Pharmacy expert improves access to diabetes care in rural communities
HOUSTON — To receive medical care for diabetes, most people visit a physician’s office, clinic or hospital. Michael J. Rush, PharmD, BCACP, CDE, NCTTP, director of HealthWise and pharmacy residency programs and assistant clinical professor of pharmacy practice at Ohio Northern University in Ada, Ohio, has helped reverse that and bring medical care to people wherever they may be. As one of the developers of a mobile clinic for diabetes care, he and his colleagues are able to provide care across rural communities that might otherwise struggle to gain access.
For this work, Rush received the American Association of Diabetes Educators’ Strategic Initiative Award.
Rush spoke with Endocrine Today about what the clinic does, how it came about and lessons other health care providers can take from it to improve their own care delivery.
What was the defining moment that led you to your field?
Rush: I’ve wanted to be a health care professional for as long as I can remember. As a child I saw medical professionals as individuals who help people, and I wanted to help people as well. In high school, I volunteered as a counselor at a summer camp for type 1 diabetes. This is where I specifically became interested in diabetes. My mother, a nurse and certified diabetes educator, would also volunteer on the medical staff at the same camp. I found myself gravitating toward the medical team and used those early experiences to learn more about the condition. My mother happily supported this and even allowed me to tag along with her to a national diabetes conference. The two of us still try to attend a diabetes-related conference together whenever we can.
You received this award for your work on a rural mobile health clinic. How did this project come about , and how has it been implemented?
Rush: The vast majority of the region the mobile health clinic serves is rural, with some citizens required to drive more than 33 miles to adjacent counties to access primary care services. The county has been designated a Health Professional Shortage Area, lacking primary care, mental health and dental care. In addition, many of our citizens are poor or lack appropriate transportation.
In the spring of 2015, we formed a consortium consisting of key health care stakeholders in our area, including our county health department, critical access hospital, a federally qualified health center and Ohio Northern University (ONU) to address these access to care concerns within the community.
At ONU nearly 50% of our students are in a health professional training program, so we felt we had the people power to provide care in conjunction with the region’s existing services. We began small, offering screenings and care coordination services at community events, such as food distribution days at food banks or community meals. We quickly gained momentum and, in the summer of 2017, incorporated a new 38-foot mobile patient care center into the service. Now the mobile clinic provides care to members of our county and surrounding communities two to three times a week.
What are the benefits of this type of offering , and what are some potential drawbacks that still need to be addressed?
Rush: Through the mobile clinic, we are discovering many unrecognized and untreated conditions. As an example, in screenings focused on blood glucose, 44% of the individuals we screen have prediabetes and another 28% have diabetes. We have also seen encouraging improvements in population health parameters since implementing this service. For example, our latest community health assessment report shows improvements in health awareness and treatment. Notably, 57% more individuals in the county are now receiving care for hypertension and dyslipidemia.
All of the services provided on the mobile clinic are provided free of charge to the patient. Because the community has a high percentage of people living in poverty, we want to remove the financial barrier to accessing health care through our clinic. Financial sustainability is the most challenging aspect of the clinic. We have been fortunate to receive financial support through grants and generous gifts from sponsors.
How can your work on this clinic be translated to more widespread use?
Rush: The transferable message of the mobile health clinic is two-fold. First, health care professionals need to be acutely aware of the needs of their community. The design of the mobile clinic was to address specific needs identified in the county health assessment. The second and most important message is that we are better when we work together. We all have unique skills and talents on the health care team, and when we work collaboratively our impact is greater. By incorporating learners into the solution, we’ve solved the health professions shortage problem with an interdisciplinary mix of health care trainees.
What area of research most interests you right now and why?
Rush: Aside from diabetes education and management, my main research interest is currently population health. In addition to my work on the mobile clinic, I also oversee several managed care aspects for the university, including an onsite community pharmacy and our employee wellness program. We also have an inbound and outbound call center that provides drug and health information to consumers and health care professionals in addition to medication therapy management to patients nationwide. Through all these services, I’m able to see the impact health policy has on patient care and outcomes. It’s important to study the impact that occurs when population health decisions are made and implemented through these service centers.
What do you think will have the greatest influence on your field in the next 10 years?
Rush: Pharmacy and diabetes education are being influenced by similar factors and experiencing parallel evolutions. We are currently seeing a shortage of primary care health care professionals, and novel health care models focusing on outcome-driven reimbursement are beginning to emerge. I believe this will create a greater emphasis on team-based care, creating new value-added roles for many professions, including pharmacy and diabetes education. I firmly believe that these new collaborative models will reshape health care delivery in the United States for the better. The future is bright.