Web Extra: Helping Close the Healthcare Gap
By Sue Stein
Dean of the School of Pharmacy
Pacific University, Oregon
The availability of healthcare has been a recognized need in our society. Sometimes the most basic health care is not available to the deserving. In our community, the Virginia Garcia Memorial Health Center is working with Pacific University to change that.
Virginia Garcias mission is clear: To provide high-quality, comprehensive, and culturally appropriate primary health care to the communities of Washington and Yamhill counties with a special emphasis on migrant and seasonal farm workers and others with barriers to receiving healthcare.
The statistics regarding their patients are staggering: 68 percent are at or below the Federal Poverty Level ($20,500 a year for a family of four); 48 percent lack insurance; 68 percent converse fluently in languages other than English and struggle for information and service because of language barriers. (http://www.virginiagarcia.org/index.html)
The following 2007 federal government statistics are further disturbing evidence regarding the healthcare gap, which includes almost 46 million Americans, 18 percent of whom are less than 65 years old without health insurance:
The lack of insurance has significant negative reverberations in society:
- They receive less preventative care: in 2003, nearly 50% of uninsured children did not receive a checkup
- Approximately 20 percent of uninsured patients use the emergency department as their primary health care provider
- It has been estimated that the number of excess deaths of uninsured adults age 25-64 is approximately 18,000 per year. http://www.nchc.org/facts/coverage.shtml
According to the 2007 published data in Pharmacoepidemiology and Drug Safety on outpatient drug safety:
- 47% of Americans have chronic conditions
- 22% have multiple chronic conditions
- Less than 50 percent of patients with chronic conditions have satisfactory levels of disease control.
- 82 percent of the U.S. population reported using at least one prescription medication, over-the-counter medication, or dietary supplement in the previous week.
The Institute of Medicine (IOM) found that the safety and risk associated with medications are severe:
- 30 percent reported using five or more of these drugs in the previous week.
- Adverse healthcare events continue to be a leading cause of death and injury.
- 1.5 million people are injured each year as a result of medication.
- Nearly 25% of ambulatory patients reported adverse drug events
- For every dollar spent on ambulatory medications, another dollar is spent to treat new health problems caused by the medication.
The Pacific University School of Pharmacy is attempting to bridge the gap in health care described above. Our curriculum integrates the principles of effective therapy management of chronic conditions, in order to educate patients and family members. We have faculty members working in the community to provide care to underserved patients. One of these, Dr. Ty Vo, is currently working in Virginia Garcia Hillsboro Primary Care Clinic and participating in the Patient Safety and Clinical Pharmacy Services Collaborative sponsored by the Health Resources and Services Administration (HRSA), the federal agency charged with improving access to healthcare services for people who are uninsured, isolated or medically vulnerable.
A key component of this Collaborative is to increase awareness of the benefits of clinical pharmacy services among healthcare providers and to promote the integration of the pharmacist into the inter-professional healthcare team. The primary emphasis is on the improvement and integration of healthcare delivery systems, which maximize the use of clinical pharmacy services and safe medication practices at each point of care that ultimately result in improved patient outcomes. Patient care provided through individualized patient assessment and management that promotes appropriate selection and utilization of medications to optimize therapeutic outcomes. These services are best provided in collaboration with a pharmacist.
Sue Stein, RPh, MS, is Dean and Associate Professor of the Pacific University School of Pharmacy, part of the College of Health Professions at Hillsboro, Ore. Stein holds a Master of Science in Pharmaceutical Sciences from the University of Wisconsin-Madison, and a Bachelor of Science in Pharmacy from the University of Wisconsin-Madison.