El Rio Heath Center is a nonprofit health center serving over 76,000 people in Tucson. In its transformation to a patient-centered medical home (PCMH) in 2010, El Rio developed interdisciplinary teams to include physicians and nurse practitioners partnered with pharmacists, behavioral health specialists, and community health advisors focused on improving patient outcomes by addressing adherence to treatment, with mechanisms put into place for evaluating the program’s results and its potential to expand to other disease states beyond diabetes, hypertension and dyslipidemia.

In order to target reasons for patient non-adherence, monthly “adherence team” meetings are held among the pharmacist, behavioral health specialist and community health advisor.  Pharmacists are responsible for addressing knowledge barriers relating to medication, encouraging the use of medication reminder methods and tailoring administration of a medication regiment to optimize patient adherence. Behavioral health consultants target motivational and mental health factors that result in non-adherence, conduct motivational interviewing, and when necessary, refer patients to services either at the clinic or with a specialist.  Community health advisors identify and help remove barriers to adherence that patients may experience, including any problems that may be due to a lack of resources (e.g., transportation, insurance, unemployment, homelessness, etc.) and connect patients to social service programs or other community resources.

During their fourth year of PharmD education at the University of Arizona, students participate in Advanced Pharmacy Practice Experience (APPE) rotations; El Rio Health Center serves as one of the clinics that students are placed in during this rotation.   In addition, first and second year residents are placed at El Rio where they participate in multiple activities including clinical (ambulatory care, internal medicine, drug information, pharmaceutical care), educational (precept pharmacy students, educate medical staff, present formal lectures and in-services), program management (plan and implement quality assurance activities, participate in provider meetings, formulary management and drug utilization review) and research (assist in design and completion of studies involving clinical pharmacists, present at a national meeting, and prepare a manuscript suitable for publication). 

The program utilizes experiential learning, including patient contact and rotations in order to provide students with real-life training experiences that acclimate them to working in a PCMH model.