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Gerber BS, Biggers A, Tilton JJ, Smith Marsh DE, Lane R, Mihailescu D, Lee J, Sharp LK. Mobile Health Intervention in Patients With Type 2 Diabetes: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2333629. [PMID: 37773498 PMCID: PMC10543137 DOI: 10.1001/jamanetworkopen.2023.33629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/05/2023] [Indexed: 10/01/2023] Open
Abstract
Importance Clinical pharmacists and health coaches using mobile health (mHealth) tools, such as telehealth and text messaging, may improve blood glucose levels in African American and Latinx populations with type 2 diabetes. Objective To determine whether clinical pharmacists and health coaches using mHealth tools can improve hemoglobin A1c (HbA1c) levels. Design, Setting, and Participants This randomized clinical trial included 221 African American or Latinx patients with type 2 diabetes and elevated HbA1c (≥8%) from an academic medical center in Chicago. Adult patients aged 21 to 75 years were enrolled and randomized from March 23, 2017, through January 8, 2020. Patients randomized to the intervention group received mHealth diabetes support for 1 year followed by monitored usual diabetes care during a second year (follow-up duration, 24 months). Those randomized to the waiting list control group received usual diabetes care for 1 year followed by the mHealth diabetes intervention during a second year. Interventions The mHealth diabetes intervention included remote support (eg, review of glucose levels and medication intensification) from clinical pharmacists via a video telehealth platform. Health coach activities (eg, addressing barriers to medication use and assisting pharmacists in medication reconciliation and telehealth) occurred in person at participant homes and via phone calls and text messaging. Usual diabetes care comprised routine health care from patients' primary care physicians, including medication reconciliation and adjustment. Main Outcomes and Measures Outcomes included HbA1c (primary outcome), blood pressure, cholesterol, body mass index, health-related quality of life, diabetes distress, diabetes self-efficacy, depressive symptoms, social support, medication-taking behavior, and diabetes self-care measured every 6 months. Results Among the 221 participants (mean [SD] age, 55.2 [9.5] years; 154 women [69.7%], 148 African American adults [67.0%], and 73 Latinx adults [33.0%]), the baseline mean (SD) HbA1c level was 9.23% (1.53%). Over the initial 12 months, HbA1c improved by a mean of -0.79 percentage points in the intervention group compared with -0.24 percentage points in the waiting list control group (treatment effect, -0.62; 95% CI, -1.04 to -0.19; P = .005). Over the subsequent 12 months, a significant change in HbA1c was observed in the waiting list control group after they received the same intervention (mean change, -0.57 percentage points; P = .002), while the intervention group maintained benefit (mean change, 0.17 percentage points; P = .35). No between-group differences were found in adjusted models for secondary outcomes. Conclusions and Relevance In this randomized clinical trial, HbA1c levels improved among African American and Latinx adults with type 2 diabetes. These findings suggest that a clinical pharmacist and health coach-delivered mobile health intervention can improve blood glucose levels in African American and Latinx populations and may help reduce racial and ethnic disparities. Trial Registration ClinicalTrials.gov Identifier: NCT02990299.
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Affiliation(s)
- Ben S. Gerber
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
- Department of Medicine, College of Medicine, University of Illinois Chicago, Chicago
| | - Alana Biggers
- Department of Medicine, College of Medicine, University of Illinois Chicago, Chicago
| | - Jessica J. Tilton
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois Chicago, Chicago
| | - Daphne E. Smith Marsh
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois Chicago, Chicago
| | - Rachel Lane
- Center for Clinical and Translational Science, University of Illinois Chicago, Chicago
| | - Dan Mihailescu
- Department of Endocrinology, Cook County Health, Chicago, Illinois
| | - JungAe Lee
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
| | - Lisa K. Sharp
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago
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Hughes TD, Roller JS, Hahn F, Ferreri SP. Racial and Ethnic Disparities in Community-Based Pharmacies: A Scoping Review. PHARMACY 2023; 11:93. [PMID: 37368419 DOI: 10.3390/pharmacy11030093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
As pharmacy practice shifts its focus toward population health care needs that serve public health, there is a need to understand community-based pharmacies' contributions to the reduction in health disparities. A scoping review was conducted to identify what community-based pharmacies in the United States are doing to target racial and ethnic disparities in community-based pharmacies. Forty-two articles revealed that community-based pharmacy services addressed racial and ethnic inequities in a variety of ways, including the types of interventions employed, as well as the ethnicities and conditions of the sample populations. Future work should focus on ensuring interventions are carried out throughout pharmacy practice and accessible to all racial and ethnic minoritized populations.
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Affiliation(s)
- Tamera D Hughes
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jessica S Roller
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Faustina Hahn
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Stefanie P Ferreri
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Shiyanbola OO, Maurer M, Mott M, Schwerer L, Sarkarati N, Sharp LK, Ward E. A feasibility pilot trial of a peer-support educational behavioral intervention to improve diabetes medication adherence in African Americans. Pilot Feasibility Stud 2022; 8:240. [PMID: 36376960 PMCID: PMC9660113 DOI: 10.1186/s40814-022-01198-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 10/31/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND African Americans are twice as likely to die from diabetes, compared to other racial and ethnic groups in the USA. Poor adherence to diabetes medications is common among African Americans and contributes to these disproportionally worse outcomes. A pilot study was conducted to determine the feasibility and acceptability of a peer-supported intervention targeting diabetes and medication beliefs, communication, and self-efficacy skills to enhance medication adherence among African Americans with type 2 diabetes. METHODS Based on the extended self-regulatory model and information-motivation-behavioral skills model, this intervention was piloted using a single group pre/post-intervention study design at two sites. Seventeen African Americans who self-reported as adherent to diabetes medicines (ambassadors) were paired with 22 African Americans with self-reported poor medication adherence (buddies). Feasibility outcomes evaluated recruitment, retention, and intervention adherence. Measures assessed at baseline and 1-month post-intervention included glycemic control (hemoglobin A1c), self-reported medication adherence, diabetes beliefs, concerns about diabetes medicines, and diabetes self-efficacy. Wilcoxon signed-rank tests assessed for differences in mean scores of outcome variables at baseline compared with a 3-month follow-up. Semi-structured 60-min interviews were conducted with each buddy to explore their acceptability of the intervention. To ensure the rigor of the qualitative data, we focused on analytic criteria such as credibility, confirmability, and transferability. RESULTS Most buddies and ambassadors were female and about 56 years old. Feasibility outcomes included recruitment success rates of 73% for buddies and 85% for ambassadors relative to our goals. Retention rate for hemoglobin A1c and medication adherence outcome assessment was 95% for buddies. Both buddies and ambassadors had excellent intervention adherence, with buddies having a mean attendance of 7.76 out of 8 sessions/phone calls and ambassadors completing > 99% of the 105 intervention calls with Buddies. Results showed a signal of change in hemoglobin A1c (effect size = 0.14) and medication adherence (effect size = 0.35) among buddies, reduction in buddies' negative beliefs about diabetes and an increase in necessity beliefs of diabetes medicines. Summative interviews with buddies showed they valued ambassador's encouragement of self-management behaviors. CONCLUSIONS Results support conduct of an efficacy trial to address medication adherence for African Americans with type 2 diabetes using a peer-supported tailored intervention. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04028076 .
