Publications: 

  1. Pharmacists improve diabetes outcomes: a randomized controlled trial.
  2. Impact of integrated behavioral health services on adherence to long-acting injectable antipsychotics.
  3. Stockpiling and food worries: Changing habits and choices in the midst of COVID-19 pandemic.
  4. The Impact of Clinical Pharmacist Led Comprehensive Medication Management on Diabetes Care at Federally Qualified Health Centers within the BD Helping Build Healthy Communities Program.
  5. COVID-19 and handwashing: Implications for water use in sub-Saharan Africa
  6. Adoption of telepharmacy within a community health center: a focus on clinical pharmacy services.
  7. Linked Pharmacist-Provider New Patient Visits in Primary Care.
  8. Impact of Chronic Disease State Management by Clinical Pharmacists on Diabetes Outcomes: Interim Results of a Prospective Pilot Study.

Pharmacists improve diabetes outcomes: a randomized controlled trial. Journal of the American Pharmacists Association 62, no. 3 (2022): 775-782. 

Authors: Wagner, Mary L., Caitlin McCarthy, M. Thomas Bateman, Daniel Simmons, and Katherine M. Prioli 

Abstract 

There is a growing shortage of primary care physicians. Pharmacists can fill the gap, and interdisciplinary teams are being evaluated as part of health care reform. 

This study aimed to determine whether adding a pharmacist to an interprofessional health team will improve diabetes outcomes. 

In this 2-phase pilot study, Medicaid-eligible patients with diabetes were randomized to receive standard of care (control arm) or standard of care plus the care of a pharmacist (intervention arm) for 12 months (phase 1). The primary outcome was change in glycated hemoglobin (A1C) from baseline. Secondary outcomes included identifying and correcting medication therapy problems (MTPs) for comorbid conditions, adherence to preventive care visits, health care utilization, self-rated health, and satisfaction surveys. After phase 1, patients in the control arm who did not achieve an A1C of < 8% were eligible to enroll into phase 2 where they received treatment with a pharmacist for 6 months. 

Of the 239 patients enrolled, 122 completed phase 1. At 12 months, intervention patients’ mean A1C was 1.85 percentage point (pp) below baseline versus 0.94 pp for control (between-group difference 0.91 pp; P = 0.0218). Most control patients (79%) who completed phase 1 and enrolled into phase 2 improved their A1C by more than 1 pp (P < 0.01). The pharmacists completed 806 patient visits and identified 2638 MTPs. Intervention patients were more adherent to preventive care visits with nutrition (P = 0.043), ophthalmology (P = 0.002), and dentistry (P = 0.007). For intervention patients, 78% rated their experience with the pharmacist as excellent whereas, for control patients, 37% rated their experience with their provider as excellent. 

Pharmacist co-management of patients with diabetes can significantly improve glucose control and patient satisfaction. Creative payment models were used to include pharmacists in the interprofessional patient care team. 

 

Impact of integrated behavioral health services on adherence to long-acting injectable antipsychotics. Journal of Integrated Care (2022) 

Authors: Maister, Ashley J., Caitlin McCarthy, Lee G. Ruszczyk, Rachael Evans, and Megan E. Maroney 

Abstract 

Integrated health care occurs when specialty and general care providers work together to address both the physical and mental health needs of their patients. The Substance Abuse and Mental Health Services Administration model of integration is broken into six levels of coordinated, co-located and integrated care. Our institution offers both co-located and integrated care among eight clinic sites. The care team is typically composed of the primary care provider, nurse and medical assistant, but other professionals may be introduced based on the patient’s medical and psychiatric conditions. The purpose of this prospective, quality improvement study was to compare the rates of adherence to long-acting injectable antipsychotics (LAIAs) between both types of integrated primary care settings at our institution. The comparison of the two settings sought to determine which environment provides improved outcomes for patients with serious psychiatric illnesses. Additionally, we aimed to assess the quality of medication-related monitoring and care team composition between care settings, and the ability of pharmacists to deliver interprofessional care team training and education on LAI use in clinical practice. 

Subjects were identified and included in the study if they had received primary care services from our institution within the previous 12 months. Patient demographic and laboratory variables were collected at baseline and when clinically indicated. The rates of adherence between care settings were assessed at intervals that align with the medication’s administration schedule (e.g. every four weeks). Medication-related monitoring parameters were collected at baseline and when clinically indicated. The interprofessional care team completed Likert scale surveys to evaluate the pharmacist’s LAIA education and training. 

There was not a statistically significant difference detected between integrated primary care settings on the rates of adherence to LAIAs. Additionally, there was not a statistically significant difference between rates of adherence to medication-related monitoring parameters or the effect of the patient treatment team composition. There was a statistically significant difference between pre- and post-session survey scores following interprofessional education and training provided by a pharmacist. 

Because overall rates of adherence were low, both primary care settings were found to be equivalent. Our study may have been underpowered to detect a difference in the primary endpoint because of the small sample size. However, our study demonstrates that interprofessional education and training may lend itself to changes in practice, which is evident by the clinically significant relative increase in adherence. The Henry J. Austin Health Center network will be implementing a standard operating procedure regarding LAIA management within the primary care setting. Further studies are needed to assess a larger number of patients between both types of primary care settings, as well as the impact of the clinical psychiatric pharmacist as a member of the treatment team. 

