Pharmacists and community health workers improve medication-related process outcomes among Cambodian Americans with depression and risk for diabetes

The impact of interprofessional collaboration between pharmacists and community health workers on medication adherence: a systematic review

BACKGROUND

There is increasing evidence to support the effectiveness of interventions involving community health workers (CHWs) in improving patient health outcomes, which reinforces their growing integration in healthcare teams. However, little is known about the interprofessional collaboration between pharmacists and CHWs. This systematic review aimed to explore the impact of interprofessional interventions involving pharmacists and CHWs on patient medication adherence.

METHODS

The English language scientific literature published in Embase, MEDLINE, Web of Science, CINAHL, Scopus, plus the grey literature were searched in October 2024. Using the software Covidence, two authors screened article titles and abstracts and assessed full-text articles for eligibility. Studies were included if (i) the intervention was delivered by pharmacists and CHWs and (ii) reported on medication adherence outcomes. Data were extracted using a customized template using Excel and synthetized narratively. The Effective Public Health Practice Project quality assessment tool was used to assess the studies' methodological quality.

RESULTS

Eight studies met the inclusion criteria, including a total of 1577 participants. Seven studies were conducted in the United States, and six were published since 2020. The interventions consisted of medication therapy management, medication reconciliation, and repeated education sessions. The CHW shared clinical and non-clinical patient information and ensured a culturally safe environment while the pharmacist delivered the clinical intervention. In five studies, medication adherence was evaluated solely through patient self-reported measures. One study used an objective measure (i.e., pharmacy refill records) to evaluate medication adherence. Only two studies assessed medication adherence using both self-reported and objective measures (i.e., pill count and proportion of days covered). A significant improvement in medication adherence was observed in three of the eight studies. Half of the studies were of weak quality and half of moderate quality.

CONCLUSIONS

There was a small number of studies identified which focused on the impact of interprofessional collaboration between pharmacists and CHWs on medication adherence. The impact of the interprofessional interventions on medication adherence was limited. Further studies of higher quality are needed to better evaluate the impact of such collaboration on patient health outcomes.

REGISTRATION

PROSPERO, ID CRD42024526969.

Interprofessional collaboration between pharmacists and community health workers: a scoping review

INTRODUCTION

Community health workers (CHWs) help bridge the cultural gap between health services and the communities they serve. CHWs work with physicians, nurses and social workers, but little is known about their collaboration with pharmacists. This scoping review aims to describe the interprofessional collaboration between CHWs and pharmacists, the types of interventions they deliver and CHWs' and pharmacists' specific roles within these interventions.

METHOD

The scientific literature published in PubMed, Embase, MEDLINE, Scopus, Web of Science, PsycInfo, CINAHL and the grey literature were searched. Inclusion criteria were that the research (i) involved pharmacists and CHWs working collaboratively and (ii) included an intervention, service or program. One researcher screened all articles, and two reviewers screened 6% of articles (20/340) assessed for eligibility, using the software Covidence. After the discrepancies were resolved, data from the included articles were extracted using a customized template for data extraction and synthesized narratively.

RESULTS

Eighteen studies met the inclusion criteria. Most were conducted in the USA (14/18) and were published since 2020 (12/18). Most interventions involved medication reviews, support for medication adherence, disease prevention or addressing the social determinants of health. Pharmacists had primarily clinical roles (i.e., medication reconciliation and patient education), while the CHWs' roles consisted of collecting patient information, supporting patient self-management, bridging the cultural gap by translating information in the patient's language and ensuring patient follow-up. The collaborative practice occurred via interprofessional referral, ranging from the CHW facilitating the link between the patient and the pharmacist, and information sharing between the CHW and the pharmacist, to an interprofessional collaborative practice where CHWs and pharmacists delivered the intervention together.

CONCLUSION

While CHWs and pharmacists had independent roles as part of the interventions, they also collaborated at various levels to deliver services to patients. CHWs have an important role to play in bridging the cultural gap between the patient and the pharmacist, in improving patient referral so that more patients can benefit from pharmaceutical services, and in identifying patients' social determinants of health. CHWs and pharmacists can work synergistically and collaboratively to tailor an intervention to the patient's needs, which can improve and optimize pharmaceutical services, and may ultimately positively impact health outcomes.

