February 18, 2020
Cheyenne C. Newsome, PharmD, BCACP and Jessica Conklin, PharmD, BCACP, CDE, AAHIV — passionate advocates for the role of pharmacists in the care of transgender persons — talk with us about the need for patient and provider education and about the benefits and risks of gender-affirming treatment.
- Gender-affirming therapy is highly effective, improving the quality of life in more than 80% of patients.
- Hormonal therapy is the cornerstone of gender-affirming therapy.
- Testosterone is used for masculinization by trans-men. It is traditionally given by intramuscular injection but subcutaneous injections are easier to administered and may have a smoother effect (e.g. lower peak effect).
- Side effects from testosterone are common including body and facial hair growth (you don't get to pick!), deepened voice (irreversible), clitoral enlargement, acne, menstrual irregularities, and weight gain from increased appetite.
- Estradiol (preferred estrogen) is used for feminization by trans-women. In addition, spironolactone is used in high doses for its anti-androgen effects. Side effects are similar to those experienced by cisgender women.
- While trans-men often develop amenorrhea, pregnancy is still possible. Frank discussions about the use of contraception, if sexually active, is important.
- A number of great resources are available to inform drug therapy decision making particularly the Endocrine Society Guidelines.
- Pharmacists can uniquely contribute to optimizing the care of trans-men and -women.
To learn more, view and download the Show Notes!
January 21, 2020
Abby Frye, PharmD, BCACP, Dawn Fuke, PharmD, BCPS, and Justin Bachman, PharmD, BCACP — Clinical Pharmacist Specialists in Primary Care from the Providence Medical Group in Portland, Oregon — talk with us about creating gender-affirming care environments.
- Current estimates suggest that about 1 million adults in Adults in the United States don't identify with the gender assigned to them at birth - but this is likely an underestimate.
- Transgender and gender non-conforming individuals face enormous and persistent stigma within our (and many other) cultures.
- Social stigma is associated with higher rates of anxiety, depression, and substance use disorders.
- Health professionals have a responsibility to take pro-active steps to counteract the discrimination that patients from vulnerable and marginalized populations face.
- Self-awareness and self-examination about communication practices are critical - this includes the information collected on patient intake forms and electronic health records as well as a patient's preferred name and pronoun.
- Insurance coverage for gender-affirming therapies as well as health screening exams for transgender persons are sometimes denied and health professionals may need to advocate for coverage.
- A wide variety of resources are available to health professionals to learn more about the care of transgender and gender non-conforming individuals.
To learn more, view and download the Show Notes!
September 12, 2018
Mary Ann Kliethermes, Pharm.D. - Professor and Vice Chair for Ambulatory Care in the Department of Pharmacy Practice at the Midwestern University Chicago College of Pharmacy talks with us about the business case for implementing the pharmacists patient care process.
Key Lessons: Using a reliably consistent process results in reliably consistent outcomes; health information systems require providers to use a consistent method of documentation; pharmacists patient care services will be billed within the existing payment framework and infrastructure; payment for services is contingent on the scope of practice (state pharmacy practice act!), provider status (at state level!), and insurance regulations (state laws!).
Helpful Resources: Check out the Patient Care Process chapter in Pharmacotherapy: A Pathophysiologic Approach and the Patient Care Process for Delivering Comprehensive Medication Management report.
July 17, 2018
Cody Clifton, Pharm.D. - Clinical Pharmacist and Special Projects Manager at Moose Pharmacy and Coordinator of Quality Assurance and Best Practices for the Community Pharmacy Enhanced Services Network U.S.A. (CPESN-USA) - talks about the use of mobile devices and apps to remotely monitor patients to improve medication adherence, effectiveness, and safety.
Key Lessons: Numerous devices and apps are available to assist patients with medication adherence; the Spencer device (by Spencer Health Solutions)* provides medication monitoring data and helps connect patients, caregivers, and pharmacists; pharmacists can partner with accountable care organizations (ACOs) to improve outcomes and reduce healthcare cost using mHealth devices and apps.
*Please note that PharmacyForward does not endorse or recommend any products or services. The Spencer device is one of several potential options that pharmacists and patients may wish to consider when adopting a mHealth solution.
June 13, 2018
Julie Lauffenburger, Pharm.D., Ph.D. - Assistant Director of the Center for Healthcare Delivery Sciences at the Brigham and Women's Hospital and co-investigator for the MedISAFE-BP study talks to us about the use of smartphone applications to improve medication adherence.
Key Lessons: Improvements in medication adherence don't necessarily lead to improvements in outcomes (e.g. blood pressure control or cardiovascular events) unless patient-monitoring data is shared and used by clinicians to make medication adjustments; smartphone apps should provide nudges to patients in a manner they find most useful; technology should make the medication use process easier, not more difficult.
May 17, 2018
Timothy Aungst, Pharm.D. - Associate Professor at the MCPHS University in Worcester, Massachusetts and the author of The Digital Apothecary blog talks to us about the current digital health landscape.
Key Lessons: Stand alone mobile health devices and apps have limited value; patient-specific data can inform diagnosis and treatment decisions; aggregated data from 1000's of users can help direct public health efforts; and pharmacists can and should play a bigger role in mHealth/digital health.