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Affiliation(s)
- Olayinka O Shiyanbola
- Division of Social and Administrative Sciences, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA.
| | - Martha Maurer
- Sonderegger Research Center, School of Pharmacy, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA
| | - Mattigan Mott
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Luke Schwerer
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Nassim Sarkarati
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, 53705, USA
| | - Lisa K Sharp
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois, Chicago, IL, USA
| | - Earlise Ward
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
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Castillo-Laborde C, Hirmas-Adauy M, Matute I, Jasmen A, Urrejola O, Molina X, Awad C, Frey-Moreno C, Pumarino-Lira S, Descalzi-Rojas F, Ruiz TJ, Plass B. Barriers and Facilitators in Access to Diabetes, Hypertension, and Dyslipidemia Medicines: A Scoping Review. Public Health Rev 2022; 43:1604796. [PMID: 36120091 PMCID: PMC9479461 DOI: 10.3389/phrs.2022.1604796] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
Objective: Identify barriers and facilitators in access to medicines for diabetes, hypertension, and dyslipidemia, considering patient, health provider, and health system perspectives. Methods: Scoping review based on Joanna Briggs methodology. The search considered PubMed, Cochrane Library, CINAHL, Academic Search Ultimate, Web of Science, SciELO Citation Index, and grey literature. Two researchers conducted screening and eligibility phases. Data were thematically analyzed. Results: The review included 219 documents. Diabetes was the most studied condition; most of the evidence comes from patients and the United States. Affordability and availability of medicines were the most reported dimension and specific barrier respectively, both cross-cutting concerns. Among high- and middle-income countries, identified barriers were cost of medicines, accompaniment by professionals, long distances to facilities, and cultural aspects; cost of transportation emerges in low-income settings. Facilitators reported were financial accessibility, trained health workers, medicines closer to communities, and patients’ education. Conclusion: Barriers and facilitators are determined by socioeconomic and cultural conditions, highlighting the role of health systems in regulatory and policy context (assuring financial coverage and free medicines); providers’ role bringing medicines closer; and patients’ health education and disease management.
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Affiliation(s)
- Carla Castillo-Laborde
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- *Correspondence: Carla Castillo-Laborde,
| | - Macarena Hirmas-Adauy
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Isabel Matute
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Anita Jasmen
- Biblioteca Biomédica, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Oscar Urrejola
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Xaviera Molina
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Camila Awad
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Catalina Frey-Moreno
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Sofia Pumarino-Lira
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Fernando Descalzi-Rojas
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Tomás José Ruiz
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Barbara Plass
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
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Zare H, Delgado P, Spencer M, Thorpe RJ, Thomas L, Gaskin DJ, Werrell LK, Carter EL. Using Community Health Workers to Address Barriers to Participation and Retention in Diabetes Prevention Program: A Concept Paper. J Prim Care Community Health 2022; 13:21501319221134563. [PMID: 36331112 PMCID: PMC9638527 DOI: 10.1177/21501319221134563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: The PreventionLink of Southern Maryland is a 5-year project to eliminate
barriers to participation and retention in the National Diabetes Prevention
Program (DPP) lifestyle change program to prevent or delay the onset of type
2 diabetes in adults with prediabetes. This is the study to identify the
obstacles to participation and retention in the DPP lifestyle change program
among high burden populations and learn how CHWs have reduced the identified
barriers to participation and retention for high burden populations. Methods: We followed the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) to conduct this literature review. We have used the
Scopus and PubMed, including all types of studies and peer-reviewed
documents published in English between 2010 and 2020. Results: From 131 identified articles, 18 articles were selected for qualitative
synthesis. The reviewed literature documented following as main barriers to
participate in a DPP lifestyle change program: time, cost, lack of
transportation, cost of transportation, commute distance, technology access,
access to facilities and community programs, caregiver responsibilities,
lack of health literacy and awareness, and language. CHWs can address these
barriers to participation and retention, they were involved in educating and
supporting roles; they worked as bridges between healthcare providers and
participants and as intervention team members. Conclusions: Diabetes prevention program participants with social determinant risk factors
who most need CHW services are unlikely to have financial resources to pay
for CHW services out-of-pocket. Hence, the public and private health plans
that pay for their prediabetes care should consider paying for these CHW
services and there is a need to trust more to CHW and have them as a
“community health teams” member.
