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March 15, 2019

Residency Match Day 2019

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

CONGRATULATIONS TO ALL WHO MATCHED DURING PHASE I of the 2019 Residency Match! By pursuing a residency, you have chosen to distinguish yourself by furthering your education and training. You are on the path to becoming the medication expert on the patient care team in all settings of care.

This year marks 56 years since ASHP began accrediting residencies and 40 years since ASHP’s Residency Match program began. Of our total 5,134 residency positions in 2019, 4,697 are now filled, with the remainder to be filled in Phase II of the Match. If you did not match during the first round, I encourage you to enter into Phase II of the Match, as there are still a number of exceptional programs with unfilled positions. ASHP’s Residency Guide: Preparation for Phase II of the Match, created by members of the New Practitioners Forum, can help you get ready for the next round.

ASHP is committed to continuing to increase the number of residency programs available in the years to come. Over the last five years, PGY1 residency positions have grown by 34% and PGY2 positions by 64%. Specifically, PGY2 residencies in ambulatory care grew by 112%, infectious disease residencies by 68%, and oncology residencies by 40%. Expansive growth occurred in emergency medicine residencies, which grew by 230%, and in pain management and palliative care residencies, which increased by 127%.

This remarkable growth shows that residency-trained pharmacists are in demand. I know that the year ahead will reward you and challenge you, creating a unique experience in your professional journey. As your professional home, ASHP is here to support you as you take this exciting step. ASHP offers a variety of resources tailored for residents, including the AJHP Residents Edition, an exceptional peer-reviewed platform dedicated to pharmacy residents, and the Career Transitions Resource Center. During your residency, stay up-to-date with best practices in research by viewing Essentials of Practice-Based Research for Pharmacists. Finally, be sure to stay involved in the ASHP New Practitioners Forum, which provides career guidance, clinician well-being and resilience resources, and opportunities for volunteer leadership.

On behalf of ASHP, congratulations once again! We are very proud of your accomplishments and wish you the best of luck throughout your residency training. I look forward to seeing you in December at the Midyear Clinical Meeting and Exhibition in Las Vegas.

 

Sincerely,

Paul

 

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March 8, 2019

North Dakota Technician Champions National Certification

This article is part of a series featuring ASHP’s pharmacy technician members and their valuable contributions to the profession. Check out ASHP’s Pharmacy Technician Forum for more information about efforts to advance the pharmacy technician workforce, as well as ways for pharmacy technicians to become more involved in ASHP.

 

Diane Halvorson, CPh.T.

AS A YOUNG ADULT, Diane Halvorson, CPh.T., never intended to become a pharmacy technician. But now, more than 25 years later, she has a gratifying career and is an influential figure in the field. As Lead Pharmacy Technician at Vibra Hospital Pharmacy in Fargo, N.D., Halvorson is a staunch advocate for improving technician certification and education programs.

Successful Technician
Halvorson began working at a hospital pharmacy more than two decades ago. As a single mother, she needed to find a way to support her son. Halvorson was lucky enough to learn the pharmacy technician trade on the job. She didn’t have any experience, but back then the job of a pharmacy technician was “very basic,” she said. She mostly managed the prescription medication stock.

Over time, her boss (the pharmacy director) took notice of her attention to detail and ability to manage her time and work efficiently. “As pharmacy evolved, I evolved along with it,” she said. “I became a sponge and started attending conventions, conferences, and any continuing education I could to expand my knowledge. The support of my peers and leaders gave me the confidence to excel.” When she began serving on the North Dakota Board of Pharmacy in 2011, she realized it was time to become certified.

“I have taken every opportunity to gain the knowledge and understanding of pharmacy and have evolved into the person I am today,” she said

National Standards for Techs
As a member of ASHP and other national and state pharmacy organizations, Halvorson was appointed by the governor of North Dakota to serve a second term on the North Dakota State Board of Pharmacy, with a goal of implementing education and certification programs in the state. The position has provided a forum to speak out about the need for standardizing pharmacy technician training across the nation.

Currently, there is no standard training or certification on a national level to become a pharmacy technician. Education and certification requirements to earn a CPh.T. degree vary by state. Some states may require more training than others, additional exams, or recertification.