   

Stockpiling and food worries: Changing habits and choices in the midst of COVID-19 pandemic. Socio-Economic Planning Sciences (2021): 101181 

Authors: Amuakwa-Mensah, Franklin, Salome Amuakwa-Mensah, Rebecca Afua Klege, and Philip Kofi Adom  

Abstract 

Albeit governments have instituted strong containment measures in the wake of the COVID-19 pandemic, concerns of continuous local spread and economic impact of the virus are impacting global food chains and food security.  

This paper investigates the effect of concern about the i) local spread and ii) economic impact of COVID-19, on the change in the amount of food and necessities bought in twelve Sub-Sahara African countries. In addition, we examine if these effects are channeled through food worries.  

The study uses a unique survey dataset by GeoPoll collected in April 2020 (first round) and May 2020 (second round) and employs a multinomial logit and generalized structural equation models. We find significant effect of concern about COVID-19 on change in the package size of food and necessities bought, which is heterogeneous across gender group and rural-urban divide.  

Our results reveal that concerns of COVID-19 might be promoting stockpiling behavior among females and those with no food worries (due to having sufficient money or resources). This if not properly managed could in the medium to long-term affect the food supply chain, food waste and exacerbate food worries problem especially for already food deprived homes. We discuss the policy implications. 

 

The Impact of Clinical Pharmacist Led Comprehensive Medication Management on Diabetes Care at Federally Qualified Health Centers within the BD Helping Build Healthy Communities Program. Journal of the American College of Clinical Pharmacy. 

Authors: Pastakia, Sonak, Alycia Clark, Katie Lewis, Damon Taugher, Rajal Patel, Liz Ali, Cecilia Wu, Racheal Butler, M. Thomas Bateman Jr, Caitlin McCarthy, Joanne Vargas, Carrie Poulsom 

 

Abstract 

The BD Helping Build Healthy Communities (HBHC) program is a philanthropically funded initiative designed to provide support for comprehensive medication management (CMM) services at Federally Qualified Health Centers (FQHCs) to support care for low-income populations. 

The primary outcome of interest was the change in glycosylated hemoglobin (HbA1c) between baseline and 6 months with changes in systolic (SBP) and diastolic blood pressure (DBP) between baseline and 6 months being evaluated as secondary outcomes. 

Awardees of the HBHC program who provided clinical pharmacist led CMM services in 2017, 2018, or 2019 to address the needs of people living with diabetes, were asked to complete a standardized monitoring template to evaluate their progress in serving patients receiving care at their clinic. The data from these reports was then analyzed using the paired t test to identify statistically significant changes in HbA1c, SBP, and DBP 

A total of eight FQHCs, providing care to a total of 2502 patients, received funding within the HBHC program for their CMM activities related to diabetes. Within the primary outcome analysis of the change in HbA1c at 6 months, a statistically significant reduction in average clinic HbA1c between baseline and 6 months (9.4 vs 8.2, mean difference 1.2, 95% CI [0.45-1.97, P <.01]) was observed. Similarly, a statistically significant reduction was observed between baseline and 6 months for SBP (140.8 vs 130.2 mm Hg, mean difference 10.5, 95% CI [2.2-18.9 mm Hg, P <.05] and DBP (83.1 vs 78.9 mm Hg, mean difference 4.15, 95% CI [0.48-7.82 mm Hg, P <.05]). 

The CMM activities within the HBHC program were able to demonstrate statistically significant reductions in HbA1c and blood pressure. Despite the inherent limitations associated with a retrospective analysis with diminishing patient follow-up over 24 months, this analysis shows that investment in clinical pharmacist led CMM could potentially have positive impacts on clinical outcomes for patients receiving care at FQHCs. Additional rigorous studies are needed to confirm the findings seen in this analysis. 

 

COVID-19 and handwashing: Implications for water use in sub-Saharan Africa. Water Resources and Economics 36 (2021): 100189.

Authors: Amuakwa-Mensah, Franklin, Rebecca Afua Klege, Philip Kofi Adom, and Gunnar Köhlin.  

 

Abstract 

Because the main modes of transmission of the COVID-19 virus are respiration and contact, WHO recommends frequent washing of hands with soap under running water for at least 20 s. This article investigates how the level of concern about COVID-19 affects the likelihood of washing hands frequently in sub-Saharan Africa. We discuss the implication of the findings for water-scarce environment. 

 The study makes use of a unique survey dataset from 12 sub-Saharan African countries collected in April 2020 (first round) and May 2020 (second round) and employs an extended ordered probit model with endogenous covariate.  

The results show that the level of concern about the spread of the virus increases the likelihood of washing hands with soap under running water for a minimum of 20 s at least five times a day. The increase in the probability of handwashing due to concern about COVID-19, ranges from 3% for Benin to 6.3% for South Africa. The results also show heterogeneous effects across gender- and age-groups, locality and various water sources. However, in Africa, the sustainability of the handwashing protocol could be threatened by the severe water scarcity that exists in the region. To sustain frequent handwashing, sub-Saharan Africa needs an effective strategy for water management and supply. 