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Affiliation(s)
- Hossein Zare
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- University of Maryland Global Campus, Adelphi, MD, USA
| | - Paul Delgado
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- OSU College of Osteopathic Medicine, Tulsa, OK, USA
| | - Michelle Spencer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roland J. Thorpe
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laurine Thomas
- Independent Health Services Research & Evaluation Consultant, Baltimore, MD, USA
| | | | - Lori K. Werrell
- MedStar Southern Maryland Hospital Center, Clinton, MD, USA
- Medstar St. Mary’s Hospital, Leonardtown, MD, USA
| | - Ernest L. Carter
- Prince George’s County Department of Health, Silver Spring, MD, USA
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6
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Wheat L, Roane TE, Connelly A, Zeigler M, Wallace J, Kim JH, Segal R. Using a pharmacist-community health worker collaboration to address medication adherence barriers. J Am Pharm Assoc (2003) 2020; 60:1009-1014. [PMID: 32943338 DOI: 10.1016/j.japh.2020.08.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/17/2020] [Accepted: 08/10/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Pharmacists are positioned to evaluate and educate patients regarding medication adherence; however, opportunities exist to leverage a collaborative approach in eliciting barriers encountered by patients, especially in minority groups. Community health workers (CHWs) are individuals from the communities who form relationships with patients and help increase their access to health care resources. This study aimed to evaluate the effectiveness of a collaboration between CHWs and pharmacists in identifying and addressing medication adherence barriers faced by hypertensive patients. METHODS After receiving training in medication therapy management support, CHWs from the South East American Indian Council collaborated with students and pharmacists from the Center for Quality Medication Management at the University of Florida to identify and address medication adherence barriers encountered by hypertensive patients who were mainly Native American or black. The CHWs documented information from the patient interviews during the initial and follow-up visits. The team collaborated to identify intervention opportunities on the basis of the adherence barriers identified. Follow-up visits were conducted to measure progress. RESULTS Thirty-three hypertensive patients with or without diabetes were included in the study. The pharmacists, in partnership with the CHWs, offered 149 interventions related to medication adherence barriers. The most commonly identified barriers included forgetfulness, adverse effects, and knowledge concerns. By the final visits, 75.6% of the barriers related to antihypertensive medications and 63.9% of the barriers related to antidiabetic medications were resolved. In addition, a paired t test indicated a significant difference in the mean blood pressure values (P = 0.006 for systolic and P = 0.008 for diastolic) recorded at the initial (mean = 136/85.7 mm Hg) and final (mean = 130.1/81.2 mm Hg) visits. CONCLUSION The findings of this pilot project support the collaboration between pharmacists and CHWs to help improve medication adherence and patient outcomes. Additional research is recommended to validate these study findings.
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7
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Hall-Lipsy E, Anderson EJ, Taylor AM, Warholak T, Axon DR, Faqeeri Z, Jastrzab R. Community health worker perspectives of an academic community medication therapy management collaboration. J Am Pharm Assoc (2003) 2020; 60:475-480.e1. [PMID: 31917249 DOI: 10.1016/j.japh.2019.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/01/2019] [Accepted: 11/16/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To qualitatively assess community health workers' (CHWs') perceptions of the challenges and benefits associated with participating in a collaborative, interprofessional medication therapy management (MTM) program for rural, underserved, predominantly Latinx, patients with diabetes and hypertension. METHODS Nine CHWs participated in a 1-hour, semistructured focus group that explored their experiences while assisting in the delivery of MTM services through an academic community partnership between an MTM provider and participating rural clinics. Audio recordings of the focus group were transcribed and thematically analyzed by 2 independent reviewers. RESULTS All program-involved CHWs participated in the focus group. Qualitative analysis identified 2 overarching themes: (1) opportunities and (2) challenges. Opportunities were further subcategorized as benefits to (1) CHWs, (2) patients, or (3) academic community MTM research. The CHWs perceived that they served as a liaison among the medical provider (prescriber), patient, and MTM pharmacist. Benefits to the patients focused on the integration of CHWs as essential to patient recruitment, especially for those who were reluctant to participate or receive a phone call from a stranger. The major challenges identified were (1) interruptions in workflow and (2) communication between CHWs and the health care practitioners (physicians, nurse practitioners, pharmacists). Specifically, the CHWs universally agreed that they needed more time after receiving patient report, scheduling a visit with the patient, and communicating with the patient's health care provider to better understand the individual's circumstances and needs. CONCLUSION This study identified perceived opportunities and challenges faced by CHWs and chronically ill, rural Latinx patients in the acceptance of MTM program. These findings may be useful for all interprofessional health care team members to better understand and appreciate the role of CHWs, while simultaneously enhancing and improving respective medication adherence efforts, and to improve collaborative, academic community programs in the future.
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Nuffer W, Gilliam E, Trujillo T, Griend JV, Thompson M. A 3-Year Chronic Disease Public Health Intervention Focused on a Network of Rural Pharmacies Supported by Student Pharmacists. J Pharm Pract 2019; 34:535-541. [PMID: 31648590 DOI: 10.1177/0897190019882868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To retrospectively analyze and report various tracked outcomes of a 3-year collaboration offering chronic disease management services in diabetes and cardiovascular disease in pharmacies across 12 rural communities supported year-round by fourth-year student pharmacists. METHODS Individualized medication therapy management services were provided to patients with cardiovascular disease and diabetes in a 6-month series based upon national guidelines standards of care. Objective laboratory measurements, adherence rates, goals set for patients, vaccination rates, and routine maintenance examinations were all tracked as part of the program. Provider acceptance of recommendations from student pharmacists were tracked, and patients completed a 3-question survey regarding satisfaction with services. RESULTS A total of 430 student pharmacists rotated through these pharmacy sites providing care to 779 unique patients across 3 years. Statistically significant improvements in A1C (-0.8%, P < .001) and systolic and diastolic blood pressure (5 mm Hg, 3 mm Hg, respectively, P < .01) were associated with the pharmacy care. Adherence issues were identified and addressed with 44% of these patients. In all, 70% of patients reported successful goal attainment of >50% from baseline. Providers accepted student therapy change recommendations 56% of the time. Patients reported satisfaction with services provided in the pharmacies (average scores of 4.22-4.67 on a 1-5 Likert-type scale). CONCLUSIONS A 3-year pharmacy intervention in 12 rural areas made positive impacts on patients' adherence rates and self-management in diabetes and cardiovascular disease and was associated with statistically significant improvements in A1C and blood pressure while challenging fourth-year student pharmacists to perform at a high level on community pharmacy rotations.
