Pharmacy Contributions to the Jamaica Dental Mission
- Christopher Lynch, PharmD, Jennifer Rosselli-Lynch, PharmD
Over the past 19 years the Southern Illinois University of Edwardsville (SIUE) School of Dental Medicine and subsequently the AT Still University Dental School have participated in a Jamaica Dental Mission where minimal cost dental work is provided to the underserved populations of Flankers, Kew Park and Cambridge. Eleven years ago, the SIUE School of Pharmacy volunteered to participate by providing pharmacy associated patient services. These services include collection of patients’ medical history, blood pressure screenings, blood glucose testing, medications, dispensing of these medications and post-operative and medication consultations.
One or two pharmacists and 4-5 pharmacy students are needed to provide pharmacy services at each of the two or three clinics. Every patient that attends the clinic will receive pharmacy services prior to any dental procedures and may receive services afterwards depending on the procedure performed. Prior to any dental work, a mandatory patient history and blood pressure are taken. Blood glucose is screened if the patient presents with any symptoms of hyper or hypoglycemia or meets the risk factors used for screening diabetes. After dental procedures, medications are dispensed and counseling occurs.
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Description of benefits to students and/or faculty and the School of Pharmacy
Students and faculty who participate in the trip are able to provide care to a severely underserved patient population in Jamaica. While doing so, students and faculty are able to learn more about the culture of the people of Jamaica and begin to understand the severity of the poverty of those being served. For many of the students, the trip is their first opportunity for international travel, and for almost all of them it is their first close interaction with the level of poverty encountered on the mission.
It has been demonstrated that pharmacy students gain valuable confidence in measuring patients’ vital signs due to participation in this trip. Reflective journals have also shown that students become more mature in their understanding of how to care for patients of a different culture and economic status.
Participation of the pharmacy school has enabled an increase in the number of patients seen at the dental clinics and recognizes patients that are not proper candidates for dental procedures due to medical histories or abnormal blood pressure or blood glucose readings. The service also identifies patients that need to seek a physician’s assistance for high blood pressure or abnormal blood glucose readings. Although these services are extremely important, they do not come without a major expense. Volunteers not only have to donate their time, but also have to pay to attend. In addition, even though some of the medical supplies and medications are donated, any essentials that are not supplied by donations must come out of the pharmacists’ pockets.
Funding for the dental mission occurs through numerous sources. Currently, pharmacists and pharmacy students pay for their travel expenses. In addition, pharmacists pay for some supplies out of pocket. Funding is also supplied by company donations from CVS Pharmacy. Donations include medications, and coloring books and plush toys for the children who have dental procedures performed. Without these sources of funding, patients would not receive the same quality of care that is currently offered.
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Summary of Impact
A pre- and post-survey completed in 2009 demonstrated statistically significant improvements in pharmacy students’ self-reported confidence levels in performing basic physical assessment skills such as measuring blood pressure and blood glucose and in performing foot inspections.
In 2010, a detailed business plan and cost analysis was performed as a student Capstone Project. This analysis showed that the value-added cost per patient of pharmacy services (exclusive of dental) was $5.11 per patient.
In 2012, pharmacy services were evaluated for impact on hypertension and diabetes education. Out of 695 blood pressure readings recorded, 25.3% of patients had uncontrolled blood pressure with a systolic reading of ≥ 140 mmHg and 42.2% between 120 – 139 mmHg. Of 143 patients screened for high blood glucose, 14.7% had blood glucose readings between 131 – 200 mg/dl, 6.3% between 201 – 300 mg/dl, and 3.5% ≥ 300 mg/dl. A total of 119 and 22 patients were educated on hypertension and diabetes respectively and were given an educational handout. These results were used to better organize the recording of hypertension and diabetes education. The diabetes component is being reevaluated this year.
In 2011 and 2015, dental participants were surveyed before and after the trip about their perceptions of pharmacy student involvement. The perceived benefit of enhancing patient care, counseling on medications, and measuring blood glucose levels increased in the 2015 post-trip survey. More dental participants indicated on the post-trip survey that they believe interprofessional activities impact their perceptions of how pharmacy students can contribute to the humanitarian mission. See attached poster presentation.
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Testimonials
“The pharmacist and pharmacy students free up the dental personnel for dental triage and treatment. Also, they have been instrumental in identifying patients who are hyperglycemic and who may be taking medications that contraindicate dental treatment.”
—-Dentist
“Without the help of the pharmacy students/ pharmacists this dental mission would not have been the success that it was! The tasks the pharmacy students/ pharmacists did were time consuming and allowed the dental students the freedom to treat more patients in the limited time we had.”
—-Dental Student
“The pharmacy students conducted themselves in a highly professional manner, and went above and beyond to the needs of the patient.”
—-General volunteer
“The Jamaica Dental Mission is my most rewarding extracurricular activity. This is a trip to small villages in the most underprivileged parts of Jamaica. It is an interprofessional trip between the SIUE School of Pharmacy and SIUE School of Dental Medicine. During this trip, we work together to access and promote oral as well as overall general health to the local communities. Each year, life-altering interventions are made by the students with the oversight of Dr. James Lynch and Dr. Jennifer Rosselli.”
—James Langley. Receiving his RESPy (Respect, Excellence and Service in Pharmacy) Award.
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Pharmacy Highlights from the 2017 JDM
Six hundred seventy two patients were seen at the clinic this past July and approximately 365 prescriptions were dispensed. Pharmacy students measured 450 blood pressures and performed 52 blood glucose measurements. In addition, 18 patients were referred for additional services using a newly developed referral process instituted this past year. Examples of these referrals included previously undiagnosed diabetes, hypertension, seizure disorders and severe depression.