Five awardees of 2022 Tier 3 pilot research grants report on their progress

Community Pharmacist Epilepsy Services Program

Investigators
Jennifer Bacci, Department of Pharmacy
Edward Novotny, Departments of Neurology and Pediatrics
H. Steve White, Department of Pharmacy
Andy Stergachis, Departments of Pharmacy and Global Health
Sabra Zaraa, Department of Pharmacy
Michelle Guignet, Department of Pharmacy
Kari VanderHouwen, Duvall Family Drugs and CPESN Washington

Project update
This project seeks to (1) develop and evaluate a training program for a community pharmacist population health intervention for people living with epilepsy (PWE) and (2) implement and evaluate the impact of the community pharmacist population health intervention on PWE’s quality of life (QoL).

A training program was developed for community pharmacists and was composed of five asynchronous online modules and two synchronous webinars. Six pharmacists from two independent community pharmacies in Washington State completed the training program over a two-month period from November 2022 to January 2023. Pharmacist knowledge and confidence were assessed using a survey administered prior to (pre) and upon completion (post) of the training program.

A prospective, two-arm, pre-post, controlled study to evaluate the impact of the community pharmacist population health intervention for PWE was launched in four independent community pharmacies in Washington State on January 15, 2023. Patient recruitment was conducted for a three-month period through May 15, 2023. Patient follow-up and data collection will continue for an additional six-month period through November 15, 2023.

Amigas Latinas Motivando el Alma (ALMA): Addressing Mental Health Needs among Latina Immigrant Women in Yakima Valley

Investigators
India Ornelas, Department of Health Systems and Population Health
Deepa Rao, Departments of Global Health and Psychiatry & Behavioral Sciences
Caty Padilla, Nuestra Casa
Magaly Solis, La Casa Hogar
Georgina Perez, Department of Health Systems and Population Health
Serena Maurer, Department of Health Systems and Population Health
Juan Gudino, Department of Health Systems and Population Health

Project update
This project consists of three aims: 1) Adapt the intervention to be successfully delivered by local community health workers in the Yakima Valley; 2) Train and support local community health workers to deliver the ALMA intervention; and 3) Assess the potential effectiveness of the ALMA intervention when delivered by community health workers in the Yakima Valley.

After initial conversations with La Casa Hogar and Nuestra Casa, two community-based organizations serving Latinos in the Yakima valley, we completed Memorandums of Understanding. To inform the adaptation of the ALMA intervention and training development, we conducted feedback sessions with community health workers (CHWs) who had previously completed the ALMA program in Autumn 2022. We used the information learned from these conversations to develop a training and implementation plan for La Casa Hogar and Nuestra Casa to offer ALMA to their communities in Autum 2023. We identified five CHWs across both organizations willing to participate in the training. Ms. Perez and Dr. Maurer developed a training manual and a curriculum for seven online training sessions and a two day in-person training.

To date, we have completed five out of seven online training sessions. We provided each CHW with a training manual which includes scripts and instructions on how to deliver each ALMA session. The two day in-person training session is scheduled for August 2023. We have begun preparation for intervention delivery including purchasing of materials needed for the ALMA program. We have been in contact with mental health professionals who could support the CHWs as they deliver ALMA.

Healing Heart and Soul: Decreasing Maternal Racial/Ethnic Health Disparities through Home-Based Monitoring of Blood Pressure, Stress/Depression, and Safety

Investigators
Rachel Chapman, Department of Anthropology
James Pfeiffer, Department of Global Health
Amelia Gavin, School of Social Work
Abril Harris, School of Social Work
Liza Perpuse, HealthPoint
Yvonne Griffin, Neighborcare Health
Tanya Sorensen, Swedish Medical Center
Katie Eastwood, Swedish Medical Center

Project update
This project seeks to contribute to understanding and ending racial/ethnic health disparities related to the COVID-19 pandemic by mitigating the impact of COVID-19 on maternal reproductive and mental health and health services in under-served and communities of color. Our overarching goals are to decrease perinatal health disparities through home-based maternal self-monitoring and self-reporting of blood pressure (BP), stress and depression (MH) and intimate-partner-violence (IPV/DV) during pregnancy.

The team has conducted seven training sessions for both NeighborCare and HealthPoint providers to explain project goals, structure and implementation within the clinics. The training session also covered our screening tool and kit along with a role play to demonstrate how our tools would integrate into patient visits.

The project is currently active in five NeighborCare Health Clinics and in one HealthPoint Clinic. Each enrolled participant received a screening tool that is intended to help enhance patient agency during their prenatal visits. The original screening tool allows both patient and provider to monitor patient symptoms regarding their mental health/stress, home and relationship safety and blood pressure.

