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Project IMPACT: Diabetes
CrossOver Healthcare Ministry
CrossOver Healthcare Ministry
CrossOver Healthcare Ministry (CrossOver) and Goochland Free Clinic’s diabetes projects integrate pharmacists who are experts in diabetes care into the diabetes care model of free clinics in the Richmond, VA area. Each clinic has a Core Diabetes Team consisting of a physician or nurse practitioner, nurse, pharmacist, and a medical assistant. The pharmacist leads the coordination of the diabetes care for enrolled patients and works closely with the patient’s primary care provider and the expanded diabetes care team, including a nutritionist, ophthalmologist, podiatrist, and counselor. The pharmacist meets patients anywhere from weekly to quarterly on-site at each of the clinics. Education, medication recommendations, and self-management are integrated into each visit. ADA recommendations are followed, and the visit model is adapted from Wagner’s Chronic Care Model.
The CrossOver and Goochland Free Clinics partner with Virginia Commonwealth University’s School of Pharmacy for Project IMPACT: Diabetes. CrossOver is Virginia’s largest free clinic providing services to over 6,300 patients each year. Established in 1983, CrossOver offers a full continuum of health care services to uninsured patients through a network of free clinics in Richmond, VA. Those services include: family medicine, primary care, obstetrics and pediatrics, podiatry, dental and vision care, mental health care, HIV diagnosis and treatment, and critical medications. CrossOver’s mission is to provide quality and compassionate health care that cares for the whole patient – body, mind, and spirit.
Goochland Free Clinic & Family Services provides a medical home for the uninsured and under-insured adult residents of Goochland County. Their mission is to provide access to health care and basic human services to Goochland community residents who are in need of assistance. Their programs which include medical, mental health, dental, housing and financial assistance, food, and clothing, are designed to respond to individuals and families with the highest levels of need: those in danger of becoming homeless, hungry, or suffering the dire consequences of foregoing health care. Their comprehensive array of programs holistically addresses human needs resulting in improved physical, social, and economic health for the clients served.
Virginia Commonwealth University’s (VCU) School of Pharmacy has been consistently ranked as one of the top pharmacy schools in the nation. The mission of VCU School of Pharmacy is to educate, create knowledge, and to provide service for its students, the pharmacy profession, and the public. The latter is accomplished partly through the each pharmacy student spending his/her last year in a practice setting as well as each student completing patient-care-related Service-Learning hours aimed to benefit the community. VCU is committed to improving health care access and forming impactful academic-community partnerships. The VCU School of Pharmacy and CrossOver have partnered to support a Pharmacy Resident who practices in the Richmond area free clinics and in the diabetes program.
Sallie Mayer, PharmD, MBA, BCPS, CDE
The patients served through CrossOver and Goochland clinics are uninsured and living 200% below the poverty line. Patients often lack financial resources needed to buy food that is compliant with a diabetic diet. Ethnicity, cultural traditions, and family dynamics also interfere with diet recommendations. Many patients served through this project do not have personal transportation and must use public transportation. Because they often travel by bus, they can carry only one or two bags from the grocery store, making it less likely that they will eat healthy, fresh foods. Another obstacle with public transit includes travel time. Some patients live only three miles from the clinic but travel an hour and a half to obtain care at the clinic. In Goochland, there is no public transportation, so patients must use the clinic’s van service or find a ride from a friend. Patients also encounter literacy issues and often do not understand the medical information that has been given to them in other health care settings.
Pharmacists’ Role on the Collaborative Care Team
Pharmacists participate in a collaborative, multi-disciplinary health care team that puts the patient first. The clinics were designed so patients could remain in the building for all types of care. The layout places the pharmacist directly in the center of all activity. The pharmacists provide personalized attention to each patient, practice sensitivity to the patients’ culture, and relate to them in a way they understand and appreciate, including partnering with interpreters when needed. Pharmacists educate patients on diabetes complications and preventable measures, stressing that small changes can make a big difference. This health care model cares for the whole patient on an emotional, physical, and spiritual level. The interaction between pharmacist and patient empowers patients to take ownership of their disease.
Relevant Statistics – Community Level
According to the Virginia Department of Health1,2:
- Approximately 8.7% or 531,000 Virginians were diagnosed with diabetes as of 2010
- 13.5% of black Virginians and 8.5% of non-Hispanic Virginians were diagnosed with diabetes as of 2010
- In the State of Virginia, 5.8% of Hispanic/Latino women and 2.1% of Hispanic/Latino men have diabetes
- Virginia Department of Health. Diabetes in Virginia: Diabetes Prevention and Control Project. Available at:http://www.vdh.virginia.gov/ofhs/prevention/diabetes/documents/2012/pdf/Diabetes%20Burden%20Report1.pdf. Accessed August 14, 2013.
- Virginia Department of Health. Prevalence of Diabetes. Available at http://www.vdh.virginia.gov/ofhs/prevention/diabetes/documents/2011/pdf/factsheets/Diabetes%20Prevalence/Prevalence%20of%20Diabetes%20in%20VA.pdf. Accessed October 9, 2013.
- Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.
- American Diabetes Association. Fast Facts Data and Statistics About Diabetes. Available at: http://professional.diabetes.org/admin/UserFiles/0%20-%20Sean/FastFacts%20March%202013.pdf. Accessed June 12, 2013.