Outcomes of a Multidisciplinary Partnership to Improve Cardiac Wellness: An Opportunity for Pharmacists

Audiology, Medicine, and Pharmacy Interprofessional Preliminary Interviews and Discussions: Improving Hearing Health Care in Rural Alabama

PURPOSE

Access and affordability of hearing health care varies depending on residency and individual financial means. Those living in rural areas have limited health care resources and experience higher levels of poverty compared to those living in urban regions. The purpose of this study was to determine the feasibility of interprofessional collaboration among physicians and audiologists and pharmacists and audiologists to improve access and affordability of hearing health care in rural communities.

METHOD

Sixteen family physicians and medicine residents and 15 community pharmacists participated in the study. Physicians and residents completed an online survey to assess education regarding hearing health care and their understanding of hearing loss intervention. They also participated in small virtual focus group discussions. Pharmacists participated in virtual discussions based on guided questions.

RESULTS

The discussions with both physicians and pharmacists highlighted the need for more education, resources, and awareness of the negative impact of hearing loss on overall quality of life. Comments from these discussions were placed within the socio-ecological model of health behavior to increase understanding of hearing health behavior.

CONCLUSIONS

Increased collaboration among medical professionals has the potential to improve access to hearing health care for those living in audiologically underserved regions of the country. Further research will identify how to increase effective and sustainable hearing health care resources in rural communities.

Cholesterol Point-of-Care Testing for Community Pharmacies: A Review of the Current Literature

Objective:

To summarize the literature on cholesterol point-of-care tests (POCTs). This article would serve as a resource to assist community pharmacists in developing cholesterol point-of-care (POC) pharmacy services.

Data Sources:

A literature search was performed in MEDLINE Ovid, PubMed, EMBASE, and Cochrane database using the following medical subject headings (MeSH) terms: point-of-care test, cholesterol, blood chemical analysis, rapid testing, collaborative practice, community pharmacy, and ambulatory care. Additional resources including device manufacturer web sites were summarized to supplement the current literature.

Study Selection and Data Extraction:

All human research articles, review articles, meta-analyses, and abstracts published in English through September 1, 2014, were considered.

Data Synthesis:

A total of 36 articles were applicable for review. Information was divided into the following categories to be summarized: devices, pharmacists’ impact, and operational cost for the pharmacy.

Conclusions:

The current literature suggests that POCTs in community pharmacies assist with patient outcomes by providing screenings and referring patients with dyslipidemia for further evaluation. The majority of studies on cholesterol POC devices focused on accuracy, revealing the need for further studies to develop best practices and practice models with successful reimbursement. Accuracy, device specifications, required supplies, and patient preference should be considered when selecting a POC device for purchase.

Pharmacists' self-perceptions in relation to the 'Advanced Pharmacy Practice Framework'

BACKGROUND

The Australian Pharmacy Practice Framework was developed by the Advanced Pharmacy Practice Steering Committee and endorsed by the Pharmacy Board of Australia in October 2012. The Steering Committee conducted a study that found practice portfolios to be the preferred method to assess and credential Advanced Pharmacy Practitioner, which is currently being piloted by the Australian Pharmacy Council. Credentialing is predicted to open to all pharmacists practising in Australia by November 2015.

OBJECTIVE

To explore how Australian pharmacists self-perceived being advanced in practice and how they related their level of practice to the Australian Advanced Pharmacy Practice Framework.

METHOD

This was an explorative, cross-sectional study with mixed methods analysis. Advanced Pharmacy Practice Framework, a review of the recent explorative study on Advanced Practice conducted by the Advanced Pharmacy Practice Framework Steering Committee and semi-structured interviews (n = 10) were utilized to create, refine and pilot the questionnaire. The questionnaire was advertised across pharmacy-organizational websites via a purposive sampling method. The target population were pharmacists currently registered in Australia.

