HbA1c] ≥ 8 %) who had at least one covisit between January 1, 2013, and October 1, 2016. The primary clinical metric was mean change in HbA1c from baseline to follow-up. Secondary outcomes included adherence to select American Diabetes Association (ADA) Standards of Medical Care. RESULTS: A total of 106 patients were included in this analysis. Patients who were managed in the PPCM model experienced a significant decrease in mean change in HbA1c from baseline to follow-up (-1.75 [2.63], P < .001). There was no significant difference in the proportion of patients receiving recommended vaccinations or cardiovascular (CV) risk reduction medications. CONCLUSION: The results suggest that physician-pharmacist covisits may improve glucose control in patients with uncontrolled diabetes.

Adolescents' reasons for tanning and appearance motives: a preliminary study.

We examined adolescents' reasons for tanning and how these relate to appearance evaluation and orientation. Two hundred and sixty-four Canadian adolescents (age range 15-19 years) in grades 10, 11, and 12 completed a survey that included scales measuring their reasons for tanning, appearance evaluation, and appearance orientation. It was found that girls and boys differed on four of nine subscales measuring reasons for tanning. Girls believed more strongly than boys that tanning improved their general appearance and that friends influenced their decision to tan. Girls also expressed less concern than boys that tanning caused immediate skin damage or premature aging. The pattern of correlations between the reasons for tanning and appearance orientation was similar for girls and boys. For both, appearance reasons for tanning and sociocultural influences on tanning were positively associated with appearance orientation. Suggestions for future research with adolescents and a proposal for a guiding model are provided.