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Affiliation(s)
- Wesley Nuffer
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO, USA
| | - Eric Gilliam
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO, USA
| | - Tara Trujillo
- 2915Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Joseph Vande Griend
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO, USA
| | - Megan Thompson
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO, USA
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Applying Contemporary Management Principles to Implementing and Evaluating Value-Added Pharmacist Services. PHARMACY 2019; 7:pharmacy7030099. [PMID: 31330816 PMCID: PMC6789523 DOI: 10.3390/pharmacy7030099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/13/2019] [Accepted: 07/18/2019] [Indexed: 12/11/2022] Open
Abstract
Value-added pharmacy services encompass traditional and emerging services provided by pharmacists to individual and entire populations of persons increasingly under the auspices of a public health mandate. The success of value-added pharmacy services is enhanced when they are carried out and assessed using appropriate theory-based paradigms. Many of the more important management theories for pharmacy services consider the “servicescape” of these services recognizing the uniqueness of each patient and service encounter that vary based upon health needs and myriad other factors. In addition, implementation science principles help ensure the financial viability and sustainability of these services. This commentary reviews some of the foundational management theories and provides a number of examples of these theories that have been applied successfully resulting in a greater prevalence and scope of value-added services being offered.
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10
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Sharp LK, Tilton JJ, Touchette DR, Xia Y, Mihailescu D, Berbaum ML, Gerber BS. Community Health Workers Supporting Clinical Pharmacists in Diabetes Management: A Randomized Controlled Trial. Pharmacotherapy 2017; 38:58-68. [PMID: 29121408 DOI: 10.1002/phar.2058] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of clinical pharmacists and community health workers (CHWs) in improving glycemic control within a low-income ethnic minority population. METHODS In a two-arm 2-year crossover trial, 179 African-American and 65 Hispanic adult patients with uncontrolled diabetes mellitus (hemoglobin A1c [HbA1C] of 8% or higher) were randomized to CHW support either during the first or second year of the study. All participants received clinical pharmacist support for both years of the study. The primary outcome was change in HbA1C over 1 and 2 years. RESULTS Similar HbA1C declines were noted after receiving the 1 year of CHW support: -0.45% (95% confidence interval [CI] -0.96 to 0.05) with CHW versus -0.42% (95% CI -0.93 to 0.08) without CHW support. In addition, no differences were noted in change on secondary outcome measures including body mass index, systolic blood pressure, high-density lipoprotein and low-density lipoprotein cholesterol, quality of life, and perceived social support. A difference in diastolic blood pressure change was noted: 0.80 mm Hg (95% CI -1.92 to 3.53) with CHW versus -1.85 mm Hg (95% CI -4.74 to 1.03) without CHW support (p=0.0078). Patients receiving CHW support had more lipid-lowering medication intensifications (0.39 [95% CI 0.27-0.52]) compared with those without CHW support (0.26 [95% CI 0.14-0.38], p<0.0001). However, no significant differences in intensification of antihyperglycemic and antihypertensive medications were observed between patients receiving CHW support and those without CHW support. Patients with low health literacy completed significantly more encounters with the pharmacist and CHW than those with high health literacy, although outcomes were comparable. CONCLUSIONS No significant differences were noted between a clinical pharmacist-CHW team and clinical pharmacist alone in improving glycemic control within a low-income ethnic minority population.
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Affiliation(s)
- Lisa K Sharp
- Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois.,Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Jessica J Tilton
- Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
| | - Daniel R Touchette
- Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
| | - Yinglin Xia
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois.,Division of Academic Internal Medicine and Geriatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Daniel Mihailescu
- Division of Endocrinology and Metabolism, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Michael L Berbaum
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Ben S Gerber
- Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois.,Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois.,Division of Academic Internal Medicine and Geriatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
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11
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Smith-Miller CA, Berry DC, Miller CT. Diabetes affects everything: Type 2 diabetes self-management among Spanish-speaking hispanic immigrants. Res Nurs Health 2017; 40:541-554. [PMID: 28877552 DOI: 10.1002/nur.21817] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/11/2017] [Indexed: 12/20/2022]
Abstract
This article is a report of qualitative findings of a mixed-methods study of the relationships among knowledge, self-efficacy, health promoting behaviors, and type 2 diabetes mellitus (T2DM) self-management among limited-english-proficient recent Hispanic immigrants, a population with increased incidence of T2DM and barriers to successful T2DM management. Semi-structured interviews were conducted with 30 participants, and physiological and demographic data also were collected. The participants generally attributed developing the disease to strong emotions and viewed T2DM as a serious disease. Although a majority understood the importance of exercise and diet in T2DM self-management, other aspects such as medication adherence were not well-understood. Obstacles to effective T2DM self-management were negative interactions and communications with health care providers and other personnel, cultural stigma related to the disease, financial constraints, immigration status, and the complexity of the disease. Suggested interventions to improve the care and self-management of this at-risk population are discussed.
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Affiliation(s)
- Cheryl A Smith-Miller
- University of North Carolina Hospital, Nursing Quality and Research, Adjunct Professor, School of Nursing, University of North Carolina, Chapel Hill, North Carolina
| | - Diane C Berry
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina
| | - Cass T Miller
- Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
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Knowledge, Attitude and Advice-Giving Behaviour of Community Pharmacists Regarding Topical Corticosteroids. PHARMACY 2017; 5:pharmacy5030041. [PMID: 28970453 PMCID: PMC5622353 DOI: 10.3390/pharmacy5030041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 07/20/2017] [Accepted: 07/23/2017] [Indexed: 11/24/2022] Open
Abstract
This study examines the relationship between community pharmacists’ knowledge, attitudes to information provision and self-reported counselling behaviours in relation to topical corticosteroids and adjunct therapy in atopic eczema. A mixed-methods approach was used whereby data from interviews with community pharmacists were used to design a structured questionnaire that a larger sample of community pharmacists completed anonymously. The questionnaire was completed and returned by 105 pharmacists (36% response rate). Pharmacists showed gaps in their knowledge on the use of topical corticosteroids in atopic eczema but had good understanding on the use of emollients. There was a significant correlation between pharmacists’ attitudes to information provision and their self-reported counselling behaviour for most themes except in relation to corticosteroid safety where less advice was given. Improving attitudes to information provision should correlate with increased counselling behaviour. However, for the theme of corticosteroid safety, further studies are needed to examine why in practice pharmacists are not providing patient counselling on this topic even though most agreed this is a topic patients should know about.
