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Published in CenterView March 29, 2010

Pharmacy project improves health quality in Mississippi Delta

By Matt Westerfield

Ask any School of Pharmacy faculty member and they'll say being a pharmacist is about more than dispensing medications. A pharmacist, they'll say, is first and foremost a health-care provider.

With that in mind, a University of Mississippi School of Pharmacy research project is looking to maximize the long-term impact pharmacists have on the overall health and quality of life of their patients.

It's part of a transition the practice of community pharmacy is undergoing, and it puts the Mississippi Delta on the frontlines of that shift.

School of Pharmacy faculty, front row from left, Kakhi
Wakefield, Dr. Leigh Ann Ross and Dr. Lauren Bloodworth,
and back row from left, Dr. Lauren Love Compton, Peggy
Duke, Dr. Gary Theilman, Dr. Jane Cross, Dr. Randy Pittman,
Dr. Joseph Byrd and Dr. Lorelei Lucas.

"The primary mission of the School of Pharmacy is education, but we also have a service mission," said Dr. Leigh Ann Ross, associate dean for Clinical Affairs in the School of Pharmacy. "Since the late 1960s, pharmacy's practice model has been evolving from solely a dispensing role to more involvement in direct patient care. This project helps us move toward that goal."

The School of Pharmacy is deeply committed to improving the health of Mississippians, said the dean of the school, Dr. Barbara Wells.

"Citizens of the Mississippi Delta have phenomenal health-care needs and very little resources for meeting them," Wells said. "The Delta Pharmacy Patient Care Management Project, funded through the Delta Health Alliance, is specifically designed to improve clinical and economic outcomes."

Wells said the school is working with community pharmacists already practicing in the Delta to help them develop their practices to better meet health needs through Medication Therapy Management (MTM) and disease-specific education. The project is now in its second year and preparing for year three.

Ross, the principal investigator of the study who also serves as chair and associate professor of pharmacy practice, says MTM is a concept aimed at achieving positive outcomes through the effective use of medications, patient education and the prevention of drug complications or interactions. In other words, it's a more comprehensive approach to patient care.

"The Delta region is one of the most underserved areas in the country," said Dr. Tommy Spell, a faculty member who serves as the project's clinical coordinator of community pharmacy development. "It's a poor area in a state with few resources. This (project) is a small part of bringing more resources to the area."

Dr. Jane Cross, clinical pharmacist, works with Jimmie
Cottone of Oakland.

Spell maintains a pharmacy practice three days a week at a store he owns in Crystal Springs. Pharmacists, he says, have always been taking care of patients. But what's unique about this project is that it provides a structure for that direct care, which is particularly important in rural areas like the Delta where there are fewer physicians and primary caregivers to go around.

"There are communities where a pharmacist is the only health-care professional a patient may see," Spell said. "This access is one of the things that's always set us apart, and it provides opportunities to improve care."

For the first year of the project, which began in 2008, faculty members visited participating community pharmacies in Batesville, Clarksdale and Yazoo City, providing Medicaid patients with MTM services and education specifically relating to asthma and diabetes.

Dr. Lauren Bloodworth, clinical assistant professor and project administrator, said the visits gave the pharmacists a chance to identify potential or actual medication-related problems. The pharmacists then would make recommendations to primary health-care providers.

Also as part of the project, pharmacy faculty members are working with another Delta Health Alliance project to have community pharmacy patient visits entered into the local primary-care provider's electronic health records.

"Year one was a productive year," Bloodworth said. Much of the year, she explained, was spent creating the infrastructure for the project, building relationships and training community pharmacists.

The current year, launched in July 2009, saw the expansion of the project to include more counties in the Delta and target a wider range of patients beyond Medicaid recipients. A health literacy and cultural competency component was added and a new community pharmacy residency program was created. Dr. Lauren Love Compton is the first resident in the program that will undergo accreditation in 2010.

Plans for year three are under way, and Ross said the project will grow to address other health concerns and chronic diseases in the coming year.

"Expanding into additional disease states like obesity and prevention measures - such as smoking cessation and immunizations - may be included in year three," she said.

Ross credits her predecessor in pharmacy practice, Dr. Joseph Byrd, with leading the way for greater involvement in the Delta. Byrd led a project to administer a community pharmacy MTM program in partnership with a health center in Clarksdale several years ago. Expanding community practice is something the School of Pharmacy has been interested in for a long time, Ross said.

With many faculty members located on the UMMC campus, the Department of Pharmacy Practice is one of six departments in the School of Pharmacy and leads the Delta project in collaboration with the school's Department of Pharmacy Administration and the Center for Pharmaceutical Marketing and Management.

The nonprofit Delta Health Alliance funds a number of projects with the aim of coordinating health efforts in the Delta. Kakhi Wakefield, project coordinator for the Delta Pharmacy Patient Care Management Project, says they report regularly to DHA and to the Health Resources and Services Administration (HRSA) and receive strong support in return.

"We have a great relationship with Delta Health Alliance and all of our Delta partners," she said.
"We appreciate the resources they provide."

Other UMMC projects in the Delta
The Medical Center is involved in a number of other projects in the Delta region, including:

• The Mercy Delta Express Project, launched in 2004, is a community-driven research effort that provides health-care opportunities in the Mississippi Delta with the use of a mobile health clinic. Under the direction of Dr. Lisa Haynie, professor of nursing, the Mercy Delta Express Project coordinates health fairs and screenings, oral-health screenings and health seminars around the Delta, often in collaboration with the State Department of Health. Funded by the Sisters of Mercy, Haynie said the project is geared toward reaching out to rural areas where there is low access to health care.
  
  
• Now in its second year, the Delta Health Rural Scholars Program was developed to raise awareness among medical students about opportunities for working in underserved rural areas and to give them a taste of what it's like serving as primary-care providers in such settings. Under the direction of principal investigator Dr. Jessica Bailey, director of medical education and associate professor of medicine, the project targets fourth-year students and residents and pairs them with physicians in the Delta for a month-long rotation. Bailey said the proposal to secure funding for year three was recently submitted.
  
  
• The Mental Health Services Improvement - Telepsychiatry in the Delta Project aims to reduce disparities in mental health treatment for those living in the Delta region and to improve the quality of services they receive at local community mental health centers. The project uses two-way telemedicine connections that link communities to mental health service providers to offer live psychiatric services. Dr. Grayson Norquist, principal investigator for the project, says he is currently writing the renewal proposal for the next year of the study.
  
  
• Last year, University of Mississippi Health Care launched Intensiview, a Philips VISICU eICU program. With funding support from the DHA, Intensiview will soon provide remote monitoring services for the Delta Regional Medical Center. The system combines interactive audio and video links with the expertise of specially trained medical staff to expand bedside care. Terri Gillespie serves as director of operations for Intensiview.
  
  
• The Delta Region-Health Education Leadership Program (DR-HELP), funded by the Institute for Improvement of Minority Health Disparities in the Delta Region, looks to impact health disparities in the Delta and other underserved areas by collaborating with Tulane University, Louisiana State University and the University of Alabama-Birmingham to attract future health-care workers and to educate local populations. Dr. Rob Rockhold, assistant vice chancellor for academic affairs, said the program aims to cultivate underrepresented students into health-care professions who then return to serve in underserved regions. Rockhold, who serves as the principal investigator, expects to begin operations soon.