Enhancing Student Confidence in Diabetes Management Skills through Pharmacist-Run Group Classes in a Community Library.

Purpose: To evaluate student pharmacists' confidence after providing education within diabetes groups in a non-medical community setting. Program Description: Three 8-week diabetes group courses were developed and executed within a local public library. The courses aimed to teach participants with diabetes how to effectively manage their medical condition to prevent future related complications. Student pharmacists were responsible for checking and recording the patients' vitals, assisting in answering questions posed by the participants throughout the session, presenting different medication information each week, and creating a brochure which described the highlights of the specific week's medication class. The student pharmacists were then surveyed regarding their confidence level in providing diabetes education in the future as well as their experience of working within these groups. Summary: Seventeen student pharmacists participated in three 8-week sessions. The majority of the student pharmacists reported increased confidence in being able to provide diabetes education as well as newfound empathy for persons with diabetes on how to manage their medical condition.

Expanding Knowledge and Changing Attitudes About Poverty: An Interactive, Interprofessional Approach.

BACKGROUND: Poverty negatively affects the lives and health of the poor. However, health professionals often have limited personal experience and receive little formal education on surviving under conditions of poverty in the United States, which may contribute to suboptimal patient care and outcomes. PURPOSE: We conducted a 3-h, interactive, experiential poverty simulation workshop with an interprofessional group of pre-professional health students to increase their comprehension about the realities of poverty. METHOD: As part of the evaluation, participants completed a self-assessment of their attitudes and skills using a Likert scale and open-ended questions; a reflection prompt about how the workshop might affect their professional practice; and a pre- and post-assessment questionnaire. DISCUSSION: Participants' attitudes about low-income patients became more favorable; they gained awareness and expressed empathy through the role-play experience. Our analysis revealed increased understanding of social determinants of health, of life challenges that patients face outside of healthcare, and that solutions must be collaborative as the challenges facing poor patients are multifactorial. CONCLUSION: The workshop allowed interprofessional students to learn from and with each other about the experiences of poor patients. Future sessions should emphasize interprofessional skill-building and action, potentially in virtual formats.

Outcomes of a college-led community-based influenza vaccine program for underserved New York City communities.

BACKGROUND: Vaccine-preventable diseases are a major public health issue. Underserved communities are at heightened risk in New York City, where influenza morbidity and mortality remain elevated. Pharmacists and student pharmacists can play important roles in these communities through vaccine-based initiatives. OBJECTIVES: Enhance student experiences in encounters with underserved individuals; determine patient satisfaction with pharmacist-administered vaccines; assess for gaps in immunization care among the underserved. PRACTICE DESCRIPTION: St. John's University, College of Pharmacy and Health Sciences (CPHS) prioritizes public health outreach to underserved neighborhoods through various initiatives organized by its Urban Institute. The CPHS's annual Pam Shea-Byrnes community outreach immunization initiative was developed to increase access to influenza vaccinations for the indigent population through the establishment of new community partnerships. PRACTICE INNOVATION: The partnership between CPHS and community-based organizations resulted in influenza vaccines administered at no cost to beneficiaries, while offering students experiences in immunization initiatives and care for the underserved. EVALUATION METHODS: Participating students completed a pre- and postexperience survey. After vaccine administration, patients completed an immunization history survey from the Centers for Disease Control and Prevention (CDC), in addition to a satisfaction survey. RESULTS: A total of 105 patients received the influenza vaccine. Of these, 53 (50.5%) patients completed both the CDC assessment and satisfaction surveys. Of the survey respondents, 81% agreed that the pharmacists and student pharmacists were friendly and professional. Most of the patients (92.5%) were satisfied with the service. Fourteen student pharmacists participated in the initiative and completed both pre-and postsurveys. Student pharmacists indicated in postsurveys a stronger personal responsibility for caring for those in need. They also agreed that there is a clear responsibility for pharmacists to personally care for those in need. CONCLUSION: Student experiences during interactions with the underserved were enriched, and patients were satisfied with the pharmacist-run initiative. Further expansion of the initiative will be considered.

Identifying medication-related problems in pharmacist-run home visits.

