Background of program: A growing body of literature shows that poor adherence rates among hypertensive and diabetic patients vary greatly, from 30% to 70%. Other studies focused on the reasons patients stopped taking their medications, showing that approximately half reported they stopped because they thought they were cured, and a quarter said they stopped because they believed their physician had told them to stop. These findings are especially important since they highlight the role of patient perceptions of illness in drug use decision making, as illustrated by the nearly 70% who stopped taking their medications for reasons related to health perceptions rather than because of drug‐related or financial reasons.
This project creates patient care teams of Community Health Workers (CHWs) and pharmacists to provide better care for people with poorly controlled high blood pressure (HBP) or diabetes mellitus (DM). Their duties include outreach, health education and health promotion. We posit that because CHWs are in a unique position to understand culturally shaped beliefs and health behaviors, they are better able to discover why people are nonadherent to medications compared to pharmacists alone. We propose that many practice barriers faced by pharmacists can be effectively addressed by CHWs.
The goal of the program is to assess the value of CHWs in identifying and resolving specific types of medication‐related problems in cooperation with pharmacists. In line with an extensive literature showing poor health outcomes particularly among minority and underserved populations who have a diagnosis of hypertension or diabetes, we seek to investigate a new health intervention aimed at Blacks and Hispanics with poorly controlled hypertension and/or diabetes and a pattern of medication‐use practices at odds with prescribed drug therapy regimens. Our long‐term goal is to improve medication‐use practices among underserved populations through medication therapy management by CHWs and pharmacists.
Prior to the 2-day CHW MTMS training event each CHW attendee is required to complete a few hours of homework that entails watching 3 recorded lectures on different aspects of the MTMS process.
CHWs are in a unique position to understand culturally shaped beliefs and health behaviors. Thus, they are better able to discover why people are nonadherent to medications compared to pharmacists alone. Our earlier work at UF revealed that cultural experiences shape people’s medication‐use practices. For example, some beliefs about how to treat hypertension are passed down from generation to generation and those cultural beliefs shape decisions made by patients (e.g., substituting folk remedies for prescribed anti‐hypertensives).
During the 2-Day training program a variety of skills are taught, such as Motivational Interviewing. Applying the method of Motivational Interviewing helps the CHW obtain important information from patient during the patient interviewing process. CHWs learn to use active listening skills to build rapport with patients by reflecting, empathizing, and exploring the patient’s issues.
Mock interview with Patient during an Encounter Form medication adherence discussion. No PHI has been shared during this session. This video is used as a tool for the UF CHW MTMS training events.