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1.  Engaging Students in Wellness and Disease Prevention Services 
Pharmacy education has traditionally focused on medications and treatment of disease. However, as an accessible health care professional, pharmacists can influence healthy behaviors in their patients. Encouraging/promoting healthier lifestyles in the United States is essential because the leading causes of mortality are tobacco use, poor nutrition, and inactivity. In order to prepare pharmacists for this role, student pharmacists must be taught how to implement and deliver wellness and prevention services. Community advanced pharmacy practice experiences (APPEs) occur at an ideal point in the curriculum to engage students in these activities. This article provides preceptors with guidance and tools for restructuring the community APPE at their sites to incorporate wellness and disease prevention activities.
PMCID: PMC1636924  PMID: 17149419
wellness; disease prevention; health promotion; advanced pharmacy practice experiences; community pharmacy
2.  A qualitative analysis of perceptions and barriers to therapeutic lifestyle changes among homeless hypertensive patients 
Background
Homeless individuals have higher rates of hypertension when compared to the general population. Therapeutic lifestyle changes (TLCs) have the potential to decrease the morbidity and mortality associated with hypertension, yet TLCs can be difficult for homeless persons to implement due to competing priorities.
Objectives
To identify: 1) Patients' knowledge and perceptions of hypertension and TLCs; and 2) Barriers to implementation of TLCs.
Methods
This qualitative study was conducted with patients from an urban healthcare clinic within a homeless center. Patients ≥ 18 years old with a diagnosis of hypertension were eligible. Three focus groups were conducted at which time saturation was deemed to have been reached. Focus group sessions were audio recorded and transcribed for data analysis. A systematic, inductive analysis was conducted to identify emerging themes.
Results
A total of 14 individuals participated in one of three focus groups. The majority were female (n = 8) and African-American (n = 13). Most participants were housed in a shelter (n=8). Others were staying with family or friends (n=3), living on the street (n=2), or had transitioned to housing (n=1). Participants had a mixed understanding of hypertension and how TLCs impacted hypertension. They were most familiar with dietary and smoking recommendations and less familiar with exercise, alcohol, and caffeine TLCs. Participants viewed TLCs as being restrictive, particularly with regards to diet. Family and friends were viewed as helpful in encouraging some lifestyle changes such as healthy eating, but less helpful in having a positive influence on quitting smoking. Participants indicated that they often have difficulty implementing lifestyle changes because of limited meal choices, poor access to exercise equipment, and being uninformed about recommendations.
Conclusions
Despite the benefits of TLCs, homeless individuals experience unique challenges to implementing TLCs. Future research should focus on developing and testing interventions that facilitate TLCs among homeless persons. The findings from this study should assist healthcare practitioners, including pharmacists, with providing appropriate and effective education.
doi:10.1016/j.sapharm.2012.05.007
PMCID: PMC3519971  PMID: 22835705
homeless; hypertension; perceptions; barriers; lifestyle
3.  Integration of collaborative medication therapy management in a safety net patient-centered medical home 
Objective
To describe the integration of collaborative medication therapy management (CMTM) into a safety net patient-centered medical home (PCMH).
Setting
Federally qualified Health Care for the Homeless clinic in Richmond, VA, from October 2008 to June 2010.
Practice description
A CMTM model was developed by pharmacists, physicians, nurse practitioners, and social workers and integrated with a PCMH. CMTM, as delivered, consisted of (1) medication assessment, (2) development of care plan, and (3) follow-up.
Practice innovation
CMTM is integrated with the medical and mental health clinics of PCMH in a safety net setting that serves homeless individuals.
Main outcome measures
Number of patients having a CMTM encounter, number and type of medication-related problems identified for a subset of patients in the mental health and medical clinics, pharmacist recommendations, and acceptance rate of pharmacist recommendations.
Results
Since October 2008, 695 patients have had a CMTM encounter. An analysis of 209 patients in the mental health clinic indicated that 425 medication-related problems were identified (2.0/patient). Pharmacists made 452 recommendations to resolve problems, and 384 (85%) pharmacist recommendations were accepted by providers and/or patients. For 40 patients in the medical clinic, 205 medication-related problems were identified (5.1/patient). Pharmacists made 217 recommendations to resolve the problems, and 194 (89%) recommendations were accepted.
Conclusion
Integrating CMTM with a safety net PCMH was a valuable patient-centered strategy for addressing medication-related problems among homeless individuals. The high acceptance rate of pharmacist recommendations demonstrates the successful integration of pharmacist services.
doi:10.1331/JAPhA.2011.10191
PMCID: PMC3280342  PMID: 21382806
Medication therapy management; patient-centered medical home; collaborative care
4.  Development and Implementation of an Academic-Community Partnership to Enhance Care among Homeless Persons 
Innovations in pharmacy  2011;2(1):1-7.
An academic-community partnership between a Health Care for the Homeless (HCH) clinic and a school of pharmacy was created in 2005 to provide medication education and identify medication related problems. The urban community based HCH clinic in the Richmond, VA area provides primary health care to the homeless, uninsured and underinsured. The center also offers eye care, dental care, mental health and psychiatric care, substance abuse services, case management, laundry and shower facilities, and mail services at no charge to those in need. Pharmacist services are provided in the mental health and medical clinics. A satisfaction survey showed that the providers and staff (n = 13) in the clinic were very satisfied with the integration of pharmacist services. The quality and safety of medication use has improved as a result of the academic-community collaborative. Education and research initiatives have also resulted from the collaborative. This manuscript describes the implementation, outcomes and benefits of the partnership for both the HCH clinic and the school of pharmacy.
PMCID: PMC3258539  PMID: 22259752
Academic-Community partnership; medication therapy management; community engagement; homelessness; medication related problems

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