Union News

Pharmacist Shawn Taylor’s healthcare philosophy sounds simple enough: provide the best possible health care to every patient regardless of their ability to pay. But putting that principle into practice is anything but easy, which is why Dr. Taylor’s successful efforts, both in the mountains of North Carolina and in Honduras, helped earn her the Ambulatory Care Pharmacist of the Year Award.

Reserved for “a pharmacist with immense moral character, good citizenship, and high professional ideals who has made significant contributions to their area of practice,” the award is given by the North Carolina Association of Pharmacists.

Michelle Chaplin, assistant dean of pharmacy on Wingate’s Hendersonville campus, says the organization, which has more than 2,000 members, couldn’t have made a better choice.

“Shawn is truly deserving of this award,” she says. “She has worked to build a practice serving majority low-income patients in Western North Carolina. She has worked to expand her skill set to meet the needs of this community and, in her success, has also paved the way for additional pharmacy positions to be created and filled.

“She’s also obtained grants and worked to establish accredited services to further the reach of her care. Shawn continues to publish much of her work and inspires student pharmacists by involving them significantly in scholarship and her practice site.”

In her Foundations of Pharmacy Practice and Community Health Engagement class, Taylor helps students understand that no matter how much they know about the medications they’re dispensing, they won’t be successful unless they can communicate well with their patients and help them overcome some daunting hurdles.

“I tell my students that 50 percent of the job is figuring out the best medication and the other 50 percent is figuring out how the patient is going to get the medication into their body,” Taylor says.

Alongside her at the Dale Fell location of the Appalachian Mountain Community Health Centers during clinical rotations, they see what she means. As an example, she describes one of a dozen or so patients she sees in a typical day: a man experiencing homelessness who needs insulin therapy to manage his diabetes. “For someone in his scenario, there are a lot of barriers: no access to a refrigerator, the need for a clean injection site even though he doesn’t get to bathe frequently, the need to dispose of supplies in a safe way,” she explains. And the list goes on.

She has enrolled him in a patient-assistance program to get him insulin even though he’s uninsured, and she’s prescribed the type of insulin that can last the longest without refrigeration. A diabetes grant has provided funds for a glucometer and other testing supplies so he can track his blood sugar.

“He has a lot of edema in his legs, because he sleeps in his car and can’t keep his feet elevated, so we found him some compression stockings, and that swelling is improving,” Taylor says. “And a social-work team is working on finding him housing.”

It’s been a three-year process to get the patient this far. But Taylor won’t give up, and that persistence is part of what she wants to pass on to her students.

“I challenge students to think about what is the best medication first and not to be deterred by the fact that the patient may not have easy access to the medicine or may not have a high rate of medication adherence,” she says. “Our role is to pick the best combination of medications and then work out how to make the situation work.”

Getting students involved

Taylor acts as a “preceptor,” or onsite instructor, for students in their third and fourth years of pharmacy school. She has about 14 students doing monthlong rotations with her each year. Onsite with her, they work as autonomously as the law allows, running appointments themselves while Taylor observes.

“Sometimes it starts out being very terrifying for them, but over the month they get more confident,” she says. “It’s especially good when they get to follow up with the same patients, seeing how their intervention worked or didn’t.”

Taylor says students are often shocked by the barriers some of their patients face, even though they’ve heard about them in class.

“Oftentimes we’re quick to judge people who are not taking their medications,” Taylor says. “But students who have been on the dispensing side of the situation get to unpack the other side of that when they are in the center and patients open up to them. They get to hear firsthand that a patient is struggling to either pay for their medicine or buy groceries or gas. And if they don’t take their medicine, they don’t immediately feel any different. So it’s a lot easier to understand their decision when you are talking with them.”

As a clinical pharmacist practitioner, an additional license that allows her to provide treatment unsupervised for certain conditions, Taylor sees patients one-on-one for 40-minute appointments, helping them manage their health despite hurdles. She became the first CPP at Appalachian Mountain Community Health Centers in 2017 and quickly proved the value of her services.

