Direct patient care services by community and ambulatory care pharmacists in Idaho.

Background Pharmacists are one of the most accessible but unoptimized healthcare providers in the community. They are medication experts and have authority to independently prescribe in Idaho. Through the provision of direct patient care services (i.e., those distinct from traditional prescription dispensing functions), pharmacists have a greater opportunity to impact chronic disease prevention and management across the state. This can be done by filling gaps in community care (e.g., prescribing recommended therapy) and directly managing and preventing chronic diseases. However, current practices surrounding pharmacist-provided direct patient care services are unknown. Objective To characterize direct patient care services provided by Idaho community and ambulatory care pharmacists as well as to assess individual pharmacists' and their work sites' capacity and barriers in providing and expanding services. Setting Community and ambulatory care pharmacists' work sites in Idaho. Method We administered a cross-sectional, electronic, 20-min survey to Idaho community and ambulatory care pharmacists. Main outcome measure The survey focused on collecting data on current practices, capacity, and barriers related to pharmacist-provided direct patient care services. Results The survey was completed by 280 eligible community and ambulatory care pharmacists with the majority of respondents (n = 250) offering pharmacist-provided direct patient care services. Pharmacists most often prescribed therapy for tobacco cessation (nicotine replacement, bupropion, varenicline), naloxone, and devices for patients with diabetes. Top barriers to individual pharmacists providing services were dispensing load and workload while top barriers to work sites (e.g., environment) were reimbursement/billing, number of available staff, and workflow. Conclusion Idaho community and ambulatory care pharmacists currently offer direct patient care services to patients across the state, but face barriers in providing and increasing services offered.

Hepatitis C Treatment Cascade in a Federally Qualified Health Center.

Hepatitis C (HCV) care cascades have been described in diverse clinical settings, patient populations and countries, highlighting the steps in HCV care where improvements can be made and resources allocated. However, more research is needed to examine barriers to HCV treatment in rural, underserved populations and in Federally Qualified Health Centers (FQHCs). As part of a quality improvement (QI) project, this study aimed to describe and evaluate the HCV treatment cascade in an FQHC serving a large rural patient population in the Western United States. Standardized chart abstraction was utilized to aggregate data regarding patient demographics, the percentage of patients achieving each step in the treatment cascade, and relevant patient (i.e., viral load) and service variables (i.e., whether and when patients received treatment or medication). 389 patients were identified as having HCV and 86% were aware of their diagnosis. Fifty-five percent had their infection confirmed via viral load, 21% were staged for liver disease, 24% received a prescription for treatment, and 19% achieved cure. Compared to national data, the current regional sample had greater rates of diagnosis awareness and access to care, as well as sustained virologic response (SVR), but lower rates of viral load confirmation. Current findings suggest that rural patients living with HCV who receive care at FQHCs struggle to navigate the treatment cascade and achieve a cure, particularly with regard to infection confirmation, liver staging, and prescription. However, compared to national estimates, patients had greater rates of diagnosis awareness/treatment access and SVR.

Identifying Medication Management Confidence and Gaps in Training Among Community Health Workers in the United States.

Community Health Workers (CHWs) are a group of trained health professionals who advocate for members within their communities on social and health care issues. CHWs are increasingly utilized due to their affordability, accessibility, and ability to relate to patients. Evaluating CHW medication management practices, confidence, and training gaps may provide a better understanding of medication management training needs. The purpose of this cross-sectional survey was to assess CHW confidence in medication management, describe medication management services, and identify areas of focus to improve CHW medication management training. A 32-item survey was administered to CHWs in Idaho, Indiana, Nevada, and Oregon through their state's CHW email listservs. The survey content covered four domains: (1) demographic information, (2) work history, (3) experience with medication management and (4) CHW training including specific questions regarding medication management training. Two free-response questions assessed whether medication management training was beneficial and gathered suggestions for medication management-specific training. A total of 77 CHWs completed the survey of which, 90.9% were female, 38.9% worked as CHWs between 1 and 3 years, and 89.6% received instate CHW training. Over three-fourths of respondents (79.2%) provide medication management-related services and 57.1% rate their confidence in medication management as 'poor' or 'fair.' CHWs reported a need for additional medication management training within CHW certificate and continuing education programs. CHWs provide medication management services but have low confidence in their ability to provide such services. A greater emphasis on medication management training should be included in CHW certificate and continuing education programs.