Narrator - Dr. Abel  00:00
Welcome to HelixTalk, an educational podcast for healthcare students and providers, covering real life clinical pearls, professional pharmacy topics and drug therapy discussions.

Narrator - ?  00:11
This podcast is provided by pharmacists and faculty members at Rosalind Franklin University, College of Pharmacy.

Narrator - Dr. Abel  00:17
This podcast contains general information for educational purposes only. This is not professional advice and should not be used in lieu of obtaining advice from a qualified health care provider.

Narrator - ?  00:27
And now on to the show.

Dr. Sean Kane  00:31
Welcome to HelixTalk, Episode 79 I'm your co host, Dr. Kane. I'm Dr. Schuman, and I'm Dr. Patel, and today's episode is entitled cutting hair and blood pressure pharmacist in the barber shop, and I am incredibly excited to introduce two interviewees to this podcast, something that we really haven't done too much of before. We have Dr. Lynch and Dr. Blyler In a Skype call with us to help introduce a study that they were involved in that was recently published in the New England Journal of Medicine. So we'll go ahead and introduce both of you. Would you would you mind just stating your name and kind of what your background is?

Speaker 1  01:03
Hello. My name is Kathleen Lynch, and I worked on the cluster randomized trial of barbershop blood pressure reduction in barbershops. I'm originally from New Jersey, and worked at Brooklyn hospital and completed a residency there, and now I work in inpatient pharmacy again.

Speaker 2  01:21
My name is Adair Blyler, or Ciantel Adair Blyler. I'm a Clinical Pharmacist at Cedars-Sinai Medical Center, where I still work, and this is where we did the barbershop trial. I am a graduate of UNC School of Pharmacy, and we're happy to be here.

Dr. Sean Kane  01:36
That's amazing. So I wanted to start off the episode just talking about the study. And I think that, based on the title alone, it really captured a lot of people's attention. Of, wait, what is this about? It's about barbershops and blood pressure reduction. Could we just kind of briefly go through what the study was, why it was done, and what were some of the very overarching themes in terms of the findings of the study?

Speaker 1  01:58
Sure, so the study was conducted because non Hispanic, Black men have the highest burden of hypertension related death compared to other groups, which begs the need for a community based outreach. So this was a cluster randomized trial, with the barbershop being the unit of randomization, and we screened all male customers in barbershops at 78 barbershops around the Los Angeles area, and we wound up with a cohort of 52 barbershops and 319 hypertensive men that were customers of those barbershops. And we followed them for a period of six months, and half the barbershops were randomized to a comparison group where a barber served as a health promoter, so encouraged the men to get their blood pressure checked, make lifestyle modifications and follow up with their physicians. And then the other half of barbershops, which we refer to as the intervention group, were randomized to a treatment arm where a pharmacist managed their hypertension under a collaborative practice agreement with their physician and the barber encouraged them to follow up, get their blood pressure checked and take medication. So at the end of six months, the intervention group, which were under the pharmacist had a 21.6 millimeter lower blood pressure than the comparison group, and we also saw an improvement in self rated health and patient satisfaction with care and the intervention group also had a greater number of blood pressure medications prescribed and a greater number of first line blood pressure medications.

Dr. Sean Kane  03:43
That's great. Well, I think for me, one thing I just wanted to kind of highlight is the role of the pharmacist in the study. What was really interesting about the study was that these were not pharmacists in a clinic. These were pharmacists that were actually situated in the barber shop. Is that correct?

Speaker 2  03:58
Correct? Yeah. So Dr. Victor had done a prior study that linked barber health promotion with sort of what we would call usual care. Prior to coming to Los Angeles, he was based in Dallas, and he did this initial study where barbers talked to their patrons about their blood pressure and encouraged if they had high blood pressure, them to follow up with their physicians the results of the blood pressure reduction at the end of the trial were very modest, and there was a lot of reasons for that, both design issues and then also that physicians rarely intensified therapy. So the thought process here was, if he linked pharmacist led medication management, we might have a different outcome. And obviously we did. We had much, more impressive reduction of blood pressure,

Dr. Sean Kane  04:43
yeah, and I really want to highlight the degree of blood pressure reduction here. So 20, we'll call it 22 millimeters of mercury. That is an incredible reduction in an at risk patient population. Some would call it a difficult to treat or difficult to target patient population. So I think that. That number alone is very interesting, very promising for the potential role of a pharmacist in blood pressure management. Absolutely.

