Laura C. Palombi

Point-of-care screenings at the University of Minnesota: Mechanism for civic engagement

OBJECTIVES To describe Wellness Initiative of the Northland (WIN) screening events; present participant results from those events; discuss the benefits of pharmacist-conducted, community-based point-of-care (POC) testing to medically underserved patients and to the profession of pharmacy; and describe logistical considerations in launching disease screening services. SETTING Pharmacist-led community health fairs in a variety of settings, including shopping malls, churches, community pharmacies, senior residence facilities, critical-access hospitals, and clinics. PRACTICE DESCRIPTION Disease screenings for economically disadvantaged residents of northeastern Minnesota and northwest Wisconsin, held between 2005 and 2012, through WIN. PRACTICE INNOVATION Mobile POC screenings for dyslipidemia, diabetes, hypertension, and osteoporosis. MAIN OUTCOME MEASURE Percentage of screenings with out-of-range readings. RESULTS Since 2005, WIN screenings have served more than 2,000 individuals, providing 4,152 POC screenings. Out-of-range readings were obtained for 40.3% of fingerstick cholesterol tests, 24.8% of fingerstick blood glucose tests, 24.3% of blood pressure tests, and 38.7% of quantitative ultrasound heel bone density readings. CONCLUSION Community-conducted POC testing functions both as an important public health service and a mechanism by which pharmacists and student pharmacists can become involved in civic engagement.

The achievement of public health services in pharmacy practice: A literature review

BACKGROUND It is known that pharmacists are currently contributing to public health; however, the extent of this contribution as reported in the literature has not been examined. Investigating the ways that pharmacists are currently participating in public health is critical for the profession of pharmacy, pharmacy educators, and the public health community. OBJECTIVES The purpose of this study was to determine the reported contributions of pharmacy to each of the ten essential services of public health, and which of the five core competencies of public health were most frequently utilized in those contributions. METHODS A PubMed search was used to extract references that included both the words pharmacy and services in the title or abstract, and the words public health in any part of the document. A total of 247 references were extracted and categorized into the essential services and core competencies. RESULTS The essential services Inform, Educate, and Empower, and Link to/Provide Care were more frequently represented in the literature, and the core competency of Health Policy and Administration was most frequently utilized. CONCLUSION To further contribute to and integrate their contributions within population health, pharmacists must consider ways to strategically contribute to the essential services of public health and seek to increase competency in public health.

Flourishing American Indian Positive Mental Health

Positive mental health (PMH) is an important construct for understanding the full continuum of mental health. Some socially disadvantaged populations experience a paradoxically high level of PMH despite negative social experiences including discrimination. The purpose of this study is to examine the prevalence and culturally salient correlates of PMH among a cross-sectional sample of 218 American Indian adults living with type 2 diabetes mellitus. Although 17.1 percent of individuals in this sample met Patient Health Questionnaire (PHQ-9) criteria for depression, 51.5 percent were in flourishing PMH. Perceived discrimination was negatively associated with PMH, and participation in traditional cultural activities was positively associated with PMH. Traditional cultural activities did not appear to buffer the impact of discrimination on PMH. This study contributes to strengths-based research with American Indian communities, furthers our understanding of correlates of PMH, and documents comparatively high rates of flourishing mental health in our sample relative to previously published studies with diverse samples.Positive mental health (PMH) is an important construct for understanding the full continuum of mental health. Some socially disadvantaged populations experience a paradoxically high level of PMH despite negative social experiences including discrimination. The purpose of this study is to examine the prevalence and culturally salient correlates of PMH among a cross-sectional sample of 218 American Indian adults living with type 2 diabetes mellitus. Although 17.1 percent of individuals in this sample met Patient Health Questionnaire (PHQ-9) criteria for depression, 51.5 percent were in flourishing PMH. Perceived discrimination was negatively associated with PMH, and participation in traditional cultural activities was positively associated with PMH. Traditional cultural activities did not appear to buffer the impact of discrimination on PMH. This study contributes to strengths-based research with American Indian communities, furthers our understanding of correlates of PMH, and documents comparatively high rates of flourishing mental health in our sample relative to previously published studies with diverse samples.

A community partnership to respond to the heroin and opioid abuse epidemic

1Department of Pharmacy Practice and Pharmaceutical Science, University of Minnesota College of Pharmacy, Duluth, Minnesota 2 Carlton-Cook-Lake-St. Louis Community Health Board, Duluth, Minnesota 3 Carlton County, South St. Louis County Drug Courts & North St. Louis Hybrid Court, Duluth, Minnesota 4 Carlton County Sheriff’s Office, Carlton, Minnesota 5 Fond du Lac Tribal and Community College, Cloquet, Minnesota 6 Carlton County Public Health and Human Services, Cloquet, Minnesota

Naloxone Administration for Opioid Overdose Reversal in the Prehospital Setting: Implications for Pharmacists:

Background: Fatalities from opioid overdose have risen by 117% over the past 10 years. Increasing access to the opioid antagonist, naloxone can combat this trend and saves lives. This study investigates the various routes of naloxone administration for opioid reversal in the prehospital setting. Methods: PubMed, Ovid, and Google Scholar were searched for references that included the words naloxone and prehospital. Inclusion criteria were peer reviewed publications after 1995, English language, studies conducted in an outpatient setting, and intramuscular, intranasal, intravenous, or subcutaneous formulations; exclusion criteria were review articles or editorials. Results: 8 articles met the inclusion criteria: intramuscular, intranasal, intravenous, and subcutaneous dosage forms of naloxone were analyzed to compare their time to administration, time to efficacy, financial impact, administrator safety, and administrator preference. Conclusion: There is little consensus on the optimal route of naloxone administration in the prehospital setting. Little training is required for proper administration of the intramuscular auto-injector; however, the high price of this device is a barrier to access. Intranasal naloxone appears to be the optimal dosage form when considering cost, effectiveness, and administrator safety. Pharmacists must be aware of trends in naloxone use, dosage forms, and administration when caring for patients and their communities.