But standardization in the profession is needed now more than ever. Pharmacists are now working in more clinical roles, but prescriptions still need to be filled. “Pharmacy technicians should have the credentials and knowledge to fulfill this role safely and accurately,” said Halvorson.

Expanding Tech Education
Halvorson and many of her colleagues would like to see pharmacy technicians undergo the same rigors of training that pharmacists face. “I feel we should have a national standard that establishes a way to ensure all pharmacy technicians have a baseline knowledge when entering the profession,” said Halvorson. “While our education would not be as detailed as the pharmacist, our process should mirror the process of the pharmacist.” The process would include the completion of an exam that verifies the baseline knowledge, she added.

Halvorson is an advocate for improving technician certification and education programs.

Some of the strictest requirements in her field exist in her home state of North Dakota, where pharmacy technicians are required to receive their education from an ASHP/ACPE accredited program. They must take a national certification exam to demonstrate their knowledge of the field, and they may only earn their certification in the state after meeting those requirements.

Hospital pharmacies in North Dakota are also required to have a quality assurance program to track prescription errors. “If you have a near-miss or a mistake that reaches the patient, you need to document it,” said Halvorson. “Was this an isolated incident? Was there a product problem or process problem or personnel problem?”

Technician Advocacy
Donna Kisse, CPh.T., is a pharmacy technician who has gotten to know Halvorson through their service together in North Dakota’s Northland Association for Pharmacy Technicians. Kisse and other colleagues admire Halvorson for the advocacy work she’s taken on toward a goal of consistent, national certification requirements for pharmacy technicians.

“Since pharmacists are taking the lead in clinical patient care roles, pharmacy technicians must be leaders in supporting standardized qualifications to ensure pharmacies are safe, efficient, and have productive work environments,” said Kisse.

Halvorson became involved with ASHP through the Pharmacy Technicians Stakeholders Consensus Conference steering and advisory committee. “For me, being a member of ASHP has elevated my overall knowledge and fundamental understanding of the opportunities of expansion of the scope of practice that a pharmacy technician can achieve,” she said.

The ASHP Pharmacy Technician Forum, which launched last year, has also been integral to her efforts. She currently serves on the forum’s Patient Care Quality Advisory Group committee.

Halvorson began her technician career more than two decades ago and currently serves as the Lead Pharmacy Technician at Vibra Hospital Pharmacy.

Reducing Prescription Errors
Halvorson hopes that all states will move toward following strict training guidelines like those in North Dakota. By not standardizing pharmacy technician training, Halvorson said the profession is putting the safety of patients in jeopardy. “The consumer believes that any person behind the pharmacy counter has education, that those people know what they’re doing, and that they have a minimum education.”

She recalled an incident that made headlines years ago. It involved Emily Jerry, a three-year-old girl in Ohio who died in 2006 as a result of a hospital pharmacy technician error. At the time of the toddler’s death, Ohio didn’t register pharmacy technicians or require any training or licensing to do the job. In 2009, Emily’s Act was signed into law. The legislation requires that pharmacy technicians be at least 18 years of age, register with the State Board of Pharmacy, and pass a Board-approved competency exam. It also includes requirements related to technician training.

“Humans make errors, and that’s why in a pharmacy you have a check and balance,” Halvorson said. That safety net wouldn’t exist without Halvorson and other passionate pharmacy technicians.

By Jessica Firger

 

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February 13, 2019

A3 Collaborative Elevates Diabetes Care in Rural Appalachia

Amy Westmoreland, Pharm.D., BCGP, counsels a patient about her medications.

Amy Westmoreland, Pharm.D., BCGP, Pharmacy Manager and Clinical Pharmacist at Carilion Giles Community Hospital, has a frontline view of the challenges of diabetes management. For years she wondered if there was a way for her and the other pharmacists at the hospital to provide services to patients beyond filling lifesaving prescriptions. Many of the patients admitted to the 25-bed facility in rural Appalachia were there due to lack of adherence to a diabetes medication regimen.

“Many of my patients didn’t understand all of the complexities involved in taking care of their diabetes, and that could spell disaster once they were discharged from the hospital,” explained Dr. Westmoreland. She noticed that some patients weren’t entirely sure how to monitor their blood sugar, and others had only a vague idea of what they should and should not eat. Many were resistant to any sort of dietary education, or those interventions proved to be ineffective.

