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

 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

 Do NOT need passport  State Question? ◦ Red or Green  Breaking Bad ◦ Filmed here!  5 th largest state – land mass ◦ 121,000 sq miles  6 th LEAST populated ◦ 2 million  1912 – bilingual gov’t ◦ No official language

 Decrease public health $$  Lack of nursing staff  Remote areas of State

 Prescriptive Authority ◦ March 7, 2011 – protocol was added for Pharmacist to administer TSTs (regulation )  Initially indicated the pharmacists view  CDC “Mantoux Tuberculin Skin Test Video for their training…

 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  Heartland & NM Pharmacists Association website

Pharmacists TestingPublic Health Testing  Low-Risk Population (TSTs) ◦ Pharmacists to test  School  Work  Change of immigration status  High-Risk Populations ◦ public health dept.  TB suspects  Contacts  Immune compromised  HIV  TNF-alpha blockers  Other immune compromised

 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

 September 25, 2011  Five TST practicums held since September  Total of 50 pharmacists attended  Several hundred TSTs performed: < 5 positive TSTs

 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)

 “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.

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