Arizona Department of Health Prevention Services' Work to Advance Health Equity Starts With an Assessment of Its Own Organizational Culture.

OBJECTIVE: To identify skills, organizational practices, and infrastructure needed to address health equity. DESIGN, SETTING, AND PARTICIPANTS: We developed an anonymous online staff survey to assess how to address health equity and policy implications and develop a baseline for future initiatives. We distributed invitations to all Arizona Department of Health Services (ADHS) Division of Prevention Services (DPS) state- and non-state-designated employees in February 2021. MAIN OUTCOME MEASURES: Employee self-reported perceptions of how agency, division, and programs address health inequities; information about (1) organizational and individual traits needed to support our ability to implement effective health equity-focused work and (2) processes to enable improved organizational and workforce capacities; and implications for strategic planning. RESULTS: Seventy-eight percent (N = 123) of eligible staff participated. Overall, we identified 21 of 28 organizational and 17 of 31 workforce capacities needing significant improvement. Organizational capacities were "Institutional commitment to address health inequities" (described using 6 elements), "Hiring to address health inequities" (2 elements), "Structure that supports true community partnerships" (3 elements), "Support staff to address health inequities" (4 elements), "Transparent and inclusive communication" (4 elements), "Community accessible data and planning" (1 element), and "Streamlined administrative process" (1 element). Workforce capacities were "Knowledge of public health framework" (4 elements), "Understand the social, environmental, and structural determinants of health" (1 element), "Community knowledge" (1 element), "Leadership" (4 elements), "Collaboration skills" (3 elements), "Community organizing" (3 elements), and "Problem-solving ability" (1 element). Using survey results, groups of staff identified change needed, specific actions, and training and communication to increase employee understanding. Proposed activities focused on data/evaluation, program planning/contracts, communications, personnel development, and community engagement. CONCLUSIONS: This survey allowed ADHS to establish a baseline of staff knowledge of the ADHS and DPS organizational commitment to address health inequities; results show us what areas to focus on to strengthen our capacity to achieve better outcomes; and improve health and wellness for all Arizonans.

Evaluation of a Pharmacist-Led Telephonic Medication Therapy Management Program in Rural Arizona: Implications for Community Health Practice.

This study evaluated a pharmacist-led telephonic Medication Therapy Management (MTM) program for rural patients in Arizona with poor access to healthcare services. A pharmacist provided telephonic MTM services to eligible adult patients living in rural Arizona communities with a diagnosis of diabetes and/or hypertension. Data were collected and summarized descriptively for demographic and health conditions, clinical values, and medication-related problems (MRPs) at the initial consultation, and follow-up data collected at 1 and 3 months. A total of 33 patients had baseline and one-month follow-up data, while 15 patients also had three-month follow-up data. At the initial consultation, the following MRPs were identified: medication adherence issues, dose-related concerns, adverse drug events (ADE), high-risk medications, and therapeutic duplications. Recommendations were made for patients to have the influenza, herpes zoster, and pneumonia vaccines; and to initiate a statin, angiotensin converting enzyme inhibitor, angiotensin receptor blocker, beta-blocker, and/or rescue inhaler. In conclusion, this study demonstrated that while pharmacists can identify and make clinical recommendations to patients, the value of these interventions is not fully realized due to recommendations not being implemented and difficulties with patient follow-up, which may have been due to the COVID-19 pandemic. Additional efforts to address these shortcomings are therefore required.

Disparities of Access, Use, and Barriers to Seeking Health Care Services in Arizona.

BACKGROUND: Access to health care (HC) services is important for promoting and maintaining health, preventing and managing disease, reducing unnecessary disability and premature death, and achieving health equity for all persons. OBJECTIVES: We assess social indicators among people living in Arizona that are associated with access, use, and barriers to seeking HC services. RESEARCH DESIGN: We analyzed data (n=8073) from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) to describe demographic and health characteristics among persons by HC access and use, and for whom costs were a barrier to seeking care. RESULTS: Among Arizona adults, 13.5% reported lacking HC coverage, 28.7% reported lacking a personal doctor, and medical costs were a barrier to seeking care for 14.1%. Arizonans aged 18-34 years or with a high school education or less more often reported lacking HC coverage, a personal doctor, or not visiting a doctor because of costs. Past year medical and dental checkups were less common among less educated (≤high school) and never married persons. Hispanic persons more often reported lacking HC coverage or not visiting a doctor because of costs, and less often reported past year dental checkups. CONCLUSIONS: BRFSS can be analyzed to identify and quantify unique HC disparities, and the findings can serve as the basis for improving HC in communities. Expansion of HC services and providers may be achieved, in part, through incentives for providers to work in designated health professional shortage areas and/or leveraging telehealth/telemedicine in rural and urban underserved communities.

