Hearing the Underserved

Drug interactions and symptom management are already difficult enough concepts for some to understand. But when patients are deaf or hard of hearing, important details may be misunderstood -- with potentially serious consequences. Thanks to pharmacist Dana Odom Testa, a 2001 UCSF graduate, the pharmacy care needs of the deaf and hard-of-hearing community are now coming through loud and clear. Testa, who herself is deaf, has initiated a residency program focusing on the deaf and-hard of hearing in the Fremont area. With more than 400,000 deaf and hard of hearing individuals in the Bay Area and more than 5.4 million in California, the results of Testa's work could have the potential to improve pharmacy care for this population statewide. Over time, many different underserved audiences will benefit from the tailored services in which the program hopes to specialize. Testa is the first known pharmacist in the nation to provide a specialized medication service for the deaf and hard of hearing. Testa is piloting a department of clinical pharmacy residency program to create a data base of information about how better to serve the pharmaceutical needs of the deaf and hard of hearing. A pharmacy resident is a pharmacist who has elected to continue training and education beyond four years of pharmacy school. The pilot program was Testa's idea, and it has been organized and supported jointly by the UCSF School of Pharmacy and Longs Drugs. Testa has always been determined to build a bridge between the deaf and hard-of-hearing community and the health care world, writing about her goal in her personal essay when she applied for pharmacy school. "When I talked with my professors about organizing this new pilot residency program in pharmacy, they agreed that I might be able to fill this gap," Testa said. Advisors Lisa Kroon, PharmD, and Cathi Dennehy, PharmD, both UCSF assistant clinical professors of pharmacy, mentored Testa while she was getting her PharmD degree (1996-2001), and thought the residency program could also provide new information to help serve the deaf and hard-of-hearing community. Kroon and Dennehy will also evaluate the data collected from a voluntary patient survey provided by Testa to each patient. The researchers plan to get a baseline from the patient surveys, including compliance with drugs and patient satisfaction. Kroon said that before and after Testa's consultations with patients, there will be studies done on compliance and adherence to medications. The new pharmacy residency combines a three-part program: * in-depth pharmaceutical counseling for the deaf and hard-of-hearing community on three days per week (Monday, Tuesday and Friday) at Longs Drugs-Mission Ranch in Fremont, Calif, * outreach presentations to deaf and hard-of-hearing community organizations, and * teaching in the UCSF School of Pharmacy. The choice of the East Bay as a location for the pharmacy residency program was made for a number of reasons: the nearby California School for the Deaf is the only one in Northern California, a California School for the Deaf (K-12) is located in the East Bay and several hundred deaf and hard-of-hearing students at Ohlone College may use the new pharmacy counseling service. At the Longs Drugs-Mission Ranch site in Fremont, Testa answers questions in American Sign Language about prescriptions, vitamins, medical and diagnostic devices, herbal products and non-prescription medicines. Testa also provides easy access to prescription and refill services as well as medication safety tips through technology such as Telephone Devices for the Deaf (TDD). "It is important for a pharmacist to assess for drug interactions and adverse reactions to all medicines," Testa said. Another part of her job, she said, is to review the patient's immunization records such as tetanus and flu vaccinations. Although appointments are offered, walk-ins are accepted at the site. Each patient in the special program is a volunteer, and receives a counseling session and a follow-up session which is tailored to individual needs. Participants also fill out brief surveys which are kept confidential. In her outreach in the deaf and hard of hearing community, Testa presents talks at agencies such as the Deaf Counseling Advocacy Referral Agency, St. Joseph's Center for the Deaf, the Deaf Community Center in San Leandro, the Fremont Senior Center, San Jose Senior Center and Ohlone College. Audiences average between 10 and 50 people, and, to make certain she is understood, Testa uses American Sign Language or gesturing to help communicate. "There is lots of interaction with the audience," she said. "Most of the time we have an open discussion." Topics include medication safety tips, immunizations, antiretrovirals, osteoporosis, complementary and alternative medicine, depression, asthma and allergies and poison prevention. In one session recently, an elderly man asked, "I read in the paper about grapefruit interacting with some medicines and am concerned that it may interact with what I am taking." Testa described how grapefruit juice interacts with medicines by drawing a picture. "Basically, I explained that grapefruit juice saturates certain enzymes in the gastrointestinal tract," she said, "and those enzymes are essential in breaking down some medications." She explained that drugs which may interact with grapefruit juice include some cholesterol-lowering drugs (statins), some calcium channel blockers, caffeine, and some benzodiazepines (a group of tranquilizers). Establishing the pilot residency program required support and coordination of public and private sectors. Testa received support from Mary Anne Koda-Kimble, PharmD, UCSF Dean of the School of Pharmacy, and associate deans of the School of Pharmacy. Funding for the program was provided by UCSF, Longs Drugs and the Institute for Advancement of Community Pharmacy. Source: Twink Stern and Susan Levings

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