Pharmacy Outreach

Program

2011 Annual Report

Pharmacy Outreach Activities 2011

Health Fairs

Blood Pressure and Blood Glucose Screenings

Educational Presentations

Brown Bag Program

Pharmacy Outreach Program Activities and Locations

Outreach By County

Bristol

Kent

Newport

Providence

Washington

Number of Events

Presentations

Clinics

Health Fairs

Brown Bags

Calls

Annual Program Attendance

Presentations

Clinics

Health Fairs

Brown Bags

Calls

 

Pharmacy Outreach Program University of Rhode Island 

College of Pharmacy Annual Report 2011 

  Executive Summary  Appendix 

A. Sites 2011 B. Testimonials C. Descriptive Listing of Current Programs D. Brown Bag Program E.    Current Activities F.    Resource Lists 

Summary 2011

The Pharmacy Outreach Program, located at The University of Rhode Island, College of Pharmacy, is celebrating its 29th year of continued service to Rhode Island communities. In 1988, the Rhode Island Legislature awarded the College of Pharmacy a grant to provide pharmacy educational services on a full time basis. This funded Outreach Program continues today with 2 members of its staff, E. Paul Larrat, Professor and Rita Marcoux, Clinical Associate Professor having helped initiate the Outreach Program in 1988. The remaining staff of pharmacists offers over 100 years of experience in the practice of pharmacy. The accomplishments of the Outreach Program may be measured in many different ways. The staff believes the Outreach Program’s success should be measured by its ability to meet the following goals:

1. Providing all Rhode Island residents an objective, free source of information and education on their medication, health and financial medication resources.

2. Provide comprehensive prescription and over the counter review of medications to help minimize the number of adverse drug events experienced and increased medication compliance by Rhode Island Residents.

3. Ensuring that future Rhode Island pharmacists understand their patient population by offering students the opportunity to become involved and participate in our programs in the Rhode Island community.

Information and Education

Since its establishment in 1988, the Pharmacy Outreach Program has been a resource for residents and health care service organizations throughout the state. This consistent tenure has resulted in strong community ties built between our College of Pharmacy staff and the Rhode Island Community. The Outreach Program strives to remove the barrier of distance as well as the challenges experienced in busy community practices by offering programs within Rhode Islanders’ residential communities and gathering sites. The Brown Bag Program was and is the core of our program. The Brown Bag Program offers participants the opportunity to sit down one-on-one with our staff and discuss a patient’s medications uses, side effects, proper dosing, and interactions. The pharmacist is focused on a single individual and has the time to answer questions the patient may have about their medication. This welcoming environment with unlimited time to discuss a resident’s medication is the cornerstone of the program and the underlying reason the Brown Bag Program has been so popular and effective through the years. (Please see Appendix D)

The current economic environment as well as limited resources within service organizations has resulted in an increase demand for all of our programs including the Brown Bag Program. Patients require our assistance in learning how to manage their medications. Today’s drug regimens often contain complex therapies and advanced

dosage forms requiring proper administration techniques, storage, and dosing schedules. Routinely, our pharmacists answer a number of questions on specific medications and drug therapies during their presentations. Community service leaders recognize the value of these presentations and their ability to extract medication therapy concerns that their community participants have. This value is reflected in the increased number of request for presentations and increased participation that the Outreach Program has recorded over the last few years. (Please see Appendices A, B, and C)

The Outreach Program has also seen an increase in requests for our services by community leaders representing minority groups in Rhode Island and has employed, for the past five years, Spanish- and Portuguese-speaking pharmacists per diem to respond to this demand. In 2010, a full-time Spanish-speaking pharmacist was added to our staff, enabling the Outreach Program to provide services in Spanish. This service is helping to reduce some of the language and cultural barriers to our health education programs. Our efforts have been well received by Rhode Island’s Spanish- and Portuguese-speaking seniors. During the 2011 fiscal year, the Outreach Program conducted 88 activities for minority and/or other under-served adult communities. These programs included four Summer Health Fairs that provided blood pressure to over 130 participants. The program’s theme of Summer Health was emphasized with educational materials, in English and Spanish. During the fiscal year of 2011, we added monthly and quarterly activities to a total of 20 sites serving Spanish speaking residents. Our foreign language library of presentations and handouts has grown substantially to include more than 50 topics. The Brown Bag program provides a printable form in Spanish that allows the participants to review recommendations by the pharmacist once the session is completed. The Outreach Program promotes our toll-free Medication Information Line which has a bilingual option. This service provides all Rhode Islanders, especially those unable to physically attend our programs, access to the educational services offered by the Outreach Program staff.

Many residents are confused and overwhelmed by the information and complexities of their insurance coverage and the assistance programs available to them. Medicare Part D and the donut hole continue to be an area in which our program offers support and education for residents. Since the Outreach Program began, it has been actively involved in assisting residents to find affordable resources for their medication costs. Our pharmacists have worked in conjunction with the Department of Elderly affairs to promote the RIPAE program, Manufacturer Assistance Programs and Medicare Part D. In 2006, our staff and students won a national award for their activities in educating seniors about Medicare Part D. This effort continues today as our staff joins community providers in ensuring Rhode Island residents understand and choose the best plan for their prescriptions needs. Despite the increase in prescription coverage Medicare Part D offers many individuals, the total cost of their prescriptions requires many to price shop and fill their prescriptions at multiple pharmacies including mail order pharmacies. In addition some individuals obtain medications directly from their physicians as samples

or through manufacturer’s assistance programs. Prescription shopping combined with the media’s promotion of alternative therapies as a source or adjunct to treatment has increased the likelihood of unwanted side-effects and interactions. These alternative products are readily available over-the-counter, through the mail and from the internet but are rarely captured on a patient history within community practice sites. A combination of these factors may lead to increased risk of drug interactions, adverse drug reactions, duplication of medications as well as to the increased cost in managing the adverse outcomes of these events. The Outreach Program continues to offers an opportunity to address these issues so that individuals understand the complexities of their treatment, have the knowledge to actively participate in treatment decisions and ultimately improve the quality of life and cost savings. In 2011, the Pharmacy Outreach Program worked with more than 200 Rhode Island Seniors to educate them about Medicare Part D and to help them pick a plan that was most suitable for their individual needs. (Please see Appendices E and F)

The Outreach staff interacted with over 6900 Rhode Island residents through the following venues in fiscal year 2011. The following chart illustrates the response to the Pharmacy Outreach Programs. These statistics may under represent the number of individuals who are impacted by our programs because registration is not required:

County Number of Sites Bristol 6 Kent 23 Newport 11 Providence 74 Washington 17

Program Offerings Number of Events Presentations 423 Clinics 81 Health Fairs 22 Brown Bags 45 Calls 86

Outreach Program Offerings Annual Program Attendance Presentations 6942 Clinics 1030 Health Fairs 1511 Brown Bags 45 Calls 86

Pharmacists of Tomorrow

Another important goal of the Pharmacy Outreach Program is to develop innovative programs that offer students an opportunity to integrate their pharmacy education with a learning experience in community practice. The staff of the program has always felt that one of the greatest services that the program could offer residents was a future team of healthcare providers that understand their patients. The Pharmacy Outreach Program offers students, in the last year of their Doctor of Pharmacy degree, an opportunity to interact with Rhode Island’s seniors, disabled, and indigent in community and residential sites. By seeing their future patients outside the pharmacy, students begin to better understand the challenges many of these individuals face in managing their prescriptions and their health conditions. This experience is intended to instill in these future pharmacists empathy towards the elderly and indigent populations within our communities.

The students join the program for 6 week experiential rotations. The Pharmacy Outreach Program is one of the most sought after experiential rotations offered by the College. The students’ evaluations consistently state that the Pharmacy Outreach Program provided them with an opportunity to learn firsthand about patients and the value that they, as pharmacists, can provide in ensuring positive outcomes. Students experience the true needs and obstacles of Rhode Islander in managing their healthcare. This rotation is offered to over 17 students annually and the Outreach Program offers students at various other rotations the opportunity to participate in scheduled events. (Please see Appendix B)

Faculty and Staff of the Pharmacy Outreach Program Rita M. Marcoux, R.Ph., MBA Phone: 874-9275 Clinical Associate Professor email: marcoux@uri.edu E. Paul Larrat, R.Ph., Ph.D. Phone: 874-5011 Professor email: larrat@uri.edu William A. Beaulieu, B.S., R.Ph. Phone: 874-7446 Coordinator, Pharmacy Outreach Program email: wabwpc@uri.edu Nancy J. Tortolani, B.S., R.Ph.,CDOE Phone: 874-2272 Coordinator, Pharmacy Outreach Program email: ncjt@uri.edu Noemi Ramos-Desimone, Ph.D, Pharm.D.,CDOE Phone: 874-7485 Coordinator, Pharmacy Outreach Program email: nramos@uri.edu The Pharmacy Outreach Program 1-800-215-9001 College of Pharmacy email: reachrx@etal.uri.edu The University of Rhode Island uri.edu/pharmacy/outreach

Appendix F

Medication Assistance Resource List

Emergency Medication Assistance • Interfaith Dire Emergency Fund

o 421-7833 x107 • Crossroads (Traveler’s Aid)

o 521-2555 o www.crossroadsri.org

Medication Cost Assistance • RIPAE

o 462-0501, 462-3000, or Local Senior Center

o www.dea.ri.gov • The Point

o 462-4444 o http://adrc.ohhs.ri.g

ov • RxAssist

o 729-3284 o www.rxassist.org

• Medicare Part D o 1-800-MEDICARE o www.medicare.gov

• Partnership for Prescription Assistance

o 1-888-477-2669 o www.pparx.org

• AZ Medicine & Me for Medicare D

o 1-800-292-6363

• Neighborhood Health Plan

o www.nhpri.org o 1-800-963-1001

• Veteran’s Affairs Office o 253-8000 x495

• RI Department of Human Services

o www.dhs.ri.gov o 784-8100 or 1-800-

964-6211 • St. Vincent DePaul

Ministry Clinic o 401-273-1108 (Mon,

Wed, Fri) • Internet Discount

Coupons o www.internetdrugco

upons.com • AAA Discount

o 1-800-JOIN-AAA o www.AAA.com

Medication Information and Education Resource Center

Pharmacy Outreach Program The University of Rhode Island College of Pharmacy 1-800-215-9001 www.uri.edu/pharmacy/outreach

Summary of Major Chain Savings Programs

Pharmacy Plan Summary Fee Drugs Covered

-$11.99 for 90 day supply -10% off MinuteClinic $15/ year 400+ Generics

-20% off certain prescriptions -“Flat Fee” Generics -$8.99/ 30 days -$15.99/ 90 days -15% off brand names -Savings on OCs and DM2 strips

Free

500+ “Flat Fee” Generics 20% off 1000s of meds

Select Oral Contraceptives RiteAidTrueTest Strips

-$9.99 for 30 day supply -$12 for 90 day supply

$20 individual $35 family 400+ Generics

-$9.99 for 90 day supply Free

(withStop&Shop Card) 350 Generics

-$4 for 30 day supply -$10 for 90 day suply Free 300+ Generics

-$4 for 30 day supply -$10 for 90 day supply -$9 for 10 Levitra tabs*

Free 400+ generics

For more details about your pharmacy’s plan, ASK your pharmacist!

The University of Rhode Island College of Pharmacy Outreach Program

1-800-215-9001 |www.uri.edu/pharmacy/outreach

Pharmacy Outreach Program-URI College of Pharmacy www.uri.edu/pharmacy/outreach

1-800-215-9001

Proudly Presents

Helpful Resources Information and Support Centers

The RI Women's Cancer Screening Program

Offers free breast and cervical cancer screening services to women who are 40 years of age and older and without health insurance. Services include a Pap smear, pelvic exam, mammogram, follow-up services and referral for treatment. http://www.health.state.ri.us; 222-1161

Family Van

The Family Van is a minority health promotion center on wheels! The van travels throughout the state with scheduled visits at housing units, community centers, neighborhood health centers, high schools, and shopping centers. The van regularly attends health fairs providing health screening and education in a variety of settings.

For more information: http://www.womenandinfants.org/body.cfm?id=92&action=detail&ref=61 or 401-277-3629

Partnership for Prescription Assistance

The Partnership for Prescription Assistance brings together America’s pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups to help qualifying patients who lack prescription coverage get the medicines they need through the public or private program that’s right for them. Many will get them free or nearly free. Its mission is to increase awareness of patient assistance programs and boost enrollment of those who are eligible. Through this site, the Partnership for Prescription Assistance offers a single point of access to more than 475 public and private patient assistance programs, including more than 180 programs offered by pharmaceutical companies. To access the Partnership for Prescription Assistance by phone, you can call toll-free, 1-888-4PPA-NOW (1-888-477-2669) or www.pparx.org

Rhode Island Free Clinic

Rhode Island Free Clinic helps address the needs of the uninsured in Rhode Island. Today, it's the only place like it in the state--a welcoming place where adults without health insurance can go to receive free primary medical care. It's a place where people in (or interested in) the healthcare profession can give of themselves and their time and money to benefit others.

