Pharmacist-Led, Community-Led Programs Can Improve Health Literacy, with Clipper Young, PharmD, MPH

Clipper Young, PharmD, MPH
Credit: Touro University California

The idea of a multidisciplinary care team is a relatively novel one in the field of medicine. For decades upon decades, the care team consisted of an MD.

When it comes to embracing a multidisciplinary care team, some fields have been early adopters while others have remained laggards. Among the early adopters has been endocrinology and, more specifically, diabetes management.

Driven in part by a declining number of endocrinologists and ballooning rates of both type 1 and type 2 diabetes, the field has recognized and celebrates the role of other care teams members, including advanced practice providers, pharmacists, caregivers, and even people with diabetes themselves. This adoption and embrace of the multidisciplinary care team has contributed to a near-universal acceptance of the benefit of including patient voice, not only in the day-to-day management but also in the guideline writing process.

An example of the community embracing the care team and acknowledging the importance of patient voice is the Pharm2Home initiative. A program launched by the Touro University College of Osteopathic Medicine in 2020 through a grant from Sutter Health, the Pharm2Home initiative is a pharmacist-led program for managing chronic disease and medication therapy between medical appointments. Geared toward bridging the gap between real-world adherence in older adults, the program focuses on the management of half a dozen chronic diseases in diabetes, hypertension, chronic kidney disease, heart failure, asthma, and chronic obstructive pulmonary disease (COPD).

At the Association of Diabetes Care and Education Specialists (ADCES) 2023 annual meeting, Clipper Young, PharmD, MPH, clinical pharmacist and associate professor at Touro University College of Osteopathic Medicine, led a presentation where he described the impact of the community-focused program among those in senior housing facilities through clinical guideline-driven, chronic-disease-management recommendations and education. This presentation comes a year after Young presented data from the clinic arm of the program at ADCES 2022.

With an interest in the Pharm2Home initiative, the ongoing efforts, and results of participation, the editorial team of HCPLive Endocrinology reached out to Young to learn more. A portion of that conversation can be found in the following Q&A.

HCPLive Endocrinology: Can you provide a brief overview of the Pharm2Home Initiative and its goals?

Young: As the name suggests, we deliver clinical pharmacy services into patients home. There are two arms so far. There is a clinic arm and also a community health arm.

So last year, we presented the clinical health arm at ADCES and, this year, we continue the second arm. So, for the clinic arm, we first recruit patients from a safety net clinic and then we do initial visits. Hopefully, it's at their home, but not everybody is receptive for us to go to their house—in that situation, we can use telehealth. As of now, the program facilitates chronic disease management and medication therapy management.

For chronic disease management, there are 6 disease states that we are managing or comanaging with healthcare providers. They are diabetes, hypertension, heart failure, CKD, asthma, and COPD. We have practice agreement with the PCPs and also the pathologist in the clinic, which means that we can adjust their pharmacotherapy from starting, stopping, and adjusting the doses according to the patient's need from a clinical standpoint.

This is really the gist of the clinic arm and also the community health arm, which is really the focus of this year's presentation. We have been going out to the senior living facilities to deliver medication therapy management. What that means is we really take a comprehensive look at their pharmacotherapies and also matching with their chronic conditions.

The community health arm is not as focused on diabetes as the clinic arm it just because we don't have any practice protocol. Our goal is to make recommendations and share our recommendations with the senior population so that they will bring our recommendations to their primary health providers to make appropriate adjustment. With that said, we want to empower them when they talk to their health care providers and will be advocating for themselves when there are things that can be improved. The goal is really to increase the safety and efficacy of their pharmacotherapy.

HCPLive Endocrinology: Can you explain the specific emphasis on mental health within this care model?

Young: For those who are managing money multiple chronic conditions, there is a point that they have this diabetes-related distress and what that really means is they are burnt out from having to manage diabetes. We see it a lot in our patients. Now, let's bring this specific age group into the discussion.

For those who are older, that could mean they're actually managing not one but multiple chronic conditions. What we are dealing with is not just diabetes-related distress but is really as a whole is just burnout having to manage multiple chronic conditions at the same time, all day every day. With that, we see a lot of depressive symptoms that have not been diagnosed. Then during the conversation with them, we do use Patient Health Questionnaire (PHQ)-2 and sometimes PHQ-9 to tease out, whether they are experiencing some kind of depressive symptoms and maybe we can encourage them to go to their PCP and get confirmed.

Oftentimes, when it comes to mental health, I've seen that some people they're just in denial or not acknowledging that could be a problem. I'm not just talking about depression; this also includes anxiety and probably PTSD for some. So, in general, that is so important for us to somehow bring the awareness to the population that we serve so they can at least acknowledge that they have this potential problem and hopefully they're willing to get help.

When you have this, there are some underlying problems that have not been diagnosed and are adding to the problem that have been diagnosed. That can get very overwhelming. Sometimes, people will just shut down and not take care of themselves. That's the reason why that we made a point to include mental health as much as possible in our practice and we are lucky enough that we partner with another program at Touro University called the SolanoConnex. They focus on mental health through simple screenings and also refer to outside resources so the population that we serve can get the appropriate treatment or appropriate attention that they need.