Social and Psychosocial Determinants of Health Associated With Uncontrolled Diabetes in a Federally Qualified Health Center Population.

PURPOSE: Many people with diabetes have difficulty achieving glycemic targets, and social and psychosocial determinants of health may influence their ability to obtain glycemic goals. The objective of this study was to identify characteristics independently associated with A1C >9% or untested A1C compared to those with A1C ≤9% at a federally qualified health center. METHODS: This retrospective cohort study included people with a diagnosis of diabetes, who were 18-89 years of age and had a medical evaluation from a primary care provider between 1 September 2016 and 31 August 2017. The primary outcome was to identify characteristics associated with an A1C >9% or untested A1C compared to those with an A1C ≤9%. RESULTS: Of 6,185 patients meeting inclusion criteria, 2,965 (48%) had uncontrolled A1C. In the uncontrolled A1C group, 1,549 patients (52%) were female, 1,296 (44%) preferred care in a language other than English (1,273 [43%] in Spanish), and 535 (18%) had a concurrent mental health diagnosis. Multivariable logistic regression of 4,774 patients with complete data revealed that poor appointment adherence (odds ratio [OR] 3.24, 95% CI 2.30-4.57) and/or a positive Patient Health Questionnaire-2 depression screen (OR 1.35, 95% CI 1.12-1.62) had an increased risk of being in the uncontrolled A1C group. Patients with a prescription for antidepressant medication were more likely to be in the controlled group. CONCLUSION: Poor adherence to appointments and presence of depressive symptoms were associated with high A1C values. Interventions can be developed targeting these determinants to improve blood glucose levels.

Changes in pharmacy students' perceptions of underserved populations after a six-week clinical rotation in a federally qualified health center clinic.

BACKGROUND AND PURPOSE: The primary objective of this study was to assess changes in pharmacy students' attitudes and perceptions toward providing care to underserved populations after a six-week clinical experience within a Federally Qualified Health Center (FQHC) clinic. EDUCATIONAL ACTIVITY AND SETTING: A pre-post survey design was utilized to evaluate third- and fourth-year pharmacy students' attitudes and perceptions before and after a six-week clinical rotation providing direct patient care to underserved patients in FQHC clinics. Results were collected via self-administered online surveys that collected information on participants' (1) demographics, (2) past experiences interacting with underserved populations, (3) type of clinical activities completed during the rotation, and (4) personal opinions and perceptions of providing care to underserved populations. FINDINGS: Responses to seven of the 18 attitudinal questions showed a statistically significant positive change from baseline, with three questions being related to educational satisfaction. Changes in attitudes for questions related to domains of personal impact and perceptions/barriers were also significant. DISCUSSION/SUMMARY: Clinical rotations within an FQHC clinic can positively impact pharmacy students' attitudes towards underserved populations. If more students are exposed to direct patient care with underserved populations throughout their experiential training, the number of graduating student pharmacists that explore job opportunities within underserved areas may increase. Clinical rotations within an FQHC clinic can positively impact pharmacy students' attitudes towards underserved populations. If more students are exposed to direct patient care with underserved populations throughout their experiential training, the number of graduating student pharmacists that explore job opportunities within underserved areas may increase.

Integration of pharmacy students within a level II trauma center.

OBJECTIVE: To integrate fourth-year doctor of pharmacy (PharmD) students within a level II trauma center team to improve their patient care and professional communication skills. DESIGN: PharmD students completed 2 consecutive 4-week internal medicine APPEs during the course of their fourth year, which included approximately 5 weeks working on an interprofessional trauma team. During patient rounds with the interprofessional trauma team, students provided patient care in a stepwise approach, drug information responses, patient counseling, and other services requested by team members. ASSESSMENT: Ability-based outcomes (ABOs) assessment, faculty evaluations, and student self-assessment were conducted in the following areas: effective communication, drug therapy assessment and decision making, critical thinking and problem solving, and drug information retrieval. Students' mean score in these areas was 3.8 on a 5-point scale. Areas in which students needed improvement included: providing recommendations in a timely manner, self-confidence, identifying opportunity to verbally communicate with other team members, and addressing insecurities when answering drug information questions posed by the team. CONCLUSION: Integrating fourth-year PharmD students within a trauma and acute surgery team and use of ABO assessment allowed for identification of areas of the curriculum in which improvements were needed, resulting in a more targeted approach earlier in the curriculum to improve students' abilities to provide appropriate and effective patient care in an interprofessional setting.