For more information: http://www.rifreeclinic.org or 401 274-6347

RI Prescription Drug Discount for the Uninsured This program now called simply, RI HELP, can help make prescription drugs more affordable for the 19 – 65 year old residents who are at 200% of Federal Poverty Level. When a consumer enrolls in the program ($20.00 annual enrollment fee), he/she will use the RI HELP Rx drug discount card. When the card is used, the consumer will pay the lowest available costs on medications at network pharmacies throughout the state – up to 15% discount off the Average Wholesale Price for Brand Drugs and up to 40% discount off the Average Wholesale Price for generics. For more information call Pharmacare toll free: 1-800-311-0553

AZ Medicine & Me for people in Medicare Part D

AZ&Me™ Prescription Savings program for people with Medicare Part D is designed to provide significant savings to qualifying people who are enrolled in Medicare Part D prescription drug coverage plans and are having difficulty affording their AstraZeneca medicines.

• Enrollees will pay no more than $25 for a typical 30-day AstraZeneca prescription

• AZ&Me™ Prescription Savings program for people with Medicare Part D is available at most local pharmacies

• There is no program enrollment fee • Sign-up is easy

For more information: http://www.astrazeneca-us.com/content/patientAssistance/astrazeneca-medicine-and-me.asp or 1 800-292-6363 Monday through Friday, 8:00 AM to 7:00 PM EST.

The Diabetes Resource Center

Address the needs of high risk diabetes populations including the uninsured, underinsured, and homeless; Reduce the risk of diabetes related complications and hospitalizations

Who is served? People without insurance, limited insurance coverage, and homeless of the greater Providence

area. When needed, the DRC also services people throughout Rhode Island and nearby states. Approximately 800 persons are serviced yearly. Spanish-speaking Diabetes Nurse Educator is available on a part-time basis. For more information: http://www.health.ri.gov/disease/diabetes/drc.php or 401-456-4419

Pharmacy Outreach Program-URI College of Pharmacy This program is committed to providing the Rhode Island community with the latest, most complete information regarding medications. It is also invaluable to Rhode Island, in providing medication education and resource information. The program gives presentations about various disease states, develops informational media, conducts Brown Bag Programs, participates in Health Fairs and provides information on available health related. For more information, call toll-free number 1-800-215-9001 or www.uri.edu/pharmacy/outreach HealthAccessRI

It is a new way for people with little or no health insurance to obtain the services of primary care doctor at a low price.

Cost: Varies by practice but consists of these elements: One-time enrollment fee of $15 to $80; monthly fee of $25 or $30; office visit fees of $5 or $10; Doctors: 7 practices with a total of 21 family-medicine doctors. What you get: 24 hours telephone access, sick visits, well childcare, check-ups, school and sports physicals, family planning, yearly physicals. What you don’t get: Hospitalization, specialty care, x-rays, laboratory work, prescription drugs, emergency room visits, mental health care. For more information: www.Health-AccessRI.com ; 401-647-3595

Genesis Center

The Genesis Center is a multi-service organization offering a full range of services to immigrants and refugees from twenty-six countries. Current programs include:

• English for speakers of other languages • Pre-Employment training, internships an job

placement • Computer literacy

• Job training in culinary arts, office skills/ clerical, certified nursing assistants and teacher assistants

• Math, consumer education and basic survival skills • Intergenerational literacy and parenting skills • Early Childhood Education Center for children ages

six weeks to five years of age • Worksite literacy at eight business sites throughout the

state • Health education, information and referrals services • Intensive case management and referrals

For more information: http://www.gencenter.org or 401-781-6110

International Institute

We serve as a full-service immigration center providing educational, legal and social services to immigrants and refugees throughout Rhode Island and southeastern New England. Fundamental to all our programs and services is the promotion of self-sufficiency; giving client tools to help themselves become active participants in the social, political and economic richness of American life. We also provide a full range of interpreting and translating services and community education and training programs. For more information: http://www.iiri.org/whatwedo.htm or 401-461-5940 Dorcas Place- Adult and Learing Family Center Our mission is to assist low-income adults in realizing their full potential through literacy, employment, advocacy and community involvement.

In carrying out this mission we embrace these values: advocacy, collaboration, community, family, empowerment, compassion, diversity, hospitality, life-long learning, respect and responsibility. For more information, please call 401-273-8866 or http://www.dorcasplace.org/ Economic Development Center for Southeast Asians To provide an ongoing group which is culturally and linguistically accessible and which provides mutual support

and problem solving for Southeast Asian adolescent girls who are (or have been) victims of child abuse, sexual assault and/or domestic violence to assist them in recognizing, understanding and dealing with the violence, assault and/or abuse. It also enhances the knowledge base and problem solving skills of the trainees so they are prepared and empowered to provide education, outreach and support to Southeast Asian women and girls who are at risk of domestic violence, child abuse and/or sexual assault. For more information: Executive Director: Joseph R. Le, 401 274-8811

Pharmacy Outreach Program-URI College of Pharmacy www.uri.edu/pharmacy/outreach

1-800-215-9001 (Trung Tâm Giúp Đỡ Cộng Đồng Biết Thêm Về Thuốc Uống Và Medicare part D)

Xin Thông Báo Quị Vị

Những Trung Tâm Giúp Đỡ Cộng Đồng Tại Rhode Island Và Những Điều Cần Thiết Về Sức Khỏe

Chương Trình Xét Nghiệm Ung Thư Vú Đây là chương trình phục vụ miễn phí cho phụ nữ để khám vú, tử cung để có thể biết mình có bị ung thư hay không. Chương trình này đặc biệt phục vụ cho phụ nữ hiện đang sinh sống ở tiểu bang Rhode Island và từ 40 tuổi trỡ lên không có sức khỏe bảo hiểm hoặc có bảo hiểm sức khỏe nhưng không đủ tiền để đi khám những bệnh nói trên. Nếu quí vị nào muốn biết thêm chi tiết về chương trình này, vui lòng vào website hoặc gọi số sau đây: http://www.health.state.ri.us hoặc 401-222-1161 Chương Trình Xe Tai Đem Sưc Khỏe Đến Cho Cộng Đồng Đây là chương trình giúp đỡ bất cứ quí vị nào mà không có bảo hiểm sức khỏe. Chương trình này có 1 chiếc xe và chiếc xe này sẽ đến các địa điểm trong cộng đồng của tiểu bang Rhode Island để giúp quí vị khám sức khỏe. Quí vị có thể đến đây để khám như đo huyết áp, đường trong máu, mỡ trong máu, và khám coi mình có thai hay không. Ngoài ra chương trình còn giúp đỡ quí vị tìm những nơi mà quí vị có thể đi khám bác sĩ với giá cả phải chăng nếu quí vị không có bảo hiểm sức khỏe. Nếu quí vị nào muốn biết thêm chi tiết về chương trình này, vui lòng vào website hoặc gọi số dưới đây: http://www.womenandinfants.org/body.cfm?id=92&action=detail&ref=61 hoặc 401-277-3629 Chương Trình Giúp Đỡ Mua Thuốc Uống

Đây là chương trình có thể giúp quí vị nào mà không có bảo hiểm sức khỏe để trả tiền thuốc men. Chương trình này cùng với các nhà sản xuất thuốc, bác sĩ, các ngành y tế giúp quí vị mua thuốc miễn phí hoặc trả thấp. Nếu quí vị muốn biết thêm chi tiết hoặc điền đơn xin thuốc, xin vào trang web site này : www.pparx.org/Intro.php hoặc gọi số điện thoại miễn phí sau đây: 1-888-477-2669 Trung Tâm Khám Sức Khỏe Miễn Phí

Đây là nơi mà bác sĩ, y tá, dược sĩ và những người khác trong ngành y tế tình nguyện giúp cho quí vị được khám sức khỏe miễn phí khi quí vị không có bảo hiểm sức khỏe.

Nếu quí vị muốn biết thêm chi tiết hoặc có thể đến nơi này để tìm hiểu thêm, xin quí vị liên lạc đến địa chỉ sau đây hoặc gọi số dưới đây: 655 Broad Street, Providence, RI 02907; www.rifreeclinic.org hoặc 401-274-6347 Chương Trình Mua Thuốc Với Giá Rẻ Cho Những Người Không Có Bảo Hiểm Sức Khỏe

Chương trình này có thể giúp quí vị mua thuốc với giá phải chăng. Để có thể mua thuốc với giá phải chăng hay rẻ, quí vị phải có những điều kiện sau đây để được vào chương trình này. Lệ phí hang năm cho trương trình này là $20.00 đồng. 1. Quí vị nào không có bảo hiểm sức khỏe mà giúp quí vị trả

tiền thuốc. 2. Quí vị ở tuổi từ 19 đến 65 tuổi và hiện đang ở tiểu bang

Rhode Island 3. Quí vị phải có mức lương mỗi năm bằng 200% tiền ấn

định của nhà nước.

Nếu trở thành thành viên của chương trình này, quí vị có thể mua thuốc tại các nhà thuốc tay mà họ có thể gửi cho quí vị bằng bưu điện và họ có thể gửi đến tận nhà cho quí vị mà quí vị không phải trả tiền lệ phí gửi. Nếu quí vị nào muốn biết thêm chi tiết về chương trình nay, xin hãy gọi số điện thoại miễn phí sau đây: 1-800-311-0553

Chương Trình Mua Thuốc AZ Và Tôi Cho Medicare D

Chương trình này sẽ giúp quí vị nào đã vào chương trình Medicare Part D mà vẫn còn khó khăn khi mua thuốc của nhà sản xuất AstraZeneca. Nếu được vào chương trình này rồi, quí vị sẽ trả khoảng $25.00 cho 30 ngày uống thuốc của công tyAstraZeneca sản xuất. Chương trinh nay rất dễ dàn đăng ký và không phải trả tiển lệ phí hàng năm. Để trở thành hội viên của chương trình này, quí vị sẽ phải hội đủ các điều kiện sau đây:

1. Lương mỗi năm của 1 người phải dưới $30,000 một năm và $40,000 một năm cho 2 vợ chồng.

2. Uống thuốc do hãng AstraZeneca sản xuất. 3. Một năm phải trả ít nhất là 3% của số lương mỗi năm cho

những thuốc mà được sản xuất bởi công ty AstraAeneca.

Nếu quí vị muốn biết thêm chương trình này, xin quí vị vào Web sites sau đây hoặc gọi số điện thoại sau đây: http://www.astrazeneca-us.com/content/patientAssistance/astrazeneca-medicine-and-

me.asp hoặc 1-800-292-6363 từ thứ hai đến thứ sáu, từ 8 giờ sáng đến 7 giờ tối, giờ của New York Trung Tâm Tư Vấn Tiểu Đường Trong Máu

Cơ quan này sẽ giúp quí vị nào có bệnh đường trong máu mà không có bảo hiểm sức khỏe hoặc có bảo hiểm nhưng bảo hiểm không đủ để trả tiền đi bác sĩ hoặc cho những người không có nhà ở. Cơ quan này hoat động nhằm mục đích giúp quí vị giảm đi bệnh đường trong máu mà quí vị hiện đang có hoặc giúp quí vị làm thế nào để phòng ngừa không để bệnh này xảy ra cho quí vị.

Quí vị nào muốn biết thêm chi tiết, xin quí vị đến cơ quan này tại: The Diabetes Resource Center

St Joseph Hospital for Specialty Care 21 Peace Street, Providence 401- 456-4419 hoac website

http://www.health.ri.gov/disease/diabetes/drc.php Chương Trình Giúp Đỡ Cộng Đồng Của Trường Dươc Sĩ Tại Đại Học URI

Chương trình này quyết tâm giúp đỡ cộng đồng ở Rhode Island với những tin tức mới nhất về tất cả những loại thuốc có mặc trên thị trường. Ngoài ra chương trình này còn cung cấp những tư liệu về sức khỏe và nói những diển đàn về bệng tật trong cộng đồng. Chương trình này còn có thể đến những cộng đồng nhỏ để kiểm tra thuốc mà quí vị hiện đang uống để coi có phản ứng phụ hay không và giúp vị uống cho đúng. Nếu quí vị muốn biết thêm chi tiết về chương trình này, xin quí vị vào trang website này : www.uri.edu/pharmacy/outreach hoặc gọi số điện thoại miễn phí sau đây : 1-800-215-9001 Chương Trình Sức Khỏe Tại RI Đây là chương trình dành cho quí vị nào không có bảo hiểm sức khỏe hoặc có những bảo hiểm trả rất ít thì có thể vào chương trình này để đi khám bác sĩ với giá thấp. Muốn vào chương trình này quí vị phải đóng 1 lần tiền lệ phí từ $15 đến $80 đồng ; mỗi tháng quí vị sẽ đóng $25 hoặc 30 đồng ; mỗi lần đi bác sĩ phải trả khoảng $5 hoặc $10. Nếu vào chương trình này thì quí vị sẽ được trả những phần sau đây: 1. Có thể chọn trong vòng 21 bác sĩ gia đình 2. Có thể gọi cho bác sĩ 24 tiếng đồng hồ, đi gặp bác sĩ nếu

bị bệnh, có thể đi khám tổng quát

3. Quí vị có con em đi học hoặc chơi thể thao trong trường có thể đi khám sức khỏe định kỳ hoặc nếu xảy ra tai nạn trong khi chơi thể thao thì có thể đến bác sĩ khám.

