ASHP InterSections ASHP InterSections

June 1, 2010

Achieving Balance in Today’s Connected World

Diane Ginsburg, M.S., FASHP

SOCIAL NETWORKING HAS BECOME such a standard part of my day that it’s hard to believe that just a decade ago, Facebook, Twitter, etc., were mere blips on the horizon. I have to admit that it’s easy to get a little compulsive about posting updates, keeping in touch with friends and colleagues, and sharing information and opinions on everything from my latest travel exploits to what’s happening in the classroom.
As a pharmacy educator, I am blessed to be surrounded by many soon-to-be practitioners. It’s fun to tap into their wealth of knowledge about this digital world and to see how creating a virtual identity is almost second nature to this generation.

But social networking is not without its perils. As you’ll see in this issue’s cover story (page 8), we all are navigating in uncharted waters. In this new world, we’re collectively trying to figure out how best to maintain our professionalism online while taking advantage of the many social benefits of this technology. I hope the tips and tools you’ll find in the story help you to chart your course online.
You may not be aware that a lion of our profession retired recently. Rear Admiral Robert Pittman, B.S.Pharm., M.P.H., U.S. Navy, recently spoke with InterSections about his service (page 14) with the U.S. Public Health Service Commissioned Corps and the Indian Health Service. RADM Pittman’s work to bring health care to rural patients and positively influence the federal pharmacy practice model is an inspiring story for us all.
I’m sure you’ve followed the aftermath of recent catastrophic events, such as the earthquakes in Haiti and Chile. The untold story is one that’s happening at the frontlines among patient-care providers. Pharmacists who are part of Disaster Medical Assistance Teams (DMATs) and International Medical Surgical Response Teams are stepping in and providing valuable patient care. Interested in learning more about DMATs? Check out the story on page 12.

Finally, as pharmacists move into more direct patient-care roles, they are finding many opportunities to influence the health of their patients. Take a look at page 19 to see how pharmacists are using the Rx for Change (Ask-Advise-Refer) program to help patients stop using tobacco products. It’s amazing what a simple question can do to get the ball rolling toward achieving better health!
Hope you enjoy this issue! If you have any questions or suggestions for future stories, please send me an e-mail at prez@ashp.org or intersections@ashp.org. Looking forward to hearing from you!

Diane Ginsburg, M.S., FASHP

In Support of Collaborative Practice

Henri R. Manasse, Jr., Ph.D., Sc.D.

Henri R. Manasse, Jr., Ph.D., Sc.D.

IN THIS ERA OF HEALTH CARE REFORM, advanced pharmacy practice, and enhanced public focus on medication safety and efficacy, you might think that health care professionals would be on the same page in our approaches to team-based, quality patient care. Unfortunately, in the case of the American Medical Association (AMA), you would be wrong.

The AMA recently released its “Scope of Practice [SOP] Data Series: Pharmacists.” This members-only document seeks to define, describe, and prescribe the scope of pharmacy practice. And it does so using erroneous information, false statements, and pure errors of fact about pharmacists’ education, training, and scopes of practice.

It is a troubling look into the way that the AMA perceives today’s pharmacist—a point of view that is clearly out of the mainstream of contemporary practice. The SOP is devoid of what prominent national boards and regulatory bodies such as the Institute of Medicine, the National Quality Forum, the American Board of Internal Medicine, and many others are saying about the importance of collaborative care.

It is clear from the document that the AMA is concerned about the way that medication therapy management (MTM) and collaborative practice agreements are evolving. Pharmacists in hospitals and health systems and nurse practitioners are moving into areas of practice traditionally handled by physicians. But it is an evolution created by need. Drug misadventures are a reality.

With more than 18,000 FDA-approved chemical entities and dosage forms on the market and a practice model that allows any physician to prescribe any medication at any time, there has never been a more urgent need for medication experts. Pharmacists who practice in hospitals and health systems are those experts.

