Broadening pharmacy’s IMPACT

IMPACT on campus

Background: With colorectal cancer (CRC) persisting as the second leading cause of cancer deaths in the US, it is imperative that screening perceptions and behaviors among underserved populations be investigated and better understood. Latinos have exhibited lower rates of maintaining consistent and timely screening measures for CRC: while nearly 61% of non-Hispanic whites are screening regularly for CRC, Latinos fall behind at just below 45%. Federally Qualified Health Centers (FQHCs) attempt to address this disparity by providing outreach and screening services to medically underserved patients. In 2014, approximately 13% of FQHC patients nationwide self-identified as Latino; this underscores this population's need for affordable and tailored care. As the passing of the Affordable Care Act has gradually increased access to health care among Americans who had previously been uninsured, FQHCs have a unique opportunity to implement interventions that target populations and individuals who now have access to regular care. Objective: The purpose of the present study was to identify discrepancies in perceptions of CRC screening and willingness to screen among FQHCs staff and Latino community members living in San Diego, California. In-depth interviews (n=17) were held with health care providers and staff at local FQHCs (mean age: 38.8 years; 64.7% female; 88.2% Latino) and five focus groups (n=39) were conducted with community members who reside in neighborhoods served by FQHCs (mean age: 59.4 years; 79.5% female; 97.4% Latino). Method: Using standardized interview and focus group guides based on Social Ecological Model (SEM), FQHCs staff and community members were asked to describe their experience with CRC screening. Beliefs, attitudes, and perceptions regarding CRC screening and related referrals were also discussed. Interviews and focus groups were audio recorded and transcribed, and content analysis was used to create a codebook based on SEM. Two coders independently reviewed transcripts and applied codes, meeting to resolve inconsistent coding via consensus. Data were summarized according to two themes: 1) patient-level facilitators and barriers to CRC screening and 2) organizational barriers to CRC screening. Results: While patients often reported feeling that they had access to medical information and had a grasp of the basic tenets of preventive health care, FQHCs staff consistently reported a lack of CRC-specific knowledge among patients in their clinics. Community members' reported willingness to screen for CRC was higher than FQHCs staffs' perception of it. FQHCs patients were viewed by staff as being afraid or embarrassed to screen, while community members generally reported feeling comfortable with CRC screening methods. FQHCs staff identified organizational barriers, such as the fragmentation of the referral process and a lack of knowledge of appropriate screening procedures. Organizational facilitators at FQHCs were also identified, including the option of mailing completed fecal immunochemical tests (FIT) to labs as well as the overall cohesion and organizational capacities of the FQHCs' Electronic Health Record systems. Additionally, FQHCs staff reported having implemented a pilot program that sought to aid patients in understanding the importance and processes of using the FIT kit as well as facilitating the completion and return of FIT tests. Discussion: The present study's findings suggest FQHCs staff may lack confidence in their patients' abilities and knowledge in obtaining CRC screening. Several discrepancies were noted with regard to patients' willingness and ability to obtain CRC screening. Interventions that work to improve communication between FQHC staff and patients would be beneficial to the Latino populations living in this region. Citation Format: Elizabeth N. Alpert, Sumayah Nuhaily, Carolina López De la Torre, Jessica Haughton, Samir Gupta, Jesse Nodora, Balambal Bharti, Christian Ramers, Felipe Garcia, Tatianna Clark, Claudia Carrizosa, Elva M. Arredondo, Kristen J. Wells. Discrepancies in perceptions of colorectal cancer screening and willingness to screen among Federally Qualified Health Centers staff and Latino community members [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C71.

The pharmacist’s personal IMPACT

Diabetes care in California’s Lost Hills

The IMPACT of teamwork

An IMPACT on challenging patient populations

Good Samaritans in South Carolina

Translating the Adenoma Detection Rate as a Quality Measure for Endoscopists to a Public Health Approach to Screening Underserved Patients for Colorectal Cancer

Federally Qualified Health Centers (FQHCs) are a vital source of primary care for underserved populations, such as Medicaid enrollees and the uninsured. Their role in delivering care may increase through new funding allocations in the Affordable Care Act and expanded Medicaid programs across many states. Examine differences in appointment availability and wait-times for new patient visits between FQHCs and other providers. We use experimental data from a simulated patient study to compare new patient appointment rates across FQHC and non-FQHC practices for 3 insurance types (private, Medicaid, and self-pay). Trained auditors, posing as patients requesting the first available new patient appointment, were randomized to call primary care providers in 10 states in late 2012 and early 2013. Multivariate regression models adjust for caller-level, clinic-level, and area-level variables. The sample comprises 10,904 calls, including 544 calls to FQHCs. FQHCs grant new patient appointments at high rates, irrespective of patient insurance status. Adjusting for caller, clinic, and area variables, the Medicaid appointment rate at FQHCs is 22 percentage points higher than other primary care practices. Although the appointment rate difference between FQHCs and non-FQHCs is somewhat smaller for the self-pay group, FQHCs are much more likely to provide a lower-cost visit to these patients. Conditional on receiving an appointment, wait-times at FQHCs are comparable with other providers. FQHCs' greater willingness to accept new underserved patients before 2014 underscores their potential key roles as health reform proceeds.