She outgrew her capacity but was able to expand the program and hire a second full-time pharmacist. The addition of Kailey Hoots (valedictorian of Wingate’s pharmacy class of 2020) at AMCHC’s location in Murphy, North Carolina, last year means patients there have a CPP onsite rather than having to use telehealth or wait for Taylor’s next trek from Asheville to the state’s far western corner.

But when it comes to ensuring that people get the medical help they need, Taylor isn’t opposed to travel. For the past decade, she has taken off to Honduras multiple times a year, often taking students with her to serve the village of Guachipilincito as part of a Shoulder to Shoulder medical brigade. She joined the board of the organization seven years ago and has since become its president.

“I just love helping people who are less fortunate,” Taylor says of her work in the remote village of about 500 people.

After her first brigade mission with a group from Brown University, she began trying to find a way to include Wingate students in the effort. Two years later, Taylor had constructed a for-credit course associated with the brigade, and in 2015 she took Wingate pharmacy student Evan Drake with her on a mission. Since then, she’s personally taken a dozen students down and recruited other faculty members to follow suit.

This summer, Taylor took students Haley Clark and Kendall Wick on the University’s first international trip since the beginning of the Covid pandemic. During four clinic days, their Shoulder to Shoulder team, which also included a physician, a medical student, a community health liaison and interpreters, saw 88 patients, dispensed 224 prescriptions and educated 61 elementary-school students on nutrition and dental hygiene.

“Dr. Taylor let Kendall and I run the pharmacy, which definitely boosted my confidence in being able to be a pharmacist,” Clark says. “At first, I was like, ‘Oh my gosh, what are we doing? We need to go ask her.’ But by the end of the week I felt much more confident in the decisions we were making and the medication counseling as well.”

Although the physician sometimes prescribed specific medications, at other times he would simply offer a diagnosis and leave it up to the pharmacy students to determine which of the limited medications were most appropriate.

“What surprised me most about the pharmacy was the limited formulary that we had,” Clark says, describing the handful of medicines they had for chronic conditions such as hypertension and diabetes. After putting the medication, often blister-packs of capsules, in zip-top bags, they would write dosage directions in Spanish and then spend time explaining to the patients how and when to take them.

“We would give them a 140-day supply for the chronic diseases to last until the next brigade comes in October,” Wick says.

At the end of the clinic day, they often hiked out to even more remote parts of Honduras to visit homebound patients.

“The home visits were probably my favorite part,” Clark says, describing the hikes as strenuous and humbling. “I felt completely drenched in sweat, and I know I looked like I had just gotten out of the shower. We’re wearing our hiking gear, carrying water, and we would meet locals who were barely breaking a sweat. Some of them were wearing flip-flops, sandals, Crocs – you name it. They’re not breathing hard at all, and we’re dying. We walk this path one time, and they are walking this every day to go to school or into town.”

The medication counseling that Wick and Clark were able to do, both at the clinic and in remote homes, gave them a chance to practice the teach-back method, checking their patient’s understanding by asking them to state in their own words what they need to do about their health or how they need to take their medication.

Taylor says the work in Guachipilincito is one of the first times that many pharmacy students truly feel a part of an interdisciplinary team.

“Ours is a very integrated clinic, as opposed to in the U.S., where pharmacies are often siloed,” she says. “While we’re there, the patients see the doctor and the pharmacist in the same space. It’s my chance to take a back seat and concentrate on practicing my Spanish while letting the students take the lead and collaborate with the physician.”

She said often students who join her on a mission enjoy the work so much they don’t want to leave. But when they do get back, they’re able to apply their new knowledge and confidence and also contrast what they’ve experienced in an underdeveloped country with conditions in a U.S. clinic.

Through it all, Taylor says, the most rewarding part of her role as professor is the relationships she builds with students. She connects with them early, when “they most often have a narrow view of pharmacy,” but then equips them with not only the clinical education but some important soft skills. Before you know it, they’re “connecting with peers, supervisors and patients and learning how to problem-solve strategically.”

Above the awards, that’s what makes her job so satisfying.

Learn more about the Wingate University School of Pharmacy.

Original source can be found here