Making an IMPACT at FQHCs

Pharmacists offer diabetes care at federally qualified health centers in Oklahoma and Texas

Federally qualified health centers (FQHCs) play a valuable role in health care in the United States, serving as a medical safety net for underserved populations across the country. There are more than 1,000 FQHCs across the country serving more than 20 million patients, according to data from the U.S. Department of Health and Human Services Health Resources and Services Administration.

The 25 communities in APhA Foundation’s Project IMPACT: Diabetes include many FQHCs providing essential safety net care to underserved patients with diabetes. This month, Pharmacy Today will focus on two of those sites: Variety Care of Oklahoma City and Centro de Salud Familiar La Fe of El Paso, TX.

Variety Care: Communication is key

Mark Britton, PharmD, CDE, BC-ADM (left); Jamie Farley, PharmD, BCPS (center); and Vince Dennis, PharmD, BCACP, CDE.

At Variety Care, Community Champion Jamie Farley, PharmD, BCPS, and her colleagues work with a diverse patient population. Most of the patients they serve, including large majorities of the 86 enrolled in Project IMPACT, are Hispanic and uninsured, and many speak only Spanish. To help reach this population, all of Variety Care’s medical assistants are bilingual.

“We wouldn’t be able to survive without the help of our bilingual medical staff,” Farley said. “They’re really key in being able to provide translation support and help us reach the patients and understand what their challenges are.”

With the support of Michael Godard, MD, Variety Care Chief Medical Officer, Farley and clinical pharmacists from Oklahoma University College of Pharmacy Mark Britton, PharmD, CDE, BC-ADM, and Vince Dennis, PharmD, BCACP, CDE, conduct one-on-one visits with patients engaged in Project IMPACT. The pharmacist reviews the patient’s medications and lab values, tailoring the visit for the patient’s needs on that day. The Variety Care pharmacists can also modify medication doses as needed in conjunction with the patient’s primary care provider.

One unique patient activity Variety Care has introduced are food and disease state models that allow Farley and her colleagues to physically demonstrate proper eating habits and potential long-term complications. “They can visually understand [our] translation and get a better grasp of what we’re saying,” Farley told Today.

For example, the pharmacists can take the food model, with its simulated vegetables and meats, and demonstrate to patients which foods affect their blood sugar levels and what makes an appropriate portion size. “[Patients] can see what a portion of carbohydrates looks like,” Farley said. “Instead of just explaining to them that it’s half a cup of corn, we can show them what a half a cup looks like. … We can create example meals and really walk [patients] through so they get a better understanding of what can affect their disease.”

Farley and her colleagues have been able to record some incredible success stories at Variety Care. About 2 years ago, a patient came in to see his primary physician on a Monday after passing out over Thanksgiving weekend. The lab couldn’t measure his glycosylated hemoglobin (A1C), Farley said, because it was more than the 18%—the maximum value they could detect.

“He did not have health insurance, and he had been out of the health care [system] for a few years,” Farley recalled. The patient’s physician referred him to Farley, and they started working together that same day. “We [met] every 3 to 7 days for a while until his insulin dose was titrated and he understood basic self-care skills. Then we started to extend his follow-up visits, and within about 4 months his A1C was below 7%. He’s remained sustainably at goal ever since.”

Centro de Salud Familiar La Fe: A holistic FQHC

Jeri Sias, PharmD, MPH, told Today that La Fe, which also serves a predominantly Hispanic, Spanish-speaking population, takes a unique approach to the FQHC model.

“[La Fe] doesn’t view itself as just a clinic,” she said. “[We take] a holistic approach to life and well-being.” This means that La Fe provides the community with a cultural and technology center featuring cooking classes, music lessons, computer literacy instruction, and a preparatory charter school—all in addition to a full array of health care services, from primary care to dental care, eye care, women’s health, pediatrics, and more.

This holistic approach “influenced how we thought about creating the [Project IMPACT] program,” Sias explained. “It wasn’t just about pharmacists doing diabetes education; we wanted an integrated approach.” To ensure this integration, La Fe’s Project IMPACT team includes a social worker and a health educator, in addition to medical and pharmacy staff. They also provided for dental and social work services in their proposal, as well as a grocery store tour program.

“I know people have heard of [grocery store tours], but we think we have a different twist,” Sias told Today. La Fe staff accompanies patients to a local corner market, where the patients are given $5 to prepare a traditional meal for four using the healthy plate method. “We want them to know that [food] doesn’t have to be expensive to be healthy and balanced,” Sias said.

Approximately 80 patients initially engaged in the program at La Fe, which expanded on a diabetes patient education program already existing at the site. La Fe conducts weekly education sessions for about 8 to 10 patients at a time, using an integrated referral system as follow-up to ensure that they get the services they need. Sias and her colleagues also work with patients to help them overcome the economic barriers that many of them face.

The interdisciplinary aspect of La Fe’s Project IMPACT program is essential, Sias said, for two reasons. First, “diabetes affects so many different organs and parts of a person that it’s difficult for one person to take care of,” she said. “Being able to build an interdisciplinary team with people who are more specialized in specific areas is helpful.”

The second reason, Sias explained, is that the integrated team allows La Fe to customize its approach to each patient. “[If] someone in the team connects well with the patient, there is trust built,” she said. “Then when that provider makes a referral, they may take it more strongly.” Sias added that the interdisciplinary nature of the team allows for more points of entry into care, such as through the dental or eye care clinics.

Students make an IMPACT

Sias and Farley combine their FQHC work with faculty positions at the University of Texas at El Paso–University of Texas at Austin Cooperative Pharmacy Program and the University of Oklahoma College of Pharmacy, respectively.

For La Fe, the input of students has already affected the way they provide care. Sias told Today that a resident at the site had conducted research on cultural aspects of La Fe’s patient population to help them customize their patient care. For example, a typical insulin dosing schedule is based on the assumption that dinner is the largest meal of the day. “But in a traditional Mexican diet,” Sias said, “the largest meal might be at 3:00 pm. So the timing doesn’t work. … Those things are important to understand.”

Farley noted that Variety Care’s partnership with the University of Oklahoma bodes well for the future of its Project IMPACT program, as well as similar patient care initiatives. “Through this grant, we’ve been able to incorporate more exposure for pharmacy students and pharmacy residents,” she explained. “They can experience this multidisciplinary team approach to care and hopefully, it’ll continue to expand in the future.”


APhA Foundation making an IMPACT

Project IMPACT (Improving America’s Communities Together): Diabetes is a national initiative of the APhA Foundation that aims to improve care for patients with diabetes through community-based interdisciplinary teams that include pharmacists.

This project scales previous Foundation initiatives such as the Asheville Project, Patient Self-Management Program for Diabetes, and the Diabetes Ten City Challenge into 25 communities across the United States. As part of the program, the Foundation provides communities with tools, resources, guidance, and support to facilitate their success.

Pharmacy Today will continue to profile these Project IMPACT communities over the coming months, bringing you stories of innovative and unique diabetes care programs from coast to coast. Read next month’s issue to find out about Project IMPACT at the Mountain States Health Alliance in Tennessee and Alabama’s Jefferson County Department of Health.

For more information about Project IMPACT: Diabetes, visit the APhA Foundation’s website at www.aphafoundation.org.