Education & Care to Underserved Patients in a Utah Health Center
Education & Care to Underserved Patients in a Utah Health Center
Many underserved patients in Utah lack insurance coverage for health care and prescription drugs but are provided medical care in community health centers (CHCs). Before June 2000, comprehensive pharmacy services were not provided to these patients at a Utah CHC. As part of a Health Resources and Services Administration grant, a collaborative agreement between the University of Utah College of Pharmacy and Utah CHCs was established so that a faculty clinician who is a certified diabetes educator (CDE) could provide diabetes education and care to underserved patients. The College of Pharmacy faculty clinician (pharmacist CDE) collaborated with physicians and midlevel practitioners to provide diabetes education and care for 176 patients. In addition to initial diabetes education, the pharmacist CDE provided continuing disease management by providing information and feedback to patients and recommendations to providers. The pharmacist CDE conducted continuing chart reviews to track certain parameters, such as laboratory test results for hemoglobin A1c (A1C) and lipid levels, and blood pressure. Patients were followed for 1-3 years. The same outcome data were also collected for 176 patients with diabetes mellitus in another CHC clinic to provide a comparison group. Total cholesterol, low-density lipoprotein cholesterol, A1C, and triglyceride levels declined significantly from baseline at both sites. However, more patients who were provided care by the pharmacist CDE reached the American Diabetes Association A1C target goal of below 7%.
Access to health care is an enormous problem for the millions of Americans who have no medical insurance or are otherwise medically underserved. Community Health Centers (CHCs) are federally supported clinics that provide an important source of primary care for over 11 million underserved patients. The CHCs were established in 1965 under the Public Health Services Act through a federal grant program. In 2000, the Health Resources and Services Administration awarded clinical pharmacy demonstration grants to several CHCs with the goal of expanding clinical pharmacy services in these clinics, and to determine whether disease state management provided by pharmacists affects patient outcomes. In many cases, CHC patients were provided access to pharmacist care for the first time.
One requirement of the grant was that the CHCs establish a partnership with a college of pharmacy to ensure that the most current practices were incorporated in standards of care. One such project at a CHC in Salt Lake City established a relationship between the University of Utah College of Pharmacy and a Utah CHC. A collaborative practice was established between a faculty clinician and CHC physicians and midlevel practitioners (medical prescribers) to provide care for patients with diabetes mellitus. The faculty clinician was a pharmacist certified diabetes educator (CDE) and board-certified advanced diabetes manager (BC-ADM) who spoke Spanish. The latter was a special advantage since many patients seen at the Utah CHCs speak primarily Spanish.
Patients with diabetes present an enormous challenge to CHCs. One study of barriers in providing diabetes care indicated that these centers need better health care delivery systems. Providers involved in the study expressed confidence in their ability to instruct patients, but less confidence in helping patients make changes necessary to achieve certain goals. Time needed to teach patients and dealing with language or cultural issues were identified as barriers. Clinics that provide medical care for underserved patients have unique challenges in that patients are impoverished, are not well educated, and have few resources available compared with patients in other settings.
An evaluation of 2865 adult patients with diabetes in 55 midwestern CHCs reported a mean hemoglobin A1c (A1C) value per CHC of 8.6%. Few reports of interventions to improve quality of diabetes care in CHCs have been published. An assessment of an external consultative approach in New York City determined that barriers to improving the quality of diabetes care in CHCs were staff turnover and difficulty of program implementation in clinics that already have major demands. In addition, intensive patient education is needed. The no-show rate for appointments is a problem in many of these clinics. Affordability of clinic appointments, laboratory tests, and ancillary health care appointments (e.g., for ophthalmology or dental examinations) may explain why patients are less adherent than in conventional settings.
Diabetes is a complex disease that may be associated with devastating consequences and costs. Currently, 18.2 million people in the United States have diabetes, and every year 1.3 million individuals aged 20 years or older are diagnosed. Costs of this disease were estimated at $132 billion in 2002. And yet, maintaining appropriate blood glucose control prevents occurrence and progression of many complications. A "diabetes report card" for the United States provided data from participants surveyed in the National Health and Nutrition Examination Survey and the Behavioral Risk Factors Surveillance System. The data collected indicated that many patients with diabetes had suboptimal control of A1C, blood pressure, and lipid levels. Statistics compiled by the Centers for Disease Control and Prevention indicate that the prevalence of preventive care practices is suboptimal, and compliance with national health recommendations is poor.
A critical component of diabetes management is education, so that patients may have the information needed for optimal diabetes control. This may help with maintaining wellness and preventing diabetes-related complications. However, when patients are initially diagnosed, the provider may not have the time needed to provide diabetes self-management education. A CDE may provide self-management education with the target goal of maintaining appropriate blood glucose control. A pharmacist CDE may provide not only continued support and education of patients, but continuing recommendations and feedback to providers regarding optimal care of these patients.
