Evaluation of services provided in a gender health clinic.

BACKGROUND: Transgender and gender diverse (TGD) individuals face discrimination and mistreatment in healthcare spaces, resulting in poor health. The Mountain Area Health Education Center (MAHEC) Gender Health Clinic was launched in September of 2022 to meet the healthcare needs of TGD patients. OBJECTIVE: Describe services provided in and patient satisfaction with an interdisciplinary Gender Health Clinic serving TGD patients. PRACTICE DESCRIPTION: The Gender Health Clinic is a subspecialty clinic of the MAHEC Family Health Center in Asheville, North Carolina. The clinic offers interdisciplinary services to TGD patients, including primary care, gynecology, and medication management. PRACTICE INNOVATION: The interdisciplinary clinic team was assembled to create a safe environment for TGD patients to receive medical care. The pharmacy team facilitated provider training, consolidated clinical references, and provided comprehensive patient education on hormone therapy. EVALUATION METHODS: A quantitative description of services and patient demographic information was evaluated through a retrospective chart review of the first six months of the clinic. Patient satisfaction was evaluated through anonymous questionnaires. RESULTS: Forty-four patient encounters were evaluated for 23 unique patients. The mean age was 26.6 years, and 65.2% of patients were assigned female at birth. Gender identities were distributed across male (39.1%), female (34.8%), and non-conforming (26.1%). Nearly all patients (97.7%) received documented general education from any provider. Most patients (79.6%) received prescriptions for hormone therapy. More than one-third (38.7%) of patients had a documented pharmacist interaction. Twenty-one questionnaires were completed out of 23 unique patients. All respondents rated their overall experience as "Excellent" or "Very Good." Highly rated positive clinical interactions included courteous clinical staff (4.9) and having needs met (4.8). Ease of scheduling an appointment (4.3) was rated lowest among all questionnaire items. CONCLUSION: The positive patient experiences and level of services provided suggest a promising start to MAHEC's Gender Health Clinic.

Implementation of a community-based pharmacist-run attention deficit hyperactivity disorder clinic in a college health center.

BACKGROUND: Published evidence is lacking to describe the pharmacist's role in medication management within an attention deficit hyperactivity disorder (ADHD) specialty clinic. OBJECTIVES: The objectives were (1) to measure the growth of an ADHD clinic in a college health center after the integration of clinical pharmacists and (2) to evaluate provider adherence to clinic policies and procedures before and after pharmacist integration. PRACTICE DESCRIPTION: In 2017, a pharmacist-run ADHD clinic was established at a college campus. PRACTICE INNOVATION: Pharmacists conducted collaborative initial visits with psychiatrists and independently provided follow-up appointments for patients with ADHD. EVALUATION METHODS: Data were extracted from the electronic health record for patients aged 18 years or older with an ADHD diagnosis who completed a medication evaluation or medication follow-up visit from July 1, 2016 to June 30, 2019. Data were excluded if it was for another visit type, was a non-ADHD clinic provider visit, or if the visit note was classified. Data before the pharmacist integration (July 1, 2016-June 30, 2017) were compared with data after the pharmacist integration (July 1, 2017-June 30, 2019). Chi-square tests of independence evaluated differences in blood pressure monitoring, heart rate monitoring, and stimulant medication contract signature between psychiatrist- and pharmacist-run appointments. RESULTS: Pharmacist presence in the ADHD clinic increased from 0 full-time equivalent (FTE) to 0.2 FTE over 3 years. The number of appointments increased by 1003% (from 26 to 287). Compared with psychiatrist-run appointments, pharmacist-run appointments were more adherent to monitoring blood pressure (11% vs. 77%, P < 0.001) and heart rate (6% vs. 75%, P < 0.001), as well as clinic policy requiring a patient's signature on a stimulant medication contract (64% vs. 75%, P = 0.019). CONCLUSION: Pharmacists can assist psychiatrists in medication management of ADHD in the college health setting. A pharmacist-psychiatrist collaboration increased quality of care and monitoring of medication adverse effects.

Assessing barriers to patient acceptance of pharmacist-provided recommendations for international travel.

OBJECTIVES: The primary objectives of this study were to determine the percentage of travel recommendations accepted by individuals serviced at a university travel health clinic and to identify barriers to travel recommendation acceptance or implementation by travelers. A secondary objective was to use details regarding the identified barriers to refine travel clinic protocols. METHODS: This cross-sectional study utilized an 11-item questionnaire, conducted via telephone from February 2018 to April 2018. The survey was administered by a pharmacist employed at the travel clinic. The following data were collected: travel itinerary, content of pharmacist provided travel recommendation(s), acceptance of pharmacist travel recommendation(s) or reason for declining the recommendation(s), patient utilization of supplemental recommendations (e.g., traveler's diarrhea treatment flowchart, over-the-counter travel items, accessing medical care abroad), perceived usefulness of travel clinic resources, and the status of patient health during travel and upon return. Data was evaluated using descriptive statistics. RESULTS: A total of 205 travelers were screened to participate in the study; 85 surveys were completed, resulting in a 41% response rate. Of 349 travel vaccination recommendations made, 242 (69%) were accepted by patients. The vaccine recommendations with the lowest acceptance were Japanese Encephalitis (18%, n = 2/11), rabies (27%, n = 15/55), and influenza (51%, n = 41/80). The top reasons for declining included cost (40%, n = 34), lack of perceived necessity (37%, n = 31), and timing (16%, n = 14). In addition, 68% reported using travel clinic advice if they became ill during travel. CONCLUSION: This study showed a positive response to recommendations provided by this travel clinic. Cost and 'lack of perceived necessity' were identified as barriers to acceptance of recommendations. Travel clinic protocols will be refined to provide further education to travelers about unfamiliar disease states that may pose an increased risk during travel, aiming to increase acceptance of pharmacist-provided recommendations.