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November 21, 2013

Pharmacist Provider Status Update

Filed under: Ambulatory Care,Clinical,Current Issue,From the CEO,Provider Status — Kathy Biesecker @ 4:37 pm

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

I am pleased to let you know about progress ASHP is making in our efforts to achieve provider status. As I have previously communicated, a group of pharmacy stakeholders from the major national pharmacy professional associations and chain pharmacies have been diligently working over the course of the past year to create principles and define federal legislative proposals to recognize pharmacists as Medicare Part B providers in the Social Security Act.  This is no small task. The group has worked incredibly hard toward achieving this common goal.

It has been a great pleasure to see and experience just how committed all of pharmacy is to this important cause. Together, we can help patients get the access they deserve to pharmacists’ care that improves health outcomes and decreases costs.

I think it is safe to say that there has never been so much agreement among our pharmacy organizations that provider status for pharmacists is needed.  We believe we are very close as a pharmacy stakeholders group to finalizing a legislative proposal.  Many patients have been waiting too long for ready and consistent access to the only member of the team with the depth and breadth of medication knowledge that the pharmacist possesses.

We are extremely excited about the recent successful campaign led by the California Society of Health-System Pharmacists, working in collaboration with other stakeholders, to achieve provider status for pharmacists in California.  The success in California will undoubtedly help us at the federal level and serves as an example for other states to follow.

I was encouraged to see two recent articles in prominent medical and health policy publications citing the importance of having pharmacists on the team.  An article in Health Affairs by physician David Bates and pharmacist Marie Smith stated that “pharmacists belong in Accountable Care Organizations and integrated care teams.”  A position paper by the American College of Physicians defines pharmacists as part of the “clinical care team.”  It is really important to hear that physicians and other providers are publically confirming our value as essential care providers.

All of the national organizations representing pharmacists and pharmacies across the entire continuum of care will be invited to join the pharmacy provider status stakeholders group which will spearhead our efforts at the federal level.  We plan to reach consensus on a federal legislative proposal for provider status by early 2014, at which time a well-funded and focused pharmacy provider status coalition will be formed to support a bill.  We hope the coalition will have expanded its membership to include additional stakeholders representing the other health professions, patient and consumer groups, payors, business coalitions, state-based groups, and many others.

We will also hire the best lobbyists, public relations professionals, and other consultants to help ensure a successful provider status campaign, and engage and elicit the support of as many of you as possible.  Our ambitious yet realistic goal is to try to have a bill introduced in Congress by the spring of 2014.

The work that ASHP and our partner pharmacy stakeholders have done on provider status over the last year has been incredibly positive and productive.  We hope you can sense the level of excitement and optimism that we have about the prospects of achieving provider status for the patients we serve.  We truly believe that we are rapidly approaching an unprecedented and historic moment for our patients and profession.  This isn’t to say that we should begin the celebration, as we have much work still left to do. But from our perspective, the end is more in sight than ever before.

I look forward to sharing another update with you soon and to having all of you join together with us in our campaign to achieve provider status.  Enjoy your holidays, and I hope to see many of you at the ASHP Midyear Clinical Meeting in Orlando!

November 18, 2013

ASHP Foundation Traineeships Focus on Patient Care

ASHP Foundation traineeships focus on clinical areas predominated by extremely high-risk medications.

ASHP Foundation traineeships focus on clinical areas in which high-risk medications abound.

ANTICOAGULANT MEDICATIONS and the high risks associated with them pose many challenges for even the best-prepared pharmacist.

In 1985, the ASHP Research and Education Foundation confronted this problem head on by developing its first-ever traineeship program in the area of antithrombotic pharmacotherapy. The program provides trainees with the tools they need to make the best decisions for their patients when it comes to blood-thinning medications.

Key Players on Patient-Care Teams

Fast forward 28 years, and the need to equip pharmacists to manage patients’ medication therapies is more important than ever. Today, the Foundation has expanded its offerings to include additional traineeships in critical care, oncology patient care, and pain and palliative care. A pharmacogenomics traineeship is being considered.

“We offer training in areas that have been identified by ASHP members as major needs,” said ASHP Foundation Vice President Daniel J. Cobaugh, Pharm.D., FACCT, DABAT, who oversees the traineeships. “These are areas in which extremely high-risk medications predominate, and the Foundation is focused on making sure that knowledgeable pharmacists are key players on these patient-care teams.”

Creating New Opportunities

Carolyn O’Donnell, R.Ph., BCOP, formerly a clinical pharmacist at Pennsylvania’s Lancaster General Health, dove into an oncology traineeship in 2011 at The Johns Hopkins Hospital, Baltimore, after becoming a board-certified oncology pharmacist a year earlier.

