Serving Communities: Creating “medical homes” through academic-community linkages

“In summary, while improving Health IT, payment reform, and expansion of health insurance coverage are important, what is essential is a sustained effort in organizing the healthcare delivery system to achieve needed access, quality and efficiency goals.”

Written testimony of L. Allen Dobson, Jr., MD FAAFP before the Senate Committee on Health, Education, Labor and Pensions. January 22, 2008.

Issue:

The healthcare system needs reorganization to achieve improvements in access and quality, and reductions in cost and disparities. Academic pharmacy is an established partner with federal agencies in addressing thehealthcare needs of communities and special populations, including the underserved. Theseacademic-community partnerships serve as a model for communities to organize a healthcare system locally that meets its needs.

Recommendations:

  • Grant funding is essential for expanding community-engaged service activities that allow communities to organize the healthcare system that meets its needs. Innovation and accountability are the result of this approach to healthcare system organization since the driving force is the community itself.
  • Healthcare reform approaches should consider the potential for very real patient-centered approaches to care that can be developed, tested and evaluated through extramural grant funding and contracts between academic and community partners.

Background:

Being of service to the communities in which they are situated is one aspect of the three-pronged mission of higher education: teaching, research and service. Over the last few decades the service component has become less academic-centric and increasingly community-centric. Higher education’s participation in this community-centric approach to service is often referred to as community-engagement. The important aspect of community-engagement is that the community identifies the service it needs from higher education. Community-engaged service programs provide faculty at colleges and schools of pharmacy with the opportunity to provide a variety of services, including clinical care, in response to community-identified needs.

Examples of these programs include:

Extension Pharmacy Alliance for Community Health

Colleges of pharmacy at land-grant colleges were part of an initiative supported by the U.S. Department of Education Cooperative Extension program from 2001 until 2004. The Extension Pharmacy Alliance for Community Health (EPACH) brought academic pharmacy into partnerships with agricultural extension agents to address the healthcare needs of rural and often isolated populations. The needs addressed included poison control, asthma risk assessment, medication safety, integration of patients and providers through technology and support of adult caretakers. Programs associated with this collaboration offered support for providers and created health literacy approaches for culturally diverse and older adult populations. Through its partnership with the cooperative extension,The University of Tennessee College of Pharmacy created Health Education in Rural Communities Using Lap-top Computers for Education Sessions (HERCULES). The original aim of the program was to reduce poisoning through increased connection of agriculture workers with the state’s poison control center. This collaborative approach to reorganizing the healthcare system to meet community needs now has grown to be The University of Tennessee Center for Community-based Healthcare Initiatives. In short, shared information and improved utilization of existing resources has created the opportunity for a reorganization of the healthcare system available in some of the most rural parts of our nation.

The HRSA Patient Safety and Clinical Pharmacy Collaborative

HRSA has a strong track-record of bringing the needs of underserved patients, populations and communities to the attention of higher education. The HRSA Patient Safety and Clinical Pharmacy Collaborative is the result of an ongoing partnership between federally-qualified health centers and entities eligible for the 340B drug discount program and our nation’s colleges and schools of pharmacy. Through the Collaborative, federally-qualified health centers continue to develop into true medical homes providing comprehensive primary care services through an infrastructure that includes clinical pharmacy services. An important aspect of the collaborative continues to be a community-engaged approach to healthcare system organization. Colleges and schools of pharmacy leverage their resources to support the reorganization of a local healthcare system so that the important issues of access, quality, disparities and cost are able to be successfully addressed.

HRSA Patient Safety and Clinical Pharmacy Collaborative: Five major strategies for success found in high-performing organizations:

III. Integrated Care Delivery: Build an integrated health care system across providers and settings that produces safety and optimal health outcomes

G. Develop a delivery system with an established medical home and linkages with other providers and settings.

H. Develop an integrated multi-professional care team that includes clinical pharmacy services.

ftp://ftp.hrsa.gov/patientsafety/changepackage.pdf

Area Health Education Centers

Community-engagement creates opportunities for existing programs such as Area Health Education Centers to play a greater role in working with the public to reorganize healthcare systems to better meet community-identified needs and improve team-based, patient-centered approaches to care which are supported by informatics.

For additional information:

Will Lang, MPH

Vice President, Policy and Advocacy

American Association of Colleges of Pharmacy

(703) 739-2330 x1038