A3 Collaborative
About a year ago, Dr. Westmoreland heard about a unique program known as the A3 Collaborative. The collaborative is made up of three organizations – ASHP, Apexus, and AIMM (Alliance for Integrated Medication Management). Its purpose is to help healthcare providers and organizations step in to and succeed in the new era of value-based payment models. The A3 Collaborative provides funding to hospitals that would like to bolster the role pharmacists play in value-based patient care.

Dr. Westmoreland (right), collaborates with case manager Jody Janney, R.N., medical social worker Drema Gautier, Mariana Gomez De La Espriella, M.D., and hospitalist Stephanie Boggs, Pharm.D.

Through Dr. Westmoreland’s efforts, Carilion became a member of the A3 Collaborative and was the recipient of 12 months of guidance and leadership from ASHP, Apexus, and AIMM. The comprehensive medication management program she and her colleagues created with help from the collaborative is simple, but it’s already delivering significant results. Carilion’s new value-based patient care model allows diabetes patients more access to their pharmacist in the days, weeks, and months after discharge.

“Our patients are really happy that they have someone they can turn to, someone they can call and help them understand their illness better,” said Dr. Westmoreland. There have been times when she met patients who were on 30 different medications and they needed someone who could help them understand their diabetes management plan.

Postdischarge Counseling
Dr. Westmoreland and her colleagues started the program in July 2018, and they are currently following 22 patients after discharge. Before the patient is discharged, Dr. Westmoreland and her colleagues meet with the patient. They review their medication list and determine what information and help they may need after they’re discharged from the hospital and moved to ambulatory care.

Before discharge from the hospital, the attending pharmacist will ask the patient if they’d like a follow up phone call from a pharmacist to answer any lingering questions. The pharmacist also provides their information and phone number so the patient can contact them during business hours.

If a patient opts into the medication management program, then the pharmacist coach will call to follow up at 10 days, 20 days, a month, and two months after discharge. After that, calls are made once a month. During each call, a pharmacist ask a specific list of questions:

  • Are you able to afford your medication?
  • Are you taking your meds as prescribed?
  • How often do you check your blood sugar?
  • What is the range of your blood sugar ratings? Are you keeping a log?
  • Are you having any side effects such as low blood sugar occurrences?

Although the program is still relatively new, Dr. Westmoreland and her colleagues have already identified a number of medication-related problems such as duplication errors. They found, for example, that one patient was unnecessarily taking two different forms of thyroid replacement therapy. She’s observed other concerning trends as well: Many patients don’t understand the difference between long-acting insulin and short-acting insulin. Some patients are unclear how — and when — to test their blood sugar, or why it is important that a patient log this information for their doctor to review at follow-up appointments.

“Taking the time that is required to effectively review a medication list is time-consuming,” said Dr. Westmoreland. “That’s where a pharmacist has the skill set to come in and effectively look at the medications and provide recommendations for eliminating some drugs that may not be necessary, or optimize doses to make things better for the patient.”

Amy Westmoreland, Pharm.D., BCGP

Closing the Care Gap
Dr. Westmoreland said the program also addresses the disconnect that often exists between specialists and a primary care physician, especially when a patient’s doctors are not all contained in one facility — meaning there may be more than one electronic medical system where the patient’s records are kept.

“There’s a huge gap in care, in my opinion, without having the pharmacist on the care team for every patient,” said Dr. Westmoreland. “I think we’re at a crossroads in healthcare with having the pharmacist on the care team. Pharmacists have a unique knowledge of the medications, and they understand what a normal dose would be and what an exorbitant dose would be. They could look at a prescription and realize something is off or not correct, whereas nurses and doctors may not be looking at the medication lists in the way that pharmacists do.”

A3 Adds Value
Melanie Smith, Pharm.D., BCACP, DPLA, Director of ASHP’s Section of Ambulatory Care Practitioners, serves as a staff liaison for the A3 Collaborative. She noted that the collaborative allows ASHP members to test out great ideas that could help keep patients out of the hospital. “Many of our members are being tasked with setting up a clinic or setting up a service in an ambulatory care setting,” said Dr. Smith. “Participating in a program like the A3 Collaborative provides them with essential coaching and mentoring, and helps provide a foundation and the bridge they need to transition the clinical practice from inpatient to outpatient.”

