TY - JOUR
T1 - Clinical impact of a pharmacist + health coach chronic disease management program in a rural free clinic
AU - Hurst, Haley
AU - Dunn, Starla
AU - Fuji, Kevin T.
AU - Gilmore, Jessica
AU - Wilt, Stephanie
AU - Webster, Sharon
AU - Parikh, Pranav
N1 - Funding Information:
The free clinic is affiliated with the local health care system, which provides the primary source of financial support, physical infrastructure, and salaries of 4 employees (pharmacist, health coach, office manager, and clinic manager). The secondary sources of financial support include nonprofit organizations, fundraiser, grants, and individual donations. In addition, 6 physicians (doctors of medicine and doctors of osteopathy), a board-certified adult nurse pracitioner, a dentist, and a chiropractor volunteer their time to see patients on a routine schedule. This includes weekly visits by the chiropractor, visits every other week by the dentist (for approximately 3 hours in the evening), and monthly visits by the physicians and nurse practitioner (not including the medical director of the free clinic, whose visits are twice monthly). Patients who require specialty services are referred by their primary care provider (PCP) to the local health care system for specialty services, such as cardiology, podiatry, nephrology, etc. Mental health services are provided by a local donor, through which patients can be seen for counseling and psychiatry appointments at an unaffiliated local clinic. Eye examinations and eyeglass vouchers for patients are donated by local organizations. Finally, a discounted rate to the local gym is provided to free clinic patients, and the free clinic will pay for 50% of the membership fee if patients go to the gym at least 8 times per month. Nonperishable nutritional foods (e.g., fruits, vegetables, protein bars, etc.) are provided by the free clinic through donations from local churches and available grant money. Unfortunately, the food donations are not consistent and not all program patients choose or are able to receive food donations. Priority was given to patients deemed to be in greatest need of food resources including those with larger families or more children.
Publisher Copyright:
© 2021 American Pharmacists Association®
PY - 2021/7/1
Y1 - 2021/7/1
N2 - Objectives: Recent data have demonstrated benefits of pharmacist-led protocols for chronic disease state management in the primary care setting. Health coaching has also been shown to improve patient outcomes and reduce health care costs. A program was initiated in August 2017 at a rural, free clinic to provide team-based, patient-centered care management through the use of pharmacist-provider collaborative practice and health coaching for patients with chronic diseases such as diabetes, hypertension, and hyperlipidemia. Methods: After an initial patient examination, physicians could refer patients for management by the pharmacist + health coach team. Patients continued to see their primary care provider at least yearly and as needed. The pharmacist + health coach team provided a protocol-based approach to chronic disease management, as well as health education pertaining to diet and lifestyle recommendations. In-depth medication and disease state education were provided at each visit. Motivational interviewing was also conducted at each visit. Clinical metrics were collected at baseline and analyzed routinely after program initiation, including glycosylated hemoglobin (A1c), blood pressure, and lipids. Primary objectives were to evaluate the program's impact on A1c, blood pressure, and cholesterol outcomes. Results: A total of 95 patients were included in the analysis (A1c n = 37; systolic and diastolic blood pressure n = 47; total cholesterol n = 40; low-density lipoprotein [LDL] cholesterol n = 38; high-density lipoprotein cholesterol n = 40; and triglycerides n = 40). From baseline to 1 year, statistically significant improvements were observed for A1c (mean ± standard deviation, 8.55 ± 2.58 to 7.04 ± 1.12, P < 0.001), systolic blood pressure (136.79 ± 20.04 to 123.15 ± 16.81, P < 0.001), diastolic blood pressure (87.94 ± 12.28 to 78.64 ± 10.98, P < 0.001), total cholesterol (198.25 ± 52.47 to 183.55 ± 47.22, P = 0.014), and LDL cholesterol (115.74 ± 43.56 to 105.92 ± 39.27, P = 0.040). Conclusion: A protocol-driven collaborative practice approach to chronic disease management by a clinical pharmacist in conjunction with health coaching by a registered nurse in a low-income, rural, primary care setting improved A1c, blood pressure, total cholesterol, and LDL cholesterol.
AB - Objectives: Recent data have demonstrated benefits of pharmacist-led protocols for chronic disease state management in the primary care setting. Health coaching has also been shown to improve patient outcomes and reduce health care costs. A program was initiated in August 2017 at a rural, free clinic to provide team-based, patient-centered care management through the use of pharmacist-provider collaborative practice and health coaching for patients with chronic diseases such as diabetes, hypertension, and hyperlipidemia. Methods: After an initial patient examination, physicians could refer patients for management by the pharmacist + health coach team. Patients continued to see their primary care provider at least yearly and as needed. The pharmacist + health coach team provided a protocol-based approach to chronic disease management, as well as health education pertaining to diet and lifestyle recommendations. In-depth medication and disease state education were provided at each visit. Motivational interviewing was also conducted at each visit. Clinical metrics were collected at baseline and analyzed routinely after program initiation, including glycosylated hemoglobin (A1c), blood pressure, and lipids. Primary objectives were to evaluate the program's impact on A1c, blood pressure, and cholesterol outcomes. Results: A total of 95 patients were included in the analysis (A1c n = 37; systolic and diastolic blood pressure n = 47; total cholesterol n = 40; low-density lipoprotein [LDL] cholesterol n = 38; high-density lipoprotein cholesterol n = 40; and triglycerides n = 40). From baseline to 1 year, statistically significant improvements were observed for A1c (mean ± standard deviation, 8.55 ± 2.58 to 7.04 ± 1.12, P < 0.001), systolic blood pressure (136.79 ± 20.04 to 123.15 ± 16.81, P < 0.001), diastolic blood pressure (87.94 ± 12.28 to 78.64 ± 10.98, P < 0.001), total cholesterol (198.25 ± 52.47 to 183.55 ± 47.22, P = 0.014), and LDL cholesterol (115.74 ± 43.56 to 105.92 ± 39.27, P = 0.040). Conclusion: A protocol-driven collaborative practice approach to chronic disease management by a clinical pharmacist in conjunction with health coaching by a registered nurse in a low-income, rural, primary care setting improved A1c, blood pressure, total cholesterol, and LDL cholesterol.
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U2 - 10.1016/j.japh.2021.02.014
DO - 10.1016/j.japh.2021.02.014
M3 - Article
AN - SCOPUS:85103282619
VL - 61
SP - 442
EP - 449
JO - Journal of the American Pharmaceutical Association. American Pharmaceutical Association
JF - Journal of the American Pharmaceutical Association. American Pharmaceutical Association
SN - 1544-3191
IS - 4
ER -