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September 8, 2021

Pharmacists at the Helm of Pharmacogenomics Efforts

Pat Peters and his daughter, Trish Brown

AFTER SUFFERING A HEART ATTACK IN 2014, Pat Peters needed a percutaneous coronary intervention (PCI) – a procedure that many Americans undergo each year. However, unlike most other patients, Peters was lucky to have a seasoned genetic counselor and pharmacogenomics advocate by his side.

Pharmacogenomics Impact

“When my dad’s physician placed an order for clopidogrel as antiplatelet therapy, I knew from a pharmacogenomics test that he was one of the [small number] of the population that are CYP2C19 poor metabolizers, so clopidogrel would have been ineffective for him,” said Pat’s daughter, Trish Brown, who is director of AMR Payer Partnerships and Field Market Access at Illumina, a genetic sequencing company based in San Diego.

With over 20 years of experience in the genomics industry, Brown knew pharmacogenomics could immensely improve treatment decisions and improve the likelihood a drug will be safe and effective. With that in mind, she had her father’s genome preemptively tested for known gene-drug pairs. When it came time for the discussion with the cardiologist about post-PCI antiplatelet therapy, Brown informed the physician of her father’s CYP2C19 status.

“Thankfully, the cardiologist accepted the genomic results and chose an alternative agent, but unfortunately, there was no place to include the test results in the EHR other than as a PDF attached to a clinical encounter, where it would really just sit and not be seen,” Brown said, noting the hospital also did not have any staff that knew how to order or interpret genetic test results.

Pioneering Pharmacogenomics

Peters’ experience stands in contrast to the care pharmacists at St. Jude Children’s Research Hospital in Memphis, Tennessee, help provide. For the past 30 years, pharmacists have been incorporating pharmacogenomics results to help their physicians make the best treatment decisions possible.

Mary Relling, Pharm.D.

Although the hospital’s patient population is almost entirely pediatric, there was one instance where pharmacogenomics proved invaluable when a patient needed antiplatelet therapy, explained Mary Relling, Pharm.D., who holds an endowed chair in the Department of Pharmacy and Pharmaceutical Sciences at the hospital.

“This particular patient was ordered clopidogrel, and we had tested her CYP2C19 status in advance and found she lacked the gene needed to activate clopidogrel. Thus the drug would have been ineffective for preventing stroke,” said Dr. Relling, who spoke during a Pharmacogenomics Virtual Summit jointly organized by ASHP and the American Medical Association.

Avoiding potentially ineffective care in this patient “goes to show that while it’s usually a minority of the population that has a high-risk genotype, for that small percentage of patients, pharmacogenomics testing can yield a really big benefit,” she said.

Pharmacogenomics is deeply embedded at St. Jude, with Dr. Relling and her team regularly testing for genes like thiopurine methyltransferase (TPMT) and CYP2D6, which affect the metabolism of medications more commonly used there, like thiopurines for leukemia and codeine for pain.

Implementing Actionable Findings

Since 2011, pharmacists at St. Jude leading the PG4KDS program have tested for hundreds of gene variants and used those genetic data to improve medication efficacy and safety outcomes. They have so far enrolled nearly 6,000 patients and implemented 14 genes affecting 66 drugs, Dr. Relling said.

“We want to implement as many actionable findings into the electronic health record as we can, along with decision support tools, and we want to provide specific recommendations to help make better treatment decisions,” explained Dr. Relling.

One of Dr. Relling’s most significant contributions to the field of pharmacogenomics was co-founding the Clinical Pharmacogenetics Implementation Consortium (CPIC) in 2009. The 400 members of CPIC, from 269 institutions in 36 countries, generate peer-reviewed and evidence-based guidelines for providers, pharmacists, and laboratories to follow.

“We want to make these guidelines freely available to whichever institutions and laboratories want to incorporate pharmacogenomics into routine care,” Dr. Relling said. She noted that while institutions using pharmacogenomics are in the minority today, “the number is slowly growing.”

Incorporating Findings in the EHR

While Dr. Relling and her CPIC partners are developing guidelines for pharmacogenomics-based decision making, affiliates of the Implementing Genomics in Practice (IGNITE) Consortium are focusing on how best to incorporate and implement these results into the healthcare workflow.

At the University of Alabama at Birmingham School of Medicine, which is an IGNITE affiliate, Nita Limdi, Pharm.D., Ph.D., MSPH, director of the program for translational pharmacogenomics and associate director of the Hugh Kaul Precision Medicine Institute, and her colleagues are documenting what they believe will be better outcomes when genomic information is used to guide the treatment of patients like Pat Brown undergoing PCI.

To improve the chances that pharmacogenomics results are integrated into the treatment decision-making process, Dr. Limdi and a health system informatics team are developing a “genomic medicine landing page” in their EHR, where pharmacogenomic results and recommendations will be housed.

“Our position has always been that once you find something that is important to patient care, you put it in the hands of clinicians,” said Dr. Limdi, an ASHP member.