Speaker 2  05:07
Yeah, I think many magnitudes higher than what you see in typical pharmacists led trials. And I guess the other point that it's probably important to make is in most pharmacist led trials, the pharmacists are not really, truly in the driver's seat, so to speak, in terms of the management of care. Pharmacists often are relegated to the role of just making recommendations to physicians, whereas in this particular setup, we were able to make determinations about what medications we were going to give patients without having to get physician approval. We were practicing under collaborative practice agreements, and we had a little bit of latitude in terms of latitude in terms of, you know, decision making process.

Speaker 3  05:46
And I think the other important thing to add here is the cultural aspect of health care. And just looking at this subset of non Hispanic, Black passion population, and the huge talk in the health care arena is about, how do we increase access? So instead of asking them to come to a healthcare provider, we took the healthcare to them in their community. And I think this is a great example, and probably sets a stage for future interventions in cultural subsets and populations.

Speaker 4  06:17
Yeah, and as a pharmacist in a mental health clinic, again, one of the things I always think about is that that that accessibility is such a big piece of it as we've moved out of these facilities. And again, try to get people engaged in the community, again, where they're at, and we try and removing some of the stigmas about health care and avoidance of health care and at risk populations. And again, maybe you know that meeting people where they are in an informal setting to where you're encouraging more open dialog, rather than, Oh my goodness, it's a healthcare provider. I I gotta, you know, I don't want to give them the real talk kind of approach. And so again, I really like that atmosphere that we're kind of getting at here.

Dr. Sean Kane  06:49
And I know that Kathy and myself both had students, p4 appy students that actually recently presented on this. And Tammy, one of my p4 students, had a couple questions for you guys that she would like to ask, one of the questions that she was curious about was actually the difficulty in enrollment process. So I know in the manuscript, it talks about how you thought you would only need something like 20 barber shops, and ended up being quite a bit more than that, just because of a low number of patients per barber shop. How difficult was that enrollment process, and what were some strategies to help with that enrollment in terms of, you know, working with the barber and the barber shops, but just getting the patients to buy into this idea of having someone check their blood pressure and give them prescription while they're in the barber shop itself.

Speaker 2  07:31
Well, I do know that again, Dr. Victor was coming from Dallas, so he had, sort of, like, a preconceived notion of how easy it would be, potentially, to recruit African American patients in Dallas, he found that shops were quite large in size, and the African American population was sort of congregated in a certain area. So enrollment in that study was quite simple for him. He had, you know, 20 to 25 patients per shop. It's different in Los Angeles, Los Angeles, I think, is only about 8% African American, and it's sort of a big, sprawling city where people are quite spread out, so we found that shops were much smaller in size. People were in different areas. So yes, it was not similar to the Dallas setup at all. We and we found it very difficult to get large numbers of patients in single shops. The other big thing that happened with enrollment is we had pretty strict inclusion criteria. We were really targeting people with really bad hypertension, so they had to have systolic blood pressures of over 140 on two separate occasions. There was a lot of screen fails, just by virtue in fact that we were really targeting people with who are quite sick and who had very bad blood pressure,

Speaker 3  08:39
like Dr. Kane said that, you know, Tammy was one of the students doing this journal club. I had a student Marie who did the journal club. And I think both questions are similar. So their question was, you know, what are the thoughts about that $25 gift card that was given to the study participants to cover the cost and transportation to the pharmacy? And really the bigger question is, like, how does it affect the external validity? You know, if we were to replicate a similar healthcare model in the community, what's the longevity in really the practicality of such an intervention?