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Davis AM, Taitel MS, Jiang J, Qato DM, Peek ME, Chou CH, Huang ES. A National Assessment of Medication Adherence to Statins by the Racial Composition of Neighborhoods. J Racial Ethn Health Disparities 2017; 4:462-471. [PMID: 27352117 PMCID: PMC5195907 DOI: 10.1007/s40615-016-0247-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 05/22/2016] [Accepted: 05/23/2016] [Indexed: 11/26/2022]
Abstract
Adherence to statins is lower in black and Hispanic patients and is linked to racial/ethnic disparities in cardiovascular mortality. Poverty, education, and prescription coverage differentials are typically invoked to explain adherence disparities, but analyses at the level of neighborhoods and their pharmacies may provide additional insights. Among individuals filling new statin prescriptions in a national pharmacy chain (N = 326,171), we compared adherence for patients residing in mostly minority neighborhoods to those living in mainly white areas. In analyses adjusting for patient-level factors associated with poor adherence, including age, insurance, payer, prescription cost, and convenience, patients residing in black and Hispanic neighborhoods had 2-3 weeks less statin therapy over 1 year, a pattern not seen in Asian areas. In black and Hispanic neighborhoods, good adherence was associated with co-pays under $10, the use of 90-day refills, and payers other than Medicaid. Efforts to improve medication adherence for vulnerable populations may benefit from interventions at the level of local pharmacies, as well as medication benefit redesign.
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Affiliation(s)
- Andrew M Davis
- Division of General Internal Medicine, University of Chicago, 5841 S. Maryland Ave, MC3051, Chicago, IL, 60637, USA.
| | - Michael S Taitel
- Clinical Outcomes and Analytic Services, Walgreen Co, Deerfield, IL, USA
| | - Jenny Jiang
- Clinical Outcomes and Analytic Services, Walgreen Co, Deerfield, IL, USA
| | - Dima M Qato
- Department of Pharmacy Systems, Outcomes, and Policy, Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois College of Pharmacy, Chicago, IL, USA
| | - Monica E Peek
- Division of General Internal Medicine, University of Chicago, 5841 S. Maryland Ave, MC3051, Chicago, IL, 60637, USA
| | - Chia-Hung Chou
- Division of General Internal Medicine, University of Chicago, 5841 S. Maryland Ave, MC3051, Chicago, IL, 60637, USA
| | - Elbert S Huang
- Division of General Internal Medicine, University of Chicago, 5841 S. Maryland Ave, MC3051, Chicago, IL, 60637, USA
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Rojas E, Gerber BS, Tilton J, Rapacki L, Sharp LK. Pharmacists' perspectives on collaborating with community health workers in diabetes care. J Am Pharm Assoc (2003) 2016; 55:429-33. [PMID: 26161485 DOI: 10.1331/japha.2015.14123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To qualitatively assess pharmacists' perspectives on the barriers and facilitators of collaborating with community health workers (CHWs) when caring for patients with diabetes. METHODS Eight pharmacists were invited to participate in a focus group. All pharmacists had worked with CHWs for 12 months as part of a larger study. Seven pharmacists participated in a single focus group while one pharmacist participated in an individual interview. Data were analyzed by two investigators to identify common themes. RESULTS Perceived barriers included issues associated with maintaining patient confidentiality, pharmacists' level of comfort with CHWs, uncertainty about CHW roles, and inconsistent communication between pharmacists and CHWs. However, pharmacists reported that the care model fostered improvement in patient-pharmacist communication, patient adherence to medication, and assessment of patients' overall condition. CONCLUSION Pharmacists expressed positive attitudes and experiences in working with CHWs caring for a minority patient population with poorly controlled diabetes. Most believed that CHWs acted as facilitators and aided them in producing positive clinical outcomes by addressing the multiple psychosocial and contextual dimensions of patient health. Developing approaches for more frequent and effective communication between pharmacists and CHWs was the primary perceived challenge.
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Sun P, Lian J. Treatment adherence in newly diagnosed type 2 diabetes: patient characteristics and long-term impact of adherence on inpatient care utilization. Postgrad Med 2016; 128:338-45. [PMID: 26849064 DOI: 10.1080/00325481.2016.1151326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the impact of antidiabetic medication adherence on hospital utilization in patients with newly diagnosed type 2 diabetes mellitus (T2D). This study specifically analyzed patients with newly diagnosed T2D with the intent of lessening intragroup disease severity differences, and adjusting for a range of other clinical and demographic characteristics. METHODS This retrospective US claims database study evaluated adults with newly diagnosed T2D who started antidiabetic medications in 2005-2009, had ≥ 2 antidiabetic medication claims after their first (baseline). Medication adherence was evaluated using the medication possession ratio (MPR) of any or all antidiabetic medication(s) during the 3-year post-baseline period. Repeated-measures analyses examined changes in inpatient utilization from the pre- to post-baseline period. The impact of adherence on hospital utilization during the post-baseline period was evaluated with a logistic regression model to adjust for confounding factors. RESULTS The study included 192,717 patients (mean age, 55.0 years). Mean MPR for antidiabetic therapy was 0.74. MPR was highest in elderly patients and Medicare beneficiaries. Mean annualized inpatient admissions during the 3-year post-baseline period were significantly lower in patients with MPR ≥ 0.80 (1.4) than in those with MPR < 0.80 (2.2; P < 0.05). Logistic regression analysis, adjusting for patient characteristics and prior inpatient utilization, showed 39% lower odds of hospitalization (OR = 0.61; 95% CI = 0.534-0.693) for patients with MPR ≥ 0.80. People with T2D-related complications or hospitalization had approximately 2- to 3-fold higher risk of subsequent hospitalization. CONCLUSIONS In newly diagnosed T2D patients with antidiabetic therapy in the first three ensuing years, higher antidiabetic medication adherence was significantly associated with lower hospital inpatient utilization before and after adjusting for patient characteristics.