Preemptive Whole Panel Testing

Dr. Limdi hopes to further expand use of pharmacogenomics at her institution through in-house whole-panel preemptive and reactive testing. She and her team are in the process of validating the system and plan to offer it to all hospital service lines.

Nita Limdi, Pharm.D., Ph.D., MSPH

“While most testing has been done reactively— for a patient who has not responded to treatment with an antidepressant, for example — I believe it will become fairly routine to do whole-panel testing preemptively,”Dr. Limdi said.

Dr. Limdi’s conviction that pharmacogenomics holds great value is partly rooted in her experience as a pharmacist specializing in neurosciences, when she observed patients inconsistently responding to drugs like warfarin and anti-epileptics.

“Coming from that service line gave me a really deep appreciation for how much of the variability in drug response can be accounted for by genomic factors and how useful it is to have that genomic information in the patient’s record,” she said.

Pharmacogenomics Pharmacist Teams

In another effort to increase the use of pharmacogenomics at her institution, Dr. Limdi is building a team of specialized pharmacogenomics pharmacists who will lead testing efforts at her hospital. An innovative part of the model is that these pharmacogenomics pharmacists will mentor clinical pharmacists in the use of pharmacogenomics as it applies to their specialty.

“The idea is to have our pharmacogenomics service line start by doing all the initial genotype interpretation and consults, but as they hand off those results to clinical pharmacists embedded in different units, they will also shepherd them so they can be proficient in interpreting results on their own,” said Dr. Limdi.

If the model proves successful, it could be adopted at other institutions to integrate pharmacogenomics testing into routine clinical care, she suggested. As the demand for pharmacogenomics services increases, a highly specialized pharmacogenomics service team would be free to manage more complex cases, such as those with polygenic drug response signatures.

Pharmacogenomics programs like those at St. Jude’s and the University of Alabama are only two examples of the initiatives pharmacists are leading across the country. Dr.  Limdi believes this is an area of care that will grow tremendously in the coming years. “This is very much an evolving field, and I’m really excited about the possibilities it will bring,” she said.

 

By David Wild

August 26, 2021

Johnnie L. Early II and Peter H. Vlasses Named Honorary Members of ASHP

Dr. Johnnie L. Early II, R.Ph., Ph.D., FNPhA

TWO PHARMACY LEADERS WITH A PASSION for education have been presented with Honorary Membership Awards by the ASHP Board of Directors.

The awards, which recognize individuals who have made outstanding contributions to pharmacy practice, were given to Johnnie L. Early II, R.Ph., Ph.D., FNPhA, dean of Florida A&M University College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, in Tallahassee, and to Peter H. Vlasses, Pharm.D., D.Sc. (Hon.), FCCP, executive director emeritus of the Accreditation Council for Pharmacy Education (ACPE) in Chicago. Both were elected for life by unanimous vote.

A lifetime of pharmacy leadership

Dr. Early was recognized for his nearly four decades of pharmacy education and his dedication to expanding opportunities for youth from various racial and ethnic backgrounds to explore careers in pharmacy practice and the pharmaceutical sciences. A charter member of the Student National Pharmaceutical Association (SNPhA), Dr. Early has worked tirelessly to recruit diverse students and create more diverse workforces at the several universities he has worked for. He is the recipient of numerous awards for his contributions to pharmacy, including the 2018 ASHP-ABHP Joint Leadership Award, the Outstanding Alumnus Award from the Purdue University chapter of the SNPhA, the National Pharmaceutical Association’s Chauncey I. Copper Award, and the ABHP Wendell T. Hill Award. He also was among the first to be honored as a Fellow of the National Pharmaceutical Association.

Dr. Early “is a distinguished educator and visionary leader in pharmacy,” ASHP said a formal announcement. “He has been instrumental in addressing racial disparities in healthcare, expanding opportunities for BIPOC youth to explore careers in pharmacy practice and the pharmaceutical sciences, and developing a more diverse and culturally competent healthcare workforce.”

Home grown brew    

Growing up, Dr. Early said he always had an interest in science and science fiction. But his first memory of being impressed by pharmacology was around age 5. He was sick, and laying in his bed, when his maternal grandmother came to the house and asked what was wrong. She felt his forehead, then went to the kitchen and rummaged through the knife drawer. The sound piqued Dr. Early’s curiosity (“The first thing I thought was surgery,” he laughed). Instead, his grandmother went out to the front yard, cut some leaves off a plant, and brewed him a warm, bitter tea to drink. Within 30 minutes or so, he felt better.

Years later, Dr. Early considered a variety of careers in the health sciences. As an undergraduate biology major at Fort Valley State University in Georgia, he was one of several students recruited directly by the dean of Mercer University Southern School of Pharmacy, Dr. Oliver Littlejohn. The day he started pharmacy school he was also invited to be interviewed for medical school.  He explored public health and took the Dental Aptitude test where he was asked to carve a piece of chalk. Despite his dexterity, the chalk broke, and his career in pharmacy began. After graduating from Mercer, Dr. Early went on to receive his master’s and Ph.D. degrees in pharmacology/toxicity from Purdue University.