RESULTS

Seventy-two participants responded to the questionnaire. The participants were mostly female (56.9%) and in the 30-40 age group (26.4%). The pharmacists self-perceived their levels of practice as either entry, transition, consolidation or advanced, with the majority selecting the consolidation level (38.9%). Although nearly half (43.1%) of the participants had not seen the Framework beforehand, they defined Advanced Pharmacy Practice similarly to the definition outlined in the Framework, but also added specialization as a requirement. Pharmacists explained why they were practising at their level of practice, stating that not having more years of practice, lacking experience, or postgraduate/post-registration qualifications, and more involvement and recognition in practice were the main reasons for not considering themselves as an Advanced Pharmacy Practitioner. To be considered advanced by the Framework, pharmacists would need to fulfill at least 70% of the Advanced Practice competency standards at an advanced level. More than half of the pharmacists (64.7%) that self-perceived as being advanced managed to fulfill 70% or more of these Advanced Practice competency standards at the advanced level. However, none of the self-perceived entry level pharmacists managed to match at least 70% of the competencies at the entry level.

CONCLUSION

Participants' self-perception of the term Advanced Practice was similar to the definition in the Advanced Pharmacy Practice Framework. Pharmacists working at an advanced level were largely able to demonstrate and justify their reasons for being advanced practitioners. However, pharmacists practising at the other levels of practice (entry, transition, consolidation) require further guidance regarding their advancement in practice.

Point-of-care screenings at the University of Minnesota: mechanism for civic engagement

OBJECTIVES To describe Wellness Initiative of the Northland (WIN) screening events; present participant results from those events; discuss the benefits of pharmacist-conducted, community-based point-of-care (POC) testing to medically underserved patients and to the profession of pharmacy; and describe logistical considerations in launching disease screening services. SETTING Pharmacist-led community health fairs in a variety of settings, including shopping malls, churches, community pharmacies, senior residence facilities, critical-access hospitals, and clinics. PRACTICE DESCRIPTION Disease screenings for economically disadvantaged residents of northeastern Minnesota and northwest Wisconsin, held between 2005 and 2012, through WIN. PRACTICE INNOVATION Mobile POC screenings for dyslipidemia, diabetes, hypertension, and osteoporosis. MAIN OUTCOME MEASURE Percentage of screenings with out-of-range readings. RESULTS Since 2005, WIN screenings have served more than 2,000 individuals, providing 4,152 POC screenings. Out-of-range readings were obtained for 40.3% of fingerstick cholesterol tests, 24.8% of fingerstick blood glucose tests, 24.3% of blood pressure tests, and 38.7% of quantitative ultrasound heel bone density readings. CONCLUSION Community-conducted POC testing functions both as an important public health service and a mechanism by which pharmacists and student pharmacists can become involved in civic engagement.

A novel collaborative practice model for treatment of mental illness in indigent and uninsured patients

PURPOSE

The implementation and evaluation of a collaborative practice model (CPM) of mental health care at a free clinic are described.

SUMMARY

Since 2004, the mental health clinic of the Cape Fear Clinic in Wilmington, NC, has provided pharmacotherapy and psychotherapy services to a mostly female population of poor and uninsured patients (average age, about 45 years) under a CPM that includes a state-licensed Clinical Pharmacist Practitioner with prescribing privileges. Spanish is the primary language of about 28% of the clinic's patients. At patient intake and (when possible) six months later, three measures of physical and mental health are administered: the Short-Form Health Survey (SF-12), the physical and mental component summaries of the Patient Health Questionnaire for depression (PHQ-9), and the Alcohol Use Disorders Identification Test (AUDIT); psychological counseling, psychotropic medications, and laboratory monitoring are provided as appropriate. In 2009, the clinic's volunteer health care providers served 56 patients (a total of 316 office visits), providing about 165 hours of free clinical services valued at more than $15,000 and free prescription medications valued at about $123,000. Although the clinic's experience has demonstrated the feasibility of CPM-based mental health care for the indigent and uninsured, a comparison of pretest and posttest data on a sample of clinic patients did not show significant changes from mean baseline SF-12, PHQ-9, and AUDIT scores, possibly due in large part to sampling challenges resulting from the loss of many clinic patients to follow-up.

CONCLUSION

A CPM that includes a pharmacist with prescribing authority and psychologists was implemented to provide care for a low-income, uninsured, partly Spanish-speaking patient population.