Improving Access to Hepatitis C Treatment Using Clinical Pharmacist Services in an Uninsured, At-Risk Population at a Community Health Center.

While published cure rates for new hepatitis C virus (HCV) treatments exceed 90%, barriers such as cost, medication access, housing or phone service instability, and substance use complicate medication adherence for uninsured, at-risk populations. Lincoln Community Health Center (LCHC) Pharmacy, in collaboration with primary care providers and care coordination professionals, implemented clinical pharmacist services to facilitate treatment of HCV infection in uninsured patients using manufacturers' patient assistance programs (PAP). Eighty-four (84) uninsured patients initiated treatment at LCHC using PAP during the first two years of the program. Nearly all patients (65/67 or 97%) who completed lab monitoring at 12 weeks post-treatment achieved undetectable viral load or a sustained virologic response (SVR-12), considered a proxy for cure. Successfully treating HCV infection in an uninsured, at-risk population may be achieved in a safety-net community health center by incorporating clinical pharmacist services into a team-based model.

Reaching the Hard-to-Reach: Outcomes of the Severe Hypertension Outreach Intervention.

INTRODUCTION: Severe hypertension (≥180 mmHg systolic or ≥110 mmHg diastolic) is associated with a twofold increase in the relative risk of death. At the authors' Federally Qualified Health Center in the Southeast, 39% of adults (n=8,695) had hypertension, and 3% (n=235) were severe. The purpose of this project was to lower blood pressure and improve the proportion of patients achieving the Agency for Healthcare Research and Quality goal for blood pressure. METHODS: This quality improvement project was performed in 2017 in three 3-month Plan, Do, Study, Act cycles using a multidisciplinary outreach model in a community-based primary care setting. A clinical team including physicians, nurses, patient navigators, behavioral health counselors, and pharmacists contacted adult patients with severe hypertension (≥180/110 mmHg), scheduled visits, and established blood pressure and medication management goals. The data review and analysis concluded in 2019. RESULTS: Among patients with blood pressure ≥180/110 mmHg (n=235), the average age was 57 years (SD=12 years), 37% (n=87) were male, 82% (n=193) were Black, and 46% (n=108) were uninsured. The majority of those contacted attended a follow-up appointment within the 9-month project (77%, n=181) and achieved an improved systolic blood pressure (87%, n=167) and diastolic blood pressure (76%, n=146). Target blood pressure of <140/90 mmHg was achieved in 29% of patients (n=53). Medication possession ratio improved from 23% to 40% among patients reached by pharmacists (n=30). Fewer deaths occurred in those reached by the intervention than in those not reached (n=1 vs n=3). CONCLUSIONS: Multidisciplinary outreach and use of evidence-based guidelines (Eighth Joint National Committee) were associated with lower blood pressure in patients with severe hypertension.

Integrating patient safety and clinical pharmacy services into the care of a high-risk, ambulatory population: a collaborative approach.

OBJECTIVES: Lincoln Community Health Center participated in a Health Resources and Services Administration-sponsored Patient Safety and Clinical Pharmacy Services Collaborative aimed at facilitating integration of pharmacy services proven to enhance patient safety into care provided to a high-risk, ambulatory population. METHODS: The Collaborative used the Plan-Do-Study-Act (PDSA) cycle of learning from the Model for Improvement endorsed by the Institute for Healthcare Improvement to guide changes. Outcomes targeted for improvement included medication reconciliation, obesity screening and follow-up planning, adverse drug events (patient safety), and delivery of clinical pharmacy services. RESULTS: Primary changes that resulted from conducting 54 PDSA cycles of learning included enhanced data access, centralized medication access through formulary expansion, implemented a medication reconciliation guideline, designated a single point of accountability in the pharmacy, improved efficiency, staff performed nontraditional roles, extended the existing adverse drug event program, and improved communication. CONCLUSIONS: Changes made to integrate patient safety and clinical pharmacy services into the care of a high-risk, ambulatory population not only improved all targeted outcomes but also helped establish Lincoln Community Health Center as the patient's medical home.

Changes in salivary immunoglobulin A (IgA) following match-play and training among English premiership footballers.

Decreased salivary immunoglobulin A (sIgA), a component of mucosal immunity, is associated with intensive physical activity: suggesting that sIgA may be used for the monitoring of mucosal immunity with footballers. We investigated changes in sIgA in elite footballers, in response to training and match-play. There was a decrease in sIgA following training, with a return to pre-training levels after 18 hours of rest. This return to resting levels was not observed following competitive match-play. Overnight rest was sufficient for mucosal IgA recovery following training but not following two successive matches, suggesting that sIgA may be used to monitor training in multi-sprint sports.

Formulary expansion to provide access to medications prescribed by a specialist in a low-income population.

The process of expanding a medication formulary as a tool for providing access to medications prescribed by a specialist in a low-income population is described. The formulary optimized use of the 340B Drug Pricing Program and reserved patient assistance programs for costly medications. Collaborating with community physicians and organizations aided success.

Validation of the clinical internship evaluation tool.

BACKGROUND AND PURPOSE: Graduates of physical therapist education programs should be expected to function as competent clinicians. Instead, the benchmark for many clinical performance assessment tools has been "as good as an entry-level graduate." The authors developed the Clinical Internship Evaluation Tool (CIET), which measures clinical performance of the student relative to a "competent clinician." The purpose of this study was to provide evidence for validity of the tool. SUBJECTS AND METHODS: The CIET was used to evaluate physical therapist student clinical performance from 1999 to 2003. Data from 228 student evaluations, a survey of 26 clinical instructors (CIs), and an item review by 7 faculty members were used to collect validity evidence. The relevance of items on the CIET was examined by the survey and the item review. Coefficient alpha was calculated to estimate internal consistency among the items. A Spearman correlation was used to examine the relationship between 2 measures of clinical competence. A repeated-measures analysis of variance (ANOVA) compared the student scores at each clinical time frame to confirm expected improvements in performance longitudinally. Evidence for practicality was collected by the CI survey. RESULTS: Based on the faculty item review and the CI survey, all items were representative of skills and behaviors considered important for a clinically competent physical therapist. The internal consistency (alpha) was .98 for the patient management items. The average correlation of the 2 measures of clinical competence was .76. The repeated-measures ANOVA was significant and demonstrated improved patient management scores as the student progressed through the program. The CI survey results indicated that 96% of respondents agreed or strongly agreed that the instrument was short and easy to use. DISCUSSION AND CONCLUSION: The results of the study suggest that the CIET is representative of skills and behaviors necessary for students to perform at the level of a competent therapist and that the instrument is practical to use for busy clinicians. The CIET appears to be a valid tool for measuring student clinical performance and can be a time-efficient alternative for CIs in today's demanding clinical environment.