A dedication to academics

Dr. Early has had a long academic career, holding several positions at Florida A&M including program director of the Minority Biomedical Research Support Program, assistant dean for research, and dean. He then served as dean and professor for the Medical University of South Carolina and for the University of Toledo, in Ohio, before returning to Florida A&M in 2018 for his current role.

Inspired by the dean who recruited him to pharmacy school, Dr. Early has made a point of recruiting potential trainees in person when possible. Over the past two decades, he has established programs at the University of Toledo and at Florida A&M through which minority high school students spend a few days on campus learning more about pharmacy and pharmaceutical sciences careers. Last year, due to the COVID-19 pandemic, the course was shortened and put online, but students still got some hands-on experience, including making capsules.

“I’m a guy who likes to work,” he said. “And I’m always trying to figure out how to make my people and programs better. Every time somebody gets hired with us, and then is promoted and moves on to higher positions, I see that not as a loss but as an applause for the program.”

Grateful and humbled          

Dr. Early, who started attending ASHP meetings when he first became dean of Florida A&M in 1987, said he was floored to receive a call from ASHP CEO Paul Abramowitz, Pharm.D., Sc.D. (Hon), FASHP, letting him know of the honorary membership award. “It was not in my thinking that that kind of award would be anything that would come my way,” he said. He thanked Dr. Abramowitz on the phone and, in his signature style, later in a handwritten note. “It’s a most significant award, and something that I’m ever so grateful for.”

Longtime pharmacy education leader

Dr. Vlasses was honored for his nearly 45 years in the pharmacy profession. During his 20-year tenure at ACPE, he oversaw the accreditation of the professional degree program in pharmacy; strengthened continuing professional education and development for pharmacists and pharmacy technicians; and championed interprofessional collaboration in education and accreditation. He also led the establishment of the ACPE International Services Program and supported its reach to improve pharmacy education and training worldwide.

Dr. Peter H. Vlasses, Pharm.D., D.Sc. (Hon.), FCCP

In 2014, Dr. Vlasses joined forces with ASHP to create the Pharmacy Technician Accreditation Commission (PTAC) to assure and advance the quality of pharmacy technician education and training programs. He has received numerous honors including the American Association of Colleges of Pharmacy’s Board of Directors Distinguished Service Award and the National Center for Interprofessional Practice and Education Pioneer Award.

“Dr. Vlasses is a prominent leader in pharmacy who was a significant ASHP partner in developing the ASHP/ACPE national accreditation standards for pharmacy technician education and training programs,” ASHP said a formal announcement. “His vision, commitment, and collaborative leadership have helped strengthen the foundation of excellence in accreditation of the education of pharmacists and pharmacy technicians in the United States and around the world.”

A desire to change the world

Dr. Vlasses’ parents were Greek immigrants. As the older of two sons, he was expected to take over the family’s restaurant/bar and liquor store in Camden, N.J. This was in the 1960s, when young people were talking about changing the world and working to serve others. Dr. Vlasses said he didn’t see the liquor store/bar part of the business as helping, so he reluctantly approached his father and asked about pursuing college and a profession.

Instead of being upset, his father talked through three career choices with him. They ruled out medicine because Dr. Vlasses was squeamish around blood. They ruled out law because as a native Greek speaker, he had some challenges with English. But a family friend was a pharmacist with his own store. After a visit, Dr. Vlasses chose to study pharmacy, enrolling at Philadelphia College of Pharmacy and Science. He attended his first ASHP Midyear Clinical Meeting as a student in 1970, when pharmacy education was starting to change. After receiving his bachelor’s degree in pharmacy, Dr. Vlasses completed a one-year hospital pharmacy residency at Thomas Jefferson University Hospital and then completed his Pharm.D. education at the Philadelphia College of Pharmacy and Science.

Passion for research and academia

Dr. Vlasses then spent many years in academia, working for Ohio State, the Philadelphia College of Pharmacy and Science, and Jefferson Medical College in Philadelphia. He got involved in research and was elected president of the American College of Clinical Pharmacy. At the time, there was some controversy over whether pharmacists could be clinical investigators on research trials. He wrote to the Food and Drug Administration to inquire if that was permitted; the agency said it was.

“A lot of people subsequently told me that letter helped them do research and get funding,” he said. “That was something I always valued that I contributed to the profession.”

During that time, Dr. Vlasses also became more involved with professional organizations including ASHP, serving on the Council on Therapeutics and on the Research and Education Foundation and Awards program, before moving to ACPE in 1999. Not only did he help develop PTAC seeing that pharmacy technicians needed better training, but when he joined the organization, he worked to improve accredited continuing education standards for continuing education for pharmacy technicians.  providers in pharmacy who were also committed to interprofessional continuing education.

Interprofessional collaboration

“When I joined ACPE, I saw medical professionals learning in silos—doctors in medical school, nurses in nursing school, etc.,” he said. “There wasn’t a lot of interactions to say we’re on the same team, we should learn and practice together, and everybody should contribute at the top of their license.”

