El Rio Community Health Center
Program Overview
The mission of the El Rio Community Health Center is to improve the health of the community by providing comprehensive, quality health care that is affordable and accessible to all who need it. Dedicated to serving all populations, including the underrepresented and uninsured, El Rio has become one of the largest non-profit, community health centers in the United States. Currently, over 76,000 people in the Tucson community depend on El Rio as their primary source of medical and dental care.Â
Program Partners
The El Rio Community Health Center has a comprehensive team including physicians, pharmacists, dentists, nurse practitioners, physician assistants, nurses, midwifes, medical assistants, and other important support staff. This comprehensive team works together to coordinate care for all patients to improve clinical outcomes. Â Â
El Rio Community Health 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. Â Â
Community Champion:
Sandra Leal, PharmD, MPH, FAPhA, CDE
Patient Profile
El Rio Community Health Center provides accessible and affordable health care primarily to underserved populations in the greater Tucson area and southern Arizona. Â The El Rio Community Health Centers serve over 900 patients a day and the patients are primarily underserved Hispanics and American Indians. More than 76% of patients who utilize services at El Rio fall at or below the federal poverty line.
Pharmacists’ Role on the Collaborative Care Team
The vision of the El Rio Community Health Center is to be a national model of excellent health care. The Pharmacy-Based Diabetes Management Program at El Rio is an innovative program that was established in August 2001 and it has become a national model for treating patients with diabetes. Patients are referred to the pharmacist by their physicians when they have newly diagnosed or uncontrolled diabetes. Pharmacists have collaborative practice agreements 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 20102Â
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
Learn more about El Rio Community Health Center from its profile in Pharmacy Today.
View a video to learn more about this community and its patients before Project IMPACT: Diabetes.
References
Centers for Disease Control and Prevention: National Diabetes Surveillance System. Available at: http://www.cdc.gov/diabetes/statistics. Â Accessed June 16, 2013.Â
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.Â
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.Â
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.
Community Presentations
PRESENTATION 1
Location:Â Â Emerging Models for Clinical Pharmacists in Primary Care
Presenters:
Sandra Leal, PharmD, MPH, FAPhA, CDE from El Rio Health CenterMarisa Rowen, PharmD, CDE from the Pascua Yaqui Reservation of the El Rio Health Center
About the Presentation:
Sandra Leal, PharmD, MPH, FAPhA, CDE and Marisa Rowen, PharmD, CDE from El Rio Community Health Center system gave a presentation on their Project IMPACT: Diabetes communities at the Emerging Models for Clinical Pharmacists in Primary Care on January 31, 2014. Leal was Community Champion during the project for the El Rio Community Health Center in Tucson, AZ. Rowen was Community Champion for Pascua Yacqui Reservation of the El Rio Health Center. The before and after Project IMPACT: Diabetes videos for both communities were shown, as well as videos for a Federally Qualified Health Center and Accountable Care Organization in Arizona, showing the impact of clinical pharmacy services in other types of settings.
The presentation was intended to help key payer stakeholders understand the impact of clinical pharmacy on improve health outcomes. Attendees included:
Department of Health from the State of Arizona
Outcomes
Aetna
Humana
Executive Director, Alliance for Integrated Medication Management
Executive Director, Arizona Pharmacy Association'
Outcomes:
Steve Chen from University of Southern California shared results from his CMMI project and discussed provider status in California. Provider status discussions at the event indicated that Arizona will likely submit a pharmacy provider status bill this legislative session.
PRESENTATION 2
Location:
Association of Clinicians for the Underserved: Delivering Quality Care for the Underserved Annual Meeting and Health IT Forum
Presenter:
Sandra Leal, PharmD, MPH, FAPhA, CDEEl Rio Health Center
About the Presentation:
The key message of the presentation was that the utilizing of clinical pharmacists in a patient-centered medical home and accountable care organization improves health outcomes.
Outcomes:
The meeting was mostly attended by administrators and medical doctors interested in learning about clinical pharmacy integration in underserved populations. They were highly engaged in the presentation.
PRESENTATION 3
Location:
ADE Prevention Learning and Action Network Event
Presenters:
Sandra Leal, PharmD, MPH, FAPhA, CDEEl Rio Health Center
About the Presentation:
The purpose of the presentation was to showcase the value proposition of integrating clinical pharmacy services by showing the outcomes of Project IMPACT Diabetes.
Outcomes:
There was a lot of interest shown in developing similar models in California. A collaborative between APhA Foundation and AIMM was discussed as a potential team to join and contribute data.
PRESENTATION 4
Location:
Webinar presented to the National Center for Health in Public Housing Group
Presenters:
Sandra Leal, PharmD, MPH, FAPhA, CDE from El Rio Health Center
About the Presentation:Webinar presentation was titled "Understanding the Value of Integrating Pharmacy Services to Improve the Health Outcomes and Patient Safety."Â Discussed benefits of integrating clinical pharmacy services in underserved communities citing Project Impact Diabetes as a model for success in these populations.
Outcomes:Â
There was a positive response from the Public Housing group and establishing a relationship with the group could lead to potential opportunities for collaboration. Many participants have an interest in impacting underserved communities.
PRESENTATION 5
Location:
Pharmacists on the Care Team: Demonstrating Value
Presenters:
Sandra Leal, PharmD, MPH, FAPhA, CDE from El Rio Health Center
About the Presentation:
Sandra was joined by a group of people: an experienced PSPC team from QueensCare; Romic, director of pharmacy at Glendale Adventist Medical Center; Terry Hair of Community Health Alliance of Pasadena (CHAP); and Ryan Gates from Kern Medical Center. Ryan's safety net hospital serves one of the most disparate counties in the state and is severely undercapitalized and underwater. He understands the value of the pharmacist on the care team and was one of the key players in the sponsorship and passing of SB 493. Micah Hata from Western University was also involved. The Inland Empire is also a prime target for establishing pharmacist teams and Micah could be instrumental in helping provide resources via residencies and student rotations. CareMore, a medicare advantage organization with significant resources allocated to pharmacy participated as well. Content shared included outcomes related to pharmacists interventions like Project Impact Diabetes results, CMMI outcomes from USC and results from PSPC. The future integration of AIMM with APhA Foundation and value of pharmacists in creating a sustainable model was also discussed.
Outcomes:
A follow-up meeting was held in Sacramento to work on policies to fund integration of pharmacists to spread successful models.This presentation was a great opportunity to network with new sites that want to replicate care models with pharmacists. The audience was directed to the APhA Foundation website for additional information and resources.