PacificSource’s Community Health Excellence grants energize community healthcare

Now in its 14th year, PacificSource’s Community Health Excellence (CHE) program awards annual grants to healthcare providers in Idaho, Montana, Oregon, and Washington to fund projects that address gaps in healthcare delivery, improve outcomes, and make communities healthier.

In November 2023, PacificSource announced 26 healthcare organizations would receive funding for the 2023-2024 CHE cycle. Several projects will improve access to services through recruitment, retention, clinic expansion, and healthcare service integration. One-third of the projects focus on reducing health disparities and improving equitable access to care.

Here’s how two CHE grant recipients in Idaho and Washington—Family Health Services (FHS) and CHAS Health, respectively—plan to enact their ideas to improve their patients’ health and quality of life.

Clinical pharmacists help combat chronic illness in rural areas

FHS, a community health center, provides medical, dental, and behavioral healthcare as well as social services and pharmacy services to people in South Central Idaho. FHS serves many patients in rural areas who have a chronic illness such as hypertension or diabetes; many have additional health conditions. In 2023, 4,310 patients with hypertension received care at FHS, up from 3,873 patients in 2022. FHS cared for 3,193 patients with diabetes in 2023, an increase from 2,930 patients in 2022.

Treating health conditions can entail multiple medications, some of which can interact poorly with one another and increase the risk of side effects. “Nine times out of ten, it takes more than one medication to manage [diabetes],” said Shelby Lancaster, a clinical pharmacist at FHS. “Those medications just within that disease state can interact with one another and cause risk for low blood sugar, which could put the patient at risk of tremendous illness and hospitalization.”

For the 2023-2024 CHE grant cycle, PacificSource awarded $89,000 to FHS for its program, “Expansion of Integration Clinical Pharmacy in Rural Landscapes,” to build on a successful clinical pharmacy pilot funded in part with PacificSource funds. (Lancaster was hired at FHS as part of the pilot program.) With this CHE grant, FHS aims to reduce diabetes and hypertension in its rural patient population, reduce the number of medications patients need, and increase the amount of clinical pharmacist consultations it can offer.

FHS has already hired two additional clinical pharmacists to help patients better manage their conditions, and it may hire more. Lancaster is training the new pharmacists, who are participating in a clinical pharmacy rotation. The staffing expansion means patients will be able to access clinical pharmacy services at all ten of FHS’s clinics at least one day per week.

At FHS, clinical pharmacists spend between 30 minutes and an hour with a patient, depending on the severity of their health conditions and the number of medications they take. “This is team-based care at its finest,” said Lancaster. “The primary care provider (PCP) checks in to make sure things are going okay with the patient. Then I do medication reconciliation, identify medication issues, delve into motivational interviewing questions, and identify problems [the patient is] struggling with. [Then I] develop a plan and follow up with education pieces for the patient and their caregivers. [Meanwhile], I’m also communicating with the PCP to ensure they feel this is an appropriate care plan and referring [patients] to the other wonderful resources we have access to: our chronic care managers, behavioral health specialists, and diabetes educators.”

Clinical pharmacist training includes motivational interviewing, a counseling method that helps patients change their behavior by exploring their feelings and motivations. Using this technique, clinical pharmacists ask patients questions to identify problems, and make recommendations that not only get patient buy-in, but get patients motivated enough to make changes. “Being able to dig down and listen to the patient because we have some extra time with them [helps us] make those connections. Then they’ll trust us [and] make those changes in their day-to-day lives,” said Lancaster.

With funding from the CHE grant, clinical pharmacists may also receive insulin pump certification as well as training on 1) continuous glucose monitoring analysis and interpretation and 2) medication efficacy like proper dosage recommendations, the best time of day to take medications and why, and food or medicine to avoid while taking certain medications.

“I just think [the CHE grant is] a fabulous opportunity because it’s showing how valuable clinical pharmacy services are for our patients,” said Lancaster. “I’m really excited to be able to get [clinical pharmacy services] into some of our other clinics that have larger populations of patients with diabetes and hypertension to drive those numbers down and help those patients feel better. Being able to help a significantly greater population of patients than we had initially anticipated is very exciting.”

Breaking down language barriers for better health outcomes

CHAS Health provides healthcare services to people, regardless of their ability to pay, at 18 clinic locations in Spokane County, Wash. More than 35,000 people in Spokane County—7.4% of residents—speak a language other than English at home. In 2022, 4,865 CHAS Health patients preferred a language other than English. According to data from August 2023, CHAS Health’s patients speak 66 different languages, the most common of which are English, Spanish, Russian, Marshallese, Ukrainian, and Vietnamese.

Language barriers are associated with inequitable access to healthcare as well as worse health outcomes, less access to health information, and lower healthcare satisfaction compared to patients whose primary language is English. They also can lead to patients needing more healthcare services.

“Adding in a language barrier creates an extra layer of complexity for patients,” said Shelby Lambdin, Health Equity Director at CHAS Health. “When we see language barriers, there are oftentimes cultural barriers, too. By having an individual who speaks the language of that patient—either present at the visit or on the phone—we’re able to provide better care and ensure that [information] like medication doses, follow-up appointments, and where to go to pick up medication or go to a specialty appointment is laid out in a way the patient can understand.”

PacificSource awarded CHAS Health $88,490 for its program, “Language Access is Health Equity,” which will expand translation and interpreter services to make healthcare communication easier for patients whose primary language is not English. CHAS Health plans to use its CHE grant to 1) provide written, print, and electronic communication in patients’ preferred languages and 2) expand medical interpreter services by helping community health workers and other patient-facing staff become certified medical interpreters; increasing salaries for staff who provide interpreter services; and expanding contracted interpreter services.

Providing language support has already made a difference to CHAS Health patients. “Spokane has the second-largest Marshallese population in the United States,” said Lambdin. “We have quite a few staff from the Marshallese community who are working as community health workers and do a lot of interpreting within the community. Our Marshallese patients have higher rates of a lot of chronic diseases like diabetes and hypertension. We’ve seen that having language access from individuals they trust in the community has improved their engagement with their providers when they go to the clinic.

“We’re starting to see the demographics in the Spokane community shift,” Lambdin continued. “And we want to be as responsive to that as we possibly can—both from a workforce perspective and then also just providing the best care to our patients that we can. This grant—and this focus on language access, specifically—is a step in the right direction.”