Screening for tuberculosis is one of the best tools to prevent the disease and its spread. So in recent years, pharmacists throughout the region and state have been increasing their TB screening efforts.
Tuberculosis is an infectious disease that usually attacks the lungs. When left untreated, it can be fatal. It can spread when people with an active TB infection sneeze or cough or spit, sending respiratory fluids through the air. Although the drug-resistant strain of the disease recently has become a concern, the disease is generally treatable with an antibiotic regimen.
In 2011, the first local case of drug-resistant tuberculosis was identified in King County, according to Public Health – Seattle & King County. That same year, 106 cases of TB were reported in the county (at a rate of 5.5 per 100,000 people). While that rate was the lowest it had been during the past 30 years, local public health officials reports that TB remains an ongoing threat in King County.
In late 2012, the Washington State Department of Health TB Services Program and the Washington State Pharmacy Association teamed up to offer training for pharmacy practitioners to become certified in TB screening. The goal is to increase the number of pharmacies throughout Washington that offer these screenings.
Pharmacy students play an important role in this goal. In May, 91 second-year PharmD students received certification in TB screening. Department of Pharmacy faculty member Skye McKennon worked with the State Department of Health and the Washington State Pharmacy Association to create the training program, which was offered as part of the students’ Applied Therapeutics course. This program is believed to be among the first in the country to offer a certificate in TB screening to students as a part of their PharmD curriculum.
The program included a lecture on TB assessment, a chance to practice the Mantoux tuberculin skin sensitivity test — the standard TB screening tool – on one another and a tutorial on checking Mantoux test results. The training occurred shortly after the PharmD students had learned about TB in their class.
The training facilitators were nurses Julie Tomaro and Temple Parsons from the Department of Health, pharmacist Jenny Arnold from the Washington State Pharmacy Association and the School of Pharmacy’s Applied Therapeutics instructors — faculty members Colleen Catalano, Skye McKennon and Elyse Tung.
“It was a pleasure to see students gain confidence in their skills and their scope of practice,” said McKennon. “At the beginning of the training, two students were apprehensive about practicing intradermal injections on one another. After practicing and receiving guidance on their technique, they could accurately perform the injections. By the end, they were happily taking pictures of each other and the marks on their arms.”
Student evaluations for the program were overwhelmingly positive. One student wrote: “I cannot wait to offer this at my work site. I am in the process of working with my company to start doing this in our pharmacy.”
In the future, the UW School of Pharmacy, the Department of Health, and the Washington State Pharmacy Association hope to collaborate again on a TB screening program for students. In the meantime, the state Pharmacy Association is continuing to offer certification programs for practicing pharmacists.
In light of budget cuts to publicly funded TB screening programs in the state, public health agencies are increasingly relying on pharmacists and other healthcare providers to screen for TB.
Pharmacists, as one of the most accessible healthcare providers, are well-positioned to reach out to populations at high risk for acquiring and developing complications from TB. These groups include people with HIV, people with other health problems that make it hard for the body to fight bacteria, recent immigrants, Native Americans, and people who abuse alcohol or use illicit drugs. See the Centers for Disease Control and Prevention full list of risk factors.
Not only are pharmacists important to helping screen for TB; they can also help provide medication management for infected patients to help them adhere correctly to the antibiotic regimen. People with TB must take the drugs exactly as prescribed over a six- to nine-month period. If they don’t, they can relapse or develop drug-resistant TB.
McKennon is excited to think about how this training program inspired the pharmacy students who participated.
“In the big picture, the students learned the importance of the pharmacist in public health matters,” said McKennon. “They also saw how the Department of Health, nurses, the state pharmacy association, the School of Pharmacy, pharmacy practitioners and pharmacy students can collaborate for the benefit of the public.”