Pharmacists play critical roles in 340B viability

Diabetic retinopathy (DR) and diabetic macular edema (DME) are debilitating complications of diabetes; however, patients in the most vulnerable populations often face barriers in accessing recommended ocular exams, leading to major health inequity. These barriers are especially true for FQHCs, as they serve the most under resourced and underserved populations. More recently, rigorously validated, FDA cleared, autonomous AI for the detection of DR and DME has been considered as an alternative to deployed remote reading networks. We examined the impact of autonomous AI compared to remote reading on patient access and clinical workflow efficiency, measured as number of steps by the operator. During 90 days in mid-2021, at two FQHC clinics in the southeastern US, autonomous AI was provided in place of a remote reading network. All steps were completed at the point-of-care: qualified patients with diabetes were identified in the electronic health record (EHR) , diagnosed by the autonomous AI output, provided results at time of the exam, and referred to specialists where appropriate. After 90 days, 1patients with diabetes underwent autonomous AI diagnostic testing, and 30/1patients with diabetes (28.6%) were identified by the AI as having signs of vision threatening DR or DME. Testing was accomplished with fewer steps as compared to exams completed with a remote reading network at the same clinics. We conclude that implementing autonomous AI point-of-care testing for the identification of DR and DME in an FQHC setting improved workflow efficiency and patient access compared to remote reading, demonstrating a potential to address health inequities in underserved and vulnerable populations. Disclosure J.Goldstein: Employee; Digital Diagnostics. D.Weitzman: Employee; Digital Diagnostics. M.D.Abràmoff: Advisory Panel; NovaGo Therapeutics AG, Board Member; Digital Diagnostics, Consultant; Digital Diagnostics, Speaker's Bureau; AbbVie Inc., Stock/Shareholder; Digital Diagnostics.

Ton Hoek: Trailblazer of international pharmacy

Federally qualified health centers (FQHCs) provide care in underserved areas, regardless of an individual’s ability to pay, and can be a critical source of care for children with public or no insurance who have greater difficulty getting care from providers in the community. In 2013, about one‐third of FQHC patients nationally were children. The Affordable Care Act (ACA) increased federal funding for FQHCs by $11 billion between 2011 and 2015, with the policy goal of increasing access to care for underserved populations. We examined the effects of the increased funding for FQHCs on children and adults in Massachusetts.We used 2010‐2013 claims data from the Massachusetts All Payer Claims Database (APCD) to examine changes in visits to FQHCs among enrollees included in the APCD (Medicaid, commercial insurance, and visits by uninsured residents covered by the Health Safety Net).We obtained FQHC funding information from the Uniform Data Set. To assess the impact of changes in funding (federal and state) on FQHC visits, we used a shift‐share instrument to measure local exposure (5‐digit ZIP code‐level) to changes in funding: we weighted the year‐to‐year percentage change in FQHC funding by the local share of each FQHC’s patient population in 2009 and summed across FQHCs in the ZIP. We used a multivariate linear regression model to assess the association between the year‐to‐year percentage change in local exposure to FQHC funding and the percentage change in the total number of FQHC visits or number of residents with FQHC visits in 2010‐13, adjusting for each ZIP codes’ demographic and health characteristics (eg, age, median comorbidity scores). We used similar models to examine changes in ED visits and stratified models for children vs. adults. Models were weighted by the ZIP code population, and standard errors were clustered by ZIP.Children (N = 1 145 205 in 2010) and adults (N = 5 038 277 in 2010) included in the Massachusetts APCD and 31 FQHCs that received funding from the Community Health Center Fund between 2010 and 13.Annual pediatric visits at MA FQHCs increased by 10% and adult FQHC visits by 14% from 2010 to 2013. Those with vs. without FQHC visits were more likely to have Medicaid insurance (67% vs. 17%) and live in low‐income neighborhoods (37% vs. 22%). Increased visits to FQHCs by children were associated with increases in FQHC funding, for example, +6.8 percentage point (95% CI [1.7, 11.8]) with +1SD change in prior year funding. ED visits by children also decreased with greater local exposure to FQHC funding, for example, −1.3pp ([−2.4, −0.2]) with +1SD change in prior year funding. FQHC visits for adults did not vary significantly with FQHC funding, but ED visits decreased by a similar magnitude as children.Increases in FQHC funding resulted in significant increases in use of FQHC services, especially for children. ED visits for children and adults also decreased with greater FQHC funding.The ACA funding increases for FQHCs appeared to increase access to community health center services for low‐income children and reduced costly emergency department care for underserved communities.Agency for Healthcare Research and Quality.

Expanding comprehensive medication management considerations to include responses to the social determinants of health within the <scp>BD</scp><i>Helping Build Healthy Communities Program</i>

Background: Burnout continues to impact health care workers and its effect takes a toll on their lives and wellbeing, especially in primary care. Relatively few studies have focused specifically on the perspective of clinicians in Federally Qualified Health Centers (FQHCs), which offer crucial, preventative health care services to vulnerable and underserved patient populations. Objective: To examine the perspectives of clinicians working at an FQHC in the Northeast United States after the implementation of a year-long wellness initiative. Design: A qualitative analysis of clinician's discussion during focus groups conducted after the wellness initiative. Subjects and Setting/Location: A total of 28 clinicians (primary care physicians and nurse practitioners) in an FQHC in the Northeast United States. Interventions: A one-year wellness initiative with programs and activities designed to bolster wellness. Outcome Measures: Analyzed NVIVO-coded transcripts of focus group discussion to generate codes and used modified grounded theory to extrapolate meaningful themes. Results: Five key themes emerged from the qualitative analysis: (1) clinicians often felt burdened by their workload and personally responsible when they were not able to provide optimal care to patients; (2) burnout was exacerbated by systemic problems at the FQHC; (3) medical assistants, medical scribes, schedulers, and other support staff played a crucial role in the wellness of the entire team; (4) perceived differences in priorities between administration and health care workers may have contributed to burnout; and (5) a communicative and stable team helped clinicians effectively care for their patients. Conclusions: Clinician burnout is a complex problem at FQHCs with many root causes. Addressing burnout and improving clinician wellness at FQHCs will require a multifaceted approach encompassing systemic, team, and individual components. The perspectives from the clinicians at our FQHC may inform wellness strategies for other safety net, clinical institutions in the primary care setting.