Dr. Vlasses worked to change the accreditation standards for pharmacy degree programs so students were “team ready” at graduation, with education in the classroom, clinical experience, and exposed to interprofessional education in practice. Similarly, he worked with accreditor colleagues from other health professions to improve accredited continuing education standards to facilitate team-based continuing education, “planned by the team and for the team.” He initially developed joint CE accreditation standards for pharmacy, nursing and medicine. That has since grown to include acceptance by accreditors for CE accreditors for athletic trainers, dentists, dietitians, optometrists, physician assistants, psychologists, and social workers. Any combination of those trainees can learn together and receive CE credit in their professional as well as interprofessional CE credit.

Living the American dream  

Dr. Vlasses retired in 2019. He said when he received the call from Dr. Abramowitz about the honorary membership award, “I was very much honored that ASHP and the board would see me in that light, and valued the contributions I have made as a member of the organization and as a pharmacist. Starting out as a son of a Greek immigrant and the first college graduate in my family to being able to be recognized by a number of pharmacy organizations and ASHP was in many cases the American dream for me.”

 

By Karen Blum

 

August 11, 2021

Free ASHP Membership Helps P1s Navigate Career Paths

Charlotte Tran

FOR FIRST-YEAR PROFESSIONAL (P1) STUDENTS, jumping further into health-system pharmacy can be exhilarating and overwhelming. There is an increasing number of career possibilities and numerous ways of deepening one’s involvement in the pharmacy community.

To help P1 students navigate this new experience, ASHP is offering a one-year complimentary membership. With all the resources students need to continue their schooling, they can start their career journey off on a solid footing.

Bound for Ambulatory Care

For Charlotte Tran, a Pharm.D. Candidate (2023) at Chapman University School of Pharmacy in Irvine, California, networking and leadership development offerings have been a couple of the most valuable aspects of her ASHP membership.

“Through events at ASHP’s student society, I’ve had the chance to meet and hear from pharmacists in different areas of the health system and see what their days look like,” said Tran.

Meeting practicing pharmacists has given Tran an appreciation of the range of responsibilities she can look forward to as she moves towards a residency and a career as a pharmacist.

Tran, who is president of her university’s Student Society of Health-System Pharmacists, said she has developed an interest in ambulatory care pharmacy, and chronic disease statement management in particular, because of the potential to develop long-term pharmacist-patient relationships.

“I think the best possible care for patients starts by spending time with them and building relationships,” she said.

With a career in ambulatory care pharmacy in her sights, Tran has been drawing on ASHP online resources, like career profiles, to better understand what “the road to a specialization in ambulatory care looks like.” Through the ASHP website, she has also gotten help with her CV and found tips for sharpening her interviewing skills, as well as guidance on ways to get involved nationally with ASHP.

“Through the ASHP e-newsletter and discussion posts, I’ve also been able to stay up-to-date with the latest news and issues related to health-system pharmacy,” Tran added.

ASHP Membership Facilitates Connections

Joining ASHP during the pandemic proved particularly valuable for Madison Noble, a Pharm.D. candidate (2024) at Virginia Commonwealth University School of Pharmacy in Richmond. Noble said she anticipated that the virtual school setting would make it challenging to feel connected with her fellow students and faculty.

Madison Noble

“However, ASHP provided me with opportunities to get to know my peers and to network within the school and hear from residents and pharmacists in fields of pharmacy I had not considered for my own future,” she said.

Online ASHP resources such as the “Why Should I Do a Residency” page have helped Noble solidify her interest in pursuing a residency, which she said she was unsure of when she began her P1 year.

“At the start of this year, I wasn’t totally clear on what a residency was exactly, and whether it was something I wanted to pursue,” she said.

While Noble is now sure she wants to go down the residency path, she has not yet settled on a specific pharmacy stream. Drawing on the career profiles section of the ASHP site has helped her explore the variety of possibilities available within health-system pharmacy.

“I’ve learned a lot just by reading through the overviews of different careers and finding out what a typical workday looks like,” she said. Preparing well in advance, Noble will soon be submitting her CV through ASHP’s CV Review Program, where it will be reviewed by a volunteer pharmacist and provided with valuable feedback.

For others thinking of taking advantage of ASHP’s free P1 membership, Noble said that joining the organization “is a great way to learn more about areas of pharmacy you may be interested in.”

“Just within this first year of membership, I have learned so much about what a pharmacist within the health system does, and I plan to further this learning and keep my membership throughout pharmacy school,” said Noble.

Although “free time is hard to come by these days,” Noble – who is also planning to seek out ASHP student leadership opportunities at VCU – said she likes to peruse the ASHP website when she can.

“I find something new every time I explore the website,” she said. “For example, I recently found the ASHP Wellness Wednesday Podcasts. I was excited to see one on meditation techniques geared toward the pharmacy workforce.”

