Leigh Ann Ross
Although the challenges they face are immense, leaders in the UM Department of Pharmacy Practice are equipping young pharmacists with the skills they need to take a more proactive role in patient care. The department’s Community-Based Research Program is an ongoing effort comprising multiple projects geared toward determining how pharmacists can improve the wellbeing of Mississippi residents through better utilization, understanding and adherence to medications—what is known in the field of pharmacy as Medication Therapy Management, or “MTM.”
One of the projects, the Delta Pharmacy Patient Care Management Project, or “Delta Project,” was completed in 2013. Sponsored by the Delta Health Alliance through the Health Services and Resources Administration, the Delta Project served patients who were primarily low-income, underserved minorities with limited access to health care and low health literacy. During the project’s four years, School of Pharmacy faculty members and community pharmacists and their students helped patients in pharmacies, clinical settings and a workplace setting.
In its first year, the Delta Project developed MTM services at seven community pharmacies in Coahoma, Panola and Yazoo counties. In the critical areas of asthma and diabetes management, participants were trained to provide specialized MTM directly to patients, providing care not only for a patient’s asthma or diabetes, but also considering his or her entire cardio-metabolic picture, including blood pressure, cholesterol and smoking cessation. In the second year, the Delta Project expanded into five additional counties and integrated UM faculty pharmacists into clinical settings and private physician groups. Those steps increased the study’s target population beyond Medicaid patients, enrolling a larger group of participants. During year three, the Delta Project partnered with the Viking Range Corp. in Greenwood to screen all the company’s employees and develop a program treating those who had diabetes or were at risk for developing the disease.
“We’ve tried to implement that same pharmacist MTM model in the community pharmacy, in the clinic setting, in the employer-based setting and in multiple projects,” said Leigh Ann Ross, the pharmacy school’s associate dean for clinical affairs and chair of the Department of Pharmacy Practice. “In all the projects, we look at clinical outcomes such as hemoglobin A1c, blood pressure and cholesterol levels, and they have all been positively impacted,” Ross said. “We also look at humanistic parameters, such as quality of life and satisfaction with treatment, as well as the economic side. We can estimate data on cost savings and cost avoidance. Medication costs may go up, but you see the savings on the side of reduced hospitalization and emergency room visits.”
The project reached more than 2,300 patients. Almost 1,000 patients received specialized MTM-Diabetes care. Those participants showed statistically significant decreases in cholesterol, blood pressure and other indicators linked to overall cardiovascular risk. Patients with poorly controlled diabetes showed an even more pronounced benefit.
“We’ve been able to reach some of the patients who really need it the most,” Ross said. “We give patients the tools that empower them to help manage their own disease, so they’re doing a better job when they go home.”
Part of the Delta Project’s efforts involved deepening communication between pharmacists and primary care providers. The project’s electronic health record component allows pharmacists and primary providers to share medical records. Historically, pharmacists have been trained in a more traditional model, but Ross and her colleagues expect that the innovative practice models engrained in UM students will become even more valuable as the roles of health care providers shift during the 21st century.
The Delta Project was the first component of the Department of Pharmacy Practice’s much larger Community-Based Research Program. Most recently, the Community-Based Research Program was awarded a $600,000 grant from the National Association of Chain Drug Stores Foundation for a Transitions of Care project. The grant will allow the program to partner with UMMC and Walgreens to decrease hospital readmissions for patients with myocardial infarction (heart attack), congestive heart failure, pneumonia, and solid organ transplant through medication reconciliation, bedside medication delivery, and MTM in the community pharmacy.
Another recent effort, the Centers for Disease Control and Prevention Delta Health Collaborative, is funded through the CDC in partnership with the Mississippi State Department of Health (MSDH). It focuses on integrating pharmacists into federally qualified health centers to provide MTM services to people who have diabetes and co-morbid conditions, such as heart disease. Its objective is to work with patients one-on-one to improve health outcomes and resolve drug therapy problems using evidence-based practices.
In 2013, the Community-Based Research Program received funding to participate in the CDC’s Million Hearts Initiative, a national campaign to prevent one million heart attacks and strokes by 2017. The “Team Up. Pressure Down. Pioneer Challenge” allowed UM to partner with community pharmacists on a blood pressure awareness initiative. The department also completed a HIV screening and linkage to care project that impacted over 200 Mississippians.
In fall 2012, students and faculty members hosted nine health fairs across the state, providing screening and counseling for more than 350 patients. The students screened for the “ABCs”—aspirin use, blood pressure, cholesterol and smoking cessation—and linked patients to care where needed.
“In everything we do, our students are really extensions of us,” said Lauren Bloodworth, who served as director of student affairs in the Department of Pharmacy Practice during the Delta Project and continues to serve as program administrator for the Community-Based Research Program. “We’re right there beside them supervising, but they have the opportunity to perform all of the point-of-care testing and talking to actual patients and sharing their knowledge, engaging the patient. It’s a great exposure and experience for students.”
One of Bloodworth’s former students, Rosemary Call, who completed a Community Pharmacy Residency Program supported by the Delta Project, is a Medication Safety Officer at Johns Hopkins Hospital in Baltimore, Md. The skills she developed while working with the Delta Project continue to guide her career.
“Improving access and quality of care is my ultimate career goal,” said Call. “The communication skills I developed working with the Delta Project will continue to help me in this pursuit. I will never forget the impact that a small group of motivated people can make on a community, and ultimately, on a health system.”