Speaker 1  09:16
Yeah, definitely it wouldn't be sustainable if you were to have a large scale implementation study to give all participants a $25 gift card each time, and that's something we plan to look at going forward when we do conduct implementation studies and analyze the cost effectiveness. So that is a good point to consider going forward.

Dr. Sean Kane  09:40
And I think too, if you think about it, insurance, by virtue of what insurance is, it's a way that we effectively give a medication to a patient for a reduced cost, hoping that by giving them that, that they won't be as costly down the road. So in a way that we kind of have that in the sense of a copay for a medication, is this not. The same, the same vein where it's a gift card versus a reduced cost at the pharmacy itself. But as you guys talked about in the manuscript, many of the medications that you picked were on the $4 list and things like that. So it wasn't that these patients were receiving really expensive, branded medications. I think that from a feasibility standpoint, it still holds true that, you know, this is a potentially feasible study, maybe not in the same way, but certainly along the same path. I think Sure, exactly. And I think that we could easily spend the entire podcast talking about the study, the nuances of the study. It's a very exciting study, lots to unpack there. And I'd really encourage the HelixTalk audience to go to our website, HelixTalk.com and actually read the study. It's fascinating. The supplement was amazing. It had a lot of really good, detailed information about the wall posters that were hung up to help with patients buying into the the idea and things like that. You can also go to any jm.org This was published on March 12, 2018, so we certainly could talk more about that. But I think one of the reasons that we invited you to specifically was we wanted to know more about the role of the pharmacist and a research project like this, and specifically for the audience, how they might get involved in something like this in the future. Yeah, so I

Speaker 4  11:14
think the first question to that again, is, with all of us here at the school as pharmacists, you know, we enjoy the research process, but it's always kind of you see differing expectations as far as what is the role of a pharmacist in research? What can a pharmacist do from the design, process, implementation? So we want to kind of see this. What was your specific involvement? How did you become involved in this?

Speaker 2  11:35
I'm gonna let Kathy start, because she she got involved in the project much earlier than I did. I sort of came several months in. So I'll kind of let her talk about where she jumped in on the process, and then I can add my my bit.

Speaker 1  11:46
So I came prior to the study actually starting, but after it was funded. So I started in July 2014, and I actually I had completed a one year residency at Brooklyn hospital, and then was working there for a year, and then I moved to Los Angeles to start this job. So the study was funded and the design was already in place, but a lot of the groundwork hadn't been done yet. We worked with a survey research company called Westat, and they did all the screening and study outcomes in the barber shops with the participants. So there was a lot of upfront work, working with them and getting our database set up. And we also had collaborators at UCLA and Kaiser Permanente, and there was a lot of groundwork to set up the IRB relationships with them and also get everyone on board. And one of the first big projects I started on was selecting the blood pressure device that we were supposed to use. Since our primary outcome was blood pressure related, it was critical to get a really accurate blood pressure monitor, and we also wanted one that could electronically transmit the blood pressure readings to reduce data entry errors. So that was something I worked on

Dr. Sean Kane  13:05
before we move on. On that. I did want to poke your brain just a little bit because, again, it was something in the study that it sounds like you were more intimately involved in. So the in the study, blood pressure was collected five times in a given setting, and then the first two readings were discarded, and the latter three readings were averaged really good in terms of accuracy of blood pressure readings. Did you get much pushback from the patients in terms of having that cuff inflate five times in a sitting?

Speaker 1  13:33
No, sometimes the first time patron got their blood pressure measured, most people would say like, oh, this is weird to have my blood pressure measured so often. But then towards the end of the study, all the men would be telling me, when they went to their doctor's office that it was only measured once. So people really got accustomed to that many blood pressure readings. That's awesome.

Speaker 2  13:53
Yeah, and the machine was set on auto, so it was, you know, it's pretty quick. It was, you know, one after the other, probably within five minutes you could get the five readings. So yeah, it wasn't terribly uncomfortable, and it was pretty fast process. So Dr

Dr. Sean Kane  14:06
Byler, can you tell us a little bit about your background and your involvement in the study?