Many underserved patients in Utah lack insurance coverage for health care and prescription drugs but are provided medical care in community health centers (CHCs). Before June 2000, comprehensive pharmacy services were not provided to these patients at a Utah CHC. As part of a Health Resources and Services Administration grant, a collaborative agreement between the University of Utah College of Pharmacy and Utah CHCs was established so that a faculty clinician who is a certified diabetes educator (CDE) could provide diabetes education and care to underserved patients. The College of Pharmacy faculty clinician (pharmacist CDE) collaborated with physicians and midlevel practitioners to provide diabetes education and care for 176 patients. In addition to initial diabetes education, the pharmacist CDE provided continuing disease management by providing information and feedback to patients and recommendations to providers. The pharmacist CDE conducted continuing chart reviews to track certain parameters, such as laboratory test results for hemoglobin A1c (A1C) and lipid levels, and blood pressure. Patients were followed for 1-3 years. The same outcome data were also collected for 176 patients with diabetes mellitus in another CHC clinic to provide a comparison group. Total cholesterol, low-density lipoprotein cholesterol, A1C, and triglyceride levels declined significantly from baseline at both sites. However, more patients who were provided care by the pharmacist CDE reached the American Diabetes Association A1C target goal of below 7%.
Access to health care is an enormous problem for the millions of Americans who have no medical insurance or are otherwise medically underserved. Community Health Centers (CHCs) are federally supported clinics that provide an important source of primary care for over 11 million underserved patients. The CHCs were established in 1965 under the Public Health Services Act through a federal grant program. In 2000, the Health Resources and Services Administration awarded clinical pharmacy demonstration grants to several CHCs with the goal of expanding clinical pharmacy services in these clinics, and to determine whether disease state management provided by pharmacists affects patient outcomes. In many cases, CHC patients were provided access to pharmacist care for the first time.
One requirement of the grant was that the CHCs establish a partnership with a college of pharmacy to ensure that the most current practices were incorporated in standards of care. One such project at a CHC in Salt Lake City established a relationship between the University of Utah College of Pharmacy and a Utah CHC. A collaborative practice was established between a faculty clinician and CHC physicians and midlevel practitioners (medical prescribers) to provide care for patients with diabetes mellitus. The faculty clinician was a pharmacist certified diabetes educator (CDE) and board-certified advanced diabetes manager (BC-ADM) who spoke Spanish. The latter was a special advantage since many patients seen at the Utah CHCs speak primarily Spanish.
Patients with diabetes present an enormous challenge to CHCs. One study of barriers in providing diabetes care indicated that these centers need better health care delivery systems. Providers involved in the study expressed confidence in their ability to instruct patients, but less confidence in helping patients make changes necessary to achieve certain goals. Time needed to teach patients and dealing with language or cultural issues were identified as barriers. Clinics that provide medical care for underserved patients have unique challenges in that patients are impoverished, are not well educated, and have few resources available compared with patients in other settings.
An evaluation of 2865 adult patients with diabetes in 55 midwestern CHCs reported a mean hemoglobin A1c (A1C) value per CHC of 8.6%. Few reports of interventions to improve quality of diabetes care in CHCs have been published. An assessment of an external consultative approach in New York City determined that barriers to improving the quality of diabetes care in CHCs were staff turnover and difficulty of program implementation in clinics that already have major demands. In addition, intensive patient education is needed. The no-show rate for appointments is a problem in many of these clinics. Affordability of clinic appointments, laboratory tests, and ancillary health care appointments (e.g., for ophthalmology or dental examinations) may explain why patients are less adherent than in conventional settings.
Diabetes is a complex disease that may be associated with devastating consequences and costs. Currently, 18.2 million people in the United States have diabetes, and every year 1.3 million individuals aged 20 years or older are diagnosed. Costs of this disease were estimated at $132 billion in 2002. And yet, maintaining appropriate blood glucose control prevents occurrence and progression of many complications. A "diabetes report card" for the United States provided data from participants surveyed in the National Health and Nutrition Examination Survey and the Behavioral Risk Factors Surveillance System. The data collected indicated that many patients with diabetes had suboptimal control of A1C, blood pressure, and lipid levels. Statistics compiled by the Centers for Disease Control and Prevention indicate that the prevalence of preventive care practices is suboptimal, and compliance with national health recommendations is poor.
A critical component of diabetes management is education, so that patients may have the information needed for optimal diabetes control. This may help with maintaining wellness and preventing diabetes-related complications. However, when patients are initially diagnosed, the provider may not have the time needed to provide diabetes self-management education. A CDE may provide self-management education with the target goal of maintaining appropriate blood glucose control. A pharmacist CDE may provide not only continued support and education of patients, but continuing recommendations and feedback to providers regarding optimal care of these patients.