Training videos are in final stages of production for both patients and providers that are how-to-use for the screener tool and blood pressure cuff. The videos are a resource for those who may need a reminder or idea about how to use the screener tool at home or in their doctor’s office. The team also made domestic violence resources to better support those dealing with interpersonal and intimate partner violence, abuse or assault. These resources include posters to be placed in clinics and restrooms, with a QR code to access King County Domestic Violence website and a list of hotlines.

The research team revised project survey tools to collect data from study participants on patient demographic information, mental/physical health status, and patient at home safety. Both patients and providers will be asked about screening tool and BP cuff utilization and quality. Data from study participants will be obtained three times during the study including at the time of enrollment, midway through the study, and at the time of exit.

Finally, an article on the Heart and Soul feasibility study, “Preventing Health Disparities during COVID through Perinatal Home Screening as Black Authoritative Knowledge,” was recently published in the Journal of Racial and Ethnic Health Disparities by 12 co-authors from the writing, clinical and data teams. This paper discusses how the Heart Soul and Joy team piloted a study to prevent increased health disparities in BIPOC pregnant patients.

Equity Among American Indian, Alaska Native, Native Hawaiian, Pacific Islander communities under COVID-19 Telehealth Policy

Investigators
Ashok Reddy, Department of Medicine
Edwin Wong, Department of Health Systems and Population Health
Joshua Liao, Department of Medicine

Project update
This project seeks to address a major gap by using Washington State Medicaid data to analyze telehealth use and disparities among American Indian/Alaska Native (AIAN) and Native Hawaiian/Pacific Islander (NHPI) populations that have long suffered health inequity due to social determinants of health, such as poverty and language barriers. The team also seeks to develop a community and policy advisory board to gain input on our approach, implications and dissemination.

The team has completed two of three series of quantitative analyses to compare use of telehealth between AIAN and NHPI individuals compared to non-Hispanic White individuals in Medicaid between 2019 and 2021. This includes initial bivariate analysis that compares patient and community factors between groups of individuals who do and do not use telehealth in each racial/ethnic subgroup. Then, we completed estimation of hierarchical regression models that identified patient and community factors associated with telehealth use. We are currently preparing peer-reviewed manuscripts that summarize findings from the first two sets of analyses. The team is in the final stages of completing analyses that apply the Oaxaca-Blinder decomposition approach. Findings from this analysis will enable us to determine the extent to which differences in telehealth use are attributable to specific factors.

The team is also working to identify and collaborate with AIAN and NHPI community members and Medicaid policy members to gain input on approach, implications and dissemination of findings. Working with the Washington Healthcare Authority, we identified two key groups to support our work from the policy perspective: HCA Tribal Affairs (representing AIAN communities) and Compact of Free Association (COFA) Islander programs (representing NHPI communities). These initial discussions led to separate these groups for our quantitative analysis. In addition, we have met with several different community organization for both AIAN and NHPI communities to identify members who would be interested in joining ongoing discussions.

Linking practice to policy change in urban community gardens

Investigators
Melanie Malone, UW Bothell (School of Interdisciplinary Arts & Sciences)
Natalie Garcia, Department of Medicinal Chemistry
Brittany Johnson, School of Environmental and Forest Sciences
Ray Williams, Black Farmers Collective
Neli Jasuja, Young Women Empowered
Em Piro, Sustainable Seattle

Project update
Project team accomplishments include the release of publications and materials to the public. The article, “Uprooting Garden Contamination,” was published in the journal Environmental Science & Policy. The article details what environmental concerns farmers and gardeners in the Seattle metropolitan region have raised about contamination in urban gardens in the Seattle Metro region, and details systemic injustices contributing to the levels of contamination that have been documented.

The team’s recommendations for addressing contamination and improving soil health in urban community gardens have also been included in the City of Seattle Food Action Plan, which is being compiled by various governmental departments in the City of Seattle, in collaboration with Tribal governments and feedback from community partners. Numerous flyers, fact sheets and information sheets were created by graduate students, undergraduate students and alumni researchers on the project. These materials have been shared with the broader public to keep people updated about the status of contamination in urban community gardens and to protect users of contaminated spaces.

Sustainable Seattle (S2) created a grant-funded position (thanks to King Conservation District and the Rose Foundation) for a “Soil Health & Justice Advocacy Lead.” The position will be held by someone with policy expertise who will do hands-on, grassroots work to address environmental justice concerns in community gardens, and who will seek to improve soil health. Multiple undergraduate and graduate students, alumni and Doris Duke Conservation Scholars have been employed to do interdisciplinary STEM and DEI research on the project.

Finally, the project team has launched the “Soil Health Justice Initiative” to improve soil health. This has resulted in a partnership with multiple community partners including S2, Basilica Bio and Duwamish Valley Sustainability Association (DVSA). Basilica Bio has also launched a “Gardening Under the Microscope Program” to educate the public about farming in contaminated soils.