Speaker 2  14:10
Yes, I came in, like I said, a few, few months after the study had started. I was already here in Los Angeles. I had done work with other sort of at risk population. And I kind of sort of fell into this, to be perfectly honest, and was delighted to be included. So I did not do a residency. So unlike Kathy, I went to University of North Carolina, got my degree. I had always had a strong interest in infectious disease and HIV. I moved out here to Los Angeles and worked with for AIDS Healthcare Foundation, and then later for a small, independent HIV Specialty Pharmacy. And I had not enjoyed that retail experience much, and was kind of looking for something else that was had a little bit more meaning to it. And like I said, I came into this position in my very first. Position. I worked with a geriatric dual eligible population in North Carolina, and I had worked sort of in a similar capacity, where I saw patients by appointment only. I really liked that setup. And so coming back to this study kind of gave me an opportunity to meet patients one on one in a sort of scheduled environment, and I'd have really time to talk to them, instead of, you know, in the retail aspect, where you're kind of just moving, moving, moving, and you don't really have time to connect with patients or answer questions.

Speaker 3  15:28
This is how exactly I pursue my students to pursue in a military care career, because it really helped. Gives you that one on one interaction and ability to develop those relationships. Absolutely.

Dr. Sean Kane  15:40
And can I ask how many unique pharmacists were involved in the entire process, in the actual barber shops themselves? So how many people were trained that actually sat down and interacted with patients just the two of us the whole time? Yep, holy cow, you guys must have driven a lot.

Unknown Speaker  15:56
We drove a lot. Sounds

Speaker 3  15:58
pretty good amount of driving, yeah, and especially in the LA traffic, right?

Dr. Sean Kane  16:03
Yeah, well, that's amazing. I didn't pick that up from the manuscript, actually, that you were the only two pharmacists involved in the entire study, yeah. Oh, that's incredible. It sounds like we have the right people in the podcast, and so we will continue our interview here. So in terms of students that are listening, or even pharmacists that are currently listening. What advice would you have for those listeners that might be interested in pursuing research like this, in terms of getting their foot in the door, or things that they can be doing right now to kind of set themselves up for research endeavors in the future?

Speaker 2  16:35
I don't know that I have great advice. I mean, I have kind of a non traditional path to getting here. I will say I I have been interested in research in a lot for a long time. So even as an undergrad, I did a summer research internship with Mass General Hospital in Boston. And then when I was in pharmacy school, I did help a professor with some of her HIV research. So I'm sure that probably helped me when I came to interview for this position, because I did have some research experience. Kathy can probably talk more extensively because you've done a residency, so you've had extensive research experience.

Speaker 1  17:08
Yeah, I did. I did some retrospective chart review studies when I was a resident as an end as a student, and then before I became a pharmacist, I worked in on a community based study with trying to control asthma in the Rochester City School District in New York, the skills and experience I had there was really translatable to this study working in the community, like very unconventional study. I never thought I'd be working in barber shops ever. So I think it was like a very unconventional study and a really good opportunity for us to learn about hypertension and also learn about research. But I think our study was really meeting an unmet need with African American men. So I think if someone's interested in research looking for an unmet need like this is the perfect opportunity to get involved in something.

Speaker 3  18:04
I sense a theme over here that early on involvement in student life, to participate in any of these research opportunity is the best way to gather that experience. And kind of translates as you transition to becoming a new practitioner, or even a seasoned practitioner, like Dr. Blyler, exactly.

Speaker 2  18:22
Yeah. I think those early experiences you find out if it's of interest and it proves very helpful in your career down the line, great.

