SUGAR IN THE CITY: CHALLENGES OF INNER CITY HEALTH DISPARITIES IN THE MANAGEMENT OF DIABETES MARY LYNN MCPHERSON, PHARMD, BCPS, CDE

Transcription

1 SUGAR IN THE CITY: CHALLENGES OF INNER CITY HEALTH DISPARITIES IN THE MANAGEMENT OF DIABETES MARY LYNN MCPHERSON, PHARMD, BCPS, CDE

2 SUGAR IN THE CITY: CHALLENGES OF INNER CITY HEALTH DISPARITIES IN THE MANAGEMENT OF DIABETES ACTIVITY DESCRIPTION "It's not the same here" is the common refrain from pharmacists in the many free clinics, pharmacies and hospitals across our inner cities when addressing the management of diabetes in an at-risk population with minimal resources. Using a case study of an elderly diabetic, this presentation will describe the challenges of existing inner city healthcare disparities, and focus on innovative health and medication adherence strategies when conventional wisdom (diet and exercise, medication reminders) is not a practical reality. TARGET AUDIENCE The target audience for this activity is pharmacists and pharmacy technicians in hospital, community, and retail pharmacy settings. LEARNING OBJECTIVES After completing this activity, the pharmacist will be able to: Describe the prevalence of diabetes mellitus in minority and inner city populations, and the consequences of inadequate health care in this population. Describe standards of practice for the management of diabetes mellitus, and specific strategies to reduce diabetes disparities. Given an actual or simulated case of an inner-city patient with pre-diabetes, newly diagnosed diabetes, and diabetes not meeting therapeutic goals, recommend an appropriate non-pharmacologic and pharmacologic approach to management. ACCREDITATION PHARMACY PharmCon, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. NURSING PharmCon, Inc. is approved by the California Board of Registered Nursing (Provider Number CEP 13649) and the Florida Board of Nursing (Provider Number ). Activities approved by the CA BRN and the FL BN are accepted by most State Boards of Nursing. CE hours provided by PharmCon, Inc. meet the ANCC criteria for formally approved continuing education hours. The ACPE is listed by the AANP as an acceptable, accredited continuing education organization for applicants seeking renewal through continuing education credit. For additional information, please visit Universal Activity No.: H01-P&T Credits: 1.5 contact hour (0.1 CEU) Online Date: June 15, 2015 Offline Date: January 1, 2016 ACPE Expiration Date: June 3, 2018 ACTIVITY TYPE Knowledge-Based Home Study Webcast FINANCIAL SUPPORT BY Pharmaceutical Education Consultants, Inc. After completing this activity, the pharmacy technicians will be able to: List the prevalence of diabetes mellitus in minority and inner city populations List strategies to reduce diabetes disparities 1

3 ABOUT THE AUTHOR Dr. Mary Lynn McPherson received her doctor of pharmacy degree from the University of Maryland School of Pharmacy. She is professor and vice chair in the Department of Pharmacy Practice and Science at the University of Maryland School of Pharmacy, and the director of Pharmacotherapy Services at University Care Waxter in Baltimore. Dr. McPherson has maintained a practice in both hospice (local and national) and ambulatory care her entire career. She teaches extensively in the PharmD curriculum on pain management and end-of-life care, including didactic and experiential content, and she also developed one of the first and few palliative care pharmacy residencies in the US. Dr. McPherson serves on the Board of Directors of the Hospice Network of Maryland and is Chairman of the Board of the American Society of Pain Educators. She is a fellow in the American Society of Health-Systems Pharmacists and the American Pharmacists Association. Dr. McPherson has received the American Pharmacists Association Distinguished Achievement Award in Specialized Practice, the Maryland Pharmacists Association Innovative Practice Award, and the Maryland Society of Health-Systems Pharmacists W. Purdum Lifetime Achievement Award, among others. She has written four books, and many book chapters and peer-reviewed articles on pain management, palliative care, and other topics. Mary Lynn McPherson Professor, University of Maryland School of Pharmacy FACULTY DISCLOSURE It is the policy of PharmCon, Inc. to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer of any commercial product(s) and/or service(s) discussed in an educational activity. Mary Lynn McPherson reports no actual or potential conflict of interest in relation to this activity. Peer review of the material in this CE activity was conducted to assess and resolve potential conflict of interest. Reviewers unanimously found that the activity is fair balanced and lacks commercial bias. Please Note: PharmCon, Inc. does not view the existence of relationships as an implication of bias or that the value of the material is decreased. The content of the activity was planned to be balanced and objective. Occasionally, authors may express opinions that represent their own viewpoint. Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient or pharmacy management. Conclusions drawn by participants should be derived from objective analysis of scientific data presented from this monograph and other unrelated sources. 2

