Transgender/gender nonconforming adults' worries and coping actions related to discrimination: Relevance to pharmacist care.

PURPOSE: Transgender/gender nonconforming (TGNC) adults' worries and coping actions related to discrimination by healthcare professionals were evaluated. METHODS: A community-led participatory approach was used to develop, implement, and analyze the survey. Respondents were recruited using a snowball recruitment method. The questionnaire measured population demographics, health status, worry about discrimination, perceptions of health professional competency in gender-affirming care, and actions taken to cope with discrimination. Analysis used mainly descriptive methods and chi-square analysis, where appropriate. RESULTS: There were 316 usable responses from a total of 325 responses. The typical respondent was young, white, lived within the Midwest and in urban/suburban areas. About half had college degrees and 41.7% had annual household incomes of less than $25,000. High degrees of depression risk and anxiety were reported along with low self-reported health status. Most used pharmacist services with 41.6% reporting worry about discrimination associated with such services. About half (52.5%) reported pharmacists as having very little or no competency in providing gender-affirming care. Common coping actions included delayed seeking of healthcare and non-disclosure of authentic gender identity. Thirteen percent of respondents avoided healthcare because of perceived purposeful embarrassment experienced at a pharmacy. CONCLUSION: Worry about discrimination from pharmacists was common among TGNC adults and was associated with high levels of anxiety. The majority perceived pharmacists to lack competency in transgender care.

Description of pharmacist-led quality improvement huddles in the patient-centered medical home model.

OBJECTIVES: This case study describes the implementation of pharmacist-led quality improvement team huddles in the patient-centered medical home clinic model. The purpose of these huddles is to have an impact on clinic-based quality metrics. SETTING: Pharmacists embedded into primary care clinics at 2 separate health centers, within a large academic medical center, were funded by the clinics to lead their quality improvement (QI) team huddles. PRACTICE DESCRIPTION: Huddle team members vary depending on the practice sites and can include physicians, pharmacists, advanced practice providers, nurses, administrative managers, social workers, and medical assistants. These huddles are typically held every 1-2 weeks for 15-20 minutes. Small rapid plan-do-check-act cycles allow the process to be quickly assessed and altered if needed. The quality metric that the team focused on changed based on clinic goals. Two case studies showcase successful examples of quality improvement initiatives that had a significant impact on the individual clinic-based metrics. INNOVATION: The 2 case studies focus on pharmacist-led quality team huddles for controlled substance and asthma action plan metrics. The clinical pharmacists involved were pivotal to organizing and helping incorporate new processes within their clinics sites. RESULTS: The work of the team huddles brought the clinics from a nonreimbursable status to reimbursable for these metrics. DISCUSSION: Because pharmacists in the ambulatory care setting focus on chronic care disease management and QI, they are in an excellent position to lead team huddles focused on QI and registry management. By establishing interdisciplinary QI team huddles led by clinical pharmacists, these clinics were able to increase revenue for the clinic in the way of increasing pay-for-performance measures. CONCLUSION: Pharmacist-led quality improvement team huddles can have a positive impact on quality metrics, population health, and reimbursement.

Improving Ambulatory Care Resident Training: Preparing for Opportunities to Treat Mental Illness in the Primary Care Setting.

PURPOSE: The development of an outpatient psychiatry clinical practice learning experience for PGY2 ambulatory care pharmacy residents in preparation for the treatment of psychiatric disorders in the primary care setting is described. SUMMARY: With the increased prevalence of psychiatric disorders, significant mortality, and limited access to care, integration of mental health treatment into the primary care setting is necessary to improve patient outcomes. Given the majority of mental health treatment occurs in the primary care setting, pharmacists in patient-centered medical homes (PCMHs) are in a unique position with direct access to patients to effectively manage these illnesses. However, the increased need for pharmacist education and training in psychiatry has prompted a large, Midwestern academic health system to develop an outpatient psychiatry learning experience for PGY2 (Postgraduate Year 2) ambulatory care pharmacy residents in 2015. The goal of this learning experience is to introduce the PGY2 ambulatory care residents to the role and impact of psychiatric clinical pharmacists and to orient the residents to the basics of psychiatric pharmacotherapy to be applied to their future practice in the primary care setting. CONCLUSION: The development of an outpatient psychiatry learning experience for PGY2 ambulatory care pharmacy residents will allow for more integrated and comprehensive care for patients with psychiatric conditions, many of whom are treated and managed in the PCMH setting.

Patient-centered medical home: developing, expanding, and sustaining a role for pharmacists.

PURPOSE: The development of a patient-centered medical home (PCMH) health care model and the role of pharmacists in PCMHs at the University of Michigan are described. SUMMARY: In 2009, Blue Cross Blue Shield of Michigan (BCBSM) provided financial incentives to physician groups to implement PCMH principles. A partnership was formed among the department of pharmacy, college of pharmacy, and faculty group practice at the University of Michigan Health System (UMHS) to integrate clinical pharmacists into the PCMH model at eight general medicine practices. The rationale was that PCMH pharmacists could assist in managing chronic conditions by substituting or augmenting physician care, help achieve quality indicators, and increase revenue by billing for their services. At the University of Michigan, PCMH pharmacists currently provide direct patient care services at eight general medicine health centers for patients with diabetes, hypertension, hyperlipidemia, and polypharmacy, which are billable using T codes, which are payable to UMHS by most BCBSM plans. In the first year, the number of PCMH pharmacist half-day clinics varied from one to six per health center, and the mean number of patients per half-day clinic ranged from 2.2 to 6. Pharmacists in four PCMHs made more medication changes per visit than the other four, particularly for patients with diabetes. CONCLUSION: At the University of Michigan, PCMH pharmacists currently provide direct patient care services at eight general medicine health centers for patients with diabetes, hypertension, hyperlipidemia, and polypharmacy via referral from physicians.