Expanding the role of a pharmacist as a sexually transmitted infection provider in the setting of an urban free health clinic.

BACKGROUND: This study was designed to explore patient perceptions of sexually transmitted infection (STI) screening and treatment provided by a pharmacist in an urban free health clinic. With health care reform on the horizon, the role of a pharmacist is quickly evolving, making it necessary for pharmacists to sharpen their clinical skills to accurately serve their patients. One in 4 American adolescents is infected with an STI, placing pharmacists in a position to help decrease STI transmission and complications. METHODS: To assess patient attitudes toward pharmacists as STI providers, a convenience sample of patients who presented to an urban free health clinic in 2009 for STI testing were given a confidential survey of 12 statements relating to STI testing and the acceptability of a pharmacist-provider. RESULTS: Patients expressed overwhelming support of a pharmacist as their STI treatment provider (79.9%). The services they were comfortable with a pharmacist performing included running a urine screen (95.1%), performing a physical examination (81.1%), treating STIs (98.2%), and discussing STI test results (93.9%). Patients also approved of pharmacists working under a collaborative practice agreement with a physician (97.6%). CONCLUSIONS: Acceptance by patients of a pharmacist-provider for STI screening may lead to the adoption of pharmacists as providers in STI screening clinics. This would decrease barriers to treatment (eg, stigma and lack of access), increase accessibility to care, and greatly improve the identification of those infected with STIs, ultimately leading to a decrease in the spread and long-term sequelae of untreated STIs.

Implementing rapid HIV testing in outreach and community settings: results from an advancing HIV prevention demonstration project conducted in seven U.S. cities.

OBJECTIVES: The goals of this project were to assess the feasibility of conducting rapid human immunodeficiency virus (HIV) testing in outreach and community settings to increase knowledge of HIV serostatus among groups disproportionately affected by HIV and to identify effective nonclinical venues for recruiting people in the targeted populations. METHODS: Community-based organizations (CBOs) in seven U.S. cities conducted rapid HIV testing in outreach and community settings, including public parks, homeless shelters, and bars. People with reactive preliminary positive test results received confirmatory testing, and people confirmed to be HIV-positive were referred to health-care and prevention services. RESULTS: A total of 23,900 people received rapid HIV testing. Of the 267 people (1.1%) with newly diagnosed HIV infection, 75% received their confirmatory test results and 64% were referred to care. Seventy-six percent were from racial/ethnic minority groups, and 58% identified themselves as men who have sex with men, 72% of whom reported having multiple sex partners in the past year. Venues with the highest proportion of new HIV diagnoses were bathhouses, social service organizations, and needle-exchange programs. The acceptance rate for testing was 60% among sites collecting this information. CONCLUSIONS: Findings from this demonstration project indicate that offering rapid HIV testing in outreach and community settings is a feasible approach for reaching members of minority groups and people at high risk for HIV infection. The project identified venues that would be important to target and offered lessons that could be used by other CBOs to design and implement similar programs in the future.

Health Literacy and Medication Adherence Among Patients Treated in a Free Health Clinic: A Pilot Study.

BACKGROUND: A patient's health literacy is not routinely assessed during visits with a health care provider. Since low health literacy is a risk factor for poor health outcomes, assessing health literacy should be considered as part of the standard medical workup. OBJECTIVES: To evaluate the health literacy levels and medication adherence of patients treated by pharmacists in both the general medicine and the chronic care clinics at an urban free health clinic. METHODS: Eligible patients from the free health clinic completed the Rapid Estimate of Adult Literacy in Medicine (REALM), a health literacy measurement tool, during their clinic visit in 2011. Medication adherence was self-reported by the patients. RESULTS: A total of 100 patients participated (mean age = 48). The majority of participants were female (56%) and white (55%). Most (64%) of the patients scored at a high school reading level according to REALM. Only 21% of participants read at a seventh- to eighth-grade level. Overall medication adherence rate was 73%. Forgetting to take medication was the most popular reason given for nonadherence. CONCLUSION: Disease state and adherence were significantly related in patients with HIV/AIDS and hypertension. Patient's ethnicity was significantly associated with literacy levels (P < .05). Although patients' literacy levels were not significantly associated with self-reported adherence in this population, availability of a patient's baseline health literacy level as a part of the medical record may help clinicians to individualize their interaction based on the patient's health literacy level in order to achieve better health outcomes, including improved medication adherence, especially for underserved populations.

Genital, oral, and anal human papillomavirus infection in men who have sex with men.

Even though the incidence of anal cancer among men who have sex with men (MSM) is higher than the incidence of cervical cancer among women, few MSM are identified as high-risk patients in primary care or have received vaccination for human papillomavirus (HPV), the most common sexually transmitted infection worldwide, with 6.2 million new infections each year. The authors review the current literature on diagnosis and basic management of genital, oral, and anal HPV infection. Early diagnosis and treatment of patients with HPV infection is important because this infection causes patients substantial distress even in its benign manifestations. It has also been implicated in a host of cancers, including oral, cervical, penile, and anal cancers and is an independent risk factor for the development of human immunodeficiency virus infection. The incidence of HPV infection drops in women older than 30 years but remains high for MSM in all age ranges. For all of these reasons, physicians should routinely assess the sexual practices of all male patients, especially MSM, and educate them on the HPV infection risks, diagnosis, and treatment options. Physicians can have a significant impact in the primary prevention of HPV by routinely offering HPV vaccination to male patients younger than 26 years.