BACKGROUND: Home visits (HVs) may be warranted for many reasons (e.g., uncontrolled disease states, suspected psychosocial issues, frequent hospitalizations, poor health literacy). Patients who frequently visit the emergency department (ED) are high-risk individuals, oftentimes exhibiting health-related barriers and medication-related problems (MRPs). OBJECTIVES: This study seeks to answer whether HVs for frequent ED users conducted by a pharmacist with pharmacy students will detect more MRPs compared to office visits (OVs) and enhance patient perception of HV services. METHODS: Patients who visited the ED at least twice over a 12-month period were included in a retrospective chart review. Eligible patients were randomized into an HV group or OV group. Patients in the HV group were visited by a pharmacist and pharmacy students to identify and resolve MRPs, whereas patients in the OV arm brought their medications into the office for review. Patients in the HV group completed a pre- and postvisit survey about their experiences. RESULTS: Eighteen patients participated in the study: 10 patients were randomized to the OV arm and 8 patients were randomized to the HV arm. A total of 39 MRPs were identified in 8 HVs versus 33 MRPs in 10 OVs (mean 5 ± 0.926 vs. 3.3 ± 1.89, P = 0.034). Overall, nonadherence was the most common MRP and medication reconciliation was the most common intervention. All 8 HV patients completed the pre- and post-HV surveys. Post-HV survey results indicated that patients agreed that student pharmacists were professional team members and that their HV was needed. The patients agreed to recommend a pharmacist-run HV. CONCLUSION: Patient homes serve as alternative and convenient spaces for pharmacists to help manage their medications, specifically to identify MRPs and provide meaningful recommendations.

Implementing a Policy and Protocol on Managing Patients With Hypertensive Urgencies.

BACKGROUND: The use of short-acting agents, such as clonidine, for hypertensive urgency has been shown to worsen outcomes and, therefore, should be avoided in the office. OBJECTIVES: The primary objective was to achieve decreased rates of clonidine orders for immediate treatment of asymptomatic hypertension in the office. The secondary objective was to determine if reduced use leads to a decline in poor outcomes. METHODS: This was an observational cohort study evaluating a protocol and algorithm developed by clinical pharmacists on the appropriate management of hypertensive urgencies. The protocol included the provision of avoiding short-acting antihypertensives (ie, clonidine). Preintervention and postintervention reports were generated to determine the number of times clonidine was ordered in the office. Electronic health charts were also reviewed for documentation of poor outcomes related to clonidine administration within 1 week of the hypertensive urgency visit date. RESULTS: In the preintervention cohort, 106 (17.4%) orders of clonidine were captured compared with 73 (10.6%) in the postintervention group (P = 0.001). Of the patients who were administered clonidine, 7 patients in the preintervention group were advised to go to the emergency department (ED) for additional hypertensive management, 2 of whom were subsequently hospitalized; 9 patients were advised to go to the ED in the postintervention group, and no patient was subsequently hospitalized. No adverse effects were documented from in-office clonidine administration in either cohort of patients. CONCLUSION: The hypertensive urgency protocol and education reduced the number of clonidine orders and hospital admissions. The increase in ED referrals needs further assessment.

A review of advances in collaborative pharmacy practice to improve adherence to standards of care in diabetes management.

The prevalence of diabetes in the United States is increasing and so is the need to provide diabetes care. Given the time commitment and complexity of diabetes management, an interdisciplinary approach is recommended. Pharmacists are integral members of the diabetes care team because of their accessibility and expertise in medication management. Pharmacists are receiving specialized training and becoming more involved in direct patient care through collaborative practice opportunities such as medication therapy management and collaborative drug therapy management. These collaborative practice models increase patient access to care and allow pharmacists to optimize drug therapy and provide important education to promote diabetes self-management. Studies show pharmacists practicing in a variety of outpatient environments can reduce HbA1c, LDL and BP as well as improve adherence to recommended American Diabetes Association guidelines (yearly monofilament exams, dilated eye exams, microalbumin screening, etc). Pharmacists working as part of the health care team can ensure optimal diabetes management.

Pharmacist-managed oral anticoagulation therapy in the community setting.

Pharmacists are at the forefront when caring for patients requiring anticoagulation resulting from chronic conditions, complex medications therapy, or at risk for drug interactions. As a consequence, there is a greater need for pharmacist-managed anticoagulation clinics in the community setting. This article will review special considerations for oral anticoagulant therapy in the elderly, collaborative therapy management, establishment of policies and procedures, documentation of patient visits, patient counseling, and barriers to successful anticoagulation management. It will also discuss evidence-based guidelines for the use of oral anticoagulants and compare the agents currently approved by the Food and Drug Administration. Finally, barriers to anticoagulation management will be examined, including issues with adherence and communication with patients and health care providers.