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Prepare for the back-to-school rush!
Back-to-school season is a time of change, renewal, and anticipation. Parents may overlook, however, potential health issues facing their children in the classroom and schoolyard.
Increasing numbers of children and adolescents require medications during the school day for chronic medical conditions, including epinephrine injections for severe allergic reactions, rescue inhalers for asthmatics, and glucagon for hypoglycemia.
Other pupils and students may need short-term medications like pain relievers and antihistamines at some point during the year. Add to that the threat of ever-present bacterial and fungal infections (not to mention lice infestations) that are associated with children and enclosed spaces.
Many school systems have reduced the number of school nurses. The National Association of School Nurses (NASN) reports that only 39% of schools nationwide employ full-time nurses, 35% have part-time nurses, and 25% have no nurse. This means the responsibility for dealing with students’ health needs is often shifted to staff members who have little or no medical expertise.
So who can pick up the ball when the school nurse is overworked? Parents and schools do have access to a most accessible healthcare provider-the local community pharmacist-who can help ensure that the school year is a safe and healthy one.
According to Bethanne Brown, PharmD, BCACP, associate professor at the James L. Winkle College of Pharmacy at the University of Cincinnati, health issues may not always be top of mind with parents during the back-to-school scramble. Pharmacists should try to establish and cultivate relationships with the parents/guardians of school-aged children throughout the year, but particularly during the back-to-school season.
In the run-up to school, Brown advises pharmacists to proactively alert parents and children to the signs and symptoms of common infections and how to prevent them. “If you’re talking about school-age kids, head lice come to mind; be aware of what to look for and how to treat it,” she says.
Kids should also be taught how to cover their mouth and nose when they cough or sneeze by directing the airflow into their arm. “It’s been described as the Dracula sneeze-cover your mouth like Dracula would put up his cape,” she says.
Lucas Smith, PharmD, owner of Buena Vista Drug in Colorado, echoes Brown’s advice. He advocates a proactive approach for pharmacists and parents alike that was reinforced by recent experience.
“Two years ago, there was a large outbreak of lice in our public school, and we were struggling to keep RID in stock, or even get it from our wholesalers,” he recalls. “If more parents had been prepared and had it at home, it could have helped stop the outbreak faster.”
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As a Health Mart pharmacist, Smith offers its Children’s Free Vitamin Program for children from ages 2 through 11. He also promotes vaccines for children and their parents. “We’ll ask, ‘Have you had a tetanus shot in a while?’ Or we ask about other vaccines that they might need,” he says.
According to the University of Connecticut School of Pharmacy’s publication “The A-B-Cs of Kids and Medication: Re-Schooling Pharmacists and Families for Best Outcomes,” up to 20% of school-aged children suffer from chronic health conditions such as asthma, ADHD, diabetes, or food allergies. Four to six percent of them receive medication for these conditions during a typical school day.
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“While various organizations have published guidelines on how to best manage medication in children who attend school, no universal policies exist. This creates opportunities for pharmacists,” the publication notes.
An NASN 2017 position paper states a student’s ability to learn is directly related to his or her health. The student’s capacity to focus on educational tasks may be impaired by unmet medical needs and school absences.
“School-aged children suffering from chronic and acute illness are often poorly-managed,” the UConn publication states. “In the absence of universal regulations, pharmacists have an opportunity to aid caregivers and educate all parties involved in school-day healthcare. Community pharmacists are uniquely positioned to facilitate medication administration at school and prevent it whenever possible.”
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In fact, a study of medication management (MM) in Minnesota schools published in the Journal of the American Pharmacists Association confirms the need for these pharmacist-school partnerships.
The vast majority of school nurses surveyed were interested in partnering with pharmacists. Ninety percent thought that a pharmacist could assist with MM, while 80% indicated they would consult with a pharmacist. But only 12% reported that they already had informal access to a pharmacist.
“Interprofessional partnerships focused on MM and education are high on the list of services that school nurses would request of a consultant pharmacist,” the study concludes.
Prescription Meds in School
Prescription medications that must be administered while at school present special challenges for pharmacists and parents (see sidebar). Smith says that he often works with parents of children who have chronic medical needs. He begins with a conversation with the school nurse to go over the student’s specific requirements.
When it comes to dispensing duplicate medications for school and home use, Smith goes the extra mile to serve his patients.
