Madison L. Adams graduated from the University of Pittsburgh School of Pharmacy with a Pharm.D. degree in 2017, after which she entered the U.S. Public Health Service and pursued a PGY1 pharmacy practice residency with the Indian Health Service (IHS) at the Northern Navajo Medical Center (NNMC). Adams obtained conditional acceptance to pharmacy school as an undergraduate because she had known she wanted to pursue a career in pharmacy since high school. Her aunt had dealt with symptoms of multiple sclerosis her entire life and died of complications/sepsis when Adams was 15. She was very close to her aunt, whose death prompted Adams to learn about and understand diseases and the medications that can treat them. This became her motivation throughout pharmacy school and is ultimately why she was drawn to the area of infectious disease (ID). She became a BCPS in the fall after finishing her PGY1 residency.
After her residency, Adams transitioned into the role of clinical pharmacist at NNMC, where she works in all realms of pharmacy practice: pharmacist-run clinics, inpatient pharmacy, and outpatient pharmacy. Soon, staffing requirements had her working almost exclusively in the inpatient setting, where there was an overnight inpatient pharmacist vacancy. Because she was already mostly an inpatient provider, she moved into the overnight slot. She is also her facility’s antimicrobial stewardship program chair/pharmacist and precepts incoming PGY1 and PGY2 residents on ID rotations.
Adams was drawn to the IHS and NNMC partly because of her passion for working with underserved patient populations. During her residency, she was part of a women’s health interprofessional committee for the Shiprock Service Unit (three facilities). Since 2015, the pharmacists there have collectively been able to dispense OTC Plan B to any patient who requests it through an emergency contraception (EC) policy. However, many women in the patient population exceeded the manufacturer-recommended weight limit for Plan B, which in turn increased the risk for reduced efficacy. In contrast to Plan B, Ella is a schedule VI medication, meaning that it requires a prescription from a medical provider and that patients cannot purchase it OTC, which are often barriers to quick and efficient care. Moreover, Ella works slightly differently than Plan B for EC and is more effective in women with obesity. Adams identified this gap in optimal patient care – an area of need within the facility’s patient population – and created an updated EC policy whereby pharmacists could use objective data and perform a questionnaire to determine whether a patient was a better candidate for Ella or for Plan B. Ella could then be dispensed per policy under the head of OB-GYN. Indeed, Adams drafted the policy, trained over 40 pharmacists to perform the clinical assessment, created a template for the EHR to document the patient encounter, and tracked the number of hours saved based on 15-minute provider appointments. Creation of this policy has since saved the facility more than 60.0 provider contact hours while increasing access to care and advancing the clinical skills of pharmacists.
At IHS, every member of the health care team is transcending the traditional roles and norms of health care to meet the day-to-day challenges of their underserved patients in remote locations. Recently, Adams’ team admitted a woman who is over 6 weeks post-COVID diagnosis but who, because of morbid obesity from lack of access to healthy and nutritious foods, has residual hypoxia requiring oxygen. Fortunately, the patient’s small trailer is one of the few homes with electricity on the reservation where she lives; however, it was not strong enough to support the needs of her oxygen concentrator. She had therefore been without supplemental oxygen for days. She was admitted to the hospital to receive supplemental oxygen until the team could coordinate someone delivering a different setup to her remote residence.
Adams’ team also gives children multiple vaccines at a time and refills patients’ medications early because it is unknown when the children might be able to return to the facility. Every day since COVID, her team has called each patient with a positive diagnosis who went home to quarantine in order to check their pulse oximeters and oxygen requirements so that patients can be directed to return to the ED when they need care. The team has completed mass-vaccination “clinics” in the community to stop the spread of COVID and has already vaccinated thousands of patients. While working as a clinical pharmacist, Adams has impaneled patients who need more focused attention on a certain disease state (e.g., diabetes, asthma, hypertension, and seizure disorders) as well as patients deemed well enough not to have a designated care provider. This is understandably frustrating to patients, but her team addresses it with them on their first visit to the pharmacist-run clinic. She faces unique access-to-care challenges and adapts the care provided to meet the substantial needs of her patients.