Since being diagnosed with diabetes in 2009, 47-year-old Nascha* struggled to control her condition. At times, her vision was blurred and she had constant burning and numbness in her feet. As a result, her primary provider at Utah Navajo Health Systems, Inc (UNHS) referred her to the clinical pharmacy program.
After a few visits in which she received personalized education about the disease as well as an adjustment to her medication to tailor her treatment to her specific needs, her diabetes is under control for the first time. Nascha no longer has pain in her feet, her vision is clear, and she has lost 10 pounds since last summer.
Nascha is one of many patients that has improved their health dramatically since the clinical pharmacy program was first implemented at UNHS three years ago. The documented success is part of the reason why UNHS was selected as one of seven winners of the 2014 “Innovations in Care” Award as part of the BD Helping Build Healthy Communities initiative, implemented together with Direct Relief and the National Association of Community Health Centers (NACHC).
The awards seek to recognize innovative approaches to the prevention and treatment of diseases that disproportionately affect vulnerable populations in the U.S.
Serving Utah’s Most Underserved
UNHS serves Utah’s southern San Juan County, including the Utah strip of the Navajo Nation. Since beginning in 2000 with a small health clinic in Montezuma creek, UNHS is now a federally qualified health center (FQHC) with four sites serving one of the most remote areas of the contiguous United States.
Their patient population is 80 percent Navajo, and 57 percent of people in their target area do not have running water, electricity, telephone, or central heat. Between the four sites, UNHS serves 12,875 patients each year, of whom more than 25 percent are uninsured.
Clinical Pharmacists Complement Provider Care
Emily Hunter, a clinical pharmacist at UNHS, said the clinical pharmacy program was developed because of a shortage of providers, which she says is a trend in health care facilities across the nation. Being in a rural area creates additional challenges as it’s harder to attract doctors to serve those areas.
“When you’re in a rural setting, the doctor has to do it all,” said Hunter. “Clinical pharmacists can help these overworked, seeing everybody kind of doctors.”
She said patients are referred to the clinical pharmacist if their primary provider feels they need more time and instruction. Patients spend about 15 minutes with providers, but Hunter says her sessions last about 45 minutes, allowing more personalized care.
Many of the patients have one or more chronic conditions, such as diabetes, hyperlipidemia, and hypertension. The clinical pharmacist can help determine if their medication should be increased or decreased, and when to start and stop prescriptions. With a pharmacy on site at all four of UNHS’s locations, it’s easy to help patients make changes.
Overtime, measurable success in participating patients’ health and regular feedback and collaboration between everyone involved has strengthened the program.
“There’s a lot more trust between the providers and pharmacists,” said Hunter.
Personalized Education Helps Break Barriers to Improved Health
Hunter said that often in her sessions with patients, she spends time explaining basic facts about diabetes. Many people – even those who have been diagnosed for 10 years – don’t fully understand what’s going on, what sugar has to do with their condition, and how to make changes.
She frequently uses a white board to draw and explain the complexities of the condition. “It makes the biggest difference,” she said.
Hunter said solutions for better health consist of fine-tuning the patient’s medication, nutrition intake, and exercise habits.
But with poor access to good food on the reservation, nutritious meals can be difficult. Additionally, Hunter says she often encounters resistance to exercise in the area UNHS serves. There are no bike paths, very few paved roads, hardly any gyms, no swimming pools, and little access to the local track.
Much of the time, she recommends that people simply walk as it is the most convenient form of exercise under the circumstances.
Furthermore, when first starting the clinical pharmacy program, providing effective translation services was a challenge – even for native speakers.
“A lot of terms in Navajo do not have a direct translation,” said Stephanie Makihele, who works in program development for UNHS.
She said that after their translators attended a medical terminology session, they came back feeling much more confident about how to explain things to the patients.
Moreover, UNHS has a traditional Navajo healer on staff who is called in occasionally to help a patient understand how a provider’s recommendation can be in alignment with traditional medical practices.
This culturally sensitive care delivered in the patient’s native language has helped build trust between patients and health workers at UNHS.
BD Award Comes at a Critical Time
Makihele said the BD Helping Build Healthy Communities Award came at a time when UNHS was struggling to keep the clinical pharmacy program running.
“We felt like if we could continue the program, we would have enough good results to get more funding,” she said. “[The award has] been a critical resource for us and we are extremely grateful.
Makihele said most of the services provided through the program are not reimbursable through Medicaid, and that the funding helps offset what they have to pay for.
Direct Relief is privileged to work with partners like UNHS who are using innovative practices to help people in need, like Nascha, improve their health and lives.
*Name has been changed to protect patient privacy