New Opportunities to Explore

Khushali Sarnot, a Pharm.D. candidate (2024) at Southern Illinois University Edwardsville School of Pharmacy, felt being an ASHP member would serve her well as she moved towards a post-graduate residency. That feeling was affirmed when she took up a position as a hospital inpatient pharmacy intern at SSM Health Saint Louis University Hospital in St. Louis, Missouri.

Khushali Sarnot

“Every one of the pharmacists I’ve been working with recommended joining ASHP,” Sarnot said.

Apart from having access to career-building resources, one membership benefit Sarnot has enjoyed has been the daily ASHP email briefings, which have become a source of truth on all things COVID-19.

“Finding reliable and accurate information has been a challenge during the pandemic since there is so much misinformation in the media,” she said. “As the only healthcare professional in my family, I tend to be the person they look towards for information on COVID-19 and to explain some of the science behind the disease and treatments and vaccines. I’ve turned to information from ASHP to answer their questions.”

ASHP networking opportunities have also landed Sarnot an ASHP summer internship opportunity for this year. She will be working on several projects, including analyzing technician training programs.

“I hope the internship will expand my network, make me an outstanding candidate for residency and further establish my career,” Sarnot said.

After “peeking into what different specialties are doing through the ASHP website,” Sarnot is leaning towards pursuing a residency in cardiology. However, as a P1 student, she knows that her goals and aspirations could evolve in new and exciting directions as she gets more involved with the pharmacy community.

“I can’t wait to see what other opportunities I discover through my ASHP membership journey,” Sarnot said.

 

By David Wild

July 26, 2021

For P1s, Getting Involved with ASHP is Key to Success

Lisa Lubsch, Pharm.D., rounds with student pharmacists.

TAKE IT FROM EXPERIENCED PHARMACISTS: getting involved early on with professional organizations like ASHP is crucial to building a successful career and enjoying all that the profession has to offer.

“Engaging with ASHP as a first-year (P1) pharmacy student allows them to explore more career paths, take on leadership roles within the organization and develop skills that will benefit them in post-graduate training and throughout their careers,” said Lauren Pamulapati, Pharm.D., assistant professor at Virginia Commonwealth University (VCU) School of Pharmacy in Richmond.

Free Membership to P1 Students

Starting in 2020, ASHP has waived the membership fee for P1 students, making it easy for P1s to dive deeper into the field of health-system pharmacy. Members gain access to a host of resources to help them prepare for residency, investigate potential careers, and build an effective CV. Benefits like daily email briefings and podcasts also keep members abreast of pharmacy and healthcare news. Summer internship opportunities and networking and leadership possibilities can help pave the way for professional growth.

Dr. Pamulapati, who advises students and residents and serves on the ASHP Society of Student Health-System Pharmacists (SSHP) Advisory Panel, said she has found that students who get involved in professional organizations early on benefit more from advanced learning opportunities.

“I’ve noticed that students who actively participate in their local ASHP societies tend to feel more prepared for the post-graduate training application process, and they have a good idea of where they want to go because they have often already looked into career opportunities using ASHP resources,” said Dr. Pamulapati.

Moreover, networking through ASHP can give students a competitive edge when applying for a residency, she added. Dr. Pamulapati recalls being a student member of ASHP herself and being told that “pharmacy is a small world.”

“It was not until I was in residency and practicing that I realized how small it truly is, so I recommend to all my students that putting yourself out there early on and building a network helps you develop more quickly and fully as a professional,” said Dr. Pamulapati.

Benefits of ASHP Membership

Lisa Lubsch, Pharm.D., a longstanding ASHP member and clinical professor in the Department of Pharmacy Practice at the Southern Illinois University Edwardsville School of Pharmacy, said there are “outstanding benefits to getting involved with ASHP early in pharmacy school.” For example, she said, students can access internship and leadership opportunities, like joining an ASHP committee, advisory group, or council.

Jerika Lam, Pharm.D., pictured with Prashanti Alekal, M.D., provides student pharmacists with experiential education opportunities.

“Becoming a leader enhances your own professional development and can help you find and cultivate a relationship with a mentor,” said Dr. Lubsch, who said she has built her own network of colleagues and collaborators through ASHP.

One of Dr.  Lubsch’s students, who is now completing her P2 year, is a case study in how participation in an organization like ASHP can lead to a cascade of growth opportunities. After taking advantage of the complimentary P1 ASHP membership, the student, in short order, became the P1 liaison for her SSHP and began developing a professional network. The student also completed an ASHP Summer Internship and then became President-elect of the school’s SSHP.

“I’m eager to hear all about her internship and watch her take on more leadership roles,” said Dr. Lubsch.

This student may be exceptionally ambitious, but all P1 students can expect to come across opportunities for growth and leadership if they join ASHP, Dr. Lubsch said.

“Not only will they have the chance to learn about careers in the acute and ambulatory care settings, but the students will also gain an earlier understanding of the residency process and will be better able to prepare for it,” she added.

A Multitude of Networking Opportunities

ASHP member Jerika Lam, Pharm.D., associate professor at Chapman University School of Pharmacy in Irvine, California, hopes P1 students take advantage of the free ASHP membership and get “the same positive experience I had when I was a pharmacy student member of ASHP.”