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21 ACTIVITY TEST 1. Diabetes mellitus is caused by which of the following abnormalities? a. Decrease in insulin secretion b. Decrease in insulin sensitivity c. Both A and B are correct d. Neither A nor B are correct 2. Which of the following statements is correct? a. The prevalence of diabetes is growing in all ethnic and racial groups b. The prevalence of diabetes is only growing in non-white populations c. The prevalence of diabetes is only growing in white patients d. Diabetes is not growing in prevalence 3. Which of the following is NOT a possible explanation for disparities observed in diabetes management in racial and ethnic groups? a. Genetics b. Low-income neighborhoods and substandard housing c. Poverty d. Current therapies do not work as well in minority and ethnic groups 4. True or False: Patients with diabetes in minority and ethnic groups often receive lower quality health care. a. True b. False 5. PJ is a 58 year old woman who had routine lab work drawn recently. Her fasting plasma glucose is 122 mg/dl. How would you classify PJ? a. Type 1 diabetes b. Type 2 diabetes c. Prediabetes d. Gestational diabetes 6. Which of the following are the most appropriate interventions for a patient diagnosed with prediabetes? a. Insulin glargine, 20 units at bedtime, titrate to a fasting plasma glucose < 110 mg/dl b. Intensive diet counseling c. Physical activity program d. B and C e. A, B and C 20

22 7. How much aerobic activity should a patient with diabetes aim to achieve per week (assuming no contraindications)? a. 30 minutes b. 60 minutes c. 90 minutes d. 150 minutes e. 250 minutes 8. Which of the following comorbid conditions are frequently seen in conjunction with diabetes mellitus? a. Dyslipidemia b. Hypertension c. Central obesity d. All of the above 9. If a patient has an average life expectancy, and is newly diagnosed with diabetes, what is an appropriate goal A1c per the American Diabetes Association? a. < 6.0% b. < 7.0% c. < 7.5% d. < 8.0% 10. Which of the following is a rare, but potentially fatal side effect associated with metformin? a. Vitamin B6 deficiency b. Thromboembolic disease c. Lactic acidosis d. Metabolic alkalosis 11. Which of the following medication(s) increase insulin secretion from the pancreas? a. Glipizide b. Metformin c. Repaglinide d. A and C e. A, B and C 12. Which of the following medications act to block the reabsorption of glucose from the nephron? a. Sitagliptin b. Liraglutide c. Canagliflozin d. Acarbose 21

23 13. Which of the following is an example of a rapid-acting insulin? a. Glargine b. Detemir c. Aspart d. NPH e. Regular 14. A multifactorial approach to reducing disparities in diabetes health care refers to which of the following? a. The nurse, physician and pharmacist all make an appointment to counsel the patient b. Patients meet with providers in groups c. The needs of patients, providers, and systems are all addressed d. An intervention is launched every month for a year 15. Mr. Peters is an 82 year old man with end-stage dementia. He has been admitted to hospice care and has a prognosis of about 1 month. What is the goal for Mr. Peter s A1c? a. < 6.5% b. < 7% c. <8% d. Don t assess Mr. Peters A1c Please submit your final responses on freece.com. Thank you. 22