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Affiliation(s)
- Peter Sun
- a Health Economics and Outcomes Research Division, Kailo Research Group , Fishers , IN , USA
| | - Jean Lian
- b Formerly Health Economics and Outcomes Research Division, Novo Nordisk , Plainsboro , NJ , USA
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Cipriano GC, Andrews CO. The Hispanic pharmacist: Value beyond a common language. SAGE Open Med 2016; 3:2050312115581250. [PMID: 26770782 PMCID: PMC4679233 DOI: 10.1177/2050312115581250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 03/13/2015] [Indexed: 12/22/2022] Open
Abstract
Objective: To highlight the added value of bilingual Hispanic pharmacists in the care of Hispanic patients by sharing their patients’ language and culture. Summary: Inability to speak and/or write in the patients’ native language severely impairs our best efforts to deliver good health care. This is a widely recognized cause of non-compliance or less than favorable possible health outcomes in Hispanic patients. What has received less attention, however, is that the ability to speak Spanish alone may not remove completely the barrier for non-compliance among Hispanics. Bilingual Spanish–English pharmacists do not have the language barrier, but if they do not recognize and accept cultural differences, their impact in their patients’ response may still be limited. Conclusion: It is time to recognize the added value of Hispanic pharmacists to Hispanic patients’ health outcomes. Understanding and sharing a culture allows the pharmacist to make medication education and interventions relevant to the patient and spark interest in their own health care. Thus, in caring for the health of our patients, cultural barriers may be more challenging to conquer than language barriers; deep appreciation and acceptance of our patients’ belief system cannot be acquired by just reading about it, having a computerized program, or hiring an interpreter.
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DiBonaventura M, Wintfeld N, Huang J, Goren A. The association between nonadherence and glycated hemoglobin among type 2 diabetes patients using basal insulin analogs. Patient Prefer Adherence 2014; 8:873-82. [PMID: 24971002 PMCID: PMC4069147 DOI: 10.2147/ppa.s55550] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The main objective of this study was to investigate the relationship between adherence and both clinical (ie, glycated hemoglobin [HbA1c]) and nonclinical (ie, health status, work impairment, and health care-resource use) health outcomes among type 2 diabetes (T2D) patients using basal insulin. MATERIALS AND METHODS The 2012 US National Health and Wellness Survey dataset was used for this study (n=71,141). A total of 1,198 respondents who reported a diagnosis of T2D, were currently using basal insulin, and reported both their HbA1c and level of nonadherence were included in the analyses. Classical test theory and item response theory (IRT) analyses were used to provide evidence for the Morisky Medication Adherence Scale (MMAS) in this population. Adherence was then used as a predictor of HbA1c and nonclinical outcomes using regression modeling, controlling for demographics and health history. RESULTS A total of 61.44% of respondents were male, and the mean age was 60.65 (standard deviation 10.74) years. Internal consistency of the eight-item MMAS (MMAS-8) was adequate (Cronbach's α =0.68), and one factor was retained (eigenvalue =1.80). IRT analyses suggested that the MMAS-8 was most precise for those with high levels of nonadherence. A significant relationship between variables emerged, whereby each point increase in the level of nonadherence was associated with a 0.21 increase in HbA1c (B=0.212, P<0.05). A modest quadratic trend was also observed (B=0.026, P<0.05), indicating that the benefit to HbA1c may taper off at high adherence. Each point of nonadherence was associated with a 4.6%, 20.4%, and 20.9% increase in the number of physician visits, emergency room visits, and hospitalizations, respectively. DISCUSSION This study provides evidence that adherence rates are high among patients with T2D using basal insulin, and the MMAS-8 is a reliable and valid tool to assess adherence. Further, the results suggest that HbA1c increases concomitantly with nonadherence, as do poorer health status and health care-resource use.
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Affiliation(s)
- Marco DiBonaventura
- Health Outcomes Practice, Kantar Health, New York, NY
- Correspondence: Marco DiBonaventura, Health Outcomes Practice, Kantar Health, 11 Madison Avenue – 12th Floor, New York, NY 10010, USA, Tel +1 212 706 3988, Email
| | - Neil Wintfeld
- Health Economics and Outcomes Research, Novo Nordisk, Princeton, NJ, USA
| | - Joanna Huang
- Health Economics and Outcomes Research, Novo Nordisk, Princeton, NJ, USA
| | - Amir Goren
- Health Outcomes Practice, Kantar Health, New York, NY
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Horne R, Chapman SCE, Parham R, Freemantle N, Forbes A, Cooper V. Understanding patients' adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework. PLoS One 2013; 8:e80633. [PMID: 24312488 PMCID: PMC3846635 DOI: 10.1371/journal.pone.0080633] [Citation(s) in RCA: 732] [Impact Index Per Article: 66.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 10/04/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Patients' beliefs about treatment influence treatment engagement and adherence. The Necessity-Concerns Framework postulates that adherence is influenced by implicit judgements of personal need for the treatment (necessity beliefs) and concerns about the potential adverse consequences of taking it. OBJECTIVE To assess the utility of the NCF in explaining nonadherence to prescribed medicines. DATA SOURCES We searched EMBASE, Medline, PsycInfo, CDSR/DARE/CCT and CINAHL from January 1999 to April 2013 and handsearched reference sections from relevant articles. STUDY ELIGIBILITY CRITERIA Studies using the Beliefs about Medicines Questionnaire (BMQ) to examine perceptions of personal necessity for medication and concerns about potential adverse effects, in relation to a measure of adherence to medication. PARTICIPANTS Patients with long-term conditions. STUDY APPRAISAL AND SYNTHESIS METHODS Systematic review and meta-analysis of methodological quality was assessed by two independent reviewers. We pooled odds ratios for adherence using random effects models. RESULTS We identified 3777 studies, of which 94 (N = 25,072) fulfilled the inclusion criteria. Across studies, higher adherence was associated with stronger perceptions of necessity of treatment, OR = 1.742, 95% CI [1.569, 1.934], p<0.0001, and fewer Concerns about treatment, OR = 0.504, 95% CI: [0.450, 0.564], p<0.0001. These relationships remained significant when data were stratified by study size, the country in which the research was conducted and the type of adherence measure used. LIMITATIONS Few prospective longitudinal studies using objective adherence measures were identified. CONCLUSIONS The Necessity-Concerns Framework is a useful conceptual model for understanding patients' perspectives on prescribed medicines. Taking account of patients' necessity beliefs and concerns could enhance the quality of prescribing by helping clinicians to engage patients in treatment decisions and support optimal adherence to appropriate prescriptions.