“An ASHP membership will connect the student to the ASHP community and social network, which is huge!” Dr. Lam enthused.

Dr. Lam is the faculty adviser of her school’s ASHP-SSHP and works with student leaders to organize social and professional functions, including networking events with pharmacy managers from large health systems and pharmacist leaders in the pharmaceutical industry.

“These events always energize Chapman pharmacy students as they move towards their residency and fellowship post-graduate training programs,” said Dr. Lam.

Lauren Pamulapati, Pharm.D., counsels a patient.

Apart from residency-focused activities, Dr. Lam said P1 ASHP members have the chance to engage their political muscles by participating in advocacy campaigns and student-focused activities like the annual Clinical Skills Competition, and they can pursue scholarship opportunities.

These days, Dr. Lam enjoys participating in ASHP’s clinical sections, dropping in on conversations covering a range of topics, from COVID-19 vaccination efforts to drug shortages, and discussions around policies and protocols that affect patient care and safety.

“ASHP has a treasure trove of expert and specialist pharmacists who can be easily connected with through the clinical sections and other forums,” noted Dr. Lam.

Dr. Lam said her own early participation in ASHP’s student forum community informed her career choices and led to opportunities to work with pharmacy leaders across the country. The benefits of networking through ASHP have continued throughout her career, and she regularly learns about models of best practices from other institutions, Dr. Lam said.

“ASHP is a very large organization, but its community is close-knit, and the interactions are professional and personable,” Dr. Lam noted.

The way VCU’s Dr. Pamulapati sees it, joining ASHP is not only beneficial for members, allowing them to enjoy professional and academic perks — it is an act of service to the entire pharmacy profession.

“The future of our profession is in the hands of student pharmacists and new practitioners, and we need them to share their perspectives and help shape policies and create new initiatives,” said Dr. Pamulapati. “I think students should dive feet first into an organization, apply for leadership positions early on and take risks. You may not feel qualified at first but know that your voice is so valued.”

 

By David Wild

June 9, 2021

Pharmacy Mentor Helps Black Student Pharmacists and Practitioners Reach Their Potential

Joshua Blackwell, Pharm.D., M.S., volunteers his time to help those in his community.

THE ROAD TOWARD GREATER DIVERSITY, inclusion, and equity is long, but Joshua Blackwell, Pharm.D., M.S., clinical pharmacy manager for ambulatory services at UT Southwestern Medical Center, is committed to seeing it through as best as he can.

Helping the Underrepresented

Dr. Blackwell has spent the better part of the last decade helping underserved pharmacists move up in their careers. In 2013, during his pharmacy studies, he took on leadership positions at the Student National Pharmacy Association (SNPhA), an organization dedicated to serving the underserved. Dr. Blackwell started off as his chapter’s president but quickly rose to oversee all SNPhA chapters in the Midwest and ultimately became National President.

“I had the honor of helping the organization home in on their mission by creating innovative programs and opportunities to serve and strengthen communities,” said Dr. Blackwell, an ASHP member since 2011.

One initiative he worked on was the Prescription for Service competition, a collaboration with Walmart and Sam’s Club, which provides scholarships to pharmacy students based on projects they develop to help the underserved in their community.

“I’ll never forget the winners of the very first competition, in 2013,” Dr. Blackwell said. That project was done by pharmacy students at Howard University and led to a partnership between the University and the Capitol City Pharmacy Medical Reserves Corps, in which the school manages outreach efforts to local student organizations, including wellness fairs and scholarship opportunities. Another winning project Dr. Blackwell is particularly proud of was developed by pharmacy students at Texas A&M University and included a cleanup of a community park and a mural painted on a nearby basketball court to help promote equity and inclusion.

Addressing Vaccine Hesitancy

Joshua Blackwell, Pharm.D., M.S.

After strengthening his leadership chops at SNPhA, Dr. Blackwell co-founded the Pharmacy Initiative Leaders (PILs), a nonprofit organization aimed at empowering underrepresented individuals and “helping them, through authentic support and connection, succeed at every stage of their pharmacy journey,” he said.

“A key to the organization’s success has been creating a culture of community and going out and really cultivating and amplifying people’s strengths, particularly those who may not have an advanced education or the greatest financial resources,” said Dr. Blackwell.

Recently, he and his colleagues at PILs addressed vaccine hesitancy in Black communities through a webinar open to the public.

“When I got the COVID-19 vaccine myself, I had reactions from family ranging from, ‘I’m so happy for you, how’re you feeling?’ to, ‘Are they trying to kill you with the vaccine?’” Dr. Blackwell said, pointing to the infamous Tuskegee Syphilis Study as an event that spawned suspicion in Black communities regarding the motives of healthcare institutions and public health campaigns.

While historical suspicions are understandable, “People who hold on to fears based on news and social media find it hard to see the positive impact COVID-19 vaccination can have on the community,” Dr. Blackwell said.

