Integration of Clinical Pharmacist Services into an Underserved Primary Care Clinic Utilizing an Interprofessional Collaborative Practice Model.

This report describes the role of a clinical pharmacist serving onsite in an interprofessional collaborative practice care model at an urban underserved primary care clinic. It also overviews current health care legislative policy as it relates to expanding pharmacists roles as an integrated team member in medically underserved, vulnerable populations.

Evidence-Guided Integration of Interprofessional Collaborative Practice into Nurse Managed Health Centers.

The Division of Nursing, Bureau of Health Workforce, has spearheaded a 3-year effort to increase the skills of nurses to lead interprofessional collaborative practice (IPCP) teams. Since 2012, the Nurse Education, Practice, Quality and Retention program has funded 53 sites engaged in this work. The purposes of this report are to describe the IPCP framework undergirding implementation at one such site, describe the evaluation components and approach, describe how health professions students are integrated into this model, and discuss implications of IPCP for future nurse-managed/nurse-led initiatives within an evolving health care environment. Core team members include a family nurse practitioner, physician, pharmacist, social worker, and community health advocate. The clinic is located within a public housing complex; the target population is largely uninsured or underinsured with a historically high rate of emergency department utilization.

Improving diabetic retinopathy screening ratios using telemedicine-based digital retinal imaging technology: the Vine Hill study.

OBJECTIVE: To evaluate the impact of a telemedicine, digital retinal imaging strategy on diabetic retinopathy screening rates in an inner-city primary care clinic. RESEARCH DESIGN AND METHODS: This retrospective cohort study included all diabetic patients aged > or = 18 years (n = 495) seen at Vine Hill Community Clinic between 1 September 2003 and 31 August 2004. Patients were offered ophthalmology referral or digital screening. Patients choosing referral received the next available (within 3 months) appointment at the Vanderbilt Eye Clinic; patients choosing digital screening were screened during the visit. RESULTS: Retinal screening was documented for 293 (59.2%) patients, a significant improvement compared with the 23% baseline rate. Of 293 patients screened, 92 (31.4%) were screened in ophthalmology, and 201 (68.6%) were digitally screened. Among the 201 digitally screened patients, 104 (51.7%) screened negative and were advised to rescreen in 1 year, 75 (37.3%) screened positive and were nonurgently referred to ophthalmology, and 22 (11.0%) screened positive for sight-threatening eye disease and were urgently referred for ophthalmological follow-up. Digital imaging technical failure rate was 0.5%. Referral status was associated with race/ethnicity (chi2 = 7.9, P < 0.02) with whites more likely to screen negative than non-whites (62.4 vs. 47.8%, respectively). Sight-threatening disease among non-whites (14.7%) was more than double that observed for whites (5.9%). CONCLUSIONS: Digital imaging technology in the primary care visit can significantly improve screening rates over conventional methods, increase access to recommended diabetic eye care, and focus specialty care on medically indigent patients with greatest need.