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American Diabetes Month: Working as a Pharmacist at a Diabetes Health Center

There are so many different types of careers within the field of pharmacy—from research and drug development to pharmacy informatics! To highlight some of the more unique career settings in the industry, we’re introducing a new page on our website—Novel Pharmacy Practice Settings—where you can explore these unique career pathways.

In addition to learning more about unique pathways on our new webpage, we’ll also be featuring pharmacists who work in these unique settings on our blog. Today we’re excited to spotlight Rita Parsiani, PharmD, BC-ADM, CDCES!

Dr. Parsiani is a Clinical Pharmacist at the Harold Schnitzer Diabetes Health Center,

Oregon Health & Science University. The following is a look into Rita’s unique career path.

From what institution did you earn your professional pharmacy degree (e.g., Pharm.D.)?

Pacific University School of Pharmacy

Please describe your novel practice setting. What makes your career path unique?

The Harold Schnitzer Diabetes Health Center at Oregon Health & Science University is located in Portland, Oregon. It serves both adults and children with diabetes. It’s one of the only clinics on the West Coast combining pediatric and adult diabetes care in one center.

As a clinical pharmacist, I help our diabetologists, and endocrinologists care for patients with diabetes. The collaborative practice agreement between myself and our physicians enables me to engage in prescriptive activities, which include initiating, modifying, or discontinuing medication treatment for diabetes.

In addition to providing care for patients with type 1 and type 2 diabetes, I also help manage a wide array of hyperglycemic disorders, which include post-transplant diabetes, cystic-fibrosis-related diabetes, and steroid/drug-induced hyperglycemia.

Aside from using pharmacological therapy and lifestyle changes to help manage these conditions, I also incorporate various forms of diabetes technology to help optimize management, such as using a continuous glucose monitor and/or an insulin pump.

What led you to this career path? What steps did you take?

I have always had an interest in ambulatory care services. This passion stems from losing my father at a young age to cardiovascular disease.

As a pharmacy student, I truly enjoyed meeting with patients in the community or ambulatory care settings and providing patient education and medication consultation. Beyond the conventional pharmacy practice settings, I learned that pharmacists were also found providing patient care in specialty environments, so I began seeking those opportunities.

I completed rotations in transplant medicine, HIV, and infectious disease, where I found these unique areas of healthcare fascinating. I completed my postgraduate year one (PGY-1) pharmacy residency in a large, integrated health system that offered a variety of rotations and electives. Soon after joining the diabetes health center, I worked towards gaining the following certifications: Certified Diabetes Care and Education Specialist (CDCES, previously known as CDE) and Board Certified-Advanced Diabetes Management (BC-ADM). 

What does a typical workday look like for you?

Over half my time is spent providing direct patient care through office or digital visits (video or phone). These patients are referred to me directly by our physician staff. I also answer patient questions in-between visits, resolve medication barriers, and handle urgent calls related to patient diabetes care.

Aside from running this clinical pharmacy service, my other duties include committee or task force involvement and providing learning opportunities for our students/residents.

A great deal of my time is also spent providing drug-information support, which can include answering patient-specific questions, providing medication updates, or improving institutional processes to improve medication ordering, safety, and access.

Describe the most exciting or rewarding aspect of your novel practice role.

Every patient that successfully meets their blood sugar targets or A1c goals under my care is a rewarding aspect of my role! To achieve this outcome, the majority of my patients have had to overcome barriers or change their lifestyles significantly to optimize their diabetes care.

I find that establishing care with another provider on the team, such as a pharmacist or diabetes educator, can be a refreshing and motivating opportunity for patients to start something new and set some achievable goals.

The services I provide are focused on intensive blood sugar management, offering frequent visits every 1-4 weeks for a short duration of time (3-6 months). Most providers in a clinic setting cannot provide patients with this type of frequent support. The majority of my patients are on insulin regimens requiring multiple shots per day and need several adjustments to optimize blood sugar control. This service can be comforting for patients as it ensures them that they have clinical support to follow up and reassess on these frequent changes.

Describe the most challenging aspect of your role.

Despite progress in the development of managing diabetes, the burden of living with diabetes remains high and can lead to burnout quickly. While I make every attempt to help patients cope effectively by guiding treatment, the challenges and barriers that arise are often beyond my control. This can be very challenging.

Medication affordability and mental health support are just two examples of these challenges. When cost becomes a barrier, navigating through available resources is complex, confusing, and time-consuming. When someone’s mental health needs attention, it can be difficult finding a behavioral health provider to assist promptly, especially for vulnerable patients at high risk of diabetes-related complications.

How can someone learn more about this unique practice setting and the career opportunities it presents for pharmacists?

The internet is an excellent way to learn about specialty practices that have incorporated clinical pharmacy services. I suggest attending various seminars and pharmacy conferences that include topics of your interest. And don’t be afraid to connect with the event speakers!

I also suggest attending poster presentations where pharmacists are presenting new practices or initiatives in the field, reading up on the latest articles published in Diabetes Care or Diabetes Spectrum, and getting involved in the Association of Diabetes Care & Education Specialists.

What advice would you give to a current student pharmacist who is interested in pursuing a similar type of practice role in the future?

Reach out to your professors and preceptors. Chances are, your professors will be able to connect you with someone in the field. Rotations are also a great way to connect with specialty practices. It’s also a good idea to participate in events or workshops related to diabetes care. 

What general advice would you give to a high school or college student who is interested in pursuing a pharmacy career?

If possible, I highly suggest becoming a pharmacy technician while conducting the coursework necessary to apply for pharmacy school. Some pharmacy technicians work side-by-side with clinical pharmacists. Any prior healthcare experience is truly valuable.

I worked as a pharmacy technician for both a retail and hospital setting prior to pharmacy school. There were times in pharmacy school that I was grateful for that experience because I had previous knowledge of a topic or practice, which made studying a bit easier. 

Share a brief story about a time you had a positive impact on a patient, population, or community in your role as a pharmacist.

A few years ago, our institution implemented the Total Pancreatectomy with Islet Auto Transplantation (TPIAT) program. There are only a handful of hospitals throughout the country that offer the procedure, and ours is one of only three west of the Mississippi. This special surgical procedure is considered for patients with pancreatitis that fail other treatment measures. A full team of experts in pancreatic surgery, gastroenterology, diabetes care, anesthesiology, pain management, and nutrition make up this program.

Our group supports the program by evaluating these patients for surgical consideration and management if selected. In collaboration with the providers, I support our TPIAT patients by providing education, medication adjustments, and close monitoring of blood sugars post-operation. Clinical pharmacy involvement in managing glycemic control post-TPIAT has been a valuable service thus far. It’s something that hasn’t been reported in the literature. I am honored to be a part of this program as a pharmacist and to aid these patients towards recovery.

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