To mitigate the impact of these fears, he and his co-presenters explained how COVID-19 vaccines work, answered questions about these medications and about the disease, and highlighted that vaccination is important for all, including Black communities.

Navigating Widespread Biases

Dr. Blackwell’s passion for helping Black pharmacy students and practitioners reach their potential was sparked when, as a student, he faced his own race-based barriers.

“As a black male at a predominantly white institution, people assumed I played football just because a lot of African American males at the university did,” said Dr. Blackwell. In other instances, he faced microaggressions, such as being told that he was “surprisingly articulate.”

Rather than taking these slights to heart, Dr. Blackwell transformed their energy into a stronger resolve to serve his community and reach greater heights. “I’ve always tried to be an example so that other people that look like me try and have a seat at the table, along with the many other underrepresented groups out there,” he said.

Divya Varkey, Pharm.D., M.S., clinical associate professor at University of Houston College of Pharmacy, has been one of Blackwell’s most admired mentors. She said Dr. Blackwell “epitomizes the idea of ‘paying it forward,’ and his passion is easy to see when it comes to providing guidance, support, and mentorship to those around him.”

“His goal for those around him is simply stated: to ensure they are equipped with the knowledge, skills, and confidence to be the best version of themselves,” Dr. Varkey said. “To that end, as a mentor himself, Dr. Blackwell spends countless hours working with mentees to help them cultivate their own definition of success and then – and most importantly – connects them to opportunities to achieve those goals.”

ASHP and Racial Diversity, Equity, and Inclusion

Dr. Blackwell recently served on ASHP’s Task Force on Racial Diversity, Equity, and Inclusion (DEI), where he helped develop recommendations on marketing and advocacy. The recommendations range from calling on ASHP to provide scholarships to Black, Indigenous, and persons of color (BIPOC) to asking the organization to spotlight the accomplishments of BIPOC students.

“To make all pharmacists feel that ASHP is their home, they need to see themselves playing a role within the organization, and marketing and awareness of ASHP opportunities is one way to get more people at the table,” Dr. Blackwell said, adding that by virtue of taking on leadership roles – including currently serving as a member of ASHP’s House of Delegates  –  he believes he has helped further the cause of diversity, equity, and inclusion.

“Having a seat at the table is so important because it inspires others who look like me to go further, ultimately giving them more of a voice and expanding the conversation to include other viewpoints,” said Dr. Blackwell.

He is hopeful the DEI Task Force recommendations will help chip away at society-wide racial inequality and urged ASHP members to review and reflect on the recommendations as well as the actions ASHP takes to address health disparities.

“And be a voice within your state affiliates for diversity, equity, and inclusion efforts,” Dr. Blackwell urged. “While work at the national level is critical, it all starts at the state level.”

 

By David Wild

May 6, 2021

Pharmacy Teams Lead Telehealth Expansion Efforts

Caroline Pitney, Pharm.D, BCACP

WHEN THE COVID-19 PANDEMIC erupted last March, clinicians with the University of Washington (UW Medicine), the Seattle Cancer Care Alliance and their four medical centers, and many other health systems across the country quickly amped up their provision of telehealth services to continue meeting patient needs. Pharmacists were key players in this activity, said ASHP member Caroline Pitney, Pharm.D., BCACP, a clinical pharmacist with UW Harborview Medical Center.

Telehealth Growth

Prior to the pandemic, federal regulations had limited the scope of telehealth pharmacist services, leaving it mainly for patients in rural areas far from clinics or who had limited access to healthcare. However, the Coronavirus Preparedness and Response Supplemental Appropriations Act enacted on March 6, 2020, loosened restrictions on telehealth services. Then, on March 17, 2020, CMS announced its telehealth waiver had been expanded to cover diagnosis and treatment of COVID-19 and other conditions.

With UW pharmacists already embedded in ambulatory care settings as providers seeing their own patients with various disease states, it only made sense for them to jump on the telehealth bandwagon as well, Dr. Pitney said. The organization credentialed 69 pharmacists to offer comprehensive medication management via telehealth to patients in their primary care and specialty clinics. Pharmacists and other clinicians then completed learning modules on obtaining informed consent, videoconferencing etiquette, documentation, billing, adverse event reporting, and risk management. The health system selected Zoom as its secure telehealth platform, integrating it within the electronic medical record system.

Typically, at Dr. Pitney’s medical specialties clinic, doctors refer patients to pharmacists to help initiate new therapies or monitor ongoing treatment and chronic diseases. Dr. Pitney and her colleagues offered telehealth, along with in-person or telephone visits, to their patients as soon as it was available.

One benefit to video has been in face-to-face demonstrations of proper use of injectable medications, Dr. Pitney said. “It’s really challenging to try to do that over the telephone,” she said. “Before the pandemic, we would always recommend the person come in for an in-person teaching visit.”

Overall, she said, telehealth has provided a modality for pharmacists to see patients and their medications. We can ascertain patients’ ability to administer and take those medications. “Having this option in the future will only allow us to reach more patients. Not just for pharmacists but for all providers, it’s a step in the right direction,” Dr. Pitney added.   

