Project IMPACT: Diabetes
Mountain States Health Alliance (MSHA) and Dispensary of Hope
MSHA Overview
Program Overview
Mountain States Health Alliance (MSHA) is a locally owned and operated not-for-profit, healthcare system serving a 29 county, four state region with 13 hospitals and a fully integrated alliance of specialty and primary health care providers. MSHA has received the Excellence Award twice from the Tennessee Center for Performance Excellence.
The Northeast Tennessee Dispensary of Hope (NETDOH) is a community collaborative led by MSHA designed to meet the pharmaceutical needs of individuals without adequate health insurance or the financial means to afford medication. Among its patient population, NETDOH currently provides medication therapy to approximately 60 patients with diabetes monthly. Opened in 2009, NETDOH operates in collaboration with the Johnson City Downtown Clinic (JCDC), a federally qualified health center. The patients are receiving care coordination through AMPA and primary care through JCDC.
Program Partners
Mountain States Health Alliance (MSHA) is a locally owned and operated not-for-profit, healthcare system serving a 29 county, four state region with 13 hospitals and a fully integrated alliance of specialty and primary health care providers. MSHA has received the Excellence Award twice from the Tennessee Center for Performance Excellence.
The Northeast Tennessee Dispensary of Hope (NETDOH) is a community collaborative led by MSHA designed to meet the pharmaceutical needs of individuals without adequate health insurance or the financial means to afford medication. Among its patient population, NETDOH currently provides medication therapy to approximately 60 patients with diabetes monthly. Opened in 2009, NETDOH operates in collaboration with the Johnson City Downtown Clinic (JCDC), a federally qualified health center. The patients are receiving care coordination through AMPA and primary care through JCDC.
Community Champion:
Joy Waddell, PharmD
Patient Profile
MSHA serves patients who live in Washington County, TN, do not have prescription drug coverage, and earn 200% below the federal poverty guidelines (on a household basis). Around 20 to 30% of patients are classified as homeless. Some patients come to the site having not taken any medications for two years due to their health and financial circumstances. Patients struggle with reliable transportation, adherence, and lack of understanding of their disease states.
The primary source of patient referrals is via the local safety net clinics, the public health department, the public housing authority, and anyone discharged from a Washington County, TN hospital or Emergency Department who qualifies for short-term assistance.
Pharmacists’ Role on the Collaborative Care Team
Clinic providers refer patients directly to the Project IMPACT program. The Dispensary of Hope then obtains the patient’s lab work from his or her provider. On the initial visit, the patient meets with the pharmacist, sometimes in conjunction with a translator from the clinic as necessary for Spanish-speaking Hispanic population. Sessions last from 30 minutes to two hours, and the pharmacist conducts medication therapy management and educates the patient about diabetes, lifestyle choices, and self-management, and medications, and answers any questions the patient may have. The pharmacist stresses adherence as well as disease knowledge. Issues such as proper meal planning, daily foot checks and regular exercise are emphasized. For some patients, the clinic schedules a monthly session that coincides with their medication refills to ensure continuity of care. Through Project IMPACT, the pharmacist also ensures that patients are provided a comprehensive eye exam by a local ophthalmologist, at no cost to them. Staff and members of the healthcare team at the NETDOH and Johnson City Downtown Clinic communicate openly to ensure that providers are aware of progress and challenges of patients.
Relevant Statistics – Community Level
- In 2010, Tennessee ranked as having the 3rd highest age-adjusted prevalence of diabetes among adults in the U.S. (estimated at 10.6%)
- The percentage of Tennessee adults with diabetes almost doubled between 1996 and 2005, from 5.0% to 9.1%
- In 2011, diabetes was the 7th leading cause of death in the state of Tennessee with a death rate of 27.1 per 100,000 individuals
References:
- Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. Increasing prevalence of diagnosed diabetes - Unites States and Puerto Rico, 1995-2010. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6145a4.htm. Accessed July 2, 2013.
- Tennessee Department of Health. BRFSS Fact Sheet: Diabetes. Available at: http://health.state.tn.us/Downloads/Diabetes.pdf. Accessed on July 2, 2013.
- Tennessee Department of Health. Tennessee Death 2011. Available at: http://health.state.tn.us/statistics/PdfFiles/TnDeaths11.pdf. Accessed on July 2, 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%.... Accessed June 12, 2013.