Introduction or Background

Conclusions

Methods •  Free clinics currently provide care to a sizable portion of uninsured patients.1, 2 • The Maliheh Free Clinic based in Salt Lake City, Utah provides free primary health care to uninsured individuals who do not qualify for Medicare or Medicaid and live 150% below federal poverty guidelines.

• Promotion and implementation of partnerships between community free clinics and academic health centers have improved patient outcomes in several disease states.3-5

• Prior to collaborating with the College of Pharmacy, the clinic had never had clinical pharmacy services.

Correspondence Please address inquiries to:

Emmeline Tran PharmD Candidate 2014

University of Utah College of Pharmacy emmeline.tran@pharm.utah.edu

Limitations and Considerations

• The objective of this study was to assess the impact of pharmacists in a free community health clinic.

• We hypothesized that with the implementation of clinical pharmacy services, patient diabetes-related health outcomes and proper monitoring of patient diabetes and medication efficacy through laboratory tests would improve.

Results •  Baseline characteristics: 56% female, 51.2% Hispanic, mean age of 52.5 years

• A retrospective review of 213 patient charts was conducted from the initiation of pharmacy services at the clinic in December 2011 to April 2013 to examine: •  mean change in hemoglobin A1c values •  percentage change in patients at goal LDL cholesterol level (<100 mg/dL) •  percentage change in albumin-creatinine ratio laboratory tests ordered

• Stata 12 was used for the statistical analysis and descriptive analysis was performed using chi square and T test.

51.90%

92.08%

A Multidisciplinary Team Approach to Patient Care at a Free Community Health Clinic: The Role of Pharmacy on Improving Patient Outcomes

Emmeline Tran, PharmD Candidate 20141; Brandon T. Jennings, PharmD1,2; Mukul Singhal, PhD Candidate 20151,3 1University of Utah College of Pharmacy, Salt Lake City, Utah; 2University of Utah Hospital and Clinics, Salt Lake City, Utah; 3University of Utah Pharmacotherapy Outcomes Research Center, Salt Lake City, Utah

Objective

Patient referred to and scheduled for Diabetes

Day by physician.

Pharmacy reviews patient chart and

develops recommendations.

Pharmacy meets with patient for medication

reconciliation.

Patient receives a foot check and diabetes

education from nursing staff.

Pharmacy plan is finalized and

presented to medical team.

Medical team delivers plan to the patient.

Figure 1. Diabetes Day Flow Chart. Diabetes Day is a comprehensive appointment for patients with diabetes addressing different facets of diabetes care.

Pharmacy Services Implemented

213 patient charts

mean change in hemoglobin A1c

values

percentage change in patients at goal

LDL cholesterol

percentage change in albumin-creatinine

ratio test

Excluded: •  39 patients --last hemoglobin A1c

value was prior to Diabetes Day

•  10 patients –only one hemoglobin A1c

value

Excluded: •  31 patients –only

one LDL level drawn •  11 patients –

unable to calculate LDL (triglycerides

>400 mg/dL) •  1 patient –no LDL

level drawn

Excluded: •  19 patients –first

encounter with clinic after 12/2011

•  7 patients –only one visit

N = 164 N = 170 N = 187

Figure 2. Patient Exclusion Flow Chart for Each Outcome Studied.

References 1. Darnell J. What is the role of free clinics in the safety net? Med Care. Nov 2011;49(11):978-984. 2. Darnell JS. Free clinics in the United States: a nationwide survey. Arch Intern Med. Jun 14 2010;170(11):946-953. 3. Levine DM, Becker DM, Bone LR, Hill MN, Tuggle MB, 2nd, Zeger SL. Community-academic health center partnerships for underserved minority populations. One solution to a national crisis. JAMA. Jul 27 1994;272(4):309-311. 4. Smego RA, Jr., Costante J. An academic health center-community partnership: the Morgantown Health Right free clinic. Acad Med. Jun 1996;71(6):613-621. 5. Rebholz CM, Macomber MW, Althoff MD, et al. Integrated models of education and service involving community-based health care for underserved populations: Tulane student-run free clinics. South Med J. Mar 2013;106(3):217-223.

9.2

8.6

mean HbA1c

40.0%

54.7%

percent at LDL goal (<100 mg/dL)

43.9%

45.5%

percent of albumin-creatinine ratio lab ordered

* p<0.001

*

*

*

•  Information bias: patient data was examined based on outcomes prior to generally one pharmacy team visit with the patient compared to outcomes after the visit.

•  Attrition bias: several patients were lost to follow-up during the study duration. • Short duration: it was difficult to capture the extent of the effect of pharmacy services, especially with only one patient visit.

• External validity: this study was conducted in a free clinic in the Salt Lake Valley with a majority of female and Hispanic patients.

• By implementing a collaborative team-based approach to patient care that includes clinical pharmacy, we demonstrated an improvement in patient diabetes-related health outcomes. The results of this study continue to help us define the role and impact that a pharmacist can have in a community health clinic serving an underserved population.

Disclosure Authors of this presentation have the following to disclose concerning possible financial or personal relationships with commercial entities that may have a direct or indirect interest in the subject matter of this presentation: All authors: Nothing to disclose