Project IMPACT: Diabetes
PASCUA YAQUI RESERVATION OF THE EL RIO HEALTH CENTER
The mission of El Rio Community Health Center is to improve the health of the community by providing comprehensive, quality health care that is accessible to all who need it. Dedicated to serving all populations, including the underrepresented and uninsured, El Rio developed a clinic at the tribal headquarters of the Pascua Yaqui Reservation.
The clinic at the tribal headquarters of the Pascua Yaqui Reservation has a comprehensive team of providers, including pharmacists, physicians, nurse practitioners, physician assistants, and support staff who work together to coordinate care for the Pascua Yaqui tribe.
The El Rio Community Health Center system partners with the Health Services Advisory Group, the quality improvement organization for Arizona and the Patient Safety and Clinical Pharmacy Services Collaborative. Both of these organizations are committed to improving the quality of care provided to the diabetes population of focus in Project IMPACT: Diabetes. They also partner with the University of Arizona and offer a training site for pharmacy students and residents.
Marisa Rowen, PharmD
El Rio’s clinic on the Pascua Yaqui Reservation is located in the southwestern part of the Tucson metropolitan area. The clinic serves a Native American population. The majority of the patients are American Indian adults with Type 2 diabetes, hypertension, obesity and dyslipidemia. More than 40% of patients live below the federal poverty level.
Pharmacists’ Role on the Collaborative Care Team
The Pharmacy-Based Diabetes Management Program provided at the Pascua Yaqui Reservation was developed using the same model of care that had been established in the El Rio Community Health Center system. Patients are referred to the pharmacist by their provider when they have newly diagnosed or uncontrolled diabetes. Pharmacists have collaborative practice agreements with prescriptive authority with the physicians that allow them to manage the patient's medication therapy. The pharmacists use their comprehensive understanding of medication therapy, including formulary guidelines and drug protocols, to make recommendations and changes in therapy regimens as needed. The pharmacist is responsible for monitoring a patient’s medication therapy and making modifications when needed, continuous monitoring for improvement in patient outcomes, education of patients, identification/resolution of adherence and therapy related concerns, as well as monitoring for actual or potential adverse drug reactions. The pharmacist can also identify if referrals to other providers in the areas of ophthalmology, podiatry, nutrition or behavioral health may be needed based on what was identified during the pharmacy visits. The integration of pharmacists in the healthcare team at El Rio has helped to improve patient outcomes, including the patient’s quality of life, improve medication adherence, and avoid medication-related complications.
Relevant Statistics – Community Level
According to the CDC1:
- 8.1% of adults in Arizona were diagnosed with diabetes in 20101
- According to the Arizona Health Department of Health Services Bureau of Tobacco and Chronic Diseases:
- There has been an 80% increase in people diagnosed with diabetes from 1995 to 20102
- Considering that a third of the population with diabetes is undiagnosed, it is estimated that there are nearly 600,000 adults with diabetes in Arizona
- Centers for Disease Control and Prevention: National Diabetes Surveillance System. Available at: http://www.cdc.gov/diabetes/statistics. Accessed June 16, 2013.
- Arizona Health Department of Health Services Bureau of Tobacco and Chronic Diseases. Arizona Diabetes Burden Report: 2011. Available at: http://azdhs.gov/azdiabetes/documents/pdf/AZ-Diabetes-Burden-Report_2011.pdf. Accessed June 16, 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.