Class of 2009 Abstract / OBJECTIVES: Truck drivers one of the most vital components of a country’s economy, and also one of the most medically underserved populations. To date, few studies have explored the healthcare needs of over the road truck drivers. The objective of this study is to determine if a need exists for the creation of a healthcare education program for over the road truck drivers and if retail pharmacy could be an effective setting for such a program. METHODS: A needs assessment analysis was used to examine available literature concerning the healthcare of over the road truck drivers. A multi-question survey was designed to illicit the feasibility of initiating a healthcare education program to over the road truck drivers in a retail pharmacy setting. This survey was administered to third year pharmacy interns, and 67 completed surveys were collected. RESULTS: Statistics from the selected literature showed over the road truck drivers had increased health risks and barriers to receive proper healthcare. Sixty-two percent of the pharmacy interns felt they could help provide healthcare education to over the road truck drivers, but 71% of interns felt that management wanted to have as little time as possible expended providing education and counseling. CONCLUSIONS: Over the road truck drivers are at increased risk of healthcare problems due to the demands of the profession and a healthcare education program is warranted to help

INTRODUCTION: Street medicine programs utilize a nontraditional healthcare model to provide care to populations experiencing homelessness. Through street medicine programs, clinicians take to the streets to offer services to individuals who are living unsheltered. Many street medicine programs offer health professional students the opportunity to volunteer and provide care to this vulnerable population. AIM: This exploratory study aimed to answer the following question: what influence does volunteering with a street medicine program have on the career trajectories of student volunteers who ultimately choose to work with medically underserved populations (MUPs)? METHODS: This study used an exploratory mixed methods approach to answering the research question. The core ideas that emerged from the qualitative data collected from street medicine student volunteers were used to inform the development of a web-based survey administered to a broader, national sample of street medicine student volunteers. The survey included closed- and opened- ended questions, as well as demographic questions. The Health Professionals’ Attitude Towards the Homeless Inventory (HPATHI; Buck et al., 2005) questionnaire was embedded into the survey to measure students’ attitudes towards the population experiencing homelessness before and after volunteering with a street medicine program. RESULTS: The results suggested that 15 (65.22%) of the 23 participants who completed the web-based survey reported that volunteering with a street medicine program influenced their decision to ultimately work with MUPs. Of the 19 participants who provided qualitative feedback, 7 (36.84%) mentioned that their decision to work with MUPs was influenced by their increased exposure and awareness to the barriers and needs of MUPs while volunteering with a street medicine program. Additionally, 6 (31.58%) participants mentioned that their previous decision to work with MUPs was reinforced while volunteering with a street medicine program. CONCLUSION: Volunteering with a street medicine program appears to help motivate students to work with MUPs. Incorporating opportunities to volunteer with a street medicine program into current health professional school curriculum has the potential to impact a greater network of students, as well as influence decisions regarding the students’ careers.

Objective: According to the Joint Commission (2012), about 80% of serious medical errors are related to miscommunication between healthcare providers. The Joint Commission (2012) recommended the utilization of standardized communication tools to reduce the number of medical errors related to the miscommunication. The Situation-Background-Assessment-Recommendation (SBAR) communication tool is a standardized tool that has been used to improve the effectiveness of communication between healthcare providers. The purpose of this project was to evaluate the effectiveness of using SBAR communication tool for warm handoff between primary care providers and behavioral health providers in order to provide a continuous and complete transition of care for patients with psychiatric disorders or psychosocial issues. Method: A mixed method design was implemented in an integrated primary care clinic at two locations in Phoenix, Arizona. A brief presentation about the SBAR tool and copies of the SBAR tool was provided for the clinic staff. Data were gathered from four participants (two nurse practitioners and two behavioral health workers) using structured observation, pre-and post-test surveys, and structured interviews. Length of study was one month. Results: During the data collection, there were 40 observed warm handoffs, 12 unobserved warm handoffs between primary care nurse practitioners and behavioral health workers. Seventy-five percent of the participants felt that the SBAR helped them in organizing their thoughts and providing/obtaining adequate information during warm handoff. They reported satisfaction when using the SBAR tool. There was no statistically significant difference in the scores of collaboration and satisfaction about care decisions between pre and post-SBAR intervention. Conclusion: The SBAR communication tool has the potential to improve communication between primary care providers and behavioral health workers to improve the quality and safety of care for patients with psychosocial concerns. Utilizing SBAR may increase teamwork and ensures adequate hand-off information on the warm handoff. Multiple PDSA cycles should be conducted to refine the change and make it applicable and sustainable in the integrated care setting.

Introduction: Family physicians provide access to medical and behavioral healthcare for many underserved populations. Integrating behavioral health clinicians into primary care practices has been proposed as one of the most effective ways to increase access to necessary behavioral health services for many Americans. Integrated behavioral healthcare (IBHC) has begun to be implemented in family medicine practices but there is limited research examining the impact for patients and clinic staff. This study begins to fill this gap in the literature by examining the effects of implementing integrated behavioral healthcare in an urban family medicine clinic in a medically underserved area. Objective: The objective of this study is to describe patients who use IBHC services, examine behavioral health outcomes, and study patient and staff satisfaction with IBHC services. This is done in the context of the Quadruple Aim of Healthcare which purposes to improve population health, provide a better patient experience, create smarter healthcare spending, and improve medical staff work quality of life. Aspects of implementation are addressed as well, namely the appropriateness, acceptability, adoption, feasibility, and penetration of IBHC services. Methods: IBHC services were introduced to an urban family medicine clinic in a medically underserved area with a census of greater than 4,500 patients (56.17% African American, 24.4% White, 1% Asian, 22.9% Latino/a; 33.3 % Children under 18). Using information from medical records, a description and comparison of the general clinic population and those that use IBHC services is provided. Behavioral health outcomes were measured by tracking patient anxiety and depression over time, from initial session through follow-up at least 3 months after their final session for a subset of patients. Patient and clinic staff satisfaction were assessed using qualitative and quantitative methods. Supplemental analysis compare behavioral health outcomes against a previous sample of patients from the same clinic before IBHC services were present. Results: Demographic information is presented and compared to highlight the unique difference between race/ethnicity, age, and gender. This study showed that adult patients experienced a significant reduction over time from initial session to follow-up with regards to anxiety, F(1.77, 130.63) = 65.65, p < .001, and depression, F(1.78, 131.68) = 37.88, p < .001. Patient interviews and surveys were analyzed and found that patients generally reported high satisfaction with IBHC services and found their behavioral health needs where addressed in the way they wanted them to be. Finally, medical staff reported high satisfaction with IBHC services and reported that they had reduced stress, increased comfort in caring for patients with behavioral health needs, and improved work quality of life. Discussion: IBHC services were implemented at a family medicine clinic with a population that is overrepresented by minorities and uninsured patients. This study showed that implementation of IBHC addressed components of the Quadruple Aim of Healthcare, namely improvement of population health, enhanced patient experience, and improvement of clinic staff work life. IBHC services were found by patients and staff to be acceptable, appropriate, and feasible. Further, this study demonstrated the ability of a clinic to adopt IBHC services with sufficient penetration (10.8% of patients received at least brief services) after 2 years. Implications for practice and research and future directions are also discussed.