Use of clinical pharmacy services by American Indians and Alaska Native adults with cardiovascular disease.

Abstract

IntroductionThe Indian Health Service (IHS) and Tribal health programs provide clinical pharmacy services to improve health outcomes among American Indian and Alaska Native (AI/AN) adults with cardiovascular disease (CVD).ObjectivesThe study's primary objective was to describe characteristics, including social determinants of health (SDOH), associated with clinical pharmacy utilization by AI/ANs with CVD who accessed IHS/Tribal services. A secondary objective assessed changes in systolic blood pressure (SBP) associated with such utilization.MethodsAnalysis included IHS data for 9844 adults aged 18 and older with CVD who lived in 5 locations. Multivariable logistic regression was used to examine patient characteristics (eg, age, sex, health status, SDOH) associated with clinical pharmacy utilization in fiscal year (FY) 2012. A propensity score model was employed to estimate the association of elevated SBP in FY2013 with FY2012 clinical pharmacy utilization.ResultsNearly 15% of adults with CVD used clinical pharmacy services. Among adults with CVD, the odds of clinical pharmacy use were higher among adults diagnosed with congestive heart failure (adjusted odds ratio [OR] = 1.22; 95% CI:1.01‐1.47), other types of heart disease not including ischemia (OR = 1.40; 95% CI: 1.18‐1.65), and vascular disease (OR = 1.23; 95% CI: 1.04‐1.46), compared to adults without these conditions. Diabetes (OR = 4.05, 95% CI: 3.29‐5.00) and anticoagulation medication use (OR = 20.88, 95% CI: 16.76‐20.61) were associated with substantially higher odds of clinical pharmacy utilization. Medicaid coverage (OR = 0.72; 95% CI: 0.56‐0.93) and longer travel times to services (OR = 0.87; 95% CI: 0.83‐0.92) were each associated with lower odds. FY2012 clinical pharmacy users had lower odds of elevated SBP (OR = 0.71 95% CI: 0.58‐0.87) in FY2013 than nonusers.ConclusionIn addition to health status, SDOH (eg, Medicaid coverage, longer travel times) influenced clinical pharmacy utilization. Understanding characteristics associated with clinical pharmacy utilization may assist IHS/Tribal health programs in efforts to support optimization of these services.