Carolyn O’Donnell, R.Ph., BCOP, third from left, works with the Lancaster General Health e-Health team, including (from left) Mike Kling, Christine Cox, and Miska Yost.

Carolyn O’Donnell, R.Ph., BCOP, third from left, works with the Lancaster General Health e-Health team, including (from left) Mike Kling, Christine Cox, and Miska Yost.

O’Donnell’s experience there enabled her to create a new dosing protocol for raising hemoglobin levels which helps anemic patients treated at the Ann B. Barshinger Cancer Institute of Lancaster General Health.

“My protocol enabled pharmacists to adjust doses of epoetin based on a combination of hemoglobin levels and a pharmacy and therapeutics committee-approved algorithm,” said O’Donnell, now a clinical applications analyst for e-Health at Lancaster General Health.

The protocol, which keeps patients’ doses therapeutic without wide swings in their doses and lab results, “has been positively received by both patients and oncology providers,” she noted.

The knowledge that O’Donnell gleaned from the ASHP Foundation traineeship also helped her to advance her career in an unexpected way. In June 2012, O’Donnell transferred from the inpatient pharmacy department to the information technology department (e-Health) at Lancaster… a move that better utilizes her oncology expertise and one that still requires a pharmacist’s medication-use knowledge and experience.

“I’ve spent the last year developing standardized protocols using evidence-based content from the National Comprehensive Cancer Network, which provides standardized recommendations through chemotherapy templates,” she said. Combined with validation of content and practices at Lancaster General Health, the protocols have provided the groundwork for the development of a new Epic Beacon application that was implemented this month.

“I find this work to be extremely challenging and satisfying,” O’Donnell said. “I definitely feel like the ASHP Foundation traineeship deepened my clinical oncology knowledge and opened up opportunities for me that I might not have otherwise had.”

Paying It Forward

To ensure that trainees have the best experience, the ASHP Foundation selects faculty members from the nation’s top hospitals and health systems. Bradley Burton, Pharm.D., clinical pharmacy specialist in medical oncology at The Johns Hopkins Hospital, oversaw the 2012 oncology traineeship. Dr. Burton believes the program has a “pay it forward” aspect in that many trainees he has taught go on to become teachers themselves in their own workplaces.

“The program exposes trainees to a wide variety of oncologic disease states and clinical topics that they may not have had formal experience or training with,” Burton said. “By broadening their knowledge bases, trainees are able both to apply the concepts they learned to patients whom they care for and to teach their colleagues.”

Kristine Vaden Tuttle, Pharm.D., BCPS

Kristine Vaden Tuttle, Pharm.D., BCPS

Kristine Vaden Tuttle, Pharm.D., BCPS, a research clinical pharmacist with Novant Health Oncology Specialists, part of the Novant Health Forsyth Medical Center, Winston Salem, N.C., conducted her oncology traineeship under Burton and found the experience eye-opening.

“Not only did we spend time with Dr. Burton, but he also arranged time for us to meet with other clinical pharmacists to see other service lines,” said Tuttle. “In addition, he worked into the schedule a few Tumor Board discussions and several small group meetings in which we learned of their new research. It’s hard to believe how much we were able to experience in just two weeks.”

Trainees typically complete a distance-education pathway of between 40 to 80 hours before heading to in-person training sessions at predetermined sites for five to 14 days. The foundation’s program is tuition-based, with costs ranging from $3,200 to $7,500.

Experience Leads to New Drug Therapy Services

Some trainees use personal experiences with a disease state to inform their desire to battle it. When both of Glenn Williams’s parents received cancer diagnoses in the 1990s, he had some initial difficulty answering all of their questions.

Glenn Williams, B.S., R.Ph

Glenn Williams, B.S., R.Ph

Through his experiences with an ASHP Foundation oncology traineeship in 2012, Williams, B.S., R.Ph., a clinical pharmacist with SSM Cancer Care, in St. Louis, Mo., can now address his patients’ questions with authority.

“The experience helped me to create and implement medication therapy services (MTS) at our outpatient clinic,” he said, noting that MTS is Missouri’s version of a collaborative practice agreement.

“Under its guidelines, I can now independently initiate, alter or modify medication therapy according to specific protocols. This has been a dramatic change in my pharmacy practice, and it has ultimately improved patient outcomes.”

Editor’s Note: Want to know more about the ASHP Foundation oncology traineeships? Simply go to the blog on the Foundations’s website.

–By Evan Mulvihill

November 12, 2013

Children’s National Develops Innovative Peds Residency Program

Filed under: Clinical,Feature Stories,Residents,Uncategorized — Kathy Biesecker @ 3:58 pm

 

The residency program at Children’s National Medical Center has tripled in size in just five years.

FIVE YEARS AGO, the 303-bed Children’s National Medical Center in Washington, D.C., supported only two first-year pharmacy residents. Since then, the program has tripled in size to a total of six residents: three in the PGY1 pharmacy residency and three in the recently formed PGY2 pediatric pharmacy residency.

The dramatic expansion in post-graduate education resulted from the convergence of need, opportunity, and the right people, according to Ursula Tachie-Menson, B.S., Pharm.D., the hospital’s acting chief of the division of pharmacy.

“We recognized that there was a real need for a PGY2 program focused on pediatrics. There aren’t many out there, and competition for them is huge,” she said, adding that she is unaware of any other pediatric-focused PGY2 slots in all of Virginia and across a huge swath of the eastern seaboard between Baltimore and Chapel Hill, N.C.

A Strong and Growing Need for Pediatric Pharmacists

Demand for pharmacists who practice in this specialty area is widespread and growing. According to the Board of Pharmacy Specialties, approximately 70 percent of all pediatric hospital bed days are for chronic illnesses, and the Children’s Hospital Association reported that shortages of pediatric care results in many young patients having to wait weeks and sometimes months to get an appointment.

Katherine Pham, Pharm.D., BCPS

Katherine Pham, Pharm.D., BCPS

PGY1 Residency Program Director Katherine Pham, Pharm.D., BCPS, was impressed with the clinical environment when she joined Children’s National in 2008 as the NICU clinical specialist and residency coordinator. When Dr. Pham surveyed the formidable pharmacy staff at her new employer, it seemed as if the department was “just built to have second-year residencies.”

With a core of then four (now six) clinical pharmacy specialists and a substantial number of decentralized pharmacists who had completed at least one year of residency, “there were just so many clinical pharmacy resources to draw from,” she said. “We have many talented clinical specialists who can provide a high level of residency training.”

In addition, because the hospital is one of the rare freestanding pediatric hospitals on the east coast, any residency program becomes, de facto, one of pediatric specialization. Residencies in general population hospitals are more broadly based by nature.

“We knew there were not enough PGY2 programs for pediatrics on the East Coast,” said Dr. Pham.

Pursuing a PGY2 Seen as a Career Boost

Given the competitive job market faced by clinical pharmacists in some regions of the country, more opportunities for advanced clinical training are clearly needed. When Kelli Covington, Pharm.D., a current PGY2 resident at the hospital, decided to pursue a second post-graduate year (she completed her PGY1 at Children’s National), she knew it would boost her marketability.

Her decision hinged as much on the potential career boost as on her desire to participate in a clinically oriented program focused entirely on pediatrics. “I’m being trained to be an independent pediatric pharmacist,” she said. “Most PGY2 programs don’t provide that opportunity.”

In addition, the residency has opened an avenue into academia—another of her interests. Dr. Covington is currently a preceptor and lecturer at the nearby Howard University College of Pharmacy.

Both Drs. Tachie-Menson and Pham emphasize that the expansion of the residency program owes much to steadfast support from pharmacy leadership and hospital administrators. David Stockwell, M.D., executive director of improvement science in the hospital’s intensive care unit recognizes the rewards of a strong residency program.

“Residents think and act at a high level, so they’re able to operate in very complex situations,” said Dr. Stockwell. “That delivers value to our patients and therefore to our organization. And when our residents move on, they’ll help somebody in a different place, so everyone benefits.”

Residency Experience Transfers Well

Rebecca Deoras, Pharm.D.

Rebecca Deoras, Pharm.D.

Rebecca Deoras, Pharm.D., a pediatric pharmacotherapy clinical specialist at the 464-bed Brooklyn Hospital Center in New York, was among the inaugural PGY2 class of two residents in 2011-2012 at Children’s National. She calls her decision to embark on the PGY2 “hands down one of the best decisions I’ve made.”

After pharmacy school, Dr. Deoras became a staff pharmacist at a pediatric satellite facility in New York. Three years later, her path led to the Children’s National PGY1 because she sought a higher degree of clinical training and, she hoped, a competitive edge in the job market. Her choice to stay on for another post-graduate year paid off.

“I was competitive for every job I applied for,” said Dr. Deoras. “Employers were really looking for that second year of specialty training.”

Now, as the only pediatric pharmacy clinician in a community hospital, Dr. Deoras’s responsibilities run wide—PICU, NICU, general pediatrics, hematology/oncology, outpatient asthma, and the emergency department. Yet she has felt completely prepared for the demands of multiple roles, largely, she says, because of the experience and knowledge gained during the PGY2. Because “Children’s National offered me a first-hand look at what’s involved in building a PGY2 from the ground up,” Dr. Deoras hopes to develop one at her hospital.

Patients, Residents Benefit

Second-year resident Gabriella Blyumin, Pharm.D., also anticipates that a PGY2 will bestow some professional advantage, but takes a cautious view. She’s not so sure the opportunities are as plentiful as generally believed, especially for job seekers who are regionally restricted. “There are a lot of overly saturated areas and not every hospital has a pediatric unit,” she said.

Still, for pharmacists such as herself who want to immerse themselves in pediatrics, the second-year residency at Children’s National offered an attractive opportunity. From the time of her first neonatology rotation in pharmacy school, Dr. Blyumin knew that pediatrics was right for her. But because her PGY1 was at an adult community hospital with a 20-bed pediatric unit and a 44-bed NICU, her exposure to young patients was limited to two rotations.

That changed immeasurably when Dr. Blyumin arrived at Children’s National.

“I wanted something very heavy in clinical pediatrics. Last year, I spoke with residents here, and that affirmed to me that the clinical experience was much more in depth than I would experience at other places and that I would see things here that I wouldn’t see elsewhere,” she said. “They made a place for me on the unit, and they don’t hold my hand. I feel like I have a lot of impact on patient care here at Children’s.”

The bottom line, said Dr. Tachie-Menson, is that the pharmacy leaders believed they had the ability, clinical skills, and motivation to create a robust and dynamic residency program that serves patients and residents.

“I think we’ve succeeded in doing that,” she said. “We’ve also been successful in preparing our residents to leave here and find the jobs they really want.”

–By Steve Frandzel

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November 4, 2013

PTAC: A New Collaboration to Expand Pharmacy Technician Education, Training

Filed under: Ambulatory Care,Clinical,From the CEO,Managers,Quality — jmilford @ 3:33 pm
Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

You may have heard about a new collaboration called the Pharmacy Technician Accreditation Commission (PTAC) that has been formed by ASHP and the Accreditation Council for Pharmacy Education (ACPE).I wanted to give you additional information about this significant initiative, which is being undertaken by ASHP and ACPE. This collaboration combines ACPE’s expertise and credibility in accrediting professional pharmacy degree programs with ASHP’s strengths in accrediting pharmacy technician training and pharmacy residency programs.

PTAC will be overseen jointly by ASHP and ACPE’s boards of directors, and, we believe, will greatly advance pharmacy technician training program accreditation and help to move our profession forward.

A Long, Illustrious History

Since 1982, ASHP, advised through its Commission on Credentialing, has served as the only pharmacy professional programmatic accreditor for pharmacy technician education and training programs. Likewise, ACPE, since 1932, has been and continues to be the primary source for accrediting professional degree programs.

ACPE also plays a vital role in assuring the quality of pharmacy education. Currently, there are 258 technician programs that either are accredited or are becoming accredited, and the need for and recognition of standardized technician training programs continues to grow. PTAC was created to address this need.

ASHP envisions that PTAC will create an increased emphasis for the need for accreditation of technician training programs and also assist us in greatly expanding their numbers. It is a “win-win” collaboration, across pharmacy and the health care continuum, for both technicians and the patients who will benefit from their work.

The Details

PTAC will consist of nine voting members, pharmacists and pharmacy technicians from a wide variety of practice areas. There will also be board liaisons from ASHP and ACPE, as well as a staff secretary.

Existing ASHP technician training programs scheduled for survey through May 31, 2014, will remain under the review of ASHP’s Commission on Credentialing. After May 2014, technician education and training programs seeking accreditation will apply for accreditation through PTAC, which will use a similar process to that used by ASHP’s Commission on Credentialing.

ASHP will manage the accreditation process and will continue to schedule surveys, and reports will continue to be sent to ASHP. However, all accreditation recommendations will be made by PTAC and will require final approval of both ACPE and ASHP boards of directors.

PTAC will use ASHP’s new Accreditation Standards for Pharmacy Technician Education and Training Programs that were approved in April 2013 and go into effect starting January 2014.

ASHP’s Regulations on Accreditation of Pharmacy Technician Training Programs will also be used to govern PTAC’s procedures for accreditation. Periodically, standards and policies/regulations will be revised and/or updated following industry best practices for accreditation. These will be approved by both ASHP and ACPE boards.

Growing Need for Well-Trained Technicians

The need for highly skilled and trained pharmacy technicians has long been recognized and continues to grow. ASHP looks to PTAC to create and nurture an effective, universal accreditation process. ACPE and ASHP support the use of qualified technicians in all pharmacy settings and recognize an obligation to develop and endorse standards that will continue to supply well-qualified technicians for pharmacy practice.

This process will ultimately help pharmacists to provide more critical and essential direct care to patients. We hope that you all will support this new collaboration with ACPE and help it to be successful. Click here to learn more about the PTAC and its efforts.

Best wishes for a happy, healthy, and joyous holiday season!

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