Community Health Workers Bridging the Gap: Connecting Medicaid Members with Providers, Managed Care, and Community-Based Organizations

Background

Community Health Workers (CHWs) are key to extending health care services, especially to marginalized communities to reduce challenges related to health care access. The study objective was to qualitatively explore the comprehensive role of CHWs in bridging the gap for Medicaid managed care organization (MCO) members' access to health care providers, managed care, and community-based organizations to address health-related social needs (HRSN).

Methods

We conducted a retrospective thematic analysis of narratives developed by CHWs on their role and Medicaid member lives. Three CHWs were embedded in four predominantly Black neighborhoods of Pittsburgh, Pennsylvania, by an MCO for six-months (January-June 2017) to connect its members with the managed care, health care system, and HRSN. In total, 46 MCO members remained throughout the program. The CHWs developed narratives on 13% (n = 6) of MCO members as part of a quality improvement project. These documented narratives became raw data for this study.

Results

The age of MCO members ranged from 25 to 58 years and were Black (n = 6). The narrative had 50% of males and females. Three overarching themes in the narratives about CHWs' role were improving members' access to health care system (providers and medication), helping members with HRSN, and connecting members to managed care case management and member services.

Conclusion

CHWs as MCO staff embedded in communities could help improve its members' health care continuity, care coordination, and HRSN access. Our study demonstrates that CHWs are instrumental in bridging the gap between different systems for Medicaid MCO members. They play a crucial role in connecting the members to primary care providers, specialists, prescription drugs, MCO benefits, case management, and addressing their HRSN such as food, childcare, and housing. Future research should focus on program effectiveness by measuring member experience, health care utilization, health outcomes, and costs in Medicaid managed care settings.

A scoping review of pharmacists' clinical activities and impact on the care of patients with multiple myeloma

BACKGROUND

Treating multiple myeloma is complex, and providing supportive care through an interdisciplinary approach is essential.

AIM

To report and synthesize pharmacists' clinical activities and impact on the care of patients with multiple myeloma.

METHOD

This was a scoping review that followed the PRISMA-ScR reporting recommendations. A search was conducted in PubMed, Embase, Web of Science, Scopus, and LILACS from the inception of the database until January 10th, 2024. Papers that reported pharmacists' clinical activities in the care of patients with multiple myeloma were included. Descriptive Elements of Pharmacist Intervention Characterization Tool (DEPICT) version 2 was used to characterize the pharmacists' clinical activities. The results are presented as a narrative and tabular synthesis.

RESULTS

A total of 2885 records were identified, 10 of which met the inclusion criteria. Pharmacists' clinical activities related to 'direct patient care' (n = 8) and 'medication counseling, education, and training' (n = 7) were the most cited. Most were provided for patients (n = 8), by one-on-one contact (n = 9), and through face-to-face communication method (n = 8), with patient counseling being the main action taken by pharmacists (n = 7). Materials that supported pharmacists' actions were cited in five studies. Integrating pharmacists into interdisciplinary teams led to improved process, clinical, humanistic, and economic outcomes.

CONCLUSION

This scoping review emphasizes pharmacists' clinical activities in improving the care of patients with multiple myeloma. There is a need to develop studies with patient-reported outcomes and comprehensive reporting of pharmacists' clinical activities to ensure reproducibility and effective implementation in clinical practice.

The evolving role of pharmacists in depression care: a scoping review

BACKGROUND

Worldwide, depression is known to contribute significantly to the global burden of disease. Considering pharmacists are among the most approachable healthcare providers, they are well-placed to assist people with depression achieve positive treatment outcomes.

AIM

The primary aim was to examine the evidence regarding pharmacists' roles in interventions, outcomes, and barriers to implementation within depression care globally, with the secondary aim focusing on the Arab region.

METHOD

A scoping review was conducted according to the PRISMA-ScR extension guidelines and the Joanna Briggs Institute framework, using Scopus, Cochrane, ProQuest, and Medline databases for studies worldwide and within the Arab region (22 Arab-league countries). Article selection, along with data extraction, analysis, and narrative synthesis were performed independently by two reviewers. Discrepancies were resolved by consensus.