 

Adoption of telepharmacy within a community health center: a focus on clinical pharmacy services. Journal of the American College of Clinical Pharmacy 4, no. 8 (2021): 924-933.

Authors: McCarthy, Caitlin, M. Thomas Bateman Jr, Tyler Henderson, Ronald Jean, and Rachael Evans. 

 

Abstract 

Due to the current coronavirus disease 2019 (COVID-19) pandemic, telehealth has shifted from an underutilized service to a medical necessity almost overnight. While guidelines are available regarding implementation of telepharmacy services, there is limited practice-level evidence demonstrating successful adoption of telepharmacy for the delivery of clinical pharmacy services. 

The purpose of this article is to provide a description of how telehealth has been utilized to deliver pharmacy services within a Community Health Center (CHC), to discuss the impact of telehealth services, and to provide a framework by which other entities may create successful telehealth programs within the ambulatory care setting. 

Overall CHC productivity, clinical pharmacist productivity, and patient demographics were compared between the 7 months preceding and the 7 months after implementation of telehealth services. Patient satisfaction with telehealth was measured via anonymous surveys administered via Feedtrail XM and provider satisfaction was measured via a survey created by the New Jersey Primary Care Association. 

Telepharmacy has caused a shift in the demographics of patients receiving pharmacy services, increasing the proportion of patients with private insurance, who were 65 years or older, and who were non-English speakers. While overall productivity at the CHC remained stable, the number of clinical pharmacy encounters increased. Patients were satisfied with telepharmacy visits indicating that they were of the same or greater quality than in-person visits and expressed a preference to continue telepharmacy visits in the future. 

Our results suggest that telepharmacy is an effective way to deliver care particularly around chronic conditions. To be sustainable, telehealth requires ongoing support from local, State, and Federal agencies in terms of maintaining regulations around expanded scopes of practice and in terms of reimbursement. 

 

Linked Pharmacist-Provider New Patient Visits in Primary Care. The American Journal of Managed Care 26, no. 5 (2020): e162-e165.

Authors:  Bateman Jr, M. Thomas, Caitlin McCarthy, and Kemi Alli 

 

Abstract 

The study aims to implement a project of linked pharmacist-provider new patient visits and then evaluate the impact on the productivity of the provider and pharmacist. 

 A clinical pharmacist was integrated into the workflow at 2 sites (sites A and B) of Henry J. Austin Health Center, a federally qualified health center, so that new patients were scheduled to see the pharmacist in a 15-minute encounter immediately before a 15-minute encounter with the primary care provider. 

 Reports generated in the electronic health record were downloaded into Microsoft Excel for statistical analysis. Two-sample 2-tailed t tests assuming unequal variances were used to evaluate changes in the mean number of appointments checked in and canceled before and after the project’s implementation to study provider productivity, the primary study outcome. Descriptive statistics were used to report the pharmacist’s productivity. 

Statistically significant increases in the number of checked-in new patient visits and in all visits of any type were observed at site A; however, these changes were not observed at site B. 

The linked visits between the pharmacist and provider allowed for increased provider productivity at 1 of the sites. Based on these results and provider feedback from both sites, this project was viewed as a positive initiative. Scheduling challenges were a barrier to project success at site B. 

 

Impact of Chronic Disease State Management by Clinical Pharmacists on Diabetes Outcomes: Interim Results of a Prospective Pilot Study. Endocrinology, Diabetes and Metabolism Journal Volume 2 Issue 4

Authors: Caitlin McCarthy and M. Thomas Bateman 

 

Abstract 

The study aims to provide program methodology and outcomes data identifying the impact of clinical pharmacy services provided to patients with diabetes mellitus.  

Adult patients with diabetes mellitus identified by a member of the primary care team were referred to the pharmacist-led disease state management program, a patient-centered medication therapy management (MTM) program developed through university collaboration with a local Federally Qualified Health Center. 

Pharmacist-delivered disease state management and medication therapy management across three or more face-to-face encounters over the course of six months. 

Clinical outcomes were followed for 6 months from the time of referral and enrollment into the program. The primary diabetes endpoint, glycosylated hemoglobin, and patient-reported experience with care were collected at baseline and the end of the study. Clinical pharmacists documented the content of clinical visits, including the number of visits per patient, duration of encounters, number and proportion of identified medication therapy problems, and the number and proportion of associated interventions to optimize pharmacotherapy.  

Glycosylated hemoglobin was significantly reduced versus baseline at the 6-month assessment in both the intent-to-treat (−2.7%; P < 0.0001) and the per-protocol groups (−3.0%; P < 0.0001). Patient-reported satisfaction with care was higher for the pharmacists as compared to the primary care providers with significantly more patients rating the care received from the pharmacist as excellent (P = 0.001). The pharmacists completed 158 visits, identifying and resolving an average of 7.7 medication therapy problems for each subject included in the analysis. 

In this model of MTM, the clinical pharmacists were able to identify and resolve interventions which subsequently resulted in statistically significant reductions observed in the primary diabetes endpoint and high levels of satisfaction with care.