Treat, Teach, Innovate: Why This Pharmacist Never Has a Dull Day

Zhou begins her day at one of her new clinical sites, UCSF Primary Care at China Basin, which serves San Francisco’s growing Mission Bay neighborhood.

“In primary care clinics like this, pharmacists like myself are working with patients to understand and manage their medications, even changing the dose of their medications depending on what’s going on with their chronic conditions,” she explains.  

Administrative director Joanne De Leon gives Zhou a tour before the pharmacist begins seeing patients. UCSF Health patient Jackie Persons joins virtually via a convenient telehealth appointment.

“My days look really different depending on where my patients are, and they could be in San Francisco, Oakland, or Sacramento,” Zhou says.  

With appointments done — for now, Zhou heads over to the School of Pharmacy at UCSF’s Parnassus Heights campus.

But first, a quick snack in her “mobile office” — the car.

At Zhou’s office at the Parnassus Heights campus, thank you cards from former students line her bookcase alongside textbooks and an anatomical heart model. She logs onto a Zoom meeting with the Cut Hypertension Program team where she’s the lead pharmacist.  

The project is a community-based hypertension treatment project through the local nonprofit organization Roots Community Health. Cut Hypertension trains barbers as health coaches to counsel and screen clients for high blood pressure. When clients are screened and have high blood pressure, the program’s team provides regular care to help control their hypertension via medication and lifestyle counseling — all from the barbershop.

“The whole clinic environment can be off-putting for some people,” Zhou explains. “Sometimes people don’t feel heard or are rushed through their appointments or — if they share what’s really going on — it might just mean more tests or more bad news.”

“A community space like a barbershop and a barber that the patient has known for years can just feel more comfortable.”

Although the project serves anyone, the Cut Hypertension Program offers interventions focusing on Black barbershops because Black Americans face one of the world’s highest rates of hypertension. Nearly 60% of Black adults were living with high blood pressure in 2023, the latest national survey shows. These high hypertension rates are driven by many factors, including poorer access to quality health care. UCSF research found that health care workers were less likely to increase Black patients’ medications in response to persistently high blood pressure when compared to patients from other communities. And men, who tend to visit physicians less than women, are particularly at risk.

Previous research by UCSF and others show that models like the Cut Hypertension Program, that pair health education by trained barbers with follow-up care from pharmacists in the shop, can be incredibly effective. In one study, 64% of men in a similar program reached their target blood pressure — a much higher proportion than men who were simply handed a pamphlet.

Cut Hypertension has trained barbers in 12 barbershops in Oakland and San Francisco, and is expanding into Sacramento.

"A haircut is a great opportunity to start a conversation about someone’s health, especially for someone who doesn't engage with their primary care provider and who has high blood pressure," Zhou says.

Zhou and the team discuss a new hypertension protocol for the Sacramento expansion.

“In many clinics, nurses provide blood pressure checks and adjust medications per protocols,” she says. “This new hypertension protocol will act like a set of detailed instructions for the new nurse who will be on-site in our Sacramento barbershops. We hope this protocol will enable us to be more interdisciplinary, with me as a consulting member of the team, since I’m based in San Francisco.”

Protocols like these are just one part of creating and evaluating new ways for pharmacists to reach people, Zhou says. “When I’m not teaching or seeing patients, I spend a lot of time thinking about my research to improve hypertension control in the community but also in our clinics.” 

Next, Zhou heads downstairs to one of the campus’ large classrooms where she’ll be guest lecturing.  

Here, an audience of nearly four dozen first-year medical students has gathered to learn how to take a medication history. If you’ve ever tried to remember three or more medicines by name, you might understand why it’s harder than it looks.

Hospital pharmacists, Zhou tells the class, play life-saving but frequently unseen roles in managing the fast-changing medications of admitted patients as they heal. Still, collecting a good medication history is a team sport.  

“When I go into patients’ medical records, 95% of the time the medication lists aren’t accurate — maybe they’ve self-discontinued a medication,” she recounts. “It really helps when different clinicians are asking because patients will tell different people different things.”

Zhou teaches classes in cardiovascular care in the spring and fall quarters. There, Zhou leads learners in understanding the medicines, building treatment plans, and, just as importantly, talking to patients.  

Back at Parnassus, the learners spend time practicing taking a medication history, switching between playing the role of a patient trying to remember their medications and that of a comforting physician, gently coaxing their memories.  

Zhou then leads the learners through an exercise in using artificial intelligence to help the budding physicians identify drug interactions before she heads over to San Francisco’s Bayview-Hunter’s Point neighborhood. 

A 20-minute drive through San Francisco’s winding streets, and Zhou arrives outside B&F Barbershop on Palou Avenue. The sounds of chatter and buzzing razors fill the room. On the wall, posters advertising Cut Hypertension’s services entice potential clients, “Want a free haircut?” one reads. Medical care comes with a free haircut, the flyer says.  

A small, 2022 survey by Zhou and Cut Hypertension found that men in the neighborhood cited insurance and cost as major barriers to seeing a primary care physician regularly. Eight out of 10 men surveyed said they’d prefer to get primary care outside the clinic and roughly half of those men listed a pharmacy, at home, or in a barbershop as preferred venues.

“What we’re trying to do is bring medicine to the community instead of the other way around,” she says. “It could be a barbershop, it could be a nail salon, it could be a church. But we at Cut Hypertension, we really believe that Black barbershops and salons can be places of health promotion and outreach, community building, and treatment for the community.”

Zhou checks in with the barbers and the Cut Hypertension team before heading next door to a pop-up restaurant for a bite — and some screenings. B&F Barbershop owner Dwayne Robinson has just concluded a class on local entrepreneurship. As the cafe tables free up, Zhou grabs a seat and introduces herself to Tyree Robinson and offers him a free blood pressure screening.

Cut Hypertension is deepening its work in the neighborhood, building stronger partnerships with local clinics to not only allow barbers to refer clients to the program, but also allow clinics to refer their patients for care in the barbershop. This effort bridges community space and clinical care, strengthening the continuum of care.

“We created a health coaching training for our barbers, who aren’t health care providers by any means. Word spread. The barbers we trained referred their friends who were barbers, and the network just grew,” Zhou explains. “The heart of it is really the barbers who want to help their communities.”