4. Quí vị có con nhỏ cũng được khám nếu con quí vị bị đau. Tuy nhiên quí vị sẽ không được hưởng những thứ sau đây:

1. Bệnh viện 2. X quang 3. Đi bác sĩ chuyên môn 4. Laboratory work 5. Mua thuốc uống 6. Đi phòng cấp cứu 7. Trị bệnh tâm thần Ngoài ra nếu quí vị muốn biết thêm, xin vào website : www.Health-AccessRI.com ; 401-647-3595 Genesis Center - Trung T â m N ă ng Khiếu Đây là cơ quan có thể giúp đồng bào tỵ nạn về việc học tiếng Anh, dạy học những công việc như nấu ăn, làm trợ lý thư ký văn phòng, hoặc trở thành phụ tá giao viên dạy học, hoặc để trở thành phụ tá cho y tá. Ngoài ra cơ quan này còn giúp quí vị kiếm việc làm và hướng dẫn các điều biết cần thiết cho nghành y tế. Nếu quí vị nào muốn biết thêm về cơ quan này, xin vào website sau đây hoặc gọi số điện thoại sau đây : http://www.gencenter.org; 401-781-6110. Địa chỉ: 620 Potter Ave, Providence, RI 02907 International Institute -Trung T â m Qu ốc T ế Đây là cơ quan giúp đỡ người tỵ nạn để chúng ta hòa nhập vào xã hội Mỹ một cách dễ dàng. Cơ quan này giúp đồng bào tỵ nạn nhũng việc sau đây: 1. Giúp đỡ trong việc thông dịch 2. Giúp đỡ trong việc vào công dân Mỹ và bảo

lãnh cho người thân vào Mỹ 3. Giúp đỡ về việc điền đơn xin làm thẻ xanh 4. Giúp đỡ đồng bào tỵ nạn khi mới đến Mỹ tìm

chỗ ở, trường học cho con cái, dạy nghề và giúp tìm việc làm.

5. Ngoài ra cơ quan này còn giúp đỡ cho quí vị học tiếng Anh va những lớp này được dạy vào ban ngày, ban đêm và thứ bảy hàng tuần. Cơ quan này cũng dạy để lấy bằng trung học, dạy vị tính và lấy bằng công dân Mỹ.

Nếu quí vị muốn biết thêm về chương trình này, xin quí vị liên lạc website: 401-461-5940 hoặc

http://www.iiri.org/whatwedo.htm;

Dorcas Place-Trung Tâm Dạy Nghề Cho Người Lớn Và Gia Đình Đây là trụ sở giúp đỡ quí vị nào đã lớn tuổi có gia đình hoặc chưa có gia đình và lương mỗi năm thấp muốn đi học để lấy bằng tốt nghiệp trung cấp hoặc muốn học thêm đại học. Ở đây có hướng dẫn dạy nghề, tìm việc làm sau khi học nghề. Quí vị nào muốn biết thêm chi tiết xin liên lạc theo website sau đây: http://www.dorcasplace.org/ hoặc 401-273-8866 Trung Tâm Phát Triển Kinh Tế Cho Các Nước Đông Dương. Trung tâm nay giúp đỡ những em gái bị làm nhục về thể sát lẩn tinh thần v à l à nạn nhân của sự đánh đập ở trong hoặc ngoài nhà. Ngoài ra trung tâm này còn giúp các em hiểu biết và nhận thức về sự bạo đọng và hành hạ như thế nào nhằm giúp các em tránh khỏi xảy ra. Nếu quí vị muốn biết thêm chi tiết, vui lòng gọi: Joseph R. Le -401-274-8811

Appendix A

Appendix A Sites for Pharmacy Outreach Program- 2011

Bristol County:

Barrington Senior Center Benjamin Church Bristol Senior Center Franklin Court St. Mary’s Church Warren Senior Center Kent County: Buttonwoods Community Center Charles Ford Terrace Coventry High School Career Day Coventry Senior Center DeAngelis Manor I and II East Greenwich Senior Center Greene Public Library Greenwich Bay Manor Greenwich Village Apartments Greenwood Terrace Hardig Brook Village Kent County YMCA Matthew XXV Meadowbrook Terrace MS Support Group Pilgrim Senior Center Plaza Esperanza Temple Am David Warwick Terrace West Bay Manor West Shore Terrace West Warwick Senior Center Wildberry Apartments Newport County: Anthony House Atria Aquidneck Place Clarke School House Edward King House Harbor House Insight-Newport Portsmouth Housing Authority Portsmouth Senior Center Sakonnet Bay Manor Tiverton Senior Center West House

Providence County: 201 Thurbers Ave 1890 House Adelante Apartments Allegria Court Atria-Lincoln Bear Hill Village Blackstone Falls Blackstone Valley Community Health Center Bradford Court Bridge at Cherry Hill Capital City Community Center Carroll Towers Charlesgate North and South Chateau Claire Chimney Hill Apartments CHisPA Cranston Senior Center Cranston Senior Guild Crepeau Court Cumberland Senior Center Dexter Manor Dominica Manor Dorcas Place Douglas Manor East Bay Manor East Bay RSVP East Providence Senior Center East Side Apartments Elmhurst House Elmwood Adult Day Care Emerald Bay Manor Epoch Assisted Living on the East Side Fairmont Heights Forand Manor Fox Point Senior Center Gatewood Apartments Grace Church Apartments Harris House Insight-Cranston Insight-East Providence Insight-Lincoln Insight-Woonsocket Jewish Community Center John Hope Settlement House Johnston Senior Center Kennedy Manor Leon Mathieu Senior Center Lincoln Senior Center

McAuley House Metcalf Apartments North Bay Manor PACE organization of RI Park Ave Apartments Parkview Manor Pocassett Bay Manor Progreso Latino Ralph Holden Community Center Salvatore Mancini Senior Center St. Edwards Pantry St. Germaine Manor St. Elizabeth’s Court St. Elizabeth’s Place St Germaine Manor St. Martin de Porres Center Temple Emmanuel Temple Torat Village at Waterman Lake VJ Doyle Manor Washington Hill Apartments West End Community Center Westminster Senior Center Wilfred Manor Woonsocket Senior Center Washington County: Arcadia YMCA Babcock Village Brightview Commons Indian Run Village Apartments Insight- Westerly La Casa Narragansett High Career Day Narragansett Indian Tribe North Kingstown Senior Center Peacedale House Richmond Senior Center Saugatucket Springs Slocum Grange South Bay Manor South County YMCA The Center Westerly Senior Center

Appendix B

Equal Housing Opportunity

CENTRAL FALLS HOUSING AUTHORITY 30 WASHINGTON STREET

Central Falls, RI 02863 Main Office (401) 727-9090

Fax (401) 728-0291 February 10, 2012 To Whom It May Concern: This letter is in support of the University of Rhode Island Pharmacy Outreach program. The Central Falls Housing Authority has benefited from this program by ways of educational outreach to elderly and disabled residents of Central Falls Housing Authority. Programming has included medication management, diabetes and hypertension education. We have enjoyed a cooperative working relationship with University of Rhode Island Pharmacy Outreach Program staff and look forward to continuing to work with this program in the future. Sincerely, Aimee Tortolano,PSC Resident Service Coordinator Central Falls Housing Authority

February 22, 2011

To Whom It May Concern: This letter of recommendation is to confirm that the URI Pharmacy Outreach Program is indeed a great initiative that has been playing an important role in the education and health behaviors of our community members. In the past year the Pharmacy Outreach Program developed and implemented a summer health fair for our clients which had an incredible turn out. The program has also provided other workshops in Spanish for our clients. One of the workshops was related to hypertension and the other one was about depression. The participants love the workshops and the interaction with the provider. They ask many questions and have asked me to bring the Pharmacy Outreach Program to CHisPA for additional workshops. We are very pleased with the information the program provides and its methods of conveying the information with power point presentations, visuals and an open mind. It is also greatly appreciated that they offer these workshops in Spanish given that a large part of our population are Spanish speaking. I would, with no doubt, recommend the Pharmacy Outreach Program to other agencies and community centers. The work they do is essential in the development of a healthier and safer Rhode Island! If you may have any further questions please feel free to contact me at the information given below. Sincerely, Priscilla Nascimento Health Consultant/ Tobacco Control Coordinator Center for Hispanic Policy and Advocacy 421 Elmwood Ave, Providence, RI – 02919 pnascimento@chispari.org (401) 467-0111

Nancy Tortolani, R. Ph. January 18,2012 Coordinator University of Rhode Island Pharmacy Outreach Program 123 Fogarty Hall Kingston, Rhode Island 02881 Dear Nancy, It is with pleasure that we write this letter of support for you and your students in the University of Rhode Island Pharmacy Outreach Program. Continued funding for this invaluable program is imperative. The mission of the Cranston Department of Senior Services in its capacity as a community based resource and human service agency, is to provide coordinated, creative, and comprehensive services which educate, nourish, assist, entertain, and enrich the lives of individuals 55 years of age and older. With the help of this Pharmacy Outreach Program we are able to meet our mission goal of educating our elder population in the areas dealing with health issues and their medication queries. Also, with your presentations available in Spanish, communities throughout the state are able to address and meet the education needs of a diverse population. We need this monthly program in order to continue to provide valuable and necessary health information to our senior population. Knowledge is power. This program empowers our older population to become actively involved in improving their overall health status through education. Congratulations to you and your staff for a job well done! Gratefully, Nancie Paola, Co-Director Raymond Sinapi, Jr. Co-Director Cranston Department of Senior Services 1070 Cranston Street Cranston, Rhode Island 02920 401-780-6000

March 11, 2011 To Whom It May Concern: I, Sheyla Montalvo (the Social Worker from Elmwood Adult Day Health Care Center) am delighted to be writing this letter of recommendation for the URI Pharmacy Outreach Program. The center is comprised of approximately 97% Hispanic elderly and adults with disability. One of the participants’ major interests is health education. It was a challenge trying to find someone who is bilingual. URI Pharmacy Outreach Program has made it possible for us to provide health education to our participants. It has been a blessing to have the URI Pharmacy Outreach Program come once a month for several months now. What makes this program unique is that the health education is given by an actual health care professional. With that said, the participants feel at ease to ask any questions or discuss any concerns in their language. Another great characteristic of this program is that they are not restricted to certain topics; they provide a list to choose from that will be of interest to this population. The URI Pharmacy Outreach Program RPH who has been very supportive and helpful is Noemi Ramos. I highly recommend her and the program without reservation to any agency, company, or organization inquiring about the services URI Pharmacy Outreach Program provides. Noemi is always on time, prepared, and always manages to keep the participants interested. She also is very thoughtful in bringing a student with her to translate to the participants who are not Spanish speaking. URI is running, and providing a valuable and meaningful program, and I am looking forward to continue our affiliation. Feel free to contact me via phone or email with any questions or concerns. Sincerely, Sheyla Montalvo Social Worker Sheyla.EADHC@verizon.net

Elmwood Adult Day Health Care Center

209 Elmwood Avenue Providence R.I., 02907 Ph. 401.421.6300 Fax 401.459.4005

February 20, 2012 To whom it may concern; The Pharmacy Outreach Program at the University of Rhode Island has been of great value to INSIGHT’s Community Groups. The presentations have provided our members with sound information that was presented in a very understandable and interactive presentation. No cheap commodity in this age of information, which can often be confusing and misleading. Sincerely, Richard Andrade Director of Vision Rehabilitation

To: Nancy J. Tortolani, R.Ph. Coordinator, Pharmacy Outreach Program The University of Rhode Island College of Pharmacy Dear Nancy, I want to take this opportunity to let you know how much your programs are appreciated by our guests. The Senior Café at, Temple Torat Yisrael in Cranston, and the Jewish Community Center in Providence are greatly enhanced by your programs that engage and inform so many of the seniors that come to our Meal Site. We all look forward to meeting your well informed students and hearing the important information they come to share with us. These programs always encourage discussions that go on well after your group has left and the educational value to my guests enhances their lives. Thank you so much for sharing your wonderful students and insightful programs with us. We look forward to your next visit. Till then Neal Drobnis

Cooridinator of Kosher Nutrition Jewish Family Service ndrobnis@jccri.org 338-3189 861-8800 x 107

December 13, 2011 To Whom It May Concern: I am writing in my capacity as Director of the Leon Mathieu Senior Center, Pawtucket’s Division of Senior Services in support of the University of Rhode Island’s College of Pharmacy Outreach Program. Through the University’s Outreach Program thousands of elderly and disabled members of the Senior Center and the community at large have benefited from the programs that have been presented. Monthly blood pressure screenings and one on one consultations with a pharmacist and College of Pharmacy students have had a tremendous impact on the Center’s ability to track potential health concerns of the individuals who attend the Senior Center. Having the ability to meet one on one with a pharmacist, has enabled the seniors to review their prescription and non-prescription medications to identify and eliminate any adverse drug interactions; to receive guidance on medication and health management; and in some instances to realize some savings on their medications. This resource is usually not readily available through their primary care physician. In addition to the monthly blood pressure screenings and medication brown bags, the Pharmacy Outreach Program presents educational programs that have highlighted many different health concerns from topics focusing on heart health to osteoporosis. Very understandable and thorough presentations have been offered at the Senior Center, and if there is a hot topic “Shingles Vaccine” for example the Outreach Coordinators have been very receptive to having the pharmacy students develop a program to fit our needs. Lastly, the other area where the Pharmacy Outreach Program has assisted the Senior Center Staff is during open enrollment for Medicare Part D. The Outreach program has assisted us in meeting with the elderly to help them understand their plan options so that they can make an educated decision about which plan best suits their needs. At the present time, our agency has just one case worker to assist the elderly with their health insurance needs so the help that we receive from the Outreach Program is invaluable. Please do not hesitate to contact me, should you have any further questions. Sincerely yours, Mary Lou Moran Director

December 15, 2011

To whom it may concern:

For the past six years, the Lincoln Prevention Coalition has utilized the Pharmacy Outreach Program at the University of Rhode Island. The programs that are offered address the needs of the elderly population in the Town of Lincoln and allow us to fully develop a comprehensive prevention program using evidence based strategies.