Dr. Westmoreland, for her part, hopes the success of the program will demonstrate the value of adding pharmacists to patient-care teams. “We’re trying to be very proactive before the point of discharge.” It’s important, she said, for patients to have someone they can turn to when their diabetes management becomes overwhelming, or they can’t afford their prescriptions, or their doctor is not readily available to answer questions. “I would like others to see there’s enough value in this program for it to be expanded across the system and across the nation.”

 

By Jessica Firger

 

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December 17, 2018

ASHP Continues to Lead on Pharmacy Workforce Well-Being & Resilience

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

I am pleased to share with you that over the last year ASHP has continued to increase our efforts to support the well-being and resiliency of the pharmacy workforce. ASHP is an original sponsor of the National Academy of Medicine (NAM) Action Collaborative on Clinician Well-Being and Resilience and is honored to support the pharmacy profession on this important patient care and workforce issue. As the NAM Action Collaborative on Clinician Well-Being and Resilience approaches the two-year mark, I would like to share some updates with you on our efforts to help address this important issue facing pharmacists, pharmacy residents, student pharmacists, and pharmacy technicians.

These past 15 months, through the NAM Action Collaborative and ASHP’s own organizational efforts, we have raised the visibility of clinician burnout, depression, stress, and suicide. Over that time, ASHP has developed resources, educational programming at our national meetings, and community connections for members to learn more about the issue. Former U.S. Surgeon General Vivek Murthy kicked off our 2018 ASHP Summer Meetings by challenging attendees to include well-being as the core of what we do as healthcare workers.

Summer Meetings attendees also heard about some of the science behind resilience and were introduced to interventions for building individual and team resilience through two interactive presentations by Dr. Bryan Sexton, Director of the Duke Patient Safety Center. Conversations on the topic continued in the ASHP House of Delegates, where delegates approved an ASHP policy on Clinician Well-Being and Resilience. We are very pleased to have an official professional policy for members to reference as they begin and continue discussions at their institutions. Efforts by the ASHP House of Delegates also helped form a joint ASHP Council and Commission session on the pharmacists’ role in suicide prevention during the 2018 ASHP Policy Week.

We know that burnout is associated with compromised patient safety and a loss of productivity in the healthcare workforce. As such, we continue to help advance pharmacy-specific research on resilience and well-being. ASHP recently partnered with the Pharmacy Technician Certification Board (PTCB) and Duke University Health to study the prevalence of burnout in pharmacy technicians and identify resources to support this important and growing segment of ASHP’s membership. While both NAM and ASHP are improving baseline understanding of challenges to clinician well-being, we are reminded that this is a local issue that requires local solutions to address it. ASHP members continue to share their strategies on how to foster the creation of resilience in clinical learning and managing preceptor burnout. If you traveled to Anaheim for the recent Midyear Clinical Meeting, there were multiple educational sessions on workforce well-being. Many of these sessions were recorded and will be available on ASHP eLearning in early 2019.

NAM recently kicked off a consensus study to examine systems approaches to improve patient care by supporting clinician well-being. ASHP nominated M. Lynn Crismon, Dean, University of Texas, College of Pharmacy, to serve on this committee, which will issue a report with recommendations for system changes to streamline processes and manage complexity, minimize the burden of documentation requirements, and enhance workflow and teamwork to support the well-being of all clinicians and trainees. In the meantime, the NAM clinician well-being knowledge hub continues to grow with solution strategies for leaders, organizations, and individuals, including ASHP contributions to a discussion paper on implementing optimal team-based care to reduce clinician burnout. ASHP state affiliates are also an important part of the conversation, and ASHP has created a state affiliate toolkit on well-being and resilience to assist them in their state-level efforts.

Our continued work in advancing workforce well-being and resilience is ultimately growing a foundation for long-term culture change. We have enhanced our SSHP Recognition Program for the 2018–2019 academic year to encourage our students to address the issue. We know that many of you are working on well-being and resilience within your organizations, and we would appreciate hearing from you. We encourage you to share your stories through our community on ASHP Connect. Or, maybe you know of an individual or an organization that is demonstrating positive progress on resilience and supporting a healthy and engaged workforce. If so, we encourage you to fill out this brief survey so that we can create case studies others can learn from.

I hope you share our enthusiasm about this very important work to support the resilience and well-being of the entire pharmacy workforce and about the impact this work will have on improving patient care.

Thanks so much for being an ASHP member and for everything you do for your patients and pharmacy teams. I look forward to sharing more with you in the future as ASHP’s efforts continue in this important area. Have a safe holiday season.

Sincerely,

Paul

July 31, 2018

Ohio Pharmacists Overhaul Drug Shortage Strategy

Wexner’s Crystal Tubbs (left) and Hannah Miller (right) participate in a meeting about drug shortages.

AS DRUG SHORTAGES CONTINUE TO AFFECT PATIENT CARE, health systems and hospitals across the country have begun to take steps to buffer the impact of additional medication scarcities. Pharmacists at the Ohio State University Wexner Medical Center spearheaded an approach in November 2017 to improve the organization’s response to drug shortages. The initiative focuses on rapid communication among all staff involved in the medication-use process.

Crystal Tubbs, Pharm.D., FASHP, is the Associate Director of Wexner’s Department of Pharmacy. After Hurricanes Irma and Maria damaged manufacturing facilities in Puerto Rico, which left organizations without access to small-volume parenterals and other critical drugs, Dr. Tubbs and the pharmacy staff took the lead in revamping Wexner’s drug shortage management strategy.

“Our previous process was to hold weekly drug shortage meetings, mostly with purchasing and operational staff. However, clinical staff began telling us they felt ill-informed to make operational and clinical changes when a shortage hit,” said Dr. Tubbs, an ASHP member since 2000.

In response to this feedback, Dr. Tubbs and her colleagues organized a retreat with roughly 75 staff members representing departments from across the medical center. The discussions at the retreat led to a number of significant changes, she said. “We now have two weekly drug shortage meetings that include not only pharmacy purchasing and operational leaders, but also senior pharmacy administrators, our drug information team, pharmacy technicians, pharmacy representatives from each clinical area in the hospital, medication safety experts, and information technology [IT] staff,” Dr. Tubbs explained. “Now, more people feel like they’re in the know.”

EMR Tools

To expedite the communication of drug shortage information, the team drew heavily on tools in the electronic medical record (EMR) system. “We created a drug shortage database that has become our source of truth for up-to-date and real-time information on clinical and operational action plans,” Dr. Tubbs said, adding that ASHP’s drug shortage resources often help her staff decide how to manage shortages.

Crystal Tubbs, Pharm.D., FASHP

The medical center also recently launched an EMR-integrated inventory management system that pharmacy staff across the health system can access to find real-time information about the inventory of any medication.

In addition, Dr. Tubbs and her team added banners on the EMR’s login page to convey particularly important information. “A red banner at the top of the login screen communicates urgent clinical and operational changes, and a tan banner lets staff know about less urgent measures or if a shortage has been resolved,” said Dr. Tubbs. This tool has been particularly useful in cases where actions need to be implemented quickly because a medication shortage has become critical, she noted.

Any information that is not included in the database or conveyed through banners is now sent out through a centralized drug shortage email account. According to Dr. Tubbs, the medical center’s staff members feel that this new process is “seamless and consistent” compared to the previous method, which included multiple emails from a number of accounts. “It has simplified the process for staff looking for answers to their drug shortage questions, because they can now query the single email account,” said Dr. Tubbs.

A Well-Oiled Machine

According to Hannah Miller, CPh.T., CMRP, Purchasing Manager in Wexner’s Department of Pharmacy, the new drug management process runs “like a well-oiled machine.” She added that the timing of communication with the old approach sometimes delayed an effective response and was an incomplete response to a drug shortage. The purchasing team would reach out to clinical staff only if they needed to find an alternative medication or if a shortage required a product switch or a more restrictive prescribing process.

“For example, when methylene blue 1% was discontinued in November 2016, following approval from our clinical staff, we switched to a 0.5% concentration from another manufacturer, but the transition didn’t go over very well at first,” she recalled.

Unlike the 1% concentration, which had to be mixed with saline, the 0.5% product had to be prepared with dextrose and, since it was a different concentration, the product fell under a different drug entry. “Those changes led to some hiccups, especially for our IT team and clinical staff,” said Miller. “Although the purchasing staff was able to get the necessary products through the door, we struggled to operationalize the changes associated with the alternatives on our own.”

Ultimately, they worked through the challenges by assembling methylene blue 0.5% kits that included dextrose, she explained. “With the new process in place, clinical and IT staff members are involved right from the beginning, and we manage drug shortages much more effectively,” Miller reflected.

Strategic Measures

The new approach, which elicited a “resoundingly positive” response from staff, was a boon for the hospital when it faced intravenous (IV) opioid shortages in November 2017.

“As soon as we were notified of the shortages, we held an emergency meeting to evaluate stock as well as the predicted availability of more medications and the number of days of supply on hand, which we found was quite low for several different medications,” said Dr. Tubbs.

In short order, staff developed a plan for each opioid, recommending measures like switching from IV to oral administration, or evaluating other non-opioid strategies for pain management. They also used the EMR banners to encourage clinicians to order patient-controlled anaesthesia judiciously and to select alternative agents for continuous pain management in the intensive care unit. Each time an affected opioid was prescribed, an electronic alert was triggered, and the drug shortage database was updated daily. Clinical pharmacists reviewed daily reports that listed all patients with active IV opiate orders. “Within 48 hours of implementing the restrictions, we had reduced IV opiate administration by over 50 percent,” Dr. Tubbs recalled.

Pharmacy Technicians’ Role

Miller noted that pharmacy technicians have long been important members of the drug shortage team. In addition to being the pharmacy’s buyers and purchasing managers, technicians on the hospital floors provided useful input that helped shape a drug shortage management strategy, she explained.

For example, when the hospital faced a shortage of emergency syringes in April 2017, crash cart technicians pointed out they rarely used the five syringes of epinephrine typically stocked in each cart. They also said they could turn to epinephrine vials stocked in the carts and automated dispensing cabinets, if needed. “They suggested that we reduce the number of syringes per cart to three,” Miller said. “Our clinical pharmacists agreed with that decision.” This insight freed up syringes to use with other injectable medications.

Comfort with the Unpredictable

Using a comprehensive and team-based approach to managing drug shortages that now draws on a variety of tools and strategies, Wexner has proven that, although shortages are inevitable, their impact can be mitigated. “Shortages are still uncomfortable,” said Dr. Tubbs, “but we are fortunate that we haven’t completely run out of any specific medications since changing our approach and improving how we communicate information on drug shortages.”

 

By David Wild

June 18, 2018

Underserved Patients Rely on Pharmacists to Fill Care Gap

Nazia S. Babul, Pharm.D., BCACP, Clinical Pharmacist and Clinical Assistant Professor at the University of Illinois College of Pharmacy, counsels patients at CommunityHealth, a free clinic in Chicago.

PROVIDING HEALTHCARE TO UNINSURED AND UNDERINSURED INDIVIDUALS is a challenge that continues to grow. With rising premium costs, the threat of major insurers on the verge of withdrawing from health exchanges, and the potential for reductions in coverage, three health systems — Yale-New Haven Health, Ascension, and the University of Illinois Hospital and Health Sciences System — are calling on clinical pharmacists to help address gaps in care.

Ambulatory Care at Yale-New Haven Health
“Our pharmacists teach underserved patients about their medications, optimize their dose, determine if they’re really receiving the best medication given their particular situation, and find the lowest-cost options for them,” explained Lee Ann Miller, Pharm.D., Director of Clinical Pharmacy Services at Yale-New Haven Health in Connecticut. “These are all steps that can improve adherence and outcomes while also reducing healthcare resource utilization and lowering the overall cost of care.”

Although pharmacists at Yale-New Haven Health provide beneficial care to patients, funding is a concern. Dr. Miller explained that, although pharmacists at ambulatory care clinics often spend up to an hour with a patient, a lack of provider status means they bill Medicaid and Medicare at the lowest-level evaluation and management incident-to code, which reimburses $20 on average.