The current state of practice, including a greater demand for pharmacists’ clinical skills and a growing number of new practitioners seeking pharmacy residencies, further bears out the need for pharmacists’ medication management services in the context of team-based care.

Instead, even though collaborative drug therapy management is currently authorized in 45 states, the AMA has chosen to use their policy document to raise fears in the reader that pharmacists aren’t competent to conduct MTM.

ASHP will not passively stand by and allow this publication to go unanswered. I recently sent a letter to AMA Executive Vice President and Chief Executive Officer Michael D. Maves, M.D., M.B.A., in which I laid out the inaccuracies and untrue representations in the SOP and asked the AMA to retract the document or, at minimum, correct it.

In this new world of patient care, it will take every health profession working together to ensure that patients receive the safest, most effective care. Pharmacists are a critical component of that care delivery model, and ASHP continually stands at the ready to promote the importance of collaborative practice.

April 9, 2010

Health Care Reform and PPMI: Is There a Connection?

Lynnae M. Mahaney, M.B.A., FASHP

AN EPOCH BATTLE surrounding the final passage of health care reform has finally come to an end. Regardless of your political or philosophical leanings, reform is now law and it will affect each and every one of us.

For pharmacists, there are many opportunities contained within this 2,700-page bill, the most sweeping health legislation since the passage of Medicare in 1965. It authorizes the creation of a medication therapy management (MTM) grant program as well as a medical home demonstration program that includes pharmacist-delivered MTM.

It will reduce hospital readmissions and provides medication reconciliation services. It offers grants to create community health teams that will include pharmacists. It establishes a National Healthcare Workforce Commission with pharmacist representation and allows for Food and Drug Administration approval of biosimilars.

There are many other elements in this huge piece of legislation that ASHP’s government affairs team will be analyzing and reporting on in the weeks and months to come. Stay tuned!

At this pivotal time in history, pharmacy needs a real vision for practice. This issue’s cover story focuses on the efforts by ASHP and the ASHP Foundation to lead the charge for the new Pharmacy Practice Model Initiative. Read on page 8 why we are embarking on this national debate about the best practice models for the future. We need your thoughts about pharmacy’s way forward and encourage you to get involved!

As you’ll see on page 12, innovative practice models exist all over the country. At New York University Langone Medical Center, pharmacists are now integrally involved in medical rounding in virtually every area of the hospital. They have  successfully shown administrators how pharmacists’ involvement in medication-use management can reduce errors and improve the bottom line.

Pharmacists also are increasingly involved in advanced clinical activities, such as the team at Thomas Jefferson University Hospital in Philadelphia that oversees anticoagulation therapy for surgery patients. Take a look on page 17 to see how these pharmacists work with an interdisciplinary team to reduce incidents of deep vein thrombosis.

This issue of ASHP InterSections is full of stories about pharmacists who are completely dedicated to our profession and to their patients. We hope you enjoy it! Drop me a line at prez@ashp.org or contact me on the new ASHP Blog and let me know what you think!

Lynnae M. Mahaney, M.B.A., FASHP

January 21, 2010

A Year to Remember

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Lynnae M. Mahaney, M.B.A., FASHP

AS WE GREET THE NEW YEAR, I have to admit that, in some ways, I am glad that 2009 is behind us. It was a year of unprecedented economic challenges. We watched as Congress struggled with the critical issue of health care reform. And many of us who work in emergency departments (EDs) dealt with the ongoing challenge of an H1N1 pandemic. This first issue of 2010 reflects some of these challenges and sheds light on what may be coming around the corner. It also shows how far we have come as a profession and the many ways in which we contribute to quality patient care.

Our cover story, on page 8, is about how health care reform may affect hospital pharmacists, and it is eye-opening and full of hope. ASHP has advocated for many years that pharmacists need to be recognized as health care providers. Although the bill that passed the House in November doesn’t explicitly allow for that designation, it does open the door for pharmacists to demonstrate their medication management expertise as part of innovative care models such as “medical homes.” As the saying goes, although we are just at the “beginning of the beginning,” this is very good news.

