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WINTER/SPRING patients inhale asthma medications incorrectly, misread instructions or try to inject insulin without removing tops." That means they aren't getting any medication or proper amounts. "And as you can imagine that is not good for the patient," says Freund. "So, having a medications expert can decrease medications errors and help patients take meds properly," says Rachel Wolf, Transitions of Care program manager. "This program has really proven itself. We've seen a huge reduction in readmissions and patients really appreciate the extra care they receive." In addition to clinicians and patients seeing the benefit of this program, pharmacy students get hands-on experience treating patients. "I actually wasn't even familiar with this type of program before I entered pharmacy school, so to be a part of something so hands on in the community is a great and rewarding experience," says Ashley Huntsberry, fourth-year pharmacy student. As a result of participating in the home visit program, Huntsberry adds, "I am more confident and feel better prepared to anticipate potential problems patients may experience after being discharged from the hospital." The program has been so successful that it's reduced hospital readmissions for high-risk patients by more than 90 percent. Senior Clinical Instructors Drs. Emily Kosirog and Jeff Freund LESSONS LEARNED T iming was everything for Drs. Matthew Hall (PharmD '13) and Nathan Netsanet (PharmD '14) . Post graduation, both had been working for large retail pharmacies when they got the call to do something a little less traditional and a little more up their alleys - building a community pharmacy from the ground up at Salud's new Longmont clinic. Hall as the manager; and Netsanet as a staff pharmacist. Construction on the clinic began in June. The pharmacy became fully operational in November. Creating an operational pharmacy and learning EXPANDING ROLE OF PHARMACISTS Collaborative Drug Therapy Management F or 58-year-old Diana, two chronic illnesses were controlling her life - diabetes and mental health issues. Tired, thirsty with blurry vision and cataracts, Diana felt terrible all the time. During one of her visits with Physician Assistant Beth Walker at the Salud Clinic in Brighton, her blood glucose level was in the 500s, putting her at risk for a heart attack or stroke. As a consequence, Walker increased her insulin and added metformin, which improved her sugars slightly. "Despite several follow up visits, changes to her medications and sessions with our in-house patient educator, Diana's sugars remained high. So, I referred her to clinical pharmacist, Dr. Kosirog," says Walker. When Senior Clinical Instructor Kosirog, who specializes in diabetes how to make it run - everything from inventory control to billing and automation systems, "Is not something they train you for in pharmacy school," says Hall. Essentially running two separate pharmacies - 340b program and Medicaid - "Can be confusing, but we're still working out the bugs." Hall wasn't totally on his own. He had help from George Hartman III, RPh, the Fort Lupton pharmacy manager and pharmacy director for Salud. How the two got here after their short stint with retail is no secret. But it is a tactic that few pharmacy students employ - relationship building. management, began researching Diana's case, she discovered that Diana had been diagnosed with bi-polar disorder 10 years prior and was on two antipsychotic medications. If used alone, these medications don't worsen diabetes. But in combination they do. "Unfortunately, in trying to control the mental health issue her diabetes worsened," says Kosirog. Meeting on an almost weekly basis, going over meds and glucose levels, Kosirog developed an individual medication plan for Diana. She also spoke with Diana's psychiatric provider and suggested a change in medications. Diana was weaned off of one of her prescriptions, and as consequence both her sugar and cholesterol numbers dropped. In fact, her A1C dropped 9 percent within four months! "Now that her sugar levels are in line, her vision has improved and she can schedule surgery to remove the cataracts," says Kosirog. According to Walker, "I think the extra education and help Diana received along with stopping and changing her psych meds has really done an amazing job. She seems more interested in her health care now and her affect has improved. Having a pharmacist on board is a tremendous asset to our center." During their fourth-year of pharmacy school, both chose rotations at one of the Salud clinics and caught the patientcentered medical home bug. "Personally, the Salud rotations made a big impact on me - especially the close access to providers," says Netsanet, who did his rotation in the anticoagulation clinic in Fort Lupton. Able to have direct contact with patients and providers - educating patients on medications, being relied on to make clinical judgments, and providing care through the anticoagulation clinics, "It was exciting and truly what I felt my education was preparing me for," says Hall. "We are really involved in care, which is something you don't get in a regular retail setting," says Netsanet. Both liked the people and the concept of clinics, so they developed relationships while there and kept in touch with their preceptors and other staff members after their rotations were over. A text here, a call there; they even dropped by when on rotation at the local hospital. "That made all the difference," says Hall. "I knew when an opening was happening and was the first to be contacted." "I can't tell you how often I see students on rotation trying to hide," says Netsanet. His advice - hang out with the pharmacist and staff. "Really ask questions. You may think you have everything figured out - where you want to work after graduation or that you're planning a residency. But you never know what your future holds," says Netsanet. All of the rotations are opportunities and according to Hall should be thought of as job interviews. "Be on your best behavior. Learn as much as you can." Obviously there are tradeoffs with a position in a clinic. "There's no big IT department trouble shooting computer problems or helping with inventory control, but the plus side is the autonomy and the ability to make the rules," says Hall. "Contrary to what people think, we didn't take a pay cut to come here. And I have found it more fulfilling and sustainable than my previous position." 13

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