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Making a name for herself in pharmacy
An unusual first name sometimes becomes something to live up to, Starlin Haydon-Greatting, BPharm, told Pharmacy Today. "Last year, I got the Pharmacist of the Year award for the Illinois Pharmacists Association (IPhA), and the pharmacist who introduced me said that I was on the level of Cher and Prince, needing only one name to describe me!" she said. Her name is more than just a quirky conversation starter, though. Haydon-Greatting explained that her name comes from an old Irish legend; a young girl named Starlin Ann dons her fallen father's armor to rally her people and stave off an invading force. "I have been kind of like that!" she said, explaining, "I've always been a person who fought for out-of-the-box thinking... We need to challenge ourselves and move forward. That's kind of how I've led my life."
Coordinating and providing MTM This envelope-pushing streak is revealed in her pharmacy career. Today, Haydon-Greatting is IPhA's Clinical Program Coordinator and Illinois Diabetes Pharmacist Network Coordinator. She is responsible for providing medication therapy management (MTM) through the APhA Foundation's Diabetes Ten City Challenge program in Illinois. "I act as the center - the cog - so that there's a central person from whom pharmacists can get assistance," she explained. Her responsibilities are varied, to say the least. "Sometimes I'm a drug information person, sometimes I'm a criteria person, sometimes I'm a quality assurance person, sometimes I have to be the one who says you don't have your documentation in on time, sometimes I'm a pharmacoeconomic analyst...Every aspect that I have studied, from the first day in college all the way up - and I'm still learning - goes into what I do," she said.
The Diabetes Ten City Challenge in Illinois is a partnership with the Midwest Business Group on Health, which is based in Chicago, but includes patients throughout much of Illinois. "I have 12 employers total, including the Tri-State Health Care Coalition in Quincy...They represent about 250 patients; they're being seen by 35 pharmacist coaches who are providing diabetes education and MTM services,"Haydon-Greatting told Today.
Haydon-Greatting believes that simple face time with a pharmacist coach is perhaps one of the most valuable elements of the Ten City Challenge program. "It's face time that improves adherence, and it's face time that lets you figure out if a medication is really working for them," she explained. "You create such a great relationship with these patients when they finally have somebody believing in them and taking the time to move them forward. Some move quickly, and some don't move so quickly, so we have to be flexible."
In addition to her management responsibilities, Haydon-Greatting also travels frequently to employers involved in the program to do her own pharmacist coaching. She explained that she sets up shop in the location's conference room and sees patients either during lunch or immediately after work. While many patients initially put up some resistance to MTM services, Haydon-Greatting thinks that pharmacists have the potential to break down those barriers. She described one case in which she broke down a particularly tough motorcycle enthusiast: "One really beautiful day, I stayed outside where everybody takes their little breaks, and the Harley guys were there with their prized possessions. I was admiring one, and I said, what's her name? ... They were impressed that I was interested in what they were driving," she said.
After this break, during counseling "my one Harley guy unclasped his arms, took his feet off the table, and said, 'You know, you ask me about my goals. Well one of my goals is that I bought this really great set of leather chaps, and I can't get into
them!'" With a common element finally established, Haydon-Greatting was able to get this patient to open up. Now he's not only eating healthily, controlling his diabetes, and fitting into his chaps; he's also one of her biggest supporters.
The Diabetes Ten City Challenge in Illinois has been a great success, Haydon-Greatting said. "Employers are interested in expanding to the cardiovascular module," she added, "because within diabetes you are already monitoring their cardiovascular process, their lipids, their blood pressure, and so forth. When you add the cardiovascular module ... you extend to the people taking hypertensive medications, and you're getting three times the patients." Counseling these patients can help Haydon-Greatting and her colleagues identify the metabolic syndrome patients who are at risk for developing type 2 diabetes. "This way, we can proactively prevent the full diagnosis of diabetes in some of them," she explained.
"Employers are interested in this, because they tend to have more of those patients, and they're often not exercising or eating right or creating lifestyle changes," Haydon-Greatting said. Personal responsibility is, to her, essential to good patient care. She believes that working individually with patients and instilling a sense of the importance of proper health is essential. "The caution about MTM is we can't make it a cookie-cutter fix," she explained. "In medicine, every single person is different. ...We have guidelines, we have protocols, we have flow charts, but we have to be able to have an alternative when someone doesn't meet those criteria, so that they can still move forward and create better health for themselves."
A personal calling
Diabetes care is a very personal mission for Haydon-Greatting. Her grandmother had diabetes, and Haydon-Greatting remembers her grandmother's "array of colored pills" piquing a clinical interest at an early age. She herself suffered from gestational diabetes while pregnant with her twin daughters and, later, her son. "My mind started going on about all the diabetes. My grandmother had diabetes; she died with the disease, and we never made any great impact. While I was up in Alaska [on a rotation with the Indian Health Service], I was doing diabetes studies with the Native American population because of the high incidence and prevalence of the disease. There's always been this common thread of diabetes education running through my life," she told Today.
Haydon-Greatting's professional career has covered a wide range of practice areas, from providing drug information with Drug Facts & Comparisons as a student pharmacist at the St. Louis College of Pharmacy, to working to better integrate pharmacy with the rest of the hospital at Memorial Medical Center in Springfield, IL, after graduating. Later in her career, she gained a great deal of experience working with the government through the Illinois state Medicaid program. "I had a 6-week contract with them at first," she explained, "and I did that from 1990 to 2001. That's longer than 6 weeks!" She also runs her own business, SHG Clinical Consulting, to help keep various MTM programs going in the Illinois region.
It was as a consulting pharmacist, after leaving Illinois Medicaid that Haydon-Greatting saw the potential MTM could have in treating diabetes. "I kept on watching the progress of Asheville, NC, where the APhA Foundation was helping the city run an MTM diabetes care program," she said. "I realized that this was exactly what I was trying to do when I worked in government...Here's this group down there proving that if you have a pharmacist coach work with a patient with chronic illness, they improve outcomes and save money in the long term, she added." Inspired by the Asheville Project's progress, Haydon-Greatting started polishing her clinical skills in preparation for the possible arrival of MTM to Illinois. "The Ten City Challenge was out there, but the last thing I thought was that Chicago would get picked. It did and it's been the best!" she told Today.
Passing the baton
Haydon-Greatting knows that she isn't on her own in working to change pharmacy in Illinois - let alone across the country. "It's a group of clinical pharmacists who are helping do this - forward-thinking people who are moving the profession forward - and it's my honor to work with all of them," she told Today. Building a community is always at the forefront of her mind, and she urges pharmacists everywhere to work together. "We have to be a collegial group that supports each other," she said. Haydon-Greatting has personally acted on this mission, creating a clinical advisory committee for her branch of the Diabetes Ten City Challenge. "You've got to have a network support system, because what if somebody gets a patient that they don't know how to coach?" she noted.
Today, with the Ten City Challenge working efficiently and effectively in Chicago and around the country, the stage is set for further progress in pharmacy and in MTM. "We're going to have some great batons to hand off to the next generation," Haydon-Greatting concluded. "This really isn't about me, it's about all those pharmacists out there who are going to pharmacy school to make a difference in the lives of their patients."