This article describes the implementation of a pharmaceutical Patient Assistance Program in a free clinic, including issues such as navigating complicated pharmaceutical company requirements, obtaining documentation for income verification, engaging healthcare providers, tracking and re-ordering medications, and developing clear expectations for patients. Successes, challenges, and lessons learned are also discussed.
Objective:
The HRTSA (HeaRt Failure Transitional Services for Adults) clinic at the University of Alabama at Birmingham Hospital serves underinsured individuals with heart failure (HF). We examined the frequency and predictors of rural and urban dwelling individuals establishing care after a HF hospitalization.
Methods:
We included individuals ≥18 years of age referred to the HRTSA clinic after a HF hospitalization from 2016-2019. We used zip code of residence and the Rural-Urban Commuting Area classification system to define urban or rural. Urban zip codes have >30% of workers commuting to Census Bureau defined urbanized areas. We defined establishing care as attending the first clinic visit. Sociodemographic and clinical variables were collected at the time of referral and compared between groups using chi-square or t-tests as appropriate. Multivariable logistic regression was used to identify predictors of establishing care separately in urban and rural dwelling individuals.
Results:
Of 855 individuals referred to the HRTSA clinic after a HF hospitalization, mean age was 50±11 years, 15% were rural dwelling, 59% were African American (AA), and 32% were female. Rural dwelling individuals were less likely to establish care than their urban counterparts, although not statistically significant (71% vs. 77%; p=0.16). In rural dwelling individuals, AAs (OR 0.11, 95% CI 0.04-0.31), those with diabetes (OR 0.26, 95% CI 0.09-0.81), and current alcohol users (OR 0.25, 95% CI 0.08-0.83) had lower odds of establishing care; whereas in urban dwelling individuals, AAs (OR 2.75, 95% CI 1.65-4.59) and those with no insurance (OR 6.22, 95% CI 3.55-10.90) had higher odds of establishing care after multivariable adjustment (Table).
Conclusions:
We identified a significant disparity in AAs. Rural dwelling AAs with HF had lower odds of establishing care after a HF hospitalization, whereas urban dwelling AAs with HF had higher odds. Efforts to reduce this disparity are warranted to improve HF care in rural dwelling AAs.
Objective:
The HRTSA (HeaRt -Failure Transitional Services for Adults) Clinic at the University of Alabama at Birmingham Hospital serves underinsured individuals with heart failure (HF). We examined the differences in sociodemographic, clinical characteristics, and depression and anxiety among food secure and insecure patients who established care in clinic.
Methods:
Between May 2018 and December 2019, 291 patients established care in the HRTSA Clinic post-hospitalization. Patients were adults ≥18 years of age with heart failure. At the first clinic visit, baseline sociodemographic and medical history were obtained. Additionally, each patient was screened for depression using the Patient Health Questionaire-9 (PHQ-9) and anxiety using the General Anxiety Disorder-7 (GAD-7) questionnaire. Patients were also screened for food insecurity (FI) using the Hunger Vital Signs screener, a validated 2-item tool created for clinical settings to rapidly identify FI. Using descriptive statistics and t-tests, we compared demographic and clinical characteristics of FI and FS clinic patients.
Results:
Of the 291 newly referred patients seen in the HRTSA Clinic and screened for food insecurity, the mean age was 50 years, 58% were African American and 29% were female. A total of 80 patients (27%) screened positive for food insecurity. FI patients tended to be female (37% vs 27%, p=0.108) and African American (68% vs. 58%, p=0.142), although not statistically significant. FI patients had statistically significant higher depression scores and had anxiety scores that trended to higher values.
Conclusions:
Food insecurity, an important social determinant of health, is associated with more depression and anxiety. Depression and anxiety are important contributors to patient-centered outcomes for heart failure patients, specifically in underserved populations. This has implications for health care providers to implement screening interventions to improve mental health in underserved populations.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.