An Academic-Community Collaboration to Deliver Medication Therapy Management (MTM) Services to Patients Living in Rural Counties of a Southwestern State in the United States.

BACKGROUND: Patients living in rural communities often experience pronounced health disparities, have a higher prevalence of diabetes and hypertension, and poorer access to care compared to urban areas. To address these unmet healthcare service needs, an established, academic-based MTM provider created a novel, collaborative program to provide comprehensive, telephonic services to patients living in rural Arizona counties. OBJECTIVE: This study assessed the program effectiveness and described differences in health process and outcome measures (e.g., clinical outcomes, gaps in care for prescribed medications, medication-related problems) between individuals residing in different rural-urban commuting area (RUCA) groups (urban, micropolitan, and small town) in rural Arizona counties. METHODS: Subjects eligible for inclusion were 18 years or older with diabetes and/or hypertension, living in rural Arizona counties. Data were collected on: demographic characteristics, medical conditions, clinical values, gaps in care, medication-related problems (MRPs), and health promotion guidance. Subjects were analyzed using 3 intra-county RUCA levels (i.e., urban, micropolitan, and small town). RESULTS: A total of 384 patients were included from: urban (36.7%), micropolitan (19.3%) and small town (44.0%) areas. Positive trends were observed for clinical values, gaps in care, and MRPs between initial and follow-up consultations. Urban dwellers had significantly lower average SBP values at follow-up than those from small towns (p < 0.05). A total of 192 MRPs were identified; 75.0% were resolved immediately or referred to providers and 16.7% were accepted by prescribers. CONCLUSION: This academic-community partnership highlights the benefits of innovative collaborative programs, such as this, for individuals living in underserved, rural areas.

Health Disparities Among American Indians/Alaska Natives - Arizona, 2017.

Compared with other racial/ethnic groups, American Indians/Alaska Natives (AI/AN) have a lower life expectancy, lower quality of life, and are disproportionately affected by many chronic conditions (1,2). Arizona has the third largest population of AI/AN in the United States (approximately 266,000 in 2017), and is home to 22 federally recognized American Indian tribal nations.* The small AI/AN sample size in previous Behavioral Risk Factor Surveillance System (BRFSS) surveys has presented analytic challenges in making statistical inferences about this population. To identify health disparities among AI/AN living in Arizona, the Arizona Department of Health Services (ADHS) and CDC analyzed data from the 2017 BRFSS survey, for which AI/AN were oversampled. Compared with whites, AI/AN had significantly higher prevalences of sugar-sweetened beverage consumption (33.0% versus 26.8%), being overweight or having obesity (76.7% versus 63.2%), diabetes (21.4% versus 8.0%), high blood pressure (32.9% versus 27.6%), report of fair or poor health status (28.7% versus 16.3%), and leisure-time physical inactivity during the past month (31.1% versus 23.0%). AI/AN also reported a lower prevalence of having a personal doctor or health care provider (63.1%) than did whites (72.8%). This report highlights the need to enhance surveillance measures at the local, state, and national levels and can inform interventions centered on confronting social inequities, developing culturally competent prevention strategies, and facilitating access to care to improve population health and work toward health equity.

Prevalence of Arthritis Among Adults with Prediabetes and Arthritis-Specific Barriers to Important Interventions for Prediabetes - United States, 2009-2016.

An estimated 54.4 million U.S. adults have doctor-diagnosed arthritis (arthritis), and this number is projected to rise to 78.4 million by 2040 (1,2). Physical inactivity and obesity are two factors associated with an increased risk for developing type 2 diabetes,* and arthritis has been determined to be a barrier to physical activity among adults with obesity (3). The prevalence of arthritis among the 33.9% (estimated 84 million)† of U.S. adults with prediabetes and how these conditions are related to physical inactivity and obesity are unknown. To examine the relationships among arthritis, prediabetes, physical inactivity, and obesity, CDC analyzed combined data from the 2009-2016 National Health and Nutrition Examination Surveys (NHANES). Overall, the unadjusted prevalence of arthritis among adults with prediabetes was 32.0% (26 million). Among adults with both arthritis and prediabetes, the unadjusted prevalences of leisure-time physical inactivity and obesity were 56.5% (95% confidence intervals [CIs] = 51.3-61.5) and 50.1% (CI = 46.5-53.6), respectively. Approximately half of adults with both prediabetes and arthritis are either physically inactive or have obesity, further increasing their risk for type 2 diabetes. Health care and public health professionals can address arthritis-specific barriers§ to physical activity by promoting evidence-based physical activity interventions.¶ Furthermore, weight loss and physical activity promoted though the National Diabetes Prevention Program can reduce the risk for type 2 diabetes and reduce pain from arthritis.