Facilitating community partnerships to reduce opioid overdose: An Engaged Department initiative

BACKGROUND The opioid crisis is a major public health priority for most United States communities and requires multi-disciplinary and multi-pronged approaches. Despite this, there is considerable unfulfilled potential for engagement of academic pharmacy with community partners to form mutually-beneficial relationships. OBJECTIVES This study sought to determine how an opioid-focused Engaged Department Initiative might increase partnerships with rural community members and positively impact faculty teaching, service, practice and research while addressing a critical public health crisis in northern Minnesota. METHODS A multidisciplinary department at a College of Pharmacy participated in an 18-month Engaged Department Initiative focused on building community partnerships to address the opioid crisis in rural communities of northern Minnesota. This initiative included internal, departmental-specific components, as well as external components focused on meeting opioid-related needs in the community. RESULTS This initiative resulted in statistically significant increases in faculty understanding of and appreciation for community engagement, as well as the creation of impactful community-led programming focused on prevention and intervention of opioid use disorder. The community partnerships that were formed and strengthened throughout the Engaged Department Initiative have led to continuing opioid-related engagement activities with an ever-increasing number of surrounding communities. CONCLUSION An Engaged Department process allowed one department to bring a higher level of attention to community engagement to the entire College of Pharmacy and to incorporate goals and initiatives related to community engagement into a new collegiate strategic plan.

OPIOIDS: cultivating interprofessional collaboration to find solutions to public health problems

ABSTRACT This study evaluated perceived effectiveness of an interprofessional case-based activity that allowed medical and pharmacy students to engage in problem-solving around the role of social determinants of health (SDOH) in opioid misuse. Students participated in a case-based activity, and then completed a post-activity survey that included five open-ended questions and the Interprofessional Collaborative Competency Attainment Survey. Twelve pharmacy students (100%) and 47 medical students (75%) completed the post-activity survey. Results indicate the activity resulted in a statistically significant increase in student ability to: 1) recognize interprofessional team members’ knowledge, skills, and contributions to the interprofessional team; 2) communicate effectively across professions; and 3) learn with, from, and about interprofessional team members to develop a patient care plan. Students also reported enhanced understanding of treatment considerations with opioid misuse, the role of SDOH, and recognition of the value of interprofessional collaboration in their future practice. This interprofessional case-based activity appeared to promote collaboration among students from different professional programs as they engaged in problem-solving around a contemporary public health issue that intersects their future practices. This activity may serve as a model for health professional programs, practitioners, healthcare systems, and communities that seek interprofessional solutions to combat opioid misuse.

The Pharmacists’ Role in Identifying and Supporting Victims of Human Trafficking

ABSTRACT Human trafficking (HT), an egregious human rights violation and escalating form of modern-day slavery, has received increasing global attention over the last decade. Despite the fact that the pharmacist is one of the most accessible health-care providers and may have more contact with trafficking victims than other health-care providers in the United States, there is currently little guidance available for pharmacists who wish to support victims of HT. To address this gap, this article provides guidance for pharmacists and pharmacy personnel who wish to provide the best possible care and referral for victims of HT.

A scoping review of opioid misuse in the rural United States

INTRODUCTION This study is a scoping review of the original research literature onthe misuse of opioids in the rural United States (US) and maps theliterature of interest to address the question: What does theoriginal research evidence reveal about the misuse of opioids inrural US communities? METHODS This study used a modified preferred reporting items for systematicreviews and meta-analyses (PRISMA) approach which is organized byfive distinct elements or steps: beginning with a clearly formulatedquestion, using the question to develop clear inclusion criteria toidentify relevant studies, using an approach to appraise the studiesor a subset of the studies, summarizing the evidence using anexplicit methodology, and interpreting the findings of the review. RESULTS The initial search yielded 119 peer reviewed articles and aftercoding, 41 papers met the inclusion criteria. Researcher generatedsurveys constituted the most frequent source of data. Most studieshad a significant quantitative dimension to them. All the studieswere observational or cross-sectional by design. CONCLUSIONS This analysis found an emerging research literature that hasgenerated evidence supporting the claim that rural US residents andcommunities suffer a disproportionate burden from the misuseof opioidscompared to their urban or metropolitan counterparts.

Ethical dimensions of the prescription opioid abuse crisis

The number of deaths by drug overdose in the United States tripled between 1999 and 2014 and reached a historic peak in 2015.[1][1] Opioids were involved in nearly two thirds of these deaths despite few rigorous examinations of the benefits of opioid treatment for pain lasting greater than 3 months