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Affiliation(s)
- Rob Horne
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Sarah C. E. Chapman
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Rhian Parham
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Nick Freemantle
- Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Alastair Forbes
- Department of Internal Medicine, University College Hospital, London, United Kingdom
| | - Vanessa Cooper
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
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Cheng Y, Raisch DW, Borrego ME, Gupchup GV. Economic, clinical, and humanistic outcomes (ECHOs) of pharmaceutical care services for minority patients: A literature review. Res Social Adm Pharm 2013; 9:311-29. [DOI: 10.1016/j.sapharm.2012.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 05/07/2012] [Accepted: 05/07/2012] [Indexed: 10/28/2022]
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Kirwin J, Canales AE, Bentley ML, Bungay K, Chan T, Dobson E, Holder RM, Johnson D, Lilliston A, Mohammad RA, Spinler SA. Process indicators of quality clinical pharmacy services during transitions of care. Pharmacotherapy 2012; 32:e338-47. [PMID: 23108762 DOI: 10.1002/phar.1214] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The American College of Clinical Pharmacy charged the Public and Professional Relations Committee to develop a short white paper describing quality measures of clinical pharmacists' patient care services in transitional care settings. Transitional care describes patient movement from one health care setting or service to another. Care transitions are associated with an increased risk of adverse events for patients. Pharmacists play an important role in ensuring that medication errors and adverse events are minimized during these transitions, largely through the reconciliation of medications and assurance of continuity of care. Quality measures are often divided into three domains: structure, process, and outcome. Given the typical nature of the pharmacist's role, process indicators are best suited to evaluate quality clinical pharmacist services. However, process indicators relevant to pharmacists' activities are not yet fully described in the literature. The committee searched available literature describing quality measures that are directly influenced by the pharmacist during care transitions. This white paper describes these process indicators as quality measures of clinical pharmacists' services, identifies the transitional settings and activities to which they are most applicable, and provides the published sources from which indicators were derived. For process indicators that could not be found in published sources, we propose relevant measures that can be adapted for use in a given setting. As pharmacists become more involved in diverse and emerging patient care areas such as transitional care, it will be critical that they use these types of measures to document the quality of new services and reinforce the need for pharmacist participation during transitions of care.
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Affiliation(s)
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- American College of Clinical Pharmacy, Lenexa, Kansas 66215, USA.
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Gerber BS, Rapacki L, Castillo A, Tilton J, Touchette DR, Mihailescu D, Berbaum ML, Sharp LK. Design of a trial to evaluate the impact of clinical pharmacists and community health promoters working with African-Americans and Latinos with diabetes. BMC Public Health 2012; 12:891. [PMID: 23088168 PMCID: PMC3571948 DOI: 10.1186/1471-2458-12-891] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 10/16/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Given the increasing prevalence of diabetes and the lack of patients reaching recommended therapeutic goals, novel models of team-based care are emerging. These teams typically include a combination of physicians, nurses, case managers, pharmacists, and community-based peer health promoters (HPs). Recent evidence supports the role of pharmacists in diabetes management to improve glycemic control, as they offer expertise in medication management with the ability to collaboratively intensify therapy. However, few studies of pharmacy-based models of care have focused on low income, minority populations that are most in need of intervention. Alternatively, HP interventions have focused largely upon low income minority groups, addressing their unique psychosocial and environmental challenges in diabetes self-care. This study will evaluate the impact of HPs as a complement to pharmacist management in a randomized controlled trial. METHODS/DESIGN The primary aim of this randomized trial is to evaluate the effectiveness of clinical pharmacists and HPs on diabetes behaviors (including healthy eating, physical activity, and medication adherence), hemoglobin A1c, blood pressure, and LDL-cholesterol levels. A total of 300 minority patients with uncontrolled diabetes from the University of Illinois Medical Center ambulatory network in Chicago will be randomized to either pharmacist management alone, or pharmacist management plus HP support. After one year, the pharmacist-only group will be intensified by the addition of HP support and maintenance will be assessed by phasing out HP support from the pharmacist plus HP group (crossover design). Outcomes will be evaluated at baseline, 6, 12, and 24 months. In addition, program and healthcare utilization data will be incorporated into cost and cost-effectiveness evaluations of pharmacist management with and without HP support. DISCUSSION The study will evaluate an innovative, integrated approach to chronic disease management in minorities with poorly controlled diabetes. The approach is comprised of clinic-based pharmacists and community-based health promoters collaborating together. They will target patient-level factors (e.g., lack of adherence to lifestyle modification and medications) and provider-level factors (e.g., clinical inertia) that contribute to poor clinical outcomes in diabetes. Importantly, the study design and analytic approach will help determine the differential and combined impact of adherence to lifestyle changes, medication, and intensification on clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01498159.