“Sometimes it’s us and/or the parent having to call their insurance company in order to approve an additional inhaler or whatever it is that they need, so they can have it in both places,” he explains. “We try to work with the parent to get the approval, so we can fill the prescription, and so they don’t have to pay out of pocket for it. Sometimes we have to try to fill the prescription as soon as we can the next time so they can get backstopped.”
While all 50 states have immunization requirements for children in preschool and K-12, the recent measles outbreak in the United States, the worst in 30 years, has underscored the reality that many children do not receive the immunizations they need.
Several states have eliminated the religious or philosophical exemptions to vaccinations in response to the outbreak.
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“Concerns based on misinformation about the vaccine safety and effectiveness, as well as disease severity, may lead parents to delay or refuse vaccines,” CDC reports. “All parents want to make sure their children are healthy and are interested in information to protect them. We have to work to ensure that the information they are receiving to make health decisions for their children is accurate and credible.”
Walgreen’s vice president of Pharmacy Operations and Specialty, Rina Shah, PharmD, calls this outbreak of measles “alarming.”
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“It is a responsibility of every healthcare professional to make sure that all parents have the most up-to-date information as they make those decisions,” she says. “Not only are they helping themselves but, because of herd immunity, they’re helping the community as well.”
Walgreens views the back-to-school period as a time to get all family members current on their immunizations. “Parents take care of their children, but sometimes they forget to take care of themselves,” Shah explains. “It’s critical that before they get exposed to all of the children in school, the entire household is up-to-date with their vaccinations to ensure that they’re preventing any disease that might be out there.”
Approximately 400 Walgreens stores nationwide offer a Healthcare Clinic or other provider retail clinic services. The clinics offer school physicals and routine vaccinations like Tdap, meningitis, and HPV, as well as flu and pneumonia shots starting in late August.
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This year, Walgreens partnered with the ME to WE Foundation and Mental Health America to create “WE Teachers,” a nationwide initiative to give teachers access to tools and resources. Through the program, teachers can access online digital training modules to help them identify and assess issues affecting their students, such as youth violence, poverty, bullying, and mental health and wellbeing. The online modules will begin rolling out this fall and will be available to teachers in the United States and Puerto Rico. These educational modules will be available in both English and Spanish.
Off to College
Once adolesents reach college age and are able to take more responsibility for their own health, the focus of the advice that pharmacists can provide changes, Brown says. “With college-age students that are sharing dorm rooms and bathrooms, you have to worry about athlete’s foot and other health conditions that are easily transmitted,” she points out.
College-bound students should assemble a first aid kit with basics like bandages, antibiotic ointment, acetaminophen or ibuprofen, plus instructions for their uses. It should also include a list of emergency contacts and phone numbers (their parents’ number, physician’s number, and the local hospital’s number) and insurance information in the event that the student is incapacitated or has to go to the emergency room.
Students who take prescription medications should be well versed in all the particulars, including the medication’s name, dosage, frequency of use, any food or drink restrictions, and possible side effects. They should also inform their roommate(s), resident advisor(s), and campus health center staff if they rely on an emergency medication like an autoinjector.
Pharmacists can coordinate with students to ensure that they have a sufficient supply of their medications while away from home. “A lot of physicians will write a 90-day supply now, so make sure they’ve got enough to last for a while,” suggests Brown. “If you need to mail their prescriptions, do it in a timely fashion so they don’t run out.”
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Even though they may be using their parents’ health insurance, some students who are at colleges far away from home may find it helpful to have a pharmacist in their college town who they can reach out to for assistance when they need it, she adds. Such an option should be discussed with the student and parents.
Pharmacists can also suggest to parents that they have “the conversation” with their college-bound teenager “about illicit drugs, and the pitfalls of alcohol as well as general safety,” Brown says.
The Bottom Line
As summer winds down, community pharmacists have the opportunity to focus on the fact that healthy students are better learners. Working together, pharmacists and parents can ensure that they are giving children, adolescents, and young adults the best start to the new academic year.
“There’s a lot of moving pieces when we think about what parents are going through during the back-to-school time frame,” says Walgreens’ Shah. “From a health perspective, we have done quite bit to understand that patient’s journey, how to make it easy for them, and how to increase awareness of all the preventative and precautionary tricks that they need to be aware of to be set up for success.”