Diana Fortune RN, BSN TB Program Manager New Mexico TB ETN/PEN 2012

1. Doorway to a New Era Pharmacists as Public Health Partners Diana Fortune RN, BSN TB Program Manager New Mexico TB ETN/PEN 2012

2. November 2010 • 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

3. Background on New Mexico

4. 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

5. Barriers to accessible TSTs • Decrease public health $$ • Lack of nursing staff • Remote areas of State

6. Newspaper Coverage……

7. NM Board of Pharmacy • 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…

8. Official collaboration begins….. • 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

9. Division of Services…… • 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 Pharmacists Testing Public Health Testing

10. 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

11. CEU provided by NM Pharmacist Association

12. TST Practicums….. • September 25, 2011 • Five TST practicums held since September • Total of 50 pharmacists attended • Several hundred TSTs performed: < 5 positive TSTs

13. Project Evaluation • 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)

14. Formal 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.

15. In conclusion: • 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