Diana Fortune RN, BSNTB Program Manager

New Mexico

TB ETN/PEN 2012

Doorway to a New EraPharmacists as Public Health Partners

NM Pharmacist Association contacted TB program – Considering prescriptive authority for pharmacists to place TSTs◦ Regulatory agencies

Medical Board Nursing Board Department of Health

TB Program

NM pharmacists large range of prescriptive authority◦ Lack of accessible health care in many areas

November 2010

Background on New Mexico

Land of Enchantment: Fun Facts Do NOT need passport

State Question?◦ Red or Green

Breaking Bad◦ Filmed here!

5th largest state – land mass◦ 121,000 sq miles

6th LEAST populated◦ 2 million

1912 – bilingual gov’t◦ No official language

Decrease public health $$

Lack of nursing staff

Remote areas of State

Barriers to accessible TSTs

Newspaper Coverage……

Prescriptive Authority◦March 7, 2011 – protocol was added for Pharmacist to

administer TSTs (regulation16.19.26.12) Initially indicated the pharmacists view

CDC “Mantoux Tuberculin Skin Test Video for their training…

NM Board of Pharmacy

Met on June 2, 2011◦ TB Program (TBP)◦ Pharmacist Association◦ Board of Pharmacy

NM TBP leading roll in education of pharmacists TST training◦ Press release on August 31, 2011◦Webinar – Heartland National TB Center; Sept 8, 2011

Understanding the TST: A Primer for Non-TB Staff (Diana Fortune) Open to other states – 61 registered attendees Required for NM Pharmacists to view prior to TST Practicum

Archived @ Heartland & NM Pharmacists Association website

Official collaboration begins…..

Division of Services……

Pharmacists Testing Public Health Testing

Low-Risk Population (TSTs)◦ Pharmacists to test

School Work Change of immigration status

High-Risk Populations◦ Tested @ public health dept.

TB suspects Contacts Immune compromised

HIV TNF-alpha blockers Other immune compromised

In addition…… TST Health History◦Utilize DOH standardized form◦Accurate reading of TST

CDC cut-points Referral of +TST◦ CXR prior to health dept referral◦May refer to PCP

Refer high-risk clients to public health◦Do not test at pharmacy

CEU provided by NM Pharmacist Association

September 25, 2011

Five TST practicums held since September

Total of 50 pharmacists attended

Several hundred TSTs performed: < 5 positive TSTs

TST Practicums…..

Informal by NM Pharmacist Association◦ Participating pharmacists indicated a confidence in their

ability to provide this service to the public

◦Around 100 TST applied no positive TSTs (at time of survey)

Project Evaluation

“Outcomes of a Pharmacist Performed Tuberculosis Testing Initiative in New Mexico”◦ University of New Mexico College of Pharmacy

Objectives◦ Provide a qualitative assessment of the TSTs performed by pharmacists

& identify potential benefits of providing TST at community pharmacies◦ Evaluate outcomes of TB testing performed in a community pharmacy

setting◦ Describe the standardized training for pharmacists to accurately place,

read and interpret the TST.

Formal Project Evaluation

• Increased access to TSTs

• Pharmacists referrals when clients presented with signs or symptoms of TB disease

• In the era of declining public health dollars • all avenues of collaboration to ensure sustained TB

prevention efforts should be explored

In conclusion: