ASHP InterSections ASHP InterSections

May 25, 2018

Student Pharmacists Shine at the Jackson Free Clinic

Filed under: Feature Stories — jmilford @ 12:27 pm

Medical students Stephen Grado and Jessica Jenkins, along with student pharmacist Khyati Ganatra, review notes from a patient interview.

IMAGINE, IF YOU WILL, a place where medical students and pharmacy students give up their Saturdays to work collegially, teach and learn from each other, and provide uninsured patients with vital medical care. That place is the Jackson Free Clinic (JFC) in Jackson, Miss.

Collaborative Practice

The clinic is a nonprofit organization run by students at the University of Mississippi Medical Center. Its mission is to provide high-quality health services — including exams, treatment, testing, prescription medications, education, and preventive care — to uninsured community members. The JFC also provides an innovative environment where pharmacy students can demonstrate the value pharmacists bring to an interdisciplinary care team.

“We are able to show medical students the depth of our drug and disease state knowledge, while they are able to teach us about the diagnostic process and considerations that take place when evaluating a new patient,” said Kaitlyn Jones, a fourth-year student pharmacist at the University of Mississippi School of Pharmacy. “We both develop respect for each other’s professions and work together to enhance our patient’s care.” Jones also serves as the Pharmacy Student Director for the clinic and as a board member of the JFC.

Katie McClendon, Pharm.D., Assistant Dean for Student Services at the University of Mississippi School of Pharmacy, became involved with the clinic as a pharmacist volunteer in 2013. At that time, few student pharmacists participated in the clinic. Today, several student pharmacists are members of the JFC’s Board of Directors, and the clinic has expanded to include eight care teams, each with about seven students from various medical disciplines, including pharmacy.

A Typical Day

Meredith Oliver, a fourth-year student pharmacist at the University of Mississippi School of Pharmacy, began volunteering at the JFC last year. According to Oliver, when patients arrive, they are checked in at the front desk and a team receives each chart to review before meeting the patient. Once the patient’s height and weight are charted, he or she is taken for an interview.

“As a pharmacy student, I always ask what medications the patient is taking, including any herbal or OTC supplements,” said Oliver. “Once we talk with the patient, we go back to the team room and discuss our plan for the patient.”

After the treatment plan is formulated, the team presents the plan and any recommended medications to the supervising physician and pharmacist onsite that day for approval. Next, the team talks to the patient about their treatment plan and medications. Each team sees between two and five patients a day.

Oliver finds it rewarding to share her medication expertise with the rest of the team. “The younger medical students have not had pharmacology, and they greatly appreciate the frequent teaching moments pharmacy students provide about how to write a prescription, drug classes within a disease state, and pharmacology review of medications selected for the patient,” she said.

Real-Life Impact

Jones recalled a recent experience where she helped a patient with medication reconciliation. “Our patient was only able to tell us the number and color of pills they took every day,” she said.

Student pharmacist Lauren Pohl talks to a patient about the plan for his medications and provides him with medication samples.

The medical students were unsure how to proceed, and Jones explained that they could call the patient’s pharmacy to get the medication history. The medical students were unaware that this was an option, and hesitant to call, so I handled it, she said. “Even though it was a simple action that took no longer than 10 minutes, offering to call the patient’s pharmacy turned out to be a critical action, allowing our team to adjust their current medications and provide better care to the patient,” Jones said.

Jones also described how she helped a medical student identify alternative antibiotics for a patient when the first choice for antibiotics was unavailable. “Working together, we were able to find an alternative regimen that was feasible for both our patient and our attending physician,” she said.

 

Medication Assistance Education

In addition to caring for patients, student pharmacists have taken the lead in identifying medication assistance programs and assisting patients with the often complex forms. “It’s been a great learning experience for our students to fill out the paperwork,” said Dr. McClendon.

For example, Jones worked with her team to help an asthmatic patient who couldn’t afford her two inhalers. Jones recommended starting a patient assistance application through a specific drug company, which would provide both inhalers.

Jones explained the process to the patient, helped her submit the application, and set up a follow-up appointment to make sure the medication was controlling the patient’s asthma. “The collaboration between pharmacy and medical students created an opportunity for me to educate the medical students about patient assistance and to provide the patient with no-cost medications that were critical for her asthma control,” said Jones.

The Future of Collaboration

According to Lauren Ramsey, also a fourth-year pharmacy student at the University of Mississippi School of Pharmacy, “The interprofessional team education at JFC has vastly improved the relationship between students of different healthcare professions. Pharmacy and medical students share their knowledge and better understand each other’s roles in interprofessional, team-based care. Every student adds value to the patient’s care and gains experience working alongside peers in multiple healthcare professions.”

Internal Medicine resident Madison Williams, M.D., writes her portion of a note as Pohl and medical students Tiffany Martin and Naishal Patel evaluate OTC medication options.

Ramsey, a native of Mississippi, grew up understanding the issues affecting her state, particularly disparities in healthcare and reduced access to preventative services. “At JFC, pharmacy students play a vital, active role in ensuring that patients have access to care and appropriate medication therapy. These patients would likely fall through the cracks of our healthcare system,” she said. “It’s highly rewarding to participate in their care.”

Will working together as students make a difference to doctors and pharmacists of the future? The student volunteers think so. Ramsey believes the effects of this collaboration will stretch far beyond the actual experience. “We are very fortunate at the University of Mississippi and at JFC to have pharmacy and medical students who genuinely respect each other.”

“It is our hope that pharmacy students show their value and knowledge while on the team,” she said. “I think the importance of collaboration with pharmacy will remain with medical students long after they become physicians.”

-By Ann Latner

 

May 7, 2018

Provider Status and Opioids Legislation Update

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

I WOULD LIKE TO UPDATE YOU on ASHP’s ongoing efforts to advocate for passage of legislation that would recognize pharmacists as patient care providers in the Medicare program, as well as legislative efforts related to the opioid epidemic.

As the 115th Congress begins to shift focus to the November elections, opportunities for healthcare legislation are limited. We anticipate that any healthcare-related legislation will be mainly focused on the opioid epidemic. As a lead member of the Patient Access to Pharmacists’ Care Coalition, ASHP is working to determine ways in which provider status language might be addressed in the pending opioid bills. However, given that the focus of these bills is mainly on opioids, our efforts for now may need to shift to articulating how pharmacists can play important roles in helping to solve this major public health problem.

Efforts to obtain provider status are part of ASHP’s larger vision that medication use will be optimal, safe, and effective for all people all of the time. Our intent is to enhance our members’ ability to provide care as part of the interprofessional patient care team.

As states look to expand their scope of practice laws to promote the direct patient care roles of pharmacists, ASHP is supporting state-level efforts of our members and working at the federal level to include these direct patient care roles in Medicare. We also want to make sure our members are well-positioned to align their efforts with Medicare modernization, which is now focused on moving toward value-based models that align payment with quality and outcomes. ASHP members are in an excellent position to lead efforts to optimize medication therapy through value-based models, and ASHP will be there to make sure that Congress, Medicare and Medicaid, states, and others understand the many advanced practice models our members are engaged in as well as the direct patient care roles they play.

As we continue to work with Congress, states, and public and private payers to recognize pharmacists as patient care providers, we will keep you apprised of these activities and our many advocacy efforts on your behalf — addressing persistent drug shortages, rising drug costs, and threats to the 340B Drug Pricing Program, as a few examples.

Thank you for your support and your continued engagement as we work together to help our patients achieve optimal medication therapy outcomes and to advance pharmacy practice.

Sincerely,

Paul

May 4, 2018

Can Pharmacists Have it All? Balancing a Dream Career with a Busy Family

Editor’s Note: This story is part of a special series examining the growing number of women in pharmacy leadership.

Kelly Epplen, Pharm.D., BCACP, FASHP

JUGGLING YOUR CAREER, KIDS, HOBBIES, AND FRIENDSHIPS can sometimes be a wobbly balancing act, but Kelly Epplen, Pharm.D., BCACP, FASHP, has integrated the elements of work and family into a cohesive and satisfying lifestyle.

“I believe having a rewarding career has made me a better mother, and being a good mom has made me a better practitioner,” said Dr. Epplen, Associate Professor of Clinical Pharmacy Practice and Administrative Sciences at the James L. Winkle College of Pharmacy at the University of Cincinnati. “Being a mother is the most rewarding, most challenging, and most important job I have, but being a pharmacist completes me as a person. And the nurturing elements of motherhood bleed into my role as a healthcare professional.”

A Balancing Act

With four teenagers, coordinating a career and a family is not easy. “I may get up at 3 a.m. to read an article, prepare for a lecture, or write a paper so that I can get my kids up at 6 a.m. and get them out the door for school,” she said. “Or I may leave work at 3 p.m. to get to a baseball game or volleyball match, and then pick work back up at 8 p.m. It is not for everyone, but it works for me!”

Dr. Epplen and her husband have a team approach to raising their children, which gives each of them the time and space to pursue their own professional goals. While this approach has been successful, it has also led to occasional work and family clashes.

For instance, Dr. Epplen was scheduled to deliver a presentation at the 2016 ASHP Summer Meetings that coincided with her daughter’s eighth-grade play. “I was so upset I had to miss her play. Ask any mom who works outside the home — the guilt can be overwhelming at times!” she said. “But I sat her down and explained the situation. It turned out that she was completely OK with it, and I quickly remembered that I am raising strong, independent kids who often are more mature than I give them credit for.”

Ambulatory Care Expertise

That strength and independence are some of the characteristics Dr. Epplen models for her children. Since becoming a board-certified ambulatory care specialist in 2011, she has largely dedicated her career in pharmacy to enhancing clinical roles for pharmacists in the ambulatory setting to improve patient care.

“I have had the opportunity to justify, develop, establish, and maintain several ambulatory care services across multiple health systems in the Greater Cincinnati area,” she noted, pointing to her work in anticoagulation, pharmacotherapy, and family medicine. “My goal right now is to establish the role of ambulatory care pharmacists within the accountable care organization [ACO] at which I practice and to demonstrate how pharmacists can significantly improve quality of care for high-risk populations while creating a positive return on investment.”

For example, she has led projects looking at medication-related performance measures in medication adherence and the management of osteoporosis in women. She found that pharmacists’ interventions helped significantly  improve Star Ratings and contribute to increased incentive payments in this value-based performance environment.

A Real Person

A faculty member at the University of Cincinnati College of Pharmacy since 2009, Dr. Epplen’s primary teaching responsibilities focus on women’s health and topics in health-system pharmacy practice, professional practice development, and pharmacy management.

Dr. Epplen serves as the faculty advisor for Ana Jenjebir, a student pharmacist.

Dr. Epplen said she starts the course on health-system pharmacy practice by painting a full picture of her life, sharing what she finds exciting about pharmacy as well as other activities she participates in outside of clinical practice.

“I think it is important that students understand that I am a real person, including being a mom, a pharmacist, an ambulatory care specialist, a professional, and an advocate for the profession,” she said.

Dr. Epplen typically precepts two Advanced Pharmacy Practice Experience students per month, chairs the Honor Council for the University of Cincinnati College of Pharmacy, serves as a continuing education administrator, and sits on the college’s Reappointment, Promotion, and Tenure committee.

“Inevitably, after class I have a line of female students wanting to know how I balance everything. However, I tell them that, to me, there is no balance. Integration of work and home life is essential to my success,” she said.

ASHP Roles

Dr. Epplen has been an active ASHP member since 1997 and was introduced to service opportunities within ASHP by her own female role model and mentor, ASHP Past President Marianne Ivey, Pharm.D., M.P.H., FASHP. Dr. Epplen became active in ASHP’s Section of Ambulatory Care Practitioners (SACP) 20 years ago through her involvement in the Section Advisory Group on Reimbursement for Cognitive Services (now called the Section Advisory Group on Compensation and Practice Sustainability)

She is a Fellow of ASHP and served as the Chair of the Executive Committee of SACP from 2015 to 2016. “Being elected Chair was one of the proudest moments I have ever had professionally,” Dr. Epplen recalled. “It was a professional validation that I had been elected by my peers to represent one of the fastest-growing sections of our professional community.”

The leadership role offered Dr. Epplen an opportunity to advance ambulatory care pharmacy practice and share her experiences in ambulatory care with initiates to the field. “It was also as an opportunity to learn from advanced practitioners with established ambulatory care services,” she noted.

As gratifying as it was to be elected Chair of a prominent ASHP committee, Dr. Epplen noted that the pinnacle of her career as an ambulatory care pharmacy specialist was speaking at ASHP’s inaugural Ambulatory Care Summit in 2014.

“To be a part of such a gathering of ambulatory care specialists from across the country, as we came together to define ambulatory care pharmacy practice and our roles and responsibilities in patient care, was truly inspiring,” said Dr. Epplen, who authored a briefing paper for the summit, co-authored ASHP’s Minimum Standard for Ambulatory Care Pharmacy Practice, and co-authored a chapter in Building Ambulatory Care Services.

“Ambulatory care pharmacy practice has experienced significant growth over the last decade, and I am proud to say that I have been present for that growth!” she said.

Advice for Young Women Pharmacists

Dr. Epplen often collaborates with members of the ASHP Section of Ambulatory Care Practitioners.

Dr. Epplen has had many opportunities to work alongside strong female ambulatory care leaders. “All of these women exhibited characteristics that I have incorporated into my work life: dedication, determination, confidence, and independence,” she said.

Based on the wisdom she’s gleaned from her mentors and the experience she has gained, Dr. Epplen has some advice for women starting their careers in ambulatory care pharmacy: “Find successful female professionals to emulate, take time to meet with them often, and ask them what they love about their career path and what pitfalls to look out for,” she recommended.

Women pharmacists should also consider identifying their professional and personal goals, giving thought to how these goals complement each other, and figuring out how barriers might prevent them from achieving those goals, Dr. Epplen added.

“Learn how to integrate your personal and professional lives. Figure out how it can work for you and your family,” she suggested. “And realize that your house may not always be perfect. You may not be at every dance recital or sporting event. Your laundry may not always be done. And then realize that it is okay! Give yourself a break!”

 

By David Wild

 

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