This financial picture makes it difficult to make a case for expanding the clinical pharmacist workforce beyond the eleven pharmacists who are embedded across the health system’s roughly 200 ambulatory care offices and clinics, explained Dr. Miller. “Moving to value-based payment structures and having provider status would certainly give us the help we need to offer this same level of service at other clinics,” she added.

Ascension’s Social Mission
Despite the low level of reimbursement currently available, pharmacists continue to provide important care. Ascension, the largest nonprofit health system in the country, with facilities in 22 states, offers free medications to those who can’t afford them through one of 45 Dispensary of Hope locations. The Dispensary of Hope program collects medications donated by pharmaceutical manufacturers and distributes them to certain pharmacies and safety-net clinics. At some Dispensary of Hope locations, health leadership may purchase additional medications as part of a safety net formulary for their institutions.

The pharmacy team at the Medical Mission at Home provides medications and counseling to underserved patients.

“In the fourth fiscal quarter of 2017, our Dispensary of Hope pharmacies served 6,460 unique patients,” said Lynn Eschenbacher, Pharm.D., FASHP, National Director of Pharmacy Operations at the Resource Group, which is part of Ascension.

Another Ascension initiative, the Medical Mission at Home project, features daylong community health events that provide patients with primary and speciality care services. As part of the initiative, underserved individuals also receive medications and counseling about their medications, explained David Neu, Pharm.D., MSHSA, Vice President of Pharmacy at Saint Thomas Health, a member of the Ascension network in Nashville, Tenn. According to Dr. Neu, Nashville is host to the largest of the four annual Medical Mission at Home days and recently provided care to more than 750 patients during a single day.

“We see a lot of people with untreated hypertension, diabetes, asthma, or chronic obstructive pulmonary disease — or people who are not adherent to their medication regimen — so pharmacists have an opportunity to make an important impact on their care,” Dr. Neu explained.

Patients are assessed by a nurse and triaged to the appropriate health caregiver, whether that is a physician, pharmacist, or nurse practitioner. Prescriptions can be written and filled onsite using both Dispensary of Hope medications and subsidized medications purchased by the participating Saint Thomas Health hospital, noted Dr. Neu. All medications are provided at no cost to patients during the event.

“Pharmacists also provide counseling and patient education such as inhaler training,” he explained. They assist individuals who need help paying for medications, whether that means obtaining a coupon voucher, connecting with a patient assistance program, or pointing patients to a Dispensary of Hope location. “There’s an aspect of social work to the care our pharmacists provide during these events, which is important as uninsured and underinsured patients have a hard time navigating our health care system to meet their medication needs,” reflected Dr. Neu.

Caring for Chicago’s Poor
At the University of Illinois Hospital and Health Sciences System (UI Health), ambulatory care pharmacists help some of the poorest and most vulnerable communities in Chicago,” said ASHP member Sandra Durley, Pharm.D., Senior Associate Director of Ambulatory Care Pharmacy and Clinical Assistant Professor at the University of Illinois College of Pharmacy, Chicago. “Many of these individuals lack insurance and convenient access to healthcare services and are considered to be medically underserved.” Care is available at UI Health’s on-campus pharmacies and at 20 outpatient clinics and four pharmacy-based clinics staffed with 38 full-time clinical pharmacists.

At Mile Square Health Center, a federally qualified health center that is also part of UI Health, a clinical pharmacist works alongside physicians and nurse practitioners to care for patients with diabetes and other illnesses, many of whom are underinsured or uninsured, explained Dr. Durley. And in an institutional collaboration, two University of Illinois College of Pharmacy clinical pharmacists work four days each week at CommunityHealth, the largest volunteer-based free clinic in the country, she added.

Like Dr. Eschenbacher, Dr. Durley is concerned about the future of underinsured and uninsured patients. Although pharmacy services help improve health outcomes among the underserved, pharmacists are not always compensated. However, she also struck an optimistic note, pointing to the Pharmacy and Medically Underserved Areas Enhancement Act, which, if passed, would recognize pharmacists as healthcare providers under Medicare Part B in medically underserved areas. “That is an important first step in getting compensation for pharmacist services,” Dr. Durley said.

 

By David Wild

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