Bedlam Community Health Clinic: a collaborative interdisciplinary health care service for the medically indigent.

OBJECTIVE: To describe a collaborative interdisciplinary health care service delivery system for the medically indigent in the Tulsa and northeastern Oklahoma area independent of state or federal funding. SETTING: Northeastern Oklahoma and Tulsa. PRACTICE DESCRIPTION: Community and ambulatory care for indigent patients. PRACTICE INNOVATION: Bedlam Community Health Clinic (BCHC), which opened in August 2003, provides services to patients through partnerships among the health care disciplines of the University of Oklahoma College of Pharmacy, Nursing, and Medicine; is staffed by community physicians and pharmacists who volunteer their time and expertise; and is funded by the local community. MAIN OUTCOME MEASURES: Experiences and patients served. RESULTS: BCHC is a collaborative interdisciplinary clinic that addresses the needs of the medically indigent in Tulsa and northeastern Oklahoma. Conceived, developed, and funded by the local community, it does not depend on state or federal funding. A variety of services, both general medicine and specialty, are provided through BCHC. Since its opening in August 2003, the clinic has provided hands-on training for students from a variety of health care disciplines. The pharmacist-patient encounters provide helpful, meaningful drug information. The participation of volunteer pharmacists enables medically underserved or indigent patients to access pharmaceutical care and addresses the diverse health care needs of this often overlooked population. CONCLUSION: Health professionals and students in the Tulsa area have created an innovative mechanism for serving indigent patients who otherwise would lack adequate health care services.

Commonly prescribed medications and potential false-positive urine drug screens.

PURPOSE: The implications of potential false-positive urine drug screen (UDS) results for patients receiving commonly prescribed medications were evaluated. SUMMARY: A comprehensive literature review was conducted to identify false-positive UDSs associated with all clinic formulary medications, as well as common nonprescription medications. The references of each report describing a medication whose use was associated with false-positive UDS results were also reviewed. If a class effect was suspected, additional agents in the category were searched. A total of 25 reports of false-positive UDS results were identified. Categories of medications included antihistamines, antidepressants, antibiotics, analgesics, antipsychotics, and nonprescription agents. Reports of false-positive results were found for the following formulary and nonprescription medications: brompheniramine, bupropion, chlorpromazine, clomipramine, dextromethorphan, diphenhydramine, doxylamine, ibuprofen, naproxen, promethazine, quetiapine, quinolones (ofloxacin and gatifloxacin), ranitidine, sertraline, thioridazine, trazodone, venlafaxine, verapamil, and a nonprescription nasal inhaler. False-positive results for amphetamine and methamphetamine were the most commonly reported. False-positive results for methadone, opioids, phencyclidine, barbiturates, cannabinoids, and benzodiazepines were also reported in patients taking commonly used medications. The most commonly used tests to screen urine for drugs of abuse are immunoassays, even though false-positive results for drugs of abuse have been reported with a number of these rapid-screening products. Results from such tests should be confirmed using additional analytical methods, including gas chromatography-mass spectrometry. CONCLUSION: A number of routinely prescribed medications have been associated with triggering false-positive UDS results. Verification of the test results with a different screening test or additional analytical tests should be performed to avoid adverse consequences for the patients.

Men's health initiative risk assessment study: effect of community pharmacy-based screening.

OBJECTIVES: To determine whether community pharmacists using a risk assessment tool could encourage men who were overdue for a physical examination to visit a physician and to calculate the return on investment from the pharmacy perspective for offering a complimentary risk assessment service. DESIGN: 12-week, prospective cohort study using convenience sampling among men who visited participating pharmacies. SETTING: Cross-section of community pharmacies. PATIENTS: 382 men aged 25-74 years with potential health risks that were untreated or uncontrolled, or who had not had a physical examination within the past year. INTERVENTION: Screening for specific health risks with or without telephone follow-up. MAIN OUTCOME MEASURE: Overall male patient response to pharmacist recommendations for follow-up medical care. RESULTS: Of 382 men identified by the Men's Health Risk Assessment Tool (MHRAT) as being at risk for 1,194 significant health conditions (mean, 3.1 conditions per patient), 69% had not received a physical examination from a physician for a period ranging from more than 1 year to 22.6 years. Of men who were recommended to make an appointment, 64% were seen by a physician or were waiting on a scheduled appointment at the end of the study. No differences were seen between the telephone intervention group and the control group in rates of obtaining a physician examination. CONCLUSION: A positive public health initiative involving community pharmacists was demonstrated in this study. Community pharmacists had a significant impact on motivating men to see a physician for follow-up care once a potential health risk was identified. The MHRAT and the pharmacist recommendation or patient education were the motivating factors and not follow-up telephone interventions by the pharmacist. Given community pharmacists' unique accessibility, an enormous opportunity exists for community pharmacists to raise awareness of men's health care and influence men's health behavior.