Speaker 4  18:30
And so I think one of the things is like, I can imagine the logistics. I know we talked a little bit about the barbershop atmosphere, but just the overall scope of all the moving parts here and again, seems like it'd be, it'd be daunting. So we kind of wanted to see if we could talk a little could talk a little bit about some of maybe the challenges as far as the design or implementation. I guess first, it sounds like you all again, kind of came in after the funding piece. But can you tell us anything about that? Was there any difficulties getting funding or kind of selling this to, you know, to an organization to say, hey, we've got this, this interesting idea. What do you

Speaker 2  19:02
think? I don't know much about that. Did they get funded

Speaker 1  19:05
on its first try? No, it was on the second try. And there was actually a pilot study that neither Adair I was involved with that took place at one barbershop in Altadena, with about a dozen patients. They had actually identical results as ours. They had about a 20 millimeter reduction in blood pressure after six months, so that definitely helped. And then also Dr. Victor's prior barbershop work. He's been working on barbershop studies for probably the past 20 years, so he has a really strong record of working with barbershops on blood pressure, so that definitely helped get funded

Dr. Sean Kane  19:45
for your component. Specifically, what were some of the challenges or logistic hurdles that you guys had to overcome to kind of accomplish your role in the study?

Speaker 1  19:55
Well, one thing, just a practical thing, is, since we were you. Using angiotensin receptor blockers, ACE inhibitors and diuretics. We obviously had to check baseline labs and follow up labs after starting that. So one thing that we found is we used a point of care device to get a basic metabolic panel, which also helped the men with participating in the study as easy as possible, like we were going to them checking their blood pressure there, and we were also getting baseline and follow up labs with a finger stick using this point of care device, which was really helpful. So that's one way we did our due diligence, checking labs and making it easy for participation.

Dr. Sean Kane  20:40
And I feel like had you not had that, your ability to safely monitor drug therapy and really get the patients going on drug therapy would have been dramatically impaired, because that's another hurdle to go to a lab to get your blood drawn and things like that. So I'm sure that having that was a game changer for you guys, right?

Speaker 2  20:58
Oh, absolutely made things much easier. And again, the patient didn't have to go to the traditional healthcare setting to get the laboratory work done. So that made it very, very easy. The other, the other thing I was going to say, one of the big hurdles that we came up against, and we haven't really touched on that yet, was getting people to be comfortable taking medication. So there was a lot of pushback initially, where people didn't want to take meds. And so, you know, we talk a little bit about this in the paper, but there is a history in the African American community to have a distrust of medical providers for historic reasons and very understandable reasons. And so when we come from our outside neighborhood into these these neighborhoods, and say, We want to give you medication, a lot of times, people were reluctant to take it. They wanted to know who we were, were we experimenting on them, what this medication was? So that was a big hurdle that we had to get over and again. I think, meeting people where they are and establishing a rapport and getting them to trust you, you know, was essential. If we couldn't do that, we wouldn't have a study. So could

Dr. Sean Kane  22:02
I assume then that you had probably a number of patients where you almost had to form a relationship before you would even be able to give them a medication? Absolutely.

Speaker 2  22:11
Yeah, I had one patient that comes to mind right right off bat, who basically said, Well, I want to improve my blood pressure, but I really don't want to take meds. I think I'm just going to eat better and work out. And his pressure was really pretty terrible, and I knew that that was not going to be enough for him, that he was going to need medication, but I kind of stuck it out with him. I think we ended up giving him about a month. So we talked about diet, we talked about exercise. He tried to implement some of those lifestyle modifications, and he would keep coming back to me at the barber shop, and his blood pressure was still elevated. And I think just because we we allowed him the chance to try what he wanted to try, and we stuck with him. He eventually trusted us, and he didn't come back and took medication. So there are a couple of patients that were like that. There were other patients that just wanted to know we weren't using some sort of experimental medication that these are old medications that have been used frequently and once, once they were notified of what we were going to be using, they were on board with taking medication.

