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UNHS receives grant from BD - Medically Speaking, Volume Two, Number Three, 9/11/2014

Utah Navajo Health System is one of seven health care organizations throughout the United States to receive a BD Helping Build Healthy Communities™ grant.

UNHS CEO Michael Jensen accepted the award, during a dinner in San Diego, California. Stephan-ie Makihele teamed with UNHS staff members, and Clinical Pharmacists to complete the grant application, after a month of work. The $100,000 grant is a multi-year initiative intended to expand access and improve care for underserved and vulnerable populations throughout the United States. The initiative, funded by BD and implemented together with Direct Relief and the National Association of Community Health Centers (NACHC), provides awards to community health centers to support innovative ap-proaches to the delivery of primary and preventive health care to underserved and vulnerable populations in the areas of diabetes, cervical cancer, and HIV.

In addition to soliciting innovative programs in those three areas, BD is also seeking innovative approaches that address comorbidities that often accompany them. The initiative highlights and provides awards to fund innovative programs that ad- dress health disparities and pressing community health needs, for populations that are at high risk or who represent a particularly high-cost burden. Awardees had proven track records of successful outcomes and metrics, including number of people served in addressing diabetes, cervical cancer, HIV, or comorbidities in their community.

Comorbidity is the presence of one or more additional disorders or diseases co-occurring with a primary disease or diagnosis. Also called multiple chronic conditions (MCC) by the U.S. Department of Health & Human Services, comorbidities pose a significant and increasing burden on the health of people throughout the U.S. Comorbidities, or MCCs, include both physical conditions such as arthritis, cancer, and HIV, and also include mental and cognitive disorders, such as ongoing depression, substance addiction, and dementia.

The following protocol was developed in 2011 – 2012 as a collaborative practice agreement between UNHS medical providers and its four clinical pharmacists (Pharm D's). The intent was to provide addit- tional disease state management from clinic staff, who were well trained in the pathology and treatment of diabetes and its related conditions. The referral process was designed to allow the primary provider to identify those patients who may benefit from increased education, follow-up, and medica- tion management.

Once referred, the clinical pharmacist would meet with the patient for an initial evaluation and needs assessment. In this visit the pharmacist would evaluate the patients' educational needs, goals, family/social structure, health beliefs, and cultural or language character- istics.

Education about self-care and patient-empowerment is then provided based on the initial assessment. Education about diabetes and how to live healthy, steered by the guidelines from the American Association of Diabetes Educators, is the primary intervention provided. Principles of motivational interviewing are central to the pharmacist-patient relationship of this protocol.

The Utah Navajo Health System (UNHS) has a robust clinical pharmacy team to provide collaborative disease state management of type 2 diabetes, including management of co-morbid hypertension and dyslipidemia. Clinical pharmacy collaborative practice agreements involve each of the four community health centers within UNHS.

According to Pharm D Albert Noyes, Director of the UNHS Clinical Pharmacy program, a portion of the $100,000 will be used to offset the staffing costs for Pharm D's, who meet with patients. Currently the Pharm D-Patient visits are a free service. The grant will help cover the cost for these visits.

"This grant will just enhance what the Phram D is already doing. It does not necessarily require us to do anything different. It is just a recognition of the value of what we're trying to do," Noyes said.

He also explained that as part of the grant award, BD wants to video a slice of one day at a UNHS facility. A video crew will come to San Juan County and interview caregivers about various programs. The video will be shown to internal BD audiences and to external groups like policy makers and potentially at conferences. Noyes said he hopes the video will help get the message, about the need to cover the costs of Pharm D-patient visits, to those who make policies.

He said Pharm D visits could help reduce patient costs in terms of fewer ER visits, fewer hospital stays or acute infections, fewer eye surgeries as a result of diabetes, and the prevention of complications from kidney disease. This could help prevent the need for dialysis or kidney transplants, which are 'big ticket items."

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