Partnering pharmacists with community health workers to deliver culturally appropriate medication management to an immigrant community

Cambodian-American survivors of the Khmer Rouge regime are socially isolated, geographically dispersed, and in poor health. As victims of torture and trauma, they have high prevalence rates of mental health disease, diabetes, stroke and heart disease. Language and culture, as well as poor health and mistrust of the medical system, are common barriers to care. Pharmacists, working with Cambodian-American community health workers (CHWs), provided culturally and linguistically appropriate medication therapy management services (MTM) to older Cambodian-Americans in Connecticut and California. Community-dwelling residents age 50 and over, with the presence of at least one chronic condition and three chronic medications, had multiple MTM visits with credentialed pharmacists and CHWs over a 6-9 month period. Face-to-face encounters occurred with patients in Connecticut, while patients in California had a CHW with them and the pharmacist linked via high-definition videoconference link. A total of 627 patients were screened, and 96 eligible patients participated in the project (53 in CT, 43 in CA). The average number of medications and conditions/patient was 10.3 and 6.6, respectively. Of the 604 medication-related problems identified, 93% were resolved during the study period. The percentage of patients' therapy goals achieved increased from 69% to 93% after MTM services were provided. There was significant improvement in adherence behavior, depression screening, and reduction of inappropriate medication use from the first to last visit. There was a significant correlation between low adherence and how patients felt in general about medicines and how prescribers use medicine. Total health avoidance costs were $3032/patient, and exceeded the cost of providing the service by a factor of 5.6 to 1. Results of a matched control survey of 140 Cambodian Americans revealed that patients who did not receive MTM services had 1.75 times more hospital visits, 4.7 times more hospital days, and 1.5 times more emergency department visits. An outcome comparison of face-to-face versus videoconference care revealed mixed results, primarily attributable to technology and social determinant variations that resulted in disparate encounter totals in the two service areas. Pharmacists, when working with Cambodian American CHWs, can provide culturally and linguistically appropriate MTM that can improve patient medication outcomes and reduce total healthcare costs. The application of new technologies allows for the provision of MTM to be available to high risk isolated patient populations. These findings are compatible with current health care delivery reforms, especially the patient-centered medical home.