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Affiliation(s)
- Ben S Gerber
- Institute for Health Research and Policy, 1747 West Roosevelt Rd. M/C 275, Chicago, IL, 60608, USA
- Jesse Brown VA Medical Center, 820 South Damen Ave., Chicago, IL, 60612, USA
| | - Lauren Rapacki
- Institute for Health Research and Policy, 1747 West Roosevelt Rd. M/C 275, Chicago, IL, 60608, USA
| | - Amparo Castillo
- Midwest Latino Health Research, Training and Policy Center, 1640 West Roosevelt Road- Suite 636, Chicago, IL, 60608, USA
| | - Jessica Tilton
- Department of Pharmacy Practice, 833 S. Wood St. M/C 886, Chicago, IL, 60612, USA
| | - Daniel R Touchette
- Department of Pharmacy Practice, 833 S. Wood St. M/C 886, Chicago, IL, 60612, USA
| | - Dan Mihailescu
- Section of Endocrinology, Diabetes and Metabolism, 1819 West Polk Street, M/C 640, Chicago, IL, 60612, USA
| | - Michael L Berbaum
- Institute for Health Research and Policy, 1747 West Roosevelt Rd. M/C 275, Chicago, IL, 60608, USA
| | - Lisa K Sharp
- Institute for Health Research and Policy, 1747 West Roosevelt Rd. M/C 275, Chicago, IL, 60608, USA
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Ruggiero L, Castillo A, Quinn L, Hochwert M. Translation of the diabetes prevention program's lifestyle intervention: role of community health workers. Curr Diab Rep 2012; 12:127-37. [PMID: 22350806 DOI: 10.1007/s11892-012-0254-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Approximately 8.3% of the US population has diabetes and estimates indicate that 79 million adults have prediabetes and 33.8% are obese, increasing their risk of diabetes. The national Diabetes Prevention Program (DPP) and subsequent translation studies have demonstrated the efficacy of the DPP lifestyle intervention (DPPLI) on lowering weight and reducing risk of type 2 diabetes over 10 years. Innovative strategies are needed to translate the DPPLI to reach people at risk of diabetes. Community health workers represent a group of individuals poised to play a role in supporting the translation of the DPPLI, especially in underserved populations. This article aims to 1) describe community health workers in general; 2) describe their role and impact on diabetes care in general; and 3) provide a detailed overview of studies involving community health workers in the translation of the DPPLI.
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Affiliation(s)
- Laurie Ruggiero
- University of Illinois at Chicago, Institute for Health Research and Policy, School of Public Health, Chicago, IL 60608, USA.
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Lora CM, Gordon EJ, Sharp LK, Fischer MJ, Gerber BS, Lash JP. Progression of CKD in Hispanics: potential roles of health literacy, acculturation, and social support. Am J Kidney Dis 2011; 58:282-90. [PMID: 21787982 DOI: 10.1053/j.ajkd.2011.05.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Accepted: 05/06/2011] [Indexed: 11/11/2022]
Abstract
Hispanics are the fastest growing minority group in the United States, and compared with non-Hispanic whites, they have a higher incidence of end-stage renal disease. Examining novel factors that may explain this disparity in progression of chronic kidney disease (CKD) in Hispanics is urgently needed. Interpersonal and patient-centered characteristics, including health literacy, acculturation, and social support, have been shown to affect health outcomes in patients with other chronic diseases. However, these characteristics have not been well studied in the context of CKD, particularly in relation to disease knowledge, attitudes, and behaviors. In this report, we examine the potential roles of these factors for CKD progression in Hispanics and propose targeted therapeutic interventions.
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White RO, Osborn CY, Gebretsadik T, Kripalani S, Rothman RL. Development and validation of a Spanish diabetes-specific numeracy measure: DNT-15 Latino. Diabetes Technol Ther 2011; 13:893-8. [PMID: 21714674 PMCID: PMC3160266 DOI: 10.1089/dia.2011.0070] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Although deficits in health literacy and numeracy have been described among Latinos, the impact of low numeracy on diabetes outcomes has not been studied. Study objectives were (1) to establish the reliability and validity of a 15-item Spanish, diabetes-specific numeracy measure (Diabetes Numeracy Test [DNT]-15 Latino) and (2) to examine the relationship between diabetes-specific numeracy and diabetes-related outcomes among a sample of Latino adults with diabetes. METHODS Data collection included patient demographics, health literacy, general numeracy, diabetes-specific numeracy, acculturation, self-efficacy, self-care behaviors, and most recent glycosylated hemoglobin (HbA1c). RESULTS Participants (n=144) were on average 47.8 years old (SD=12.1). The majority were female (62%), uninsured (81%), and of Mexican nationality (78%) and reported low levels of acculturation (96%). The DNT-15 Latino had high internal reliability (Kruder-Richardson 20=0.78). The DNT-15 Latino demonstrated construct validity, correlating with measures of health literacy (ρ=0.291), general numeracy (ρ=0.500), education (ρ=0.361), and income (ρ=0.270) (P<0.001 for each). The DNT-15 Latino was significantly associated with acculturation but unrelated to self-efficacy, self-care behaviors, insulin use, and HbA1c. CONCLUSIONS The DNT-15 Latino is a reliable and valid measure of diabetes-specific numeracy for Latino patients with diabetes; however, additional studies are needed to further explore the association between diabetes-specific numeracy and acculturation and their impact on diabetes-related outcomes for Latinos.
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Affiliation(s)
- Richard O White
- Department of Internal Medicine, Meharry Medical College, Nashville, Tennessee 37208, USA.
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White RO, Wolff K, Cavanaugh KL, Rothman R. Addressing Health Literacy and Numeracy to Improve Diabetes Education and Care. Diabetes Spectr 2010; 23:238-243. [PMID: 21297890 PMCID: PMC3032499 DOI: 10.2337/diaspect.23.4.238] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Richard O White
- Assistant professor in the Department of Internal Medicine at Meharry Medical College, Nashville, Tenn
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