Technology Bridges Barriers

Some health systems using telehealth found themselves upgrading technology as time went on. In the very early stages of the pandemic, pharmacists with Tampa General Hospital in Florida first moved some patients’ in-person visits to telephone calls, later shifting everyone to telehealth during April, May, and June while pharmacists worked from home, said ASHP member Jessica Bianco, Pharm.D., C.Ph., BCACP, CACP, a pharmacotherapy specialist in ambulatory care for the medical center. Their patient caseload includes people with diabetes and other chronic diseases, in addition to those taking anticoagulant medications.

By summer 2020, the hospital adopted a new platform with better video quality and the option to use translation services, Dr. Bianco said. Through a collaborative practice agreement there, pharmacists change or start medications and adjust doses between physician visits.

“Interestingly, I think some patients like it more,” Dr. Bianco said of telehealth. “It’s really bridged the barriers that there are for patients being able to make it to the clinic, such as transportation or parking issues.”

Streamlining Care     

Baptist Health South Florida, in the Miami area, sees many patients in their 70s, 80s, and 90s, so when the pandemic hit, clinicians and pharmacists were worried about putting them at risk. Fortunately, many patients were tech-savvy, or had family to support their adoption of telehealth, said ASHP member Jennifer Miles, Pharm.D., C.Ph., BCACP, BCMTMS, a clinical coordinator in ambulatory pharmacy there.

Jennifer Miles, Pharm.D., C.Ph., BCACP, BCMTMS

“Our patients were really happy there were minimal interruptions in their care because a lot of folks were really worried about offices shutting down and concerned with their safety and being able to get care,” Dr. Miles said. “We didn’t want to delay that.”

Dr. Miles and her colleague Faaria Quadri, Pharm.D., BCPS, work with the health system’s lipid clinic and congestive heart failure clinic. In their model, pharmacists see patients in tandem with advanced practice providers such as physician assistants or advanced practice registered nurses. Under telehealth, the provider sees a patient over telehealth for the medical portion of the visit and explains a pharmacist will call them next to go over medications and how they work, explain any potential drug interactions, help establish medication schedules, and talk about covering the medications, Dr. Miles explained.

Pharmacists also follow up with patients on a regular basis if they don’t have clinic visits scheduled to ensure they are adherent to medications. The heart failure clinic even provided bathroom scales to patients so they could continue to record their weights and blood pressures at home, Dr. Quadri noted.         

“Some patients, despite their age and risks, adamantly want to be seen in a clinic because they like that comfort of knowing they’re checked out physically,” Dr. Quadri said. “But another set is so nervous to come in, and so grateful for the opportunity to have a telemedicine visit.”

Overcoming Challenges        

Even as clinics nationwide have slowly resumed seeing patients in person, many have continued their telehealth appointments. About a third of patients at UW are still seen that way, Dr. Pitney said. At Tampa General, it’s more than half, said Dr. Bianco.

Jessica Bianco, Pharm.D., C.Ph., BCACP, CACP

There are some limitations to telehealth that clinicians still need to work through, Dr. Pitney cautioned. Not every patient has access to a computer or secure video device. Some patients, depending on their disease states, still need periodic, in-person physical exams. And while pharmacists are considered providers in Washington and many other states, CMS currently does not reimburse for pharmacist visits, whether telehealth or in-person.

Pharmacists should look at telehealth as an opportunity to highlight their clinical skills and knowledge to the general population, Dr. Quadri said.

“It’s a great opportunity to show what we’re capable of,” she said. “In the past, I think patients did not see our contributions to their medication regimens because we were making those to the providers and patients would assume it was from them. Now, they see firsthand that pharmacists can do this.”

The pharmacists offered the following tips for optimizing telehealth:

  • Know your audience. Telehealth should not be a one-size-fits-all option, Dr. Bianco said. Some patients are not comfortable with video and prefer a phone call, while others will appreciate telehealth for more of a face-to-face visit. Be aware that some patients may not have access to a computer or a secure location to do a telehealth visit, added Dr. Pitney. In those cases, a telephone visit is a good alternative to an in-person one.
  • Shed your fears. There has been some trepidation among pharmacists that this will be a big change and patients won’t like it, Dr. Miles said. Find a secure platform to continue your visits and set up infrastructure for training.

“We live in a society where our patients really want this to close the gap on the care they need, and limitations they have with their busy lives and now a pandemic keeping us all separate,” she said. “We can find creative ways to still be connected to one another…I don’t think anything will ever fully replace that human touch and being there face-to-face in the examination room with our patients, but it helps provide our presence in a way that is still supportive.”

Telehealth pharmacy practice is one of five areas of focus in ASHP’s Innovation Center. For more information, visit ASHP’s Telehealth Resource Center or listen to ASHP’s telehealth management pearls webinar. Be on the lookout for a special telehealth theme issue of AJHP later this year and a report summarizing the outcomes from the ASHP Pharmacy Executive Leadership Alliance’s virtual conference on Telehealth Innovations.

By Karen Blum

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