Nancy Tortolani, coordinator of the Pharmacy Outreach Program and her students demonstrate a profound knowledge of how to improve one’s health through their educational workshops. Programs such as the brown bag program, cold and flu, dementia, and tinnitus have been very well received at the Lincoln Senior Center. The Pharmacy Outreach Program is a vital component in addressing many issues the elderly population is facing. Their dedication, commitment, and positive attitude are invaluable to the Lincoln Prevention Coalition. The Pharmacy Outreach Program continues to be an asset to not only our coalition, but also for the Lincoln Community.

Sincerely,

Pamela C. Shayer, M.Ed, APS Lincoln Prevention Coalition 401-333-8426 pshayer@lincolnri.org

January 10, 2012 Nancy J. Tortolani, R.Ph. Coordinator, Pharmacy Outreach Program The University of Rhode Island College of Pharmacy Re: Letter of Support Dear Nancy: Director’s endorsement URI Pharmacy Outreach Program. The Portsmouth Multi Purpose Senior Center do hereby support the URI Pharmacy Outreach Program. As a former Pharmacy Technician for 18 years, I do know how this is an invaluable resource for the elders, the disabled, and the community of Newport County. Respectfully, Cynthia J. Koniecki

Portsmouth Multi-Purpose Senior Center 110 Bristol Ferry Road

PO Box 202 Portsmouth, Rhode Island 02871

Phone: 401-683-4106 Fax: 401-683-4001

February 23, 2011 To Whom It May Concern: This letter is in support of URI’s Pharmacy Outreach Program which has been an asset in the health education and programming of our community members. In the past year the Pharmacy Outreach Program conducted several workshops both in the morning to our staff and clients, on various health issues and medication reviews. The program has also provided individual medicine overview with our clients who due to lack of literacy and language often take their medications inappropriately. The participants love the workshops and the interaction with the provider, who bring a genuine approach to program. The participants ask many questions during the workshops and are always eager when the schedule is displayed at Progreso of the upcoming workshop. We are very pleased with the information as well as the way the program is delivered with the use of power point presentations, visuals and an open dialogue. On behalf of Progreso Latino and the Health and Wellness staff we thank you for our collaboration and look forward to working together. If you may have any further questions please feel free to contact me at the information given below. Sincerely, Vinnie Velazquez, MS Wellness Program Director/consultant Progreso Latino, Inc. 626 Broad St. Central Falls, RI 02863 401-617-8489

December 14, 2011

To whom it may concern:

I Linda Loxley the Case Manager at St. Martin dePorres Senior would like to testify, how important the URI Pharmacy Outreach Program is to our organization and the services provided to the community of South Providence.

I have worked with Nancy Tortolani and Noemi Ramos-DeSimone on several programs in 2011; they always are professional and supportive to our community. One of the crucial programs provided is Medicare D screening workshop; this provides personal screening for Medicare beneficiaries, so they can choose the appropriate Medicare Part D for their Medical needs. The pharmacy outreach program also provided educational workshops and medical clinics.

In 2011 I had arranged glucose testing with URI Pharmacy Outreach Program, that I could not receive support from any other organization.

Thank You for your continuous support and dedication. Please feel free to contact me with any questions at 401-274-6783.

Sincerely

Linda M. Loxley

Linda M. Loxley

Case Manager

St. Martin dePorres Senior Center

160 Cranston Street

Providence, RI 02907

January 10, 2012 Ms. Nancy J. Tortolani, R.Ph. Coordinator, Pharmacy Outreach Program The University of Rhode Island College of Pharmacy Fogarty Hall 41 Lower College Rd. Kingston, RI 02881 Dear Nancy: Thank you for the wonderful Pharmacy Outreach Program provided to us by the College of Pharmacy at the University of Rhode Island. The pharmacy students have been giving presentations at the Warren Senior Center monthly for the past year. The presentations are well-attended (12-20 participants) and the information and educational materials provided by the students are informative and valuable to the well-being of our older population. Our seniors interact with the students with their own experiences and much discussion takes place. I look forward to our continued relationship with the Pharmacy Outreach Program. The Program continues to provide information to promote a better quality of life for our senior community. In addition, I am sure the students benefit from the interaction since many will serve this population in their future endeavors. Sincerely, Mrs. Elizabeth Hoague Director

Westerly Senior Citizens Center 39 State Street

Westerly RI 02891 (401) 596-2404

January 23, 2012 To: Nancy Tortolani, R.Ph. Coordinator, Pharmacy Outreach Program The University of Rhode Island College of Pharmacy From: Don Reynolds Westerly Senior Citizens Center On behalf of the membership of the Westerly Senior Citizens Center, I would like to thank you and your students for another year of valued service to the senior citizens of the Westerly area. Many of our members look forward to your monthly visits and the free blood pressure clinics offered by you and your students. As you know this is a valuable service that helps to keep our seniors and their doctors up-to-date on their physical conditions. Also, the special programs that you offer throughout the year are not only enjoyable for the participants, but also informative. These programs attract those who don’t necessarily come to the Center on a regular basis but are attracted by the subject matter (i.e. hypertension, diabetes, “brown bag clinics.” As you are aware, the annual ”brown bag clinics” are highly anticipated by many of our mutual “regulars, who have multiple doctors prescribing multiple prescriptions. Your students have truly affected many seniors who have had questions about why they are taking certain medications, the proper schedule for taking meds, side effects, and when to consult their doctors. In a few cases, seniors were made aware that they were endangering their health by taking the same medication in two different forms from two different doctors and were directed to contact these physicians.

In addition, I would like to thank you for your students’ assistance in enrolling area seniors with Medicare D. I am sure that you are aware Medicare D is overwhelming as our social service department is approached by a tremendous number of seniors for help during a very short enrollment period. It is wonderful having a knowledgeable community partner who is willing to “step up” and assist. Thanks to you and your students, I am proud to say our Social Service workers could address every senior who asked for help in choosing and enrolling in a plan. You and your students clearly and competently presented choices to our clients so that they could make informed decisions. Our members are always commenting on the professionalism of both you and your students and the value of the programs you offer. The help that you both extend provides opportunities for services that otherwise, due to the economic climate, we would not be able to offer. I wish you the best of success for the coming year.

February 1, 2012

Noemi Ramos-DeSimone, Ph.D.,Pharm.D.

Coordinator, CDOE

Pharmacy Outreach Program

The University of Rhode Island

College of Pharmacy

Dear Noemi:

We are writing to express our appreciation for the excellent educational programs presented

by the URI Pharmacy Outreach Program for our participants at the Woonsocket Senior

Center.

The information is always comprehensive yet presented in a format easily understood by

our seniors. The range of topics is excellent and provides an added component in our

Senior Wellness programming at our center.

The Pharmacy students are always well prepared and able to answer questions and give

expert advice to those in attendance. We rely on this type of outreach for our senior

population, helping give them the tools they need to make good choices and live

independently in the community.

Sincerely ,

Susan Sgambato, B.S.

Activity Director

Linda Thibault, RN

Senior Wellness Program Manager

WOONSOCKET SENIOR CITIZENS CENTERWOONSOCKET SENIOR CITIZENS CENTERWOONSOCKET SENIOR CITIZENS CENTERWOONSOCKET SENIOR CITIZENS CENTER

84 Social Street �Woonsocket, RI 02895

WEST WARWICK SENIOR CENTER 145 WASHINGTON ST. WEST WARWICK, R.I. 02893 TEL: (401) 822-4450 FAX (401) 822-4825

*OUR MISSION IS TO IMPROVE THE “QUALITY OF LIFE” FOR SENIORS* The West Warwick Senior Center, The Pharmacy Outreach Program and The University of Rhode Island College of Pharmacy share a mission to aid local senior citizens, and adults with disabilities, by providing informational and educational services to improve and enhance their quality of life. The Pharmacy Outreach Program provides West Warwick residents with information on their medications through our educational programs and with medication therapy management through our Brown Bag Program. The many helpful topics of The Pharmacy Outreach Program is a free resource for help with health and financial medication issues. All of these services are utilized by the West Warwick Senior Center and our collaboration with the University of Rhode Island College of Pharmacy Outreach Program to fulfill our shared mission. Our senior participants look forward to the monthly seminars which are an important vehicle for informing and educating our senior citizens in this ever changing world of health care, especially with regards to the use of prescription medications. Some past presentations that piqued our senior citizens interest were presentations on Restless Leg Syndrome, Medication Safety, Pharmacy 101,Drug Interactions, Foot Care, and Medications As We Age, just to name a few. Thank you to Nancy Tortolani R.Ph, Coordinator, Pharmacy Outreach Program and the University of Rhode Island School of Pharmacy and her wonderful group of students and presenters. You provide a priceless service to our senior citizens. Manuel Murray President/CEO, West Warwick Senior Center, Director of Human Services, Town of West Warwick 145 Washington St. W. Warwick, R.I. 02893 Phone: 401-822-4450 Fax: 401-822-4825

URI College of Pharmacy Outreach Program

It was a fantastic experience for me to do the URI Pharmacy Outreach rotation.

At the first time, as an international student whose first language is not English I was nervous when performing a presentation in front of people. However, as I spent 6 weeks on doing this rotation, giving various health and disease-related presentations to educate seniors helped me practice speaking English in public and learning important presentation skills. Also, the presentation skills were much improved by feedbacks and tips from two preceptors, Nancy and Neomi. This rotation is absolutely a great choice for the pharmacy students to look for learning how to speak in public and counsel the patients.

Also participating in Brown Bag Program which is a comprehensive evaluation of medication for seniors, I learned ability to counsel patients about their medication and was able to figure out the important drug interactions among drugs seniors were usually taking. Another fun activity I enjoyed was to assist seniors through the enrollment process for Medicare Part D. It was just realized most of seniors felt difficulty signing or enrolling Medicare part D and needed someone who could give a hand. As well, it is essential for a community pharmacist taking care of elder patients to know how to enroll Medicare Part D.

Definitely, I would highly recommend to this rotation for the pharmacy students.

Haeyoung Lee, PharmD Candidate

The Universith of Rhode Island, College of Pharmacy

Class of 2012

Jeremy L. Blais, PharmD 38 Washington Street Matunuck, RI 02879 September 1, 2011

Dear Dean Jordan,

I hope that this letter finds you well. I wish I had sent it sooner, but all the fun that goes along with graduating and starting a new job has unfortunately delayed me. All the same, the reason for my writing you is to recommend with the highest levels of praise and gratitude the work that Nancy Tortolani and Noemi Ramos-DeSimone do for the College of Pharmacy through the Pharmacy Outreach program. The breadth and depth of the skills and knowledge gained through their rotation make it one of the most useful rotations available to students, and an experience that is indispensable for any pharmacist going into the community field.

The crux of the experience is the opportunity to have meaningful interaction with patients, many of them senior citizens, many of which have barriers to care or poor health literacy. Through the rotation, we learned how to speak to these patients with empathy, how to communicate healthcare information in a useable and relatable manner, and how to address many “real-world” problems such as the Medicare coverage gap or cost-savings opportunities for patients without insurance. For someone like myself who has grown up in a community pharmacy, the defining aspect of the job for me has always been the ability to empathize with patients and caringly communicate valuable information to them in a way that they can understand. The ability to form that rapport is not always innate, and for many new graduates that skill takes a significant amount of time to learn. I use the communication and problem-solving skills I learned on this rotation every single time that I step behind the counter.

Just as important as the skills that are taught on the rotation are the people teaching them. Nancy and Noemi are two beacons of positivity, always smiling, always helping, and always showing their students how to truly care about helping people. Every presentation is held to the highest standards of professionalism, and their level of pride in what they do is readily apparent. They taught me that every interaction, whether it’s one patient at a counter or a hundred people in a conference, is an equally important moment for you to represent yourself. To watch them represent the college in the way they do is inspirational. They have a thousand years of patience, especially given the populations that they serve, and they truly make the students elevate their standards to match theirs.