RESULTS

Forty studies reporting various roles and services provided by pharmacists in depression management were included. Most articles (24) described studies on pharmacist-led specific/single interventions/management strategies, and 16 described studies in which pharmacists provided comprehensive or team-based services. The majority of studies reported positive impact on patient outcomes. In accordance with the secondary aim, only three studies assessed various pharmacists' services for people with depression in the Arab region. Barriers to effective depression-related care included time constraints and training needs.

CONCLUSION

This scoping review supports the expanding role of pharmacists in depression management. The interventions, impact, challenges, and research gaps identified serve as preliminary evidence for advocating for an expanded pharmacists' scope of practice in mental health, both globally and in the Arab region.

Development and Validation of a Community-Based Prediction Model for Depression in Elderly Patients with Diabetes: A Cross-Sectional Study

Background

In elderly diabetic patients, depression is often overlooked because professional evaluation requires psychiatrists, but such specialists are lacking in the community. Therefore, we aimed to create a simple depression screening model that allows earlier detection of depressive disorders in elderly diabetic patients by community health workers.

Methods

The prediction model was developed in a primary cohort that consisted of 210 patients with diabetes, and data were gathered from December 2022 to February 2023. The independent validation cohort included 99 consecutive patients from February 2023 to March 2023. Multivariable logistic regression analysis was used to develop the predictive model. We incorporated common demographic characteristics, diabetes-specific factors, family structure characteristics, the self-perceived burden scale (SPBS) score, and the family APGAR (adaptation, partnership, growth, affection, resolution) score. The performance of the nomogram was assessed with respect to its calibration (calibration curve, the Hosmer-Lemeshow test), discrimination (the area under the curve (AUC)), and clinical usefulness (Decision curve analysis (DCA)).

Results

The prediction nomogram incorporated 5 crucial factors such as glucose monitoring status, exercise status, monthly income, sleep disorder status, and the SPBS score. The model demonstrated strong discrimination in the primary cohort, with an AUC of 0.839 (95% CI, 0.781-0.897). This discriminative ability was further validated in the validation cohort, with an AUC of 0.857 (95% CI, 0.779-0.935). Moreover, the nomogram exhibited satisfactory calibration. DCA suggested that the prediction of depression in elderly patients with diabetes mellitus was of great clinical value.

Conclusion

The prediction model provides precise and user-friendly guidance for community health workers in preliminary screenings for depression among elderly patients with diabetes.

Cross-training pharmacy personnel as community health workers

Community health workers (CHWs) are frontline public health professionals who assist in bridging patients with resources and other health care team members. There is an increase in demand for CHWs, and cross-training pharmacy personnel (technicians, pharmacists) as CHWs can help with this demand. With the vital role that pharmacy team members already play in their communities, cross-training provides greater potential to help address patients' medication barriers, such as improving medication adherence. Several factors, such as the best implementation model, willingness of pharmacy personnel to take on additional roles, and service reimbursement and sustainability, should be taken into consideration for implementation. Given the potential benefits, CHW training can become another asset for pharmacy personnel to elevate patient care and reduce health care barriers faced by many patients.

Secondary analysis of a randomized trial testing community health educator interventions for diabetes prevention among refugees with depression: effects on nutrition, physical activity and sleep

BACKGROUND

Refugees have high levels of psychological distress that hamper lifestyle change efforts. We previously reported that community health educator (CHE) diabetes prevention interventions decreased HbA1c and depressive symptoms among Cambodian-American refugees with depression; this paper reports health behavior outcomes of those interventions.

METHODS

Participants were aged 35-75, Khmer speaking, at risk for diabetes, and met study criteria for likely depression by either a) antidepressant medication and/or b) prolonged elevated depressive symptoms. Participants were randomized to one of three CHE interventions: 1) lifestyle intervention called Eat, Walk, Sleep (EWS), 2) EWS plus medication therapy management with a pharmacist/CHE team (EWS + MTM), or, 3) social services (SS; control). Physical activity and sleep were measured with 7 days of actigraphy. Nutrition was measured as carbohydrates as reported in a culturally tailored food frequency questionnaire. Assessments were at baseline, end point (12 months), and follow-up (15 months).

