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.

Improving prescribing practices: A pharmacist-led educational intervention for nurse practitioner students.

BACKGROUND AND PURPOSE: To assess impact of a pharmacist-led educational intervention on family nurse practitioner (FNP) students' prescribing skills, perception of preparedness to prescribe, and perception of pharmacist as collaborator. METHOD: Prospective pre-post assessment of a 14-week educational intervention in an FNP program in the spring semester of 2014. Students participated in an online module of weekly patient cases and prescriptions emphasizing legal requirements, prescription accuracy, and appropriate therapy. A pharmacist facilitator provided formative feedback on students' submissions. Participants completed a matched assessment on prescription writing before and after the module, and a retrospective postsurvey then presurvey to collect perceptions. CONCLUSION: There was significant improvement in performance on error identification and demonstration of prescription elements from preassessment to postassessment (+17%, p < .001). The mean performance on both assessments was less than the 70% passing score. Students reported significant positive changes in perceptions, including all statements regarding their preparedness to prescribe and those addressing willingness to collaborate with pharmacists. IMPLICATIONS FOR PRACTICE: Formative education on prescribing enhanced students' understanding of safe and effective medication use with improved recognition and avoidance of prescribing errors, although it did not result in competency. Exposure to pharmacist expertise in this area may encourage collaboration in practice.

Factors influencing adults' immunization practices: a pilot survey study of a diverse, urban community in central Ohio.

BACKGROUND: Adult vaccination rates in the United States are well below recommendations with disparities in race, ethnicity, and education level resulting in even lower rates for these populations. This study aimed to identify the barriers to and perceptions of immunizations in adults in an urban, underserved, multicultural community. Understanding the factors that influence adults' decisions to receive routinely recommended vaccines will aid health care providers and public health officials to design programs to improve vaccination rates. METHODS: This cross-sectional, survey-based study was conducted in January 2014 in Columbus, Ohio. Participants were recruited from four urban federally-qualified health centers and four grocery stores affiliated with those clinics. The survey gathered self-reported receipt of immunizations, knowledge about indications for immunizations, and factors influencing decisions to receive an immunization. Data was analyzed in 2014. Descriptive statistics were generated for all survey items and Chi-Square or Fisher's Exact tests were used as appropriate to test for associations between demographic characteristics and factors influencing immunization decisions. RESULTS: The top five factors likely to affect the decision to receive an immunization among the 304 respondents were: "doctor's recommendation" (80.6 %), "knowing why I should get a vaccine" (78.2 %), "knowing which vaccines I need" (75.5 %), cost (54.2 %), and "concern about getting sick if I get a vaccine" (54.0 %). Significant differences in factors influencing the immunization decision exist among respondents based on ethnicity and education level. For those participants with self-identified diabetes, heart disease, or asthma, less than half were aware that certain immunizations could reduce the risk of complications associated with their disease(s). CONCLUSIONS: Data from this study may inform and shape patient education programs conducted in clinics, retailers, and communities, as well as advocacy efforts for adult immunizations. Results from this study suggest that patients would respond to programs for promoting vaccine uptake if they focused on benefits and indications for vaccines. The results also highlighted the need for education regarding immunizations for patients with chronic diseases and special indications. The differences in perceptions found between groups can be used to create targeted interventions based on the needs of those patient populations.

Assessing Interprofessional Education Collaborative Competencies in Service-Learning Course.

Objective. To investigate the effect of an interprofessional service-learning course on health professions students' self-assessment of Interprofessional Education Collaborative (IPEC) competencies. Design. The semester-long elective course consisted of two components: a service component where students provided patient care in an interprofessional student-run free clinic and bi-weekly workshops in which students reflected on their experiences and discussed roles, team dynamics, communication skills, and challenges with underserved patient populations. Assessment. All fifteen students enrolled in the course completed a validated 42-question survey in a retrospective post-then-pre design. The survey instrument assessed IPEC competencies in four domains: Values and Ethics, Roles and Responsibilities, Interprofessional Communication, and Teams and Teamwork. Students' self-assessment of IPEC competencies significantly improved in all four domains after completion of the course. Conclusion. Completing an interprofessional service-learning course had a positive effect on students' self-assessment of interprofessional competencies, suggesting service-learning is an effective pedagogical platform for interprofessional education.