While not every student will be lucky enough to do “brown bag” programs on a regular basis once they graduate, the skills you learn are really the bread-and-butter of community pharmacy. How often does a patient walk in, and empty a bag of unlabeled pills out on the counter to try to figure out what they are taking? How

often do we have to peruse a patient’s profile to figure out gaps in care, or alternative therapies? How often do we have to try to overcome communication barriers, either linguistic or age-induced, in order to help patients? The mind-set that the outreach program puts you in gets used every single day in a pharmacy. For any student looking to become a complete community pharmacist, the Outreach Program really is a “must-take” rotation.

I was fortunate enough to be offered a position as a pharmacy manager for CVS out of school. About 3 weeks after I passed my boards, my district manager sent out an email looking for a pharmacist to talk to a Parkinson’s Disease support group at the Leon Mathieu Center in Pawtucket, a site I was familiar with thanks to my Outreach rotation. I jumped at the opportunity, and using the skills I spent six weeks working on with Nancy and Noemi, I put together a presentation and was able to generate a very good two-way discussion that addressed a wide-range of issues these patients were dealing with. The presentation went over very well, so well that I am now in the process of putting together more presentations through CVS for various groups in the area, from professional-level presentations for nurses to patient education pieces. I can tell you, with one hundred percent certainty, that Nancy and Noemi are responsible for my success that day. Everything I displayed that day was a direct reflection of the professionalism, empathy, presentation skills, and confidence they teach their students day in and day out. They are truly a credit to the College of Pharmacy, and the value of the work that they do, both for their patients and for their students, cannot possibly be overstated.

Sincerely,

Jeremy L. Blais, PharmD

Hello Noemi, Here is my reflection on the Outreach rotation: I truly enjoyed my 6 weeks participating in the URI Pharmacy Outreach Program. Before entering this rotation I was not confident in my skills of communicating with the public, particularly in counseling on medications. I hoped to gain better communication skills so that I would better serve the public as a pharmacist. What I didn't anticipate when entering this rotation was the variety of experiences I would have that would not only improve my verbal communication skills, but also allow me to broaden my experience with the public in many other ways. As I gave my first presentation on this rotation, I immediately recognized that I would have to learn to address this audience differently than the nurses and doctors I had communicated with on previous rotations. I learned to break down complex disease states, medication regimens, and mechanisms of action into simple terms that senior citizens could understand and apply to their own lives. It was also clear to me that the community truly appreciated our presence and the wealth of information we could provide. After our talks they felt that they could make more educated decisions about their healthcare. Many people we visited stated that they wished the Outreach program came more often and asked when we would be coming to their center again, and what topic we would present. I really felt that we were making an impact in the lives of these individuals.

Another aspect of Pharmacy Outreach that I truly enjoyed was the brown bag program. I had anticipated that this would significantly improve my counseling skills, and I truly felt more confident in interviewing patients by the end of my 6 weeks. I was also amazed on how it taught me to relate to the patient and ask the right questions to delve deeper into their complex medication regimens. All of the people who we saw were truly grateful for our time and the information we provided. In all cases I felt we were able to make meaningful interventions to optimize their drug therapy and encourage them to take an active role in their healthcare by communicating with their doctors and pharmacists.

This rotation allowed me such a variety of experiences in different community settings that I truly feel prepared to communicate with a variety of patient subgroups. I spoke to groups of higher and lower education and income levels, a variety of ethnic groups, and even a Spanish-speaking population. I especially enjoyed doing the presentation on herbals in Spanish with Noemi. It was terrifying to try and communicate in a different language, but I also enjoyed pushing out of my comfort zone and trying to improve my Spanish skills so that I can better communicate with my patients in the future. This is a work in progress, but I am extremely thankful to have had this opportunity and look forward to continuing to improve my Spanish in the future.

Another skill that I learned on this rotation was how to take blood pressure. I know it is something that I will use in the future and I appreciated the opportunity to practice during the blood pressure clinics. The blood pressure clinics were well-attended and many patients have records of coming every month. Again, this is an example of how Pharmacy Outreach is improving the health of the community by empowering them to take an active role in their health. Overall this rotation was a wonderful experience and I feel tremendously lucky to have learned so much from Nancy and Noemi as well as the members of the communities we served.

This program has a strong impact on the communities of Rhode Island and I feel is an excellent representation of the URI College of Pharmacy. I would definitely recommend this rotation to future students as it is a tremendous learning experience.

Thanks so much for everything!

Sincerely,

Jess Lehmann

How I felt about my experience with The URI Pharmacy Outreach Program:

Over the six weeks working with the URI Pharmacy Outreach Program I learned a great deal about how to communicate with others in the public. In the past four years at the University of Rhode Island, I learned a great deal of clinical information on disease states as well as medications and proper therapies. However, it wasn’t until this rotation that I felt comfortable in properly speaking and counseling patients about their medications. Originally when starting the Outreach rotation I was somewhat frightened about the amount of presentations that were expected of me. I was used to one or two a month in various classes, and never felt relaxed speaking in front of large groups of people. Throughout the time I spent on this rotation I learned what worked when speaking to the community. I became aware of what kept people’s attention, and spoke to the audience’s interests. Practicing a power point presentation at home before going to a senior center or community forum would help a bit, but it wasn’t until the second or third time presenting a topic such as the flu, or Medicare Part D that I would really understand the material, start to expect what questions the audience would ask and what were the crucial take home points to re-enforce. Using the Brown Bag Program to speak one on one to patients taught me how to counsel on what side effects to expect, what therapeutic goals a patient wanted to achieve as well as when to talk to a patient’s doctor about alternative therapies that may be choices for them. It was here that I could use my clinical skills to help optimize their therapy while learning how to communicate to different types of patients. Overall this was my favorite rotation because I felt that I was making a difference in the community while furthering my counseling skills. Every senior center or fair that the other students and I attended appeared to enjoy that we came and always asked when the next time the program was coming to that community center was (and when we did, they always remembered us). In my opinion, I learned the most important skill I will take with me in my future career, speaking to others about their medications. Knowing a great deal about medications, how they work or when they should be taken is good to know, but it isn’t until one can properly communicate this knowledge to others that a pharmacist’s role can be appreciated. Ryan Wilkin PharmD Candidate

URI College of Pharmacy Outreach Program

Throughout the final year of pharmacy school my fellow students and I become exposed to a tremendous variety of pharmaceutical care. Hospitals, walk in clinics, managed care facilities and community pharmacies provide the learning environments that teach us just how influential we can be in proper patient care. However, I felt that my time spent with the Pharmacy Outreach Program showed me just how important we can be, and how trusted we actually are by the community. I learned an extraordinary amount about pharmacy and medicine during my various other rotations, and I don’t mean to downplay their importance in any way, but the patient interaction that occurred during the Outreach Program has, I believe, prepared me to be a community pharmacist more than any other rotation. The scope of topics (upwards of 80 now, I believe) as well as the opportunity to visit with patients and hear the questions that they have really created an environment that mimicked the community setting. Speaking with older patients and hearing the questions that maybe they don’t get an opportunity to ask their own pharmacist allowed me to understand the importance that a pharmacist can play in the everyday life and care of any patient, not just the elderly. Often times one of the seniors we would go to see would say that they had been taking their medicine forever and had no questions about it. When we dug a little deeper sometimes we learned that they were taking it at the wrong time, or not with food, or some other incorrect way and that they were in fact having some unpleasant side effects that they thought they just had to live with. Upon counseling them they were often surprised yet relieved at what they had just learned, and the sincere thanks that they offered us let us know we had done a good job and it felt great too. Knowing that sometimes these patients are embarrassed to talk about certain topics or “don’t want to be a bother” gave us an opportunity to let them know that nothing related to their health is too embarrassing to ask about, and as we often joked to them during presentations, anytime we can get pulled away from the computer or a telephone argument with an insurance company is a good time for us as well, so we certainly encouraged their speaking with us. Lastly, even among the elderly population there is a wide range of knowledge and understanding of medications. One of the points I tried to work on was tailoring my counseling to the appropriate patients. Finding that balance between speaking to the patient so they can understand you, but not talk down to them at the same time was a skill I feel I was able to improve upon. This skill will become extremely important to providing the best patient care possible as I begin my own career. While many different things are learned in all of our rotations, I fell that the Outreach Program, and its focus on counseling and patient education, will allow me to have the biggest impact on my patients’ care as a community pharmacist. The counseling and communication skills I honed, as well as the excellent reviews of common prescription problems and over the counter products this rotation allows, along with the clinical knowledge I have gained from my previous rotations will no doubt allow me to have a successful and meaningful career. I would recommend this rotation to any student interested in community pharmacy and who would like to make a difference in their patients’ health. Thomas Kaufmann, PharmD

Appendix C

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Appendix C Pharmacy Outreach Program University of Rhode Island College of Pharmacy 874-2676 reachrx@etal.uri.edu www.uri.edu/pharmacy/outreach Program Listings for 2011 Available in Spanish and/or Portuguese where indicated. ABC’s of Diabetes (Spanish) An overview specific for the diabetic patient focusing on A: A1C level B: Blood pressure and C: Cholesterol and the importance of all 3 in the diabetic patient. Adverse Drug Reactions Medicines are used to treat or prevent illness or disease. However, sometimes these medicines may cause problems- adverse drug reactions. Learn how to recognize the risks and avoid them. Age Related Macular Degeneration (AMD) (Spanish) A chronic disease of the eye that causes a gradual loss of central vision and is the leading cause of severe vision loss in people over the age of 50. Learn about prevention, risk factors, and treatment of the 2 forms of AMD- Wet AMD and Dry AMD. Allergies (Spanish) Allergies are a very common condition. Learn what causes them and how they affect our health. Appropriate treatments, both prescription and over-the-counter will be discussed. Alternative Remedies for Arthritis Non-traditional treatments are becoming more popular choices for relief of arthritis pain and inflammation. Learn more about the more popular herbal choices, joint manipulation, acupuncture and dietary supplements. Alzheimer’s Disease (Spanish) Up to date discussion of treatment options available for this progressively debilitating disease affecting more than 4 million Americans. Learn what is happening in the on-going clinical trials for treatment. Angina (Spanish) What exactly is angina? This often misunderstood condition impacts the health of many. Learn the causes and latest treatments available. Anti-platelets and Anticoagulants (Spanish) Many people are taking a blood thinner, for example aspirin, Coumadin® or Plavix®. These medications require increased monitoring and place you at a greater risk of drug interactions and adverse effects. It is important to understand the correct way to take these medications and how to avoid problems in your medication regimen. Arthritis (Spanish) Arthritis is the number one cause of disability in the United States. Treatment options for osteoarthritis include lifestyle changes, medications, surgery and alternative treatments. Asthma Millions of people are living with asthma. Learn how to properly manage asthma by monitoring, proper medication administration and understanding your asthma action plan. Brown Bag Program (Spanish) Sit down with our professional pharmacy staff to review and discuss your medications and the diseases they are being used to treat. This serves as an excellent opportunity to evaluate your current medication regimen and ensure that you are taking them properly for maximum benefit. Also review what choices you have to make your medications more affordable. *Please note: Brown Bag Programs are only available on a signup basis.

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Cardiac Function and the Need for Medical Therapy Learn about the anatomy of the heart and how the heart is affected by diseases and the cardiac medications that are used to treat them. Cholesterol (Spanish and Portuguese) Elevated cholesterol levels increase the risk of heart disease and strokes. Controlling cholesterol involves diet, exercise and medications. Learn more about one of the most prescribed drug categories. Chronic Obstructive Pulmonary Disease (COPD) (Spanish and Portuguese) Chronic Bronchitis and Emphysema are the two most important lung diseases that make COPD the 4th leading cause of death in the USA. Learn how to decrease the risks and treat COPD and its complications. Cold and Flu (Spanish) What the difference is between the two and how to properly treat each one as well as effective prevention practices. What to look for in an over-the-counter medication choices and what is the newest information on the flu vaccine. Common Cold How to navigate the pharmacy aisle when choosing an OTC med for treating the cold. What really works and why? Communicate Before You Medicate (Spanish) Learn what you should know about prescription medications and how to get the best results from them. Know what questions to ask, how to avoid medication errors, and understanding why your doctor prescribed a certain medication and the role of your pharmacist in dispensing that medication. Tips on cost cutting and resource information about prescription assistance programs. Compliance (Spanish) How closely do you follow your medication regimen instructions? Do you know the costs- both health wise and financial- of not being compliance. Learn what you can do to be more compliant. Constipation We’re not afraid to talk about it and you shouldn’t be either! Understanding the causes, symptoms, and treatments that can relieve and prevent occurrences. Dementia Did you know... dementia affects an estimated four million people in the United States each year? The prevalence of dementia increases with advancing age with as many as 20% of people over age 80 suffering from the disease. Dementia affects the brain and has a variety of causes. While memory loss is a common symptom, there are many different effects on the body. Depression (Spanish) Depression is not a normal part of aging. How to recognize and treat depression and why drug therapy has become an effective treatment choice. Diabetes: A Basic Understanding (Spanish) An overview of the signs and symptoms of diabetes, prediabetes and the hereditary and lifestyle risk factors. In addition, the importance of early screening for diabetes and lifestyle modifications such as proper nutrition and exercise. Diabetes: More Comprehensive Review (Spanish) A thorough review of both Type 1 and Type 2 diabetes including signs/symptoms, risk factors, proper control of blood glucose levels and health issues affecting the diabetic. Understanding the role of insulin and oral hypoglycemic agents in the treatment of diabetes. Diabetes: Type 1 (Spanish) Focusing in on the treatments specific for the Type 1 diabetic. Review of insulin, testing, insulin pens and helpful resources. Diabetes: Type 2 (Spanish) Focusing in on the treatments specific for the Type 2 diabetic. Review of oral medications, testing and helpful resources.

