Pharmacists have shown to increase clinical and humanistic outcomes in medically underserved populations through non-dispensing services. Limited information is available regarding the pharmacy workforce's involvement and ability to serve in this role. The objectives were to measure the proportion of pharmacists working with underserved populations and to assess barriers they encountered when trying to assist. 363 licensed Ohio pharmacists responded to an electronic survey between December 2011 and March 2012 (response rate 19.7 %). The survey assessed personal and environmental barriers that prevent pharmacist involvement with underserved populations using 5-point Likert scales. Multiple logistic regressions identified barriers that influenced pharmacists' involvement in providing non-dispensing services to underserved populations. 43 % of respondents were assisting underserved populations mostly in their place of work (83 %). Environmental barriers were indicated to effect pharmacists most. Uninvolved pharmacists most agreed with environmental barriers of "Hesitant to volunteer before knowing commitment", "Never approached to assist", and "Not enough time during shifts". Logistic regression 1 incorporated all pharmacists and indicated barriers of "Not interested in this area of work" (OR = 0.589) and "Unsure where to volunteer" (OR = 0.660) as significant. Logistic regression 2 was limited to pharmacists with access to patients at place of work and indicated "Not interested in this area of work" (OR = 0.443), "Employer never approached to assist" (OR = 0.557), "No time during work shifts" (OR = 0.537), and "Work location low underserved accessibility" (OR = 0.487) as significant predictors. More pharmacists might become engaged as volunteers. Increasing communication between community and pharmacists may reduce reported volunteering barriers.
Objective The American Diabetes Association treatment guidelines recommend that patients with diabetes over 40 years of age with one or more risk factors for cardiovascular disease be prescribed statin medication. Despite the guideline, use of statins among elderly patients with diabetes is low. Medicare Part D was implemented in 2006 to increase affordability and access to prescription medications for Medicare enrollees. The main objective of this study was to analyse trend in statin users with diabetes before and after implementation of Part D. Methods Data were obtained from the Medical Expenditure Panel Survey for 2004-2008. Patients who were diabetic (ICD-9 code 250) and either elderly (Ն65 years) or near elderly (57-64 years) were included in the analysis. Chi-square analysis was used to compare statin users before and after Part D for both the elderly and near-elderly populations. For elderly patients, trends in statin users were analysed for subpopulations based on gender, race/ethnicity, income, education level and perceived health status. A logistic regression analysis was conducted to identify factors that predicted use of statin. Key findings Between 2004 and 2008 patients who reported using statins increased from 55.05 to 61.25% for the elderly and from 54.99 to 55.89% for the near elderly. The elderly population had a significant increase in the percentage of patients reporting use of statins after the implementation of Part D (P = 0.002). Logistic regression identified post-Part D period (0.75, 95% confidence interval (CI) 0.60-0.94; P = 0.013), female gender (1.28, 95% CI 1.05-1.57; P = 0.013) and African-American race/ethnicity (1.53, 95% CI 1.19-1.96; P < 0.00) as significant predictors of reporting statin use among study population. Conclusion The study results imply that Part D may have influenced an increase in prescriptions of statins to elderly patients with diabetes. Logistic regression and trend analysis indicate that Part D was unable to reduce disparities in prescriptions for racial and gender subgroups.
BackgroundWhile current CDC guidelines recommend screening between the ages of 13–64 at least once and annually for high-risk individuals, this is often not practiced. Early diagnosis has become key to preventing the spread of HIV. It has been suggested that a late diagnosis, one where a patient is symptomatic, implies a loss of 10.5 years in their lifespan.MethodsFrom January 1, 1, 2015 to December 31, 2018, 113 newly diagnosed HIV-infected patients enrolled in care at The Positive Health Clinic (PHC), a Ryan White funded clinic, located in Pittsburgh, PA.ResultsThe median age was 32, 78% male, 64% MSM (Figure 1). At the time of HIV diagnosis, the median CD4 count was 325 U/L and HIV viral load was 65,000 copies. 32 patients (28%) had a CD4 count <200 and 13 had an AIDS-defining illnesses (Figure 2). Only 50% of HIV diagnoses were based on a provider’s clinical suspicions, 26% were driven by patient request, and 24% were the result of system driven screenings. 90.2% of patients had prior healthcare contact before the HIV diagnoses, suggesting missed opportunities. Of all the newly diagnosed HIV patients, 62% were symptomatic, prompting them to be tested for HIV (Figure 3). In 20% of the symptomatic cases, the patient requested to be tested for HIV, highlighting missed opportunities for clinicians to include HIV in their differential. A previous test for HIV within one year of their HIV diagnosis positively correlated with early diagnosis (CD4 >200 copies) (P = 0.007). System driven screenings for HIV also positively correlated with early diagnosis (CD4 >200 copies) (P < 0.001).ConclusionWaiting for clinical suspicion is not enough. To prevent patients from developing life-threatening AIDS-defining illnesses screening must be done at each interaction with the healthcare system for high-risk patients and annually for patients without risk factors. Disclosures All authors: No reported disclosures.
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