As you will see on page 12, pharmacists around the country are approaching the pandemic of H1N1 in new and novel ways, finding opportunities for patient counseling, education, and emergency preparedness. For example, after a change in a New York state law allowed pharmacists to administer influenza and pneumococcal vaccines, the pharmacy department at Montefiore Medical Center in the Bronx stepped up to the plate, initiating a series of immunization training programs. Conducted by faculty members from Touro College of Pharmacy in Harlem, the programs have certified more than 60 pharmacists since the fall.

Quality health care is a team affair, and at the Carolinas Medical Center-NorthEast, in Concord, North Carolina, a team of pharmacists is changing how infectious disease cases are handled in the ED. Take a look on page 17 to see how pharmacists are reducing hospital re-admissions caused by infection.

As you can see here, this issue of ASHP InterSections is full of stories about pharmacists who are making a difference. We hope you enjoy it! Drop me a line at prez@ashp.org or contact me on the new ASHP Connect Blog, and let me know what you think.

Lynnae M. Mahaney, M.B.A., FASHP

A New Day For Pharmacy Practice

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Henri R. Manasse, Jr., Ph.D., Sc.D.

Henri R. Manasse, Jr., Ph.D., Sc.D.

THIS ISSUE’S COVER STORY highlights the ways in which health care reform may impact pharmacists in their day-to-day work. It is truly an exciting time to practice pharmacy. But we must remember that the future of our profession is still unwritten. We still haven’t reconciled our traditional notions of what pharmacists do with the new patient-care-oriented training and capabilities that today’s pharmacy school graduates bring to the table.

I believe that pharmacy will be relegated to an ancillary service in the future if we fail to utilize this talent more actively and more effectively. We need a practice revolution of sorts. We need to have a spirited discussion about what our profession should look like in the future.

There is no better time than now, a time when drug therapy is riskier and more complex than ever, a time when pharmacists are proving the value of having a medication expert involved in therapy decisions, and a time when our hospitals are coming under increased pressure to adopt best practices and quality guidelines.

As it has done so often in its history, ASHP is stepping up, taking on the issue of practice model reform. Together with the ASHP Foundation, we have launched a Pharmacy Practice Model Initiative to begin examining these important questions.

This multi-year initiative has a number of components, including an invitational consensus summit, a robust social marketing campaign, and demonstration projects. The initiative will focus on five areas to shape the future of our profession:

• Fostering the creation of new pharmacy practice models that ensure that all hospital and health-system patients receive safe, effective, efficient, accountable, and evidence-based care

• Highlighting patient-care-related services that should be consistently provided by departments of pharmacy in hospitals and health systems

• Identifying which technologies support this new practice model

• Ensuring that pharmacy resources are deployed as efficiently as possible

• Identifying specific actions that we can all take to bring about practice change

We want the Pharmacy Practice Model Initiative to be an ongoing conversation that happens among all members, and we are encouraging pharmacists to participate through a number of avenues. We have a robust website (www.ashp.org/ppmi) with lots of resources for you to delve into. And there will be wide-ranging discussions on ASHP Connect, our online community. Change will only happen if every pharmacist gets involved. Join us. This is your revolution!

Henri R. Manasse, Jr., Ph.D., Sc.D.

December 18, 2009

The Politics of Healthcare Reform

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Henri R. Manasse, Jr., Ph.D., Sc.D.

Henri R. Manasse, Jr., Ph.D., Sc.D.

NOW THAT THE BRUISING PRESIDENTIAL CAMPAIGN is finally behind us, Americans are wondering how the new realities in Washington, D.C., might affect their daily lives.

Whatever your personal political leanings might be, it’s clear that President Obama’s sweeping healthcare reform proposals are some of the most ambitious in decades.

His plan focuses on access and affordability as well as promoting public health via prevention and chronic disease state management. The latter is