As part of federal and local efforts to increase access to high quality, clinical preventive services (CPS) in underserved populations, the Los Angeles County Department of Public Health (DPH) partnered with six local health system and community organization partners to promote the use of team care for CPS delivery. Although these partners were at different stages of organizational capacity, post-program review suggests that each organization advanced team care in their clinical or community environments, potentially affecting >250,000 client visits per year. Despite existing infrastructure and DPH's funding support of CPS integration, partner efforts faced several challenges. They included lack of sustainable funding for prevention services; limited access to community resources that support disease prevention; and difficulties in changing health-care provider behavior. Although team care can serve as a catalyst or vehicle for delivering CPS, downstream sustainability of this model of practice requires further state and national policy changes that prioritize prevention. Public health is well positioned to facilitate these policy discussions and to assist health system and community organizations in strengthening CPS integration.

Emerging research suggests that chronic conditions such as cardiovascular disease, diabetes, and asthma are often mediated by adverse social conditions that complicate their management. These conditions include circumstances such as lack of affordable housing, food insecurity, barriers to safe and reliable transportation, structural racism, and unequal access to healthcare or higher education. Although health systems cannot independently solve these problems, their infrastructure, funding resources, and well-trained workforce can be realigned to better address social needs created by them. For example, community pharmacies and the professionals they employ can be utilized and are well-positioned to deliver balanced, individualized clinical services, with a focus on the whole person. Because they have deep roots and presence in the community, especially in under-resourced neighborhoods, community pharmacies (independent and chain) represent local entities that community members recognize and trust. In this article, we provide case examples from California, United States, to illustrate and explore how community pharmacies can be leveraged to address patient social needs as part of their core responsibilities and overall strategy to improve healthcare quality.

In 2014, the Los Angeles County Department of Public Health received federal funding to improve the prevention and control of hypertension in the population through team-based health care delivery models, such as pharmacist-led medication therapy management. To inform this work, the department conducted a 3-part needs assessment consisting of 1) a targeted context scan of regional policies and efforts, 2) a key stakeholder survey, and 3) a public opinion internet-panel survey of Los Angeles residents. Results suggest that political will and professional readiness exists for expansion of pharmacist-led medication management strategies in Los Angeles. However, several infrastructure and economic barriers, such as a lack of sufficient payment or reimbursement mechanisms for these services, impede progress. The department is using assessment results to address barriers and shape efforts in scaling up pharmacist-led programming in Los Angeles.

As part of the federal Supplemental Nutrition Assistance Program Education (SNAP-Ed) in Los Angeles County (LAC), corner store conversions (CSCs) were an integral part of a broader, more coordinated effort to improve nutrition and to prevent obesity in low-income populations. To date, little is known about this experience in LAC. The present study addresses this gap by describing lessons learned from implementing the SNAP-Ed Small Corner Store Project (SCSP) in this region. The project, which began in 2013, sought to scale CSCs in underserved communities of LAC, employing behavioral economics (e.g., prominently displaying healthy foods at checkout aisles or using in-store signage to promote healthy options) to encourage patron selection of healthier food items. Results from an assessment of the SCSP suggest that for CSCs to do well, careful considerations should be given to factors such as time (e.g., amount of staff time dedicated to the effort), staff capacity (e.g., # staff available to assist), and available resources that can be leveraged (e.g., support from community-based organizations). For some stores, inadequate food distribution or a lack of capital improvement infrastructure (e.g., refrigeration for fresh produce/storage of excess food that can be repurposed) were key barriers that required additional funding. Although local efforts that incentivize small businesses to undergo CSCs may initially nudge store owners to participate, increasing overall consumer demand for healthier food products (i.e., so as to help maintain sales volume) remains a key to sustaining store conversions long after SNAP-Ed resources are gone.

Objective

To examine behavioural intention to reduce soda consumption after exposure to the Choose Health LA 'Sugar Pack' campaign in Los Angeles County, California, USA.

Design

A cross-sectional street-intercept survey was conducted to assess knowledge, attitudes, health behaviours and behavioural intentions after exposure to the 'Sugar Pack' campaign. A multivariable regression analysis was performed to examine the relationships between the amount of soda consumed and self-reported intention to reduce consumption of non-diet soda among adults who saw the campaign.

Setting

Three pre-selected Los Angeles County Metro bus shelters and/or rail stops with the highest number of 'Sugar Pack' campaign advertisement placements.

Subjects

Riders of the region's Metro buses and railways who were the intended audience of the campaign advertisements.

Results

The overall survey response rate was 56 % (resulting n 1041). Almost 60 % of respondents were exposed to the advertisements (619/1041). The multivariable logistic regression analysis suggested that the odds of reporting intention to reduce soda consumption among moderate consumers (1-6 sodas/week) were 1·95 times greater than among heavy consumers (≥1 soda/d), after controlling for clustering and covariates. Respondents with less than a high-school education and who perceived sugary beverage consumption as harmful also had higher odds; in contrast, respondents aged ≥65 years had lower odds.

Conclusions

Results suggest that future campaigns should be tailored differently for moderate v. heavy consumers of soda. Similar tailoring strategies are likely needed for younger groups, for those with less educational attainment and for those who do not perceive consumption of soda as harmful.

INTRODUCTION: Community-based health interventions often demonstrate efficacy in clinical trial settings but fail to be implemented in the real-world. We sought to identify the key operational and contextual elements of the Los Angeles Barbershop Blood Pressure Study (LABBPS), an objectively successful community-based health intervention primed for real-world implementation. LABBPS was a cluster randomized control trial that paired the barbers of Black-owned barbershops with clinical pharmacists to manage uncontrolled hypertension in Black male patrons, demonstrating a substantial 21.6 mmHg reduction in systolic blood pressure. Despite this success, the LABBPS intervention has not expanded beyond the original clinical trial setting. The aim of this study was to determine the facilitating and limiting factors to expansion of the LABBPS intervention. METHODS: We undertook a qualitative assessment of semi-structured interviews with study participants performed after trial completion. Interviews included a total of 31 participants including 20 (6%) of the 319 LABBPS program participants (patrons), 10 (19%) barbers, and one (50%) clinical pharmacist. The semi-structured interviews were focused on perceptions of the medical system, study intervention, and influence of social factors on health. RESULTS: Several common themes emerged from thematic analysis of interview responses including: importance of care provided in a convenient and safe environment, individual responsibility for health and health-related behaviors, and engagement of trusted community members. In particular, patrons reported that receiving the intervention from their barber in a familiar environment positively influenced the formation of relationships with clinical pharmacists around shared efforts to improve medication adherence and healthy habits. All interviewee groups identified the trust diad, comprising the familiar environment and respected community member, as instrumental in increasing health-related behaviors to a degree not usually achieved by traditional healthcare providers. DISCUSSION: In conclusion, participants of an objectively successful community-based intervention trial consistently identified key features that could facilitate wider implementation and efficacy: social trust relationships, soliciting insights of trust bearers, and consistent engagement in a familiar community setting. These findings can help to inform the design and operations of future community-based studies and programs aiming to achieve a broad and sustainable impact.