DKICP Faculty Chosen For National Clinical Scholars Teams

Improving the health of everyone within a community, throughout an island, or within a state, takes some creative thinking, as well as coordination of resources and efforts across a variety of health professions. Developing leaders who can do that to improve the lives of those facing health disparities is the main goal of the Robert Wood Johnson Foundation Clinical Scholars program. For the first time, teams of Hawaiʻi professionals have been chosen for the exclusive program, with two of the eight members being from the Daniel K. Inouye College of Pharmacy.

The Robert Wood Johnson Foundation, the largest U.S. philanthropic organization focused on health, created the Clinical Scholars program. It selects interdisciplinary teams of health care providers, including pharmacists, physicians, physical therapists, dentists, nurses, social workers and others in clinical and academic settings. The teams must be tackling problems that “require solutions that embrace a scientific-rational approach while also recognizing the very real contributions of politics, behavior, environment and other complex factors.”

The three-year program offers leadership training, mentoring and networking opportunities, all focused on increasing their impact as health care leaders and problem-solvers in their own communities, in health-disparate populations.

Empowering homeless with diabetes

Dr. Camlyn Masuda, Pharm.D., CDE and BCACP, and DKICP assistant specialist, is part of a team led by Dee-Ann Carpenter, MD, assistant professor at the John A. Burns School of Medicine (JABSOM) at the University of Hawaiʻi at Mānoa. Other members include Marjorie Mau, MD, professor at JABSOM; Francie Julien-Chinn, assistant professor of social work, UH Mānoa; and Aukahi Austin Seabury, Ph.D. in clinical psychology.

“Our team’s focus is on providing diabetes (DM) and pre-DM education to Hawaiʻi’s homeless populations, and training volunteers on providing education on DM and pre-DM to people who are homeless,” says Masuda. “Homelessness is a major public health problem here in the state, with a per-capita rate of 46 homeless per 10,000 people. That puts Hawaiʻi’s homeless population among the top two states in the country.”

Hawaiʻi also ranks among the top states when it comes to the prevalence of diabetes. “Educating the public about this and other chronic diseases, and helping them manage their disease is an important step in changing these statistics, but reaching homeless populations is especially difficult,” she says. “Many homeless people with chronic diseases, such as diabetes, only get medical care when they have complications from their conditions and end up in an emergency room.”

Their proposed project centers around using community outreach to educate and empower people who are homeless and have DM and pre-DM so they can better manage their chronic conditions. “Our team will develop a DM and pre-DM self-management education program, and train shelter staff and other peer educators to implement it,” explains Masuda.

Each member of the team brings unique expertise to this issue and in dealing with the social disparities that affect medical care of homeless populations, she adds. “Including pharmacists in this effort makes perfect sense. The role of a pharmacist is not just filling prescriptions but educating patients about their medications and helping them manage their disease by starting or adjusting doses of medications specifically selected for a patient.”

The team is working with the JABSOM Homeless Outreach and Medical Education Project, which provides medical care to the homeless at different sites on Oʻahu. Several of those sites will be selected to implement the team’s project. They are also exploring options for being able to offer on-site internet access to connect staff and patients with experts elsewhere on the island or in the state.

Meanwhile, Masuda and other Clinical Scholars from Hawaiʻi have the opportunity to learn from past and present program participants through twice-yearly in-person sessions on the mainland and regular distance-learning events.

More focus on geriatrics

Hawaiʻi’s population is aging at a greater rate than the United States, as a whole. Between 2010 and 2018, the state’s population of residents 65 years or older grew by 33.7 percent, compared to 30.2 percent across the country. At the same time, the number of health professionals with special training in geriatric care is not keeping up. Hawaiʻi’s only formal geriatric training is on the island of Oʻahu.

“Currently, we’re not adequately equipped to care for all of our kupuna (elderly) throughout the islands due to a severe shortage of geriatric medical and mental health providers, especially on the island of Hawaiʻi,” says Chad Kawakami, Pharm.D. and DKICP assistant professor. “That’s our team’s wicked problem.”

The KOKUA Project: Kupuna Outreach and Knowledge in Underserved Areas

Team members Chad Kawakami, Pharm.D.; Pia Lorenzo, MD; and Robin Miyamoto, Psy.D.

Kawakami is working with team leader Pia Lorenzo, MD, who specializes in geriatric medicine, and Robin Miyamoto, a clinical psychologist and assistant professor at UH Mānoa. “The experience that each of us brings to the team really fits together well.”

Their project has a three-pronged approach:

• Improve community geriatric knowledge using interprofessional tele-education to reach the existing and incoming primary care workforce.
• Transform a traditional rural primary care clinic system into an age-friendly one.
• Disseminate training sources, action plans, and other materials to other rural primary care clinics.

Working with the Hawaiʻi Island Family Residency program and staff at the Hilo Medical Center, the trio hopes to help make Hawaiʻi Island Family Health Center a more age-friendly place. One way to do that is to make everyone on staff familiar with the 4Ms framework –What Matter, Medications, Mentation and Mobility.

“The cornerstone to this philosophy is starting with what matters to the patient, in terms of their goals for care and their quality of life,” Kawakami explains.

Considering which medications are necessary and appropriate, whether patients could be suffering from depression or dementia, and how to help them maintain mobility as long as possible are all important in tailoring healthcare plans for elderly patients, he add.

In the first year of their Clinical Scholars program, his team is developing a curriculum, creating a needs assessment and figuring out how the training will fit into a clinic’s routine. In year two they plan to implement the training and incorporate the 4Ms into the practice. In year three they will create a website that contains a toolkit for other clinics to use.

“A lot of the training can be done using existing telemedicine technology,” he says. “It’s a good way to reach rural clinics and provide this type of training, because it’s economical and convenient for everyone.”