Speaker 3  23:10
I think you addressed very important point over here about adherence and the importance of pharmacist helping to overcome the adherence issues is, I mean, if it's happening in the, you know, trials, then it can definitely happen in the real life. And I kind of was smiling as you said, you know, you let the patient try the lifestyle modification so they feel like they're involved in their care, that they are heard in their healthcare decisions. And if that didn't work, then come back and, you know, we'll talk about medications. And that's the kind of approach I sometimes use in my patient population,

Speaker 2  23:48
yeah, I think, and you know, not to bash doctors or anything like that, but you know, doctors are often under time crunch, particularly primary care physicians. And so, you know, when a patient comes in, they see a problem, they'd like to treat it. They want to treat it quickly. And I think a lot of our patients, you know, sort of voiced feeling like things weren't fully explained, and it felt rushed. And so again, we were in a very unique position that we had the time to sit down and talk with people. You know, our visits lasted anywhere from 15 minutes to 45 minutes. You know, most doctors are in and out in 15 minutes. If they're not, there's a nurse chasing after them, yelling at them to speed it up. So we were kind of in a unique position where we could sit down, listen to their questions, concerns, answer those questions, concerns. I think that that really did help down the line with adherence and ultimately with improved outcomes.

Speaker 3  24:38
Agree, and that's a true representation of how pharmacists can work as an extender of these providers who literally do not have enough time to spend with the patients, right? So our question is, you know, this trial was great. We encourage our listeners to go and take a read at it too. But where are we headed from here? How do you see the study results change? In the future clinical practice.

Speaker 2  25:02
Well, we hope this is a good example of how pharmacists can be better utilized and the healthcare system sort of our first step. We'd like to do some implementation research. We want to be able to prove that these results are replicable in other cities or in other healthcare systems. As Kathy mentioned, before we do it, we did have a nice partnership with Kaiser Permanente of Southern California. We're in talks with them to see if they could do a pilot. We were also in talks with Vanderbilt about potentially doing a pilot in Nashville, Tennessee, again, to be able to show that these results are replicable with other pharmacists and other settings. And I think ultimately, if we, if we're able to show that this is doable, that pharmacists can manage chronic conditions and non traditional health settings, but eventually payers would get on board, and insurance companies would be willing to reimburse pharmacists for their work, and yeah, I think that would be huge for changing clinical practice, for for pharmacists, And obviously alleviating the burden that a lot of primary care physicians are facing right now.

Dr. Sean Kane  26:05
So I think, from my point of view, at least one of the reasons why this New England article was so widely distributed and so interesting was the fact that barber shops were selected. It sounds like a very unusual or non traditional environment. Would you guys mind just to kind of wrap things up, explaining why were these barber shops targeted, and kind of the background of that decision, sure.

Speaker 1  26:26
Well, it's the perfect place to find men. And in our study, we found that the men, on average, were going to their barbershop for a decade, which is an extremely long history of patronage. And they would go at a frequency of every two weeks, which is incredible, and also the perfect increment to measure blood pressure. Yeah.

Speaker 2  26:48
So it's a it's also a setting where people go to gather information. Sharing is common. There's a real trust that many of these patrons build with their barbers. So it was essential to get the barber's endorsement of the study when they encourage their patrons to follow up with us, it you know, they, they trust these men, so they they were more willing to come to talk to us, and obviously, to take medication from us. But I think in terms of like cohort retention, we talked a lot about cohort retention in the paper. This is a place where people come frequently for many years, and we know that we can find them there. I guess we also didn't mention earlier that a lot of our patients had established physicians. They had insurance. It wasn't that they didn't necessarily have access to health care. They just weren't going to see doctors. So obviously, us coming to where they are made a huge difference.

Dr. Sean Kane  27:40
So as we kind of covered already, the fact that the study was based on the fact that we were in this non-traditional environment for pharmacists in terms of providing this clinical care for patients, I think it really begs the question of, are we going to see more of this, and will anyone pay for that kind of care for patients?

Speaker 4  27:57
So yeah, reimbursement is a big factor. And again, is if you have people that are ready, kind of in a research role. You have a chance to kind of do the job regardless, but for others to be able to really take and run with it, or even to be sustainable for future research, you really got to show some of those really important outcomes. You know, again, we have, we have blood pressure, for example. What does that mean in terms of cost savings? So we can, we can track that to, for example, mis strokes, hospitalizations that have dollar value. Saying a pharmacist, even in this odd setting, can save you dollars,

Speaker 3  28:28
yeah, and absolutely upfront cost of hiring a pharmacist and running these frequent screening and you know, follow up services might be higher, but if you're looking at the health care dollars saved so they're talking about cost savings for preventing hospitalization, like you said, Dr. Schuman, this is going to all pay off at the end, and a study like this that shows a clinical outcome is going to serve as a foundation for insurance or payers to understand what value pharmacists can bring in in a health care team.