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Diabetes and Depression For the diabetic patient, there are many sources of depression: being diagnosed, learning how to take care of the disease, changing the diet, all the associated costs that come with the equipment as well as the meds. Learn about recognizing and treating depression in the diabetic patient. Diabetes and Eye Care The potential for complications pertaining to the eye is very real and serious for the diabetic patient. Learn how to prevent and treat diabetic eye disease. Diabetes: Management of Hypoglycemia, Hyperglycemia and Sick Days (Spanish) Overview of signs and symptoms of low and high blood sugar levels and how to properly manage them. Review of most common medications that may cause hypoglycemia. Also, how the person with diabetes should properly care of themselves during sick days. Diabetic Supplies A complete guide to diabetic supplies. What you need and the best ways to get them. Diabetes Medications: Adverse Effects and Drug Interactions An overview of all the classes of medications used in the treatment of diabetes and their most important adverse reactions and drug interactions. Disposal of All Medications and Sharp Diabetic Supplies (Spanish) Advice on how to dispose of medications no longer needed. Also, how to dispose of needles and sharps according to RI laws. Drug Interactions 51% of adult Americans take 2 or more medications per day and those over 65 years old average 4 or more medications every day. Plus Americans self medicate with over-the-counter drugs and herbals. Add to that the number of foods and beverages that interact with medications. All can significantly increase the risk of a drug interaction and it is important to know how to avoid these potentially dangerous interactions. Fall Prevention (Spanish) As we age, many factors will affect our mobility and stability. Medications, environment, disease states all have the ability to make our lives a little unsafe. This presentation will address these factors and will give you good advice on avoiding the "dreaded fall". Fibromyalgia Learn about the collection of symptoms that make up this syndrome affecting as many as 6 million Americans. Risk factors, diagnosis, medications and lifestyle changes are all explored in discussing FMS-FibroMyalgia Syndrome. Flu 2011 (Spanish) Find out what is the up to date information on the 2010 projections of the flu virus, how the vaccine differs this year from previous vaccines and ways to treat the flu. Foot Care (Spanish) Blisters, corns, bunions and more of different things that can happen to your feet. Learn about these conditions and your treatment options. Gallbladder and Gallstones A review of what is the function of our gallbladder and why gallstones form – risks, symptoms and treatments currently available will be discussed. Generic Drugs The how, what and why of drugs that do not carry the brand name but are chemically equivalent and less expensive. GastroEsophageal Reflux Disease (GERD) (Spanish) Just a fancy name for heartburn? Learn about lifestyle and drug choices for the treatment of this common condition. Getting the Most Out of Your Prescription Dollar Are you spending too much money on your medications? Learn how to properly use formularies, access cost saving programs and other helpful ways to minimize prescription costs.

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Gout Need to dispel the myths from the facts of gout? This presentation will demystify and educate you with the facts of this highly misunderstood disease. Healthy Heart (Spanish) An overview of ways to promote and maintain good cardiac health. Heart Attack An overview of the symptoms, causes, and risk factors of heart attacks. A thorough discussion of the medications used in the treatment and a review of how to be proactive in protecting yourself from having a heart attack. Heart Attack and Stroke (Spanish) What is the difference between heart attack and stroke? What do the terms MI or CVA refer to? This presentation will help you better understand the warning signs and treatment of these two very different diseases. Headaches (Spanish) Migraine, cluster, tension and sinus headaches all cause pain. Learn how they differ and how to best treat them. Herbal and Complementary Medicine (Spanish) What are herbals and why you should be careful using them. Review of some of the most popular herbals on the market. Home Medical Tests There are more home medical tests than ever before. Cholesterol, heart disease, thyroid, stress, diabetes, allergies to name just a few. Learn the benefits and reliability of these tests and their place in disease management. Hot Topics A timely discussion of what is in the news about a specific disease or medication. Just because it is on Dr.Oz and everyone is talking about it, are you getting the correct information? Hypertension: Managing Your High Blood Pressure (Spanish) What types of changes can you make in your life to be successful in keeping your blood pressure in a healthy range as discussed by you and your doctor? How much of an impact does your diet play into the equation and how do you know what is in the foods that you are eating? Hypertension (Spanish and Portuguese) The “Silent Killer” affects one in four Americans. There are more drugs on the market to treat hypertension than any other class of medications. Learn how these drugs work in your system and why it is so important to maintain good blood pressure. Internet Pharmacy Learn how to safely navigate the internet in order to purchase medications and how to identify a legitimate on-line pharmacy that exercises competent pharmacy practice. Irritable Bowel Syndrome The causes and up to date treatments for this condition. Lab Values (Portuguese) A breakdown of what all those lab values mean, why they are being tested and what the normal values are. Finally a chance to understand those complicated lab reports! Lyme Disease (Spanish) Emerging as one of today’s most troubling health concerns! Important to know the signs and symptoms of Lyme, how it is treated and how to protect yourself from contracting it. Medicare Part D (Spanish) A comprehensive presentation explaining the drug coverage component of Medicare detailing the specifics of its standard plan and differences to that standard plan offered by the participating insurance companies. Resources for obtaining help navigating through the process and helpful tips on picking the right plan for you will be thoroughly discussed. For the seniors new to Medicare this presentation will be most helpful.

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Medicare Part D Workshop (Spanish) Workshops available to help Seniors navigate the “ins and outs” of the Medicare drug benefit. Information on the standard benefits, plan formularies and determining the most appropriate plan for each individual. Also, information on how to maximize the benefit through generics and therapeutic substitutions. Med D Update (Spanish) Short overview of what is currently going on with the Medicare Part D plans and what changes are in store for the open enrollment period of October 15 to December 7, 2011. For the seniors familiar with Medicare Part D and just wanting a quick preview of upcoming changes and how they may affect their current plan. Medications As We Age (Spanish) Managing diseases becomes more difficult due to changes that naturally occur as we get older and treating those illnesses can become more problematic due to our aging bodies’ natural susceptibility to unwanted side effects of medications. Medication Safety Tips on ways to ensure that you use your medications safely including storage, disposal, traveling with medications and helpful resources. Memory As we age, memory seems to be one of the casualties. But it doesn’t have to be about age. Medications, medical conditions, and other factors may cause memory problems. Find out how to combat memory loss and keep you mind agile for years to come. Men’s Health Benign Prostatic Hyperplasia, Prostate Cancer and Erectile Dysfunction are all common in aging men. Learn about prevention, early detection and treatment in the management of these disorders as well as what every man needs to know about living a healthy life. Migraines What is a migraine? What are its symptoms and triggers and how you can treat it? MRSA (Methacillin Resistant Staph. Aureus) Once strictly confined to hospital settings, this dangerous infection is now being spotted in the community setting. What is it, how is it acquired, how it can be prevented, treatments, and community implications. Multiple Sclerosis The up to the date information about the causes and treatments of this disease of the central nervous system. Oral Health (Spanish) What to do for dry mouth? How do I treat canker sores? Is there any difference among mouth washes? How you can treat small dental emergencies before you see your dentist. All of these topics and more will be discussed. Osteoporosis (Spanish and Portuguese) Osteoporosis is the loss of bone mass and the breakdown in the structure of the bone tissue. It is the cause of over 1.5 million fractures per year in the USA. Learn how to treat this disease with medication and lifestyle modifications. Over-The-Counter Medications 30% of Americans use and OTC product every other day creating a $41.9 billion dollar market. Learn if you are at risk using these products and what you should be looking for when shopping this market. Pain Management (Spanish) Pain may be unavoidable but controllable. Learn how to effectively manage pain and what you should know about pain medications. Parkinson’s Disease (Spanish) This degenerative disorder of the Central Nervous System affects more than 1 million Americans. Learn the latest in treatment options with medications, surgery, lifestyle changes and experimental treatments. Pharmacy 101 (Spanish) Ever wonder why some tablets are so large? Or why one month your tablet is pink and the next it is white even though it is the same drug? And what does ER, CR and XR all mean? Come join us for a discussion about the basics of medications.

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Poison Prevention for Seniors (Spanish) Accidental poisonings, both medicinal and environmental are common in the senior population. Learn preventive techniques in order to avoid a poisoning and what to do in case of one. Q & A Session (Spanish) Open format for questions regarding medications and disease management. Restless Leg Syndrome It is estimated that over 12 million Americans suffer from RLS. Learn about the syndrome and how it can be treated. Rheumatoid Arthritis (Spanish) Rheumatoid arthritis normally occurs between the ages of 40 to 60 and causes joint damage that can be both debilitating and disfiguring. A discussion of the disease and its available treatments. Shingles An increasingly common problem for older Americans. Learn how to treat and prevent this debilitating illness. Skin Disorders (Spanish) An overview of various skin conditions such as dry skin, eczema, psoriasis and dermatitis. Treatments including prescription and over the counter medications currently being used to treat these conditions will be discussed. Sleep Disorders (Portuguese) 20-40% of adults suffer from insomnia over the course of a year. Recognize what can cause sleep disorders and learn how to successfully treat them. Learn about the newest medications. Smoking Cessation (Spanish and Portuguese) A comprehensive overview of effective products used to stop smoking. Smoking and Your Medications Many smokers are not aware of how their smoking may be interfering with their medications resulting in decreased effectiveness and increased costs. Stress Awareness (Portuguese) Understanding and coping with stress is part of everyone’s everyday life. Knowing how to ease the stressful elements of our lives is a healthy alternative. Stress During the Holiday Season (Spanish) There are many dynamics that can make the holidays stressful: stress due to orchestrating a perfect family celebration, holiday bills, losses due to divorce or death in the family, crowded social calendars, etc. Learn how to recognize and handle holiday stress. Stroke (Spanish) Prompt treatment of this medical emergency could mean the difference between life and death. It is important to understand and recognize the signs that a stroke is occurring, how to properly react quickly and ways to prevent a stroke or the occurrence of a second one. Summertime Health (Spanish) Summertime presents all kinds of health challenges- safe sun exposure, proper hydration, and mosquito and tick prevention. Learn how to protect your health during the summer months. Superbugs Learn the many causes which may contribute to bacteria becoming resistant to drugs and what treatment options remain. The main four that are discussed are MRSA (Methicillin-Resistant Staphylococcus aureus), Clostridium difficile, VRE (Vancomycin- Resistant Enterococci) and MDR TB (multi-drug resistant Tuberculosis). Thyroid A review of the symptoms and treatment of an underactive and overactive thyroid. Tinnitus Learn the causes, symptoms, risk factors, treatments and coping mechanisms that affects 1 in 5 people. Tips for Traveling Seniors Planning a trip? Make sure you know how to store your medications properly to insure their efficacy and that you adhere to rules applying to the transportation of medications.

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Urinary Incontinence Learn how the medications you are taking for this disorder affecting 13 million Americans work and what is the newest in treatment. Urinary Tract Infections UTI’s can occur in people of all ages but are more common in those over 65 years of age. Signs and symptoms in older adults can be very different than those in younger patients and may result in a misdiagnosis. Learn about the causes, signs, symptoms and treatment of this common ailment. Vision Problems A discussion of the common types of vision problems, their diagnosis, and treatment. Also, a practical guide to using ophthalmic preparations properly. Vitamin D Why do we need to be concerned about Vitamin D and how do we know if we are deficient in our body’s level and if so, what are the options for supplements? Vitamins & Minerals Is it possible to get all your vitamins through a well balanced diet? Does everyone need to take supplements? After attending this lecture, you will know the answers to these important questions. Weight Loss (Spanish) Strategies for successful weight loss and a review of the over the counter weight loss products.

Appendix D

BROWN BAG PROGRAM UNIVERSITY OF RHODE ISLAND COLLEGE OF PHARMACY PHARMACY OUTREACH PROGRAM

The Pharmacy Outreach Program located at the University of Rhode Island, College of Pharmacy celebrated its 25th anniversary in 2007. The Pharmacy Outreach Program began as a pharmacy educational program to educate the public on their medication regimen based on a pilot program at the University of Michigan. Michigan’s “Brown Bag Program” was adopted by the University of Rhode Island, College of Pharmacy as the “Brown Bag Prescription Evaluation Clinic”. Planning for the Rhode Island program commenced in 1982 and was introduced to seniors in 1983. This Brown Bag Prescription Evaluation Clinic became the foundation of the Pharmacy Outreach Program which, over the years, has become known as the Brown Bag Program. Modifications to the program have occurred throughout the years but the framework on which the program was built remains the same.