RESULTS

The n = 188 participants were 78% female, average age of 55 years, half had a household income < $20,000, and modal education was 7.0 years. Individuals in the two treatment groups that received the EWS intervention significantly increased their brown rice consumption (p < .001, Cohen's d = 0.76) and their moderate-to-vigorous activity (p = .039, d = 0.32). No intervention changed sleep duration, timing, efficiency or wake after sleep onset. Across groups, individuals who increased brown rice consumption, increased vigorous activity and decreased total sleep time variability showed decreased HbA1c, with small effect sizes.

CONCLUSIONS

CHEs may improve nutrition and physical activity in refugees with depression but more intensive interventions may be required to impact sleep. Improvements in all three behaviors appear to be associated with HbA1c lowering TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02502929.

Do health education initiatives assist socioeconomically disadvantaged populations? A systematic review and meta-analyses

BACKGROUND

Health education interventions are considered critical for the prevention and management of conditions of public health concern. Although the burden of these conditions is often greatest in socio-economically disadvantaged populations, the effectiveness of interventions that target these groups is unknown. We aimed to identify and synthesize evidence of the effectiveness of health-related educational interventions in adult disadvantaged populations.

METHODS

We pre-registered the study on Open Science Framework https://osf.io/ek5yg/ . We searched Medline, Embase, Emcare, and the Cochrane Register from inception to 5/04/2022 to identify studies evaluating the effectiveness of health-related educational interventions delivered to adults in socio-economically disadvantaged populations. Our primary outcome was health related behaviour and our secondary outcome was a relevant biomarker. Two reviewers screened studies, extracted data and evaluated risk of bias. Our synthesis strategy involved random-effects meta-analyses and vote-counting.

RESULTS

We identified 8618 unique records, 96 met our criteria for inclusion - involving more than 57,000 participants from 22 countries. All studies had high or unclear risk of bias. For our primary outcome of behaviour, meta-analyses found a standardised mean effect of education on physical activity of 0.05 (95% confidence interval (CI) = -0.09-0.19), (5 studies, n = 1330) and on cancer screening of 0.29 (95% CI = 0.05-0.52), (5 studies, n = 2388). Considerable statistical heterogeneity was present. Sixty-seven of 81 studies with behavioural outcomes had point estimates favouring the intervention (83% (95% CI = 73%-90%), p < 0.001); 21 of 28 studies with biomarker outcomes showed benefit (75% (95%CI = 56%-88%), p = 0.002). When effectiveness was determined based on conclusions in the included studies, 47% of interventions were effective on behavioural outcomes, and 27% on biomarkers.

CONCLUSIONS

Evidence does not demonstrate consistent, positive impacts of educational interventions on health behaviours or biomarkers in socio-economically disadvantaged populations. Continued investment in targeted approaches, coinciding with development of greater understanding of factors determining successful implementation and evaluation, are important to reduce inequalities in health.

Self-reported outcomes of a randomized trial comparing three community health worker interventions for diabetes prevention among Cambodian Americans with depression

OBJECTIVE

Cambodian Americans have complex, interrelated and persistent medical and mental health problems stemming from genocide and the social determinants of health. We examined changes in multiple domains of self-reported health outcomes from a diabetes prevention trial.

METHODS

Cambodian Americans with depression and high risk for diabetes (n = 188) were randomized to one of three community health worker interventions: lifestyle vs lifestyle plus medication therapy management vs social services. Assessments were at baseline, 12- and 15-months.

RESULTS

The typical participant was 55 years old, female, earned below $20,000 annually, and had 7 years of education. About one-third were taking antidepressant medication and over half had elevated depressive symptoms. Relative to social services, lifestyle and lifestyle plus medication therapy management were both similarly effective at increasing diabetes knowledge, nutrition habits, sleep quality and decreasing pain; 2) lifestyle alone was superior to social services for self-reported health; and, 3) all three groups showed improved anxiety and insomnia. There were no effects on physical activity or physical functioning.

CONCLUSION

Community health worker interventions have multiple benefits beyond delaying diabetes.

PRACTICE IMPLICATIONS

Health promotion programs that are designed and delivered appropriately can impact even hard to reach and hard to treat groups.