Program thrives on ‘relationship of trust’ between community health workers and patients

Abstract

In just over 6 months of a unique partnership between community pharmacists and community health workers, Tripp Logan, PharmD, from L&S Pharmacy and Medical Arts Pharmacies in Charleston, MO, has a lot to share about helping high-risk patients stay healthy and out of the hospital. “We are located in the Mississippi Delta region, surrounded by some of the poorest counties in Missouri. Our population has lots of diabetes [and] hypertension, there are not many rural providers, and most patients have transport issues,” said Logan. As efforts to improve health shift to recognizing that addressing social determinants of health such as socioeconomic and environmental factors influence health, many states are looking to community health workers to help close some of the gaps that lead to poor health outcomes. Finding a community health worker in the community pharmacy space is still rare, however. Working with the Missouri Department of Health and Senior Services as well as other state entities, Logan said they were the first pilot pharmacy in Missouri to train community health workers. Funded through a state grant, they have had four community health workers complete a training program specific to pharmacy. Logan and his team discovered that equipping their pharmacy delivery drivers with home and patient assessments was the most efficient way to find out if a patient should be referred to a community health worker. “We found that the community health workers engaged patients and acted as their liaison and support entity—they do anything from dispatching emergency services to setting up transit and office visits with providers and physical therapists,” said Logan. They also help patients afford their medications. “This has probably been the most rewarding thing we’ve done in our pharmacy,” said Logan. Richard Segal, RPh, PhD, associate dean for faculty affairs at the University of Florida College of Pharmacy, said he’s been amazed by the way patients open up to community health workers. Segal has been involved in research and training of community health workers for several years. Community health workers often share the same cultural understanding as their patients, which allows them to more easily identify barriers patients face when it comes to taking medications. “They have a relationship of trust—information is shared with the community health worker that is not usually shared with a physician or health care provider,” said Segal. The American Public Health Association defines a community health worker as “a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community serviced. This trusting relationship enables the worker to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.” Community health workers are also credentialed through local certificate training programs. A recent study Segal led, which took place in a community pharmacy in Tampa, FL, evaluated the effect of a community health worker on patients’ adherence to antihypertensive medications. Segal said a majority of the patients revealed information to the community health worker that the pharmacist wasn’t aware of. “She uncovered the fact that many [patients] were using alternative therapies as well as the adherence barriers to prescribed medications they had,” Segal said. The pharmacists and community health workers developed action plans for these patients, and they saw adherence to medications increase over the 6-month study period. Logan said his program has resulted in more than 200 patients being referred to community health workers for services they were not receiving. But it also goes the other way. Many patients have been referred to his pharmacists, especially patients who need help with packaging and consistent medication management. “This isn’t something for the 40-year-old guy with one blood pressure medication. We are talking about people who need extra care, the most expensive patients and those who are falling through the cracks—those are the referrals we’ve been seeing.” The next phase of the grant will involve training community health workers in urban Missouri pharmacies. “My hunch is there are unique needs here, too, and they are unique to that area. Providers might not know pharmacy is there offering services,” said Logan.