Dr. Sean Kane  28:56
And as Dr. Blyler and Dr. Lynch already said, you know, we're getting new data that is going to help understand that cost benefit ratio in terms of, is this model the same model in Nashville as it is in LA, and what does that look like? And what are the potential cost savings? Then it really comes down to the question of, will Medicare, Medicaid and third party payers pay for that service to make it a viable business option for pharmacists to be involved in that role. So in terms of kind of wrapping this up, there's a lot of different ways to go from here, but I think one exciting thing is to think about, if you're currently a pharmacy student or even a pharmacist in clinical practice, how can you use the results of this study as an example to institute changing in the care of your patients?

Speaker 3  29:38
For me, if I can say personally, this study is very motivating for us to go out and actually reach out to the community members on one on one. You know what it means for the students, perhaps they can get engaged in research opportunities like this for other pharmacists and healthcare providers, even students out there. You know, we do variety of screening activities out there, but this study over here shows that, you know, control group was screened three times over the six months, and it didn't really impact their medication taking behaviors or visiting the physician behaviors or their routine habits. So yes, there is value in going out there and showing the worth of what pharmacists can do in the community by doing these screenings. But you kind of have to think about some like long term relationship building with your patients, right?

Speaker 4  30:28
And one thing that I immediately think about again, the one of the big words for me about what is a pharmacist, and the word is accessibility. And I think this is what it showed, is that we think about all the places you know, pharmacists are, and we think about community settings, and we think about, again, here at barber shop, is you, by creating that rapport, building those relationships with your patients or your clients, again, you get some of that ability to maybe have dialog. If the Rite Aid is open, there's a pharmacist there, their advice is free, there's and setting up this expectation about and some of the informality that you could then use to be able to really get at things like adherence for patients and broaching some difficult subjects, yeah.

Speaker 3  31:09
And some of the examples you know, in the community, like you said, Dr. Schuman, about accessibility of pharmacist is good. Example is large grocery chain pharmacies, right? You have the blood pressure monitor. There, you have slots for the MTM that you can see patients for. And then you may even pair up with a dietitian that can walk around the patient and talk about how to pick the right food and how to read the label and look at the sodium content and stuff. And the culmination of all this can result into habit changes, lifestyle changes, and then perhaps further follow up with their physicians.

Dr. Sean Kane  31:45
I think that for me, one big takeaway, for me is this isn't about black barbershops. It's about accessibility and developing relationships with your patients. So using the grocery store as an example, many people go to the grocery store every week, every two weeks, sometimes more frequently than that, so getting to where the patients are is important, and potentially using newer technologies, like the lab asset that they used in the study to be able to get your Chem seven on these patients to safely give therapy without sending them to a lab to make it convenient. So maybe we need to change our perspective a little bit as healthcare providers, that maybe the best way to provide care isn't in that clinic setting, but in some of these non-traditional, novel settings, and being flexible in terms of how we conduct our business to improve patient outcomes, I think that's fantastic and a really nice way to kind of wrap up this episode, Dr. Lynch and Dr. Blyler. I really appreciate all of your time, your expertise in sharing your experience with the study and your background with us. For our listeners who want to read the study, as we said, we'll have a reference at HelixTalk.com this is episode 79 we're also on Twitter at HelixTalk, and we love the five star reviews in iTunes again. Thank you so much for your time. I'm Dr. Kane, I'm Dr

Speaker 3  32:53
Schuman, and I'm Dr. Patel. And study hard.

Narrator - Dr. Abel  32:57
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Narrator - ?  33:08
to suggest an episode or contact us. We're online at HelixTalk.com thank you for listening to this episode of HelixTalk. This is an educational production copyright Rosalind Franklin University of Medicine and Science.