The Brown Bag Prescription Evaluation Clinic provides a review by a pharmacist of an individual’s prescriptions, over-the-counter medications and compliance with drug therapy regimens. The objectives of the program in 1983 were:

1. To determine patient’s perception and knowledge of their drug therapy. 2. To educate patients concerning their drug therapy. 3. To determine the number, type and any duplication of prescription drug products given to

patients. 4. To determine if intervention was necessary and to respond appropriately. 5. To gather data and evaluate trends and problems associated with drug therapy.

The goal of the program is to ensure appropriate use of medications by participants and to positively intervene in the medication regimens of patients when necessary so that they benefited from their medication use and that they are knowledgeable and informed when speaking with their health care providers. The expected outcome is two-fold:

1. To see improved patient compliance with drug therapy and enhancement of the community pharmacist’s role as a therapeutic consultant.

2. Reduction of cost of health care through amelioration of the problems of the disease related to improper use of medication.

Today, the Brown Bag Program objectives still include the original 5 identified in along with the addition of 5 more significant objectives:

1. To educate and inform the participant on the availability of health-related services and programs in the community.

2. To review participant’s current drug insurance program and how to ensure the patient is receiving the maximum benefiting from their insurance coverage.

3. To monitor for significant drug-food interactions.

4. To monitor for significant drug-lab interactions.

5. To review proper administration techniques especially with the newer dosage forms such as inhalers, patches, insulin pens and pumps and once weekly or monthly administered medications.

The goals and expected outcomes remain essentially the same in 2011 as in 1983.

Although the evaluation of medication regimens is similar to what was done previously, today’s challenge is in the number of medications prescribed to treat many of the disease states that our participants deal with daily as well as the complexities in administration of these medications. In addition to these factors are the expanded distribution channels available to patients such as the internet and mail order, an increase in the use of alternative therapies and an increased number of physicians managing a patient’s care. All these factors create obstacles for community practitioners in managing a patient’s medication history and in detecting potential medication problems for the patient. This challenge becomes even greater as more individuals are managed by formularies which may change due to contract negotiations between plans and manufacturers or when a patient makes the decision to change health coverage. The Brown Bag Pharmacists are equipped with the latest technology to assist them in obtaining the latest information available to aid participants in understanding and managing their health care. Each encounter in which a participant leaves the program with a better understanding of their medication, its use and the services available to them improves the health of Rhode Island.

By asking participants to put all of their medications into a brown bag and bring it to a sit down session with a pharmacist for a thorough evaluation of medication awareness, this program has evolved into a staple of preventative health. A better understanding by the patient of their medication regimen results in better compliance with their medications and an overall improvement in their health.

A “Brown Bag Program” consists of the patient putting all of his current prescription medications along with any over-the-counter medicines into a “brown bag” and bringing it to one of our screenings. We provide our own customized brown bag for participants. Our Pharmacy Outreach Program pharmacist then reviews the participant’s medication for the following points:

• To determine participant’s perceptions and knowledge of his/her drug therapy • To educate participant about his/her drug therapy • To review the type of prescription drug products used by the participant • To discuss participant’s disease states and how the prescribed medications work

• To evaluate participant’s compliance with prescribed drug regimen • To review drug regimen for duplication of medicines • To monitor for significant drug-drug interactions • To monitor for significant drug-food interactions • To monitor for significant drug-lab interactions • To review proper administration techniques as with inhalers • To determine if an intervention is necessary • To obtain data and information from the participant during the interview that would allow the

pharmacist to evaluate trends and problems associated with drug therapy • To educate and inform the participant on the availability of health-related services and

programs in the community • To review participant’s current drug insurance program and how to get the most cost benefit

out of a formulary system

The Brown Bag Program emphasizes a review of a participant’s disease states. This familiarizes them with their disease and the idiosyncrasies associated with that particular disease state. We also supplement our discussions with handouts and helpful aids to assist patients in managing their medications.

The Brown Bag Program continues to address the issue that many people are on numerous medications without a solid understanding of what they are taking and why. In addition, many of the participants are supplementing their prescription medications with over-the-counter products including vitamins and alternative medicines. The most significant problem consistently identified is that the participant is non-compliant due to misunderstanding of the proper dosing schedule and a lack of drug insurance coverage resulting in inability to pay.

During counseling sessions on the need for compliance, Brown Bag Pharmacists are consistently confronted with the reality that a number of participants are balancing the need to buy prescription medications with paying for food, rent and heating. Pharmacists address the cost issues of prescription medications through discussion of insurance choices with Medicare Part D, referrals to cost assistance programs available through the Partnership for Prescription Assistance Program and by making therapeutic substitution suggestions to be discussed between patient and their prescribing physician. Cost is a significant issue that has some solutions available but individuals often need guidance to access the appropriate programs. This remains the number one issue that the pharmacists confront on a daily basis in conversations with Rhode Island citizens.

As an incentive and a token of appreciation for participating in our programs, the pharmacists provide our participants with their own Brown Bag with the logo on front that is filled with items such as dose organizers, magnets, pens and pads of paper that have been supplied free of charge by sales associates of the pharmaceutical industry. Participants appreciate these small gifts. More importantly the participant is given written information about their medications and disease states and a printed copy of all of the information that was discussed during the Brown Bag interview. The participant is then able to have a written review of their current drug regimen to show to their healthcare provider or caregiver. An up-dated database for entering the

Brown Bag information was developed and implemented in 2009. This new version allows our pharmacists to enter more data in a timely basis resulting in a more complete review. It also supplies us with data that can be reviewed and studied for interventions and trends which enable us to be more proactive in our counseling sessions. An actual Brown Bag interview is enclosed in this Appendix. Brown Bag programs were held throughout the State of Rhode Island at senior centers, elderly and disabled housing complexes and disease specific support groups. The Pharmacy Outreach Program conducted 45 Brown Bags in 2011 during which more than 300 prescription drugs and 150 over-the-counter medications were reviewed.

Appendix E

CONTINUING PROGRAMS 2011 UNIVERSITY OF RHODE ISLAND COLLEGE OF PHARMACY PHARMACY OUTREACH Focus

The focus of the Pharmacy Outreach Program changes every year as we design the program to fit the current needs of Rhode Islanders. It is the mission of our program to address these needs in an effective and easily understandable manner. Programs are developed or modified to focus on topics that reflect what is happening in healthcare nationally and locally.

Education is the keystone of the Pharmacy Outreach Program. Through educational programs, residents learn about disease states and the medications used to treat them. They are given the information necessary to help them take charge of their health. Education leads to improved compliance which has a positive impact on patient outcomes. Ultimately the goal of our educational program is to decrease the societal burden of disease: increased hospitalizations, decreased productivity, and poor quality of life.

Brown Bag Program

The Brown Bag Program is the foundation of the Pharmacy Outreach Program. It offers Rhode Island residents the opportunity for a one-on-one review of their medications and the diseases with one of our staff pharmacists. A comprehensive review of their medications uses, side effects, interactions, proper dosing and therapeutic substitutions strengthens the participants’ health knowledge. This knowledge will lead to better compliance and an overall improvement in their health. A detailed description of the Brown Bag Program is in Appendix D.

Medication Education Resource Center

An integral part of the Pharmacy Outreach Program is our Medication Education Resource Center (MERC). We believe that knowledge is a key component to successfully managing one’s health. The MERC’s educational programs are an important tool in counseling the patient about their disease and its treatment. Our educational tools range from simple informational poster board presentations with a variety of handouts to more intensive programs offering Power Point presentations and videos. Each program is conducted by a pharmacist who is available for individual and group discussions and to answer questions. Appendix C provides a list of educational programs available.

As stated, education plays a large part in our efforts to reach out to the citizens of Rhode Island. The number of educational programs presented in 2011 was 423 at 90 sites in Rhode Island. Attendance has also increased as word of our value has spread and our total number of participants increased to 6942. We are proud to be able to perform this valuable service despite no increase in funding from 2008 to

2011. We are active throughout the entire state and are available to anyone who requests our services. A list of sites serviced in 2011 is in Appendix A.

In an attempt to address a consistent area of concern for our participants, many of the presentations in 2011 focused on generic medications and therapeutic substitution as a means to lower drug costs. Each topic presentation included information that allowed the patient to discuss therapeutic options with their physician in order to optimize their prescription usage. Following the national trend of providing medication therapy management (MTM) services, we recently incorporated a new method of Brown Bag Program reporting to allow us to gather data on cost savings, generic substitution, and therapeutic alternatives (Appendix D). This information is collated and analyzed. Reaching more people re-enforces the value of our outreach programs as more people take advantage of our knowledge and expertise.

The MERC continues to develop its library of programs that are available for presentation to senior citizen groups and other community organizations throughout the state. Many of these programs are now available in Spanish and Portuguese as well as English. The programs are informational but brief and colorful. The material is well received by our audiences. A short description of each topic is listed in Appendix C.

Another way we reach out to the public is through participation in local Health Fairs. Senior Centers, YMCAs, community groups, and the Senior Living Expo provide us with the opportunity to talk to people on a casual basis and in turn, provide information in a simple and non-threatening way. We participated in 22 health fairs in 2011 interacting with over 1500 participants. The Pharmacy Outreach Program is the face of Rhode Island’s pharmacist, often being the only way a person can consult a pharmacist one-on-one without having to wait in line or travel to a pharmacy. Our knowledge and empathy make us a popular resource.

Medication Information Line

The Medication Information Line was an added service offered as part of the Pharmacy Outreach Program in 1990 to provide the public with a reliable source of information about medications. This toll-free number allows individuals to speak, in confidence, to one of our pharmacists regarding their drug therapy. This information lines remains a constant for Rhode Islanders as they continue to seek financial assistance and health information to manage their prescriptions. Approximately 51% of American adults take two or more medications per day. Seniors take on average of 4 drugs per day. Add to this that a third of the American population takes two over-the-counter products per day and you end up with many medication concerns and questions.

The following provides a list of the commonly asked subjects that our staff pharmacists answering the Medication line are asked:

• Side effects of medications • Administration of medication • Financial issues • Alternative medicines

• Questions on disease state

The Medication Information Line is a unique resource within the State for all residents and is an important part of the health care system in Rhode Island. All of the Pharmacy Outreach Program pharmacists have community pharmacy backgrounds and this expertise is essential in this type of multi-topic counseling. As part of the College of Pharmacy faculty and staff, the Pharmacy Outreach Program pharmacists are able to access the resources and expertise of other members of the College. In addition, as part of our Minority Outreach, we have a Spanish option on our toll free line with a Spanish-speaking pharmacist to answer questions.

The need for assistance in managing the cost of prescriptions was reflected in the calls received by the Medication Line which showed 73% of the calls were for medication cost assistance (up from 55% in 2008) and these callers were given numerous resource options to help reduce the cost of their prescriptions. Just by referring someone to an internet site that offers discount coupons on medications can make a significant impact on affordability and therefore allow them to be compliant with their medications. The next most frequently discussed topic was drug interactions and side-effects (27%). With the average senior taking at least 4 prescription and 2 over-the-counter medications this is a major area of concern for them. The discussion attempts to enhance individuals’ awareness of the consequences of drug interactions and increase their comfort in discussing therapies with their healthcare provider. In addition, we address medication issues such as compliance, how to store and take care of your medications and what is important to know when choosing over-the-counter medication.

Minority Outreach Initiative

The Outreach Program is committed to improving health literacy among Rhode Island’s non-native English speaking senior population by reducing the language and cultural barriers to health education. Over the years, the Outreach Program has seen a steady increase in requests for services by community leaders representing minority groups in Rhode Island. Since 2006, the Outreach Program has employed Spanish- and Portuguese-speaking pharmacists per diem to respond to this demand. In 2010, a full-time Spanish-speaking pharmacist was added to our Pharmacy Outreach staff enabling the Outreach Program to provide its outreach services in Spanish. The Outreach Program routinely provides services to senior centers that are frequented mainly by the Hispanic/Latino community and provides access to education in senior housing where many Spanish-speaking seniors reside.

During the 2011 fiscal year, the Outreach Program conducted a total of 117 activities for Spanish-speaking, other minority, and under-served adult communities in Providence, Pawtucket, Cranston, and Central Falls, a 200% increase from 2010. These activities included 69 presentations, 38 blood pressure screenings, 4 brown bags, and 6 summer health fairs. The presentation topics, representing multiple health concerns, were selected to meet the needs of the attending community. Presently, our library of presentations and handouts includes more than 50 health topics and resources that are available in Spanish. (Appendix C). The Brown Bag sessions provided to Spanish-speaking seniors allowed us to

analyze the needs of the Spanish-speaking seniors and to develop ways to enhance the patient’s educational experience. In 2011, participants received a printable form in Spanish at the end of each session (Appendix D). The printable Spanish form, like the English version, contains all the information discussed with the patient during the Brown Bag session. This allows the participants to review the recommendations given by the pharmacist at their leisure once the session is complete. Moreover, the Outreach Program also continues to promote our toll-free bilingual Medication Information Line to the Spanish/Latino community. This Medication Information Line affords all Rhode Islanders, especially those unable to physically attend our programs, access to the services offered by the Outreach Program staff.

In 2011, the Pharmacy Outreach Program also led and supported initiatives outlined by the Diversity Committee at The University of Rhode Island College of Pharmacy to increase recruitment and promote retention of students from diverse backgrounds within the college. One these initiatives included the formation of a new chapter, at the College of Pharmacy, of the Student National Pharmaceutical Association (SNPhA). This student organization, supported by the National Pharmaceutical Association (NPhA), is concerned with pharmacy and healthcare related issues and minority representation in pharmacy. Part of SNPha’s objectives is the development and execution of community health-related educational programs and to develop a positive image of minority health professionals in the community. The Pharmacy Outreach Program supports the new SNPha organization and is committed to mentoring and expanding the community outreach opportunities for its students.

Educating Future Pharmacists for Rhode Island

The Pharmacy Outreach Program is an educational opportunity for many of the Doctor of Pharmacy (Pharm.D.) students who are completing their final year of a six year program in pharmacy at URI. Students work with the staff of the Pharmacy Outreach Program in a number of venues and programs offered to the community. Students participate in the Brown Bag programs, present to groups using the topics within the educational library, interact and answer medication questions with Rhode Islanders at Health Fairs and develop new programs and informational materials for our participants.

The participation of students in this program is a benefit to all Rhode Islanders. The students are given the opportunity to learn through experience with the mentoring of pharmacists who have been participating in community programs for many years. The students are afforded a forum to develop the skills necessary to communicate with their future patients, to visit community centers, housings complexities and other locations that offer them a more visible image of where many of their patients are from and to sensitize them through personal exchanges with these patients on the challenges they face in managing their disease and medications. Student participation in this program often sparks a desire to continue to give back to the community through future assistance with Brown Bag programs and educational programs once the student graduates. This year, the Outreach Program had the opportunity to work with over 10% of the graduating class of Pharm.D. students. (Appendix B)

Lastly, the diversity of the College of Pharmacy’s student population has afforded the program the opportunity to translate some of our printed materials into foreign languages to meet the needs of

Rhode Island’s diverse population. Students have assisted in developing and translation of a medical resource guide into Spanish, Vietnamese, Chinese, Italian and Portuguese. (Appendix F)

Medicare Part D

The introduction of Medicare Part D in the spring of 2005 dramatically changed Medicare recipients’ coverage and access to prescription medication. Recipients were faced with making decisions about health plan coverage driven by their medication histories. This driver led some families to choose different coverage for husband and wife predicated on their medication coverage needs. Further complicating the decision was the vast number of benefit design packages offering choices of deductibles, co-pays and cost assistance (or none) during the coverage gap when individuals are required to pay 100% of the cost of their medications. In 2006, the Pharmacy Outreach Program sat down and counseled over 600 seniors one-on-one on how to choose a Medicare D plan that best suited their needs. The College of Pharmacy students worked with the Pharmacy Outreach Program pharmacists to assist as many individuals as possible with plan selection. The students work in this area brought national attention as they were the recipients of the National Council of State Pharmacy Association Executives (NCSPAE) Medicare Part D Award in 2006.

In 2007, we focused on educating seniors on generic drugs and therapeutic substitution to avoid or delay entering the coverage gap. In 2008 and 2009 we encouraged seniors to re-assess their current plans in case there were changes in coverage. We repeated the entire process again in 2011 by holding 13 sessions at various Senior Centers and senior housing units to assist 200 seniors in evaluating and choosing a Part D plan. With the majority of seniors already enrolled in a plan, we stressed the importance of reassessing their current plan for formulary changes, increasing (or decreasing) premiums and co-payments, gap coverage and customer service. With 30 plans offered in the State of Rhode Island for 2011, many seniors were overwhelmed and were concerned about making a change. In addition, 7 of those plans had enhanced coverage (generics covered during the gap) and 14 had no deductible. By giving them a simple guide to the overall program, they had the information they needed to assess their current situation and make changes to maximize their coverage while minimizing their cost exposure.

In addition to the Part D plans, there were 7 Medicare Advantage plans available which included enhanced benefits to Medicare Parts A and B as well as Part D coverage. To further confuse the seniors, the enrollment period for these plans was extended beyond open enrollment to January 1, 2012 through February 14, 2012. Extra time was needed for reviewing these options and the seniors were thankful for our guidance.

Another major change this year to Medicare Part D open enrollment was moving the dates up in the calendar year to October 15, 2011 through to December 7, 2011. As open enrollment had always been from November 15th to December 31st, many seniors were not prepared to rethink their coverage earlier in the fall and some missed the enrollment period all together by waiting until the last minute. We were proactive in the Rhode Island community getting the word out of this major change.

For 2009 RIPAE (Rhode Island Prescription Assistance for the Elderly) changed its parameters for inclusion and required everyone to have a Part D plan in order to re-certify. Many seniors had refused to purchase a Part D plan, depending solely on RIPAE for prescription drug coverage despite the fact that it was not considered creditable coverage. Those who had not signed up for Part D when it was originally offered were assessed the penalty when signing up for Part D this year and the Outreach Program spent many hours in helping people search for the most cost-effective options. It was a trying situation which the Outreach Program handled in a sincere and professional manner.

In continuing our partnership with CMS, we attended specialized training sessions to learn to identify patients eligible for the Low Income Subsidy (LIS or “Extra Help”). Many seniors are either unaware of this benefit provided by the Social Security Administration to help defray out-of-pocket expenses of the Medicare D program, or assume they do not qualify. We made the subsidy a major component of our presentation and helped guide many seniors to the Social Security Administration (SSA) or the Point (Rhode Island’s Resource Place for seniors and adults with disabilities). Taking advantage of the LIS will save hundreds of dollars for the state’s most needy seniors. Combining education on subsidies with advocating for low-cost generics and therapeutic alternatives helped us achieve our goal of addressing the high cost of prescription medications that concerned over 70% of our callers.

It is the continuing importance of making pharmaceutical knowledge available to the general public of Rhode Island that drives the Pharmacy Outreach Program to take on the complexities of the Medicare Part D program and make it work for the people it is supposed to serve. The government reports that over 90% of people over 65 have prescription drug coverage today, compared with 76% in 2004 (UPI 2/11/09) and it is the goal of the Outreach Program to have 100% of eligible Rhode Islanders enrolled in Part D coverage.

The continued high cost of medications was mediated for some participants due to their prescription coverage under Part D. However, many seniors were subject to the coverage cap or as referred to by the seniors, the “donut hole” as dictated by provisions in their Medicare Part D coverage and were forced to pay large out-of-pocket expenses for their medications as the year progressed. It was refreshing to be able to discuss the new prescription drug coverage relief mandated by The Affordable Care Act for 2012. Seniors will get a 50% cost discount for brand name and 14% cost discount for generics instead of the previous 100% responsibility of cost by the senior during the “donut hole”. This savings translates into better medication regimen compliance, especially those on expensive brand only drugs such as inhalers and insulin. Advocating the use of generics and urging them to discuss therapeutic substitution with their physician as well as providing referrals to cost assistance programs were some of the ways in which the pharmacists were able to assist seniors in managing their health cost.

The Pharmacy Outreach Program worked with over 200 RI Seniors in 2011 educating them about Medicare Part D and helping them to pick the plan that gave them the best coverage of all of their medications at the most affordable price.

Prescription Cost Assistance

Begun as a pilot program in January 1996,the Medication for the Needy Program was implemented through the College of Pharmacy at the University of Rhode Island and is funded by the State of Rhode Island. Its beginnings were a collaborative effort through the College of Pharmacy, The George Wiley Center of Pawtucket, and the Rhode Island Medical Society. This program was established in response to the growing number of individuals in Rhode Island who were experiencing difficulty in paying for their prescription medications. Starting out slowly and methodically, the program experienced growth in each year since its inception. This program has transitioned to the “Med for Needy” Program and the Pharmacy Outreach Program continues to be a referral source for those who call.

The pharmaceutical industry has patient assistance programs providing free or discounted medicines to those who are in need. These programs, while unique to the individual companies, are intended to help those of low income who lack adequate prescription drug insurance coverage. Rhode Island residents may apply through the Partnership for Prescription Assistance stating their current income, insurance status and a list of their medications. This information is reviewed and assessed with regard to the available programs. An applicant’s eligibility is based on this information and the parameters of the available programs set by the manufacturers. If an applicant appears to be a good candidate for inclusion in a program, applications specific for those programs will be forwarded to the patient. Since assistance programs for each company differ, it is important for the Pharmacy Outreach Program to be accessible for support in the application process in order to simplify the process for the patient and their physician. This saves time, unnecessary paperwork and provides support for the researching of available prescription cost assistance.

The individual pharmaceutical manufacturer selects which of its prescription medications are included in its program. Most manufacturers participate and provide a list of medications covered by their Patient Assistance program. Over the counter drugs, some generics, and less expensive medications may not covered.

Applicants are instructed to bring the enrollment packet to their prescribing physician and urge their physician to participate. These programs require the physician to be an active participant as they can provide proof of medical necessity and are also responsible for dispensing the medication directly to the patient. Applicants may be required to submit proof of income or insurance with the manufacturer’s application. Overall processing may take 4 to 6 weeks. Normally a manufacturer will provide a 3-month supply of the medicine sent directly to the physician or will send the patient pharmacy voucher coupons. Refills may be available at the discretion of the manufacturer. Some of the manufacturers have offered assistance to seniors entering the coverage gap of Medicare D. The seniors are encouraged to call the Partnership for Prescription Assistance Program to determine if they are eligible. In addition the pharmaceutical assistance programs, there are several local programs which provide cost assistance on an emergency and/or short-term basis. These are valuable resources in this uncertain economic time when people lose their employment and accompanying health insurance. Maintaining

and updating our list of agencies will be an even more important goal of the Outreach Program as the economy worsens. (Appendix F) Other Activities for 2011

In April, in collaboration with the Rhode Island Pharmacist’s Association, the Outreach Program participated in the Face of Pharmacy event in the State House Rotunda, providing a booth on medication information and referral services. In addition to blood pressure screening, there was diabetes and cholesterol testing as well.

Hypertension affects more than 50 million Americans and continuous monitoring of blood pressure is necessary to ensure good cardiac health. The Pharmacy Outreach Program also conducts blood pressure clinics at various sites throughout the state. We conducted 81 screenings in 2011, taking the blood pressure of over 1000 people. At each encounter we discuss the lifestyle modifications and medications needed to achieve an optimal blood pressure reading. We discuss the merits of each person’s therapy and answer questions concerning all medication use. It is a wonderful opportunity to counsel patients on medication therapy.

Special Initiatives for 2011:

The Rhode Island Department of Health states that 7.8% of all Rhode Islanders have been diagnosed with diabetes. This percentage does not reflect those who have not been properly diagnosed or those Rhode Islanders lacking adequate health care. With the current trend of increasing obesity, especially in our younger generation, this percentage is certain to significantly increase in the coming years. The Outreach Program continues to expand our Diabetes educational program to include blood glucose screenings and medication counseling along with our full array of presentations and handouts. We are also active with diabetes support groups focusing on educating them about their diabetes as well as concomitant diseases that commonly affect diabetics. To further our expertise on diabetes education, our staff pharmacists completed the certification program to become Rhode Island Certified Diabetes Outpatient Educators (CDOE). In addition to being better qualified to assist diabetics with their medication regimens, diet and exercise, being a CDOE also opens a network of health professionals that we can collaborate with in the community setting and helpful resources that we can promote. All of our Diabetes educational presentations and handouts are also offered to Rhode Islanders in Spanish.

The implementation of special initiatives by the Outreach Program continued in 2011 with six summer health fairs conducted in collaboration with the Providence Housing Authority and the Division of Elderly Affairs. The program’s theme of Summer Health was emphasized with educational materials, in English and Spanish. Self-care handouts were made available along with a slide show titled “Summer Health” and a station showcasing OTC products for sun and insect protection, with an emphasis on tick control, treatment of poison ivy, proper hydration, and treatment of sunburn. Moreover, educational materials for the management of diabetes and cardiovascular diseases during the hot summer months were provided to all participants in conjunction with blood pressure screenings and medication counseling. A total of 128 participants took part in the health fair activities that provided a unique opportunity for

participants to interact with health professionals during the summer months at their community centers.

In Rhode Island, the prevalence for obesity among adults is 26%, 8% for cardiovascular diseases, and as previously stated 7.8% for diabetes. The highest rates are found to be among Hispanics and black non-Hispanics adults. To target these disparities, the Outreach Program partnered, in 2011, with the SNAP-Ed Nutrition Education Program, the Providence Housing Authority, SWAP Inc., and Progreso Latino to provide a series of educational programs in both English and Spanish. The interdisciplinary educational programs focused on modifiable risk factors for diabetes and cardiovascular diseases and emphasized practical approaches for chronic disease self-management in a culturally sensitive manner. The pharmacy presentation “Managing your high blood pressure” was combined with the nutritional presentation “Sodium in your diet”. Eight programs were conducted in urban community centers in which 91 participants attended and were educated on behavior modifications including medication compliance, physical activity, and nutritional changes.