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The use of technology to deliver remote clinical pharmacy services can help broaden the patient reach and improve health-related outcomes, especially for individuals residing in rural locations. However, it can also promulgate health disparities and inequities, hindering access to care for vulnerable patient populations such as those with a lower socioeconomic or literacy background. This dichotomy of effect requires a thorough examination to create solutions that eliminate inequities. The 2021 American College of Clinical Pharmacy Public and Professional Relations Committee has developed this white paper to examine the potential impact of remote delivery of clinical pharmacy services on health disparities and access to care and proposes solutions and calls to action for clinical pharmacists to address these areas.

IntroductionCompression therapy is well-established standard of care for chronic leg ulcers from venous disease and lymphedema. Chronic leg ulcers and lymphedema have a significant impact on quality of life, driven by pain, foul odor, and restricted mobility. Provision of layered compression therapy in resource-limited settings, as in Western Kenya and other regions of sub-Saharan Africa, is a major challenge due to several barriers: availability, affordability, and access to healthcare facilities. When wound care providers from an Academic Model Providing Access to Healthcare (AMPATH) health center in Western Kenya noted that a donated, finite supply of two-component compression bandages was helping to heal chronic leg ulcers, they began to explore the potential of finding a local, sustainable solution. Dermatology and pharmacy teams from AMPATH collaborated with health center providers to address this need.MethodsFollowing a literature review and examination of ingredients in prepackaged brand-name kits, essential components were identified: elastic crepe, gauze, and zinc oxide paste. All of these materials are locally available and routinely used for wound care. Two-component compression bandages were made by applying zinc oxide to dry gauze for the inner layer and using elastic crepe as the outer layer. Feedback from wound clinic providers was utilized to optimize the compression bandages for ease of use.ResultsAdjustments to assembly of the paste bandage included use of zinc oxide paste instead of zinc oxide ointment for easier gauze impregnation and cutting the inner layer gauze in half lengthwise to facilitate easier bandaging of the leg, such that there were two rolls of zinc-impregnated gauze each measuring 5 inches × 2 m. Adjustments to use of the compression bandage have included increasing the frequency of bandage changes from 7 to 3 days during the rainy seasons, when it is difficult to keep the bandage dry. Continuous local acquisition of all components led to lower price quotes for bulk materials, driving down the production cost and enabling a cost to the patient of 200 KSh (2 USD) per two-component compression bandage kit. Wound care providers have provided anecdotal reports of healed chronic leg ulcers (from venous stasis, trauma), improved lymphedema, and patient tolerance of compression.ConclusionsLow-cost locally sourced two-component compression bandages have been developed for use in Western Kenya. Their use has been initiated at an AMPATH health center and is poised to meet the need for affordable compression therapy options in Western Kenya. Studies evaluating their efficacy in chronic leg ulcers and Kaposi sarcoma lymphedema are ongoing. Future work should address adaptation of compression bandages for optimal use in Western Kenya and evaluate reproducibility of these bandages in similar settings, as well as consider home- or community-based care delivery models to mitigate transportation costs associated with accessing healthcare facilities.

There is a growing interest in the healthcare community to focus on the healthcare needs of lesbian, gay, bisexual, transgender, or genderqueer (LGBTQ) patients, particularly transgender and gender diverse (TGD) patients. TGD individuals have historically experienced rejection and mistreatment by healthcare providers yet have significant health needs, highlighting the need for providing affirming care. Medication therapy for TGD individuals involves many nuances and special considerations for managing concomitant therapies and drug interactions. Additionally, approaches to caring for TGD patients involve both medical interventions as well as social and legal processes. Pharmacists can assist and facilitate the care for TGD patients through a variety of mechanisms. This narrative review describes strategies to recognize and address many aspects of the care for TGD individuals, including destigmatizing care, affirmation strategies, and an overview of therapeutic misconceptions and concerns. Ultimately, this manuscript serves as a guide for pharmacists to care holistically for TGD patients.delivery of healthcare, gender dysphoria, gender identity, hormones, transgender persons | INTRODUCTIONThere is a growing interest in the societal and health care experience of persons who identify as lesbian, gay, bisexual, transgender, or genderqueer (LGBTQ), frequently referred to as "LGBTQ Health." National surveys report transgender and gender diverse (TGD) persons account for 0.6% or 1.3 million of the population in the United States, and approximately 11% of those identify as LGBTQ. 1,2 Advocacy and LGBTQ experts consider this a gross underestimation, however, based on the limitations of survey-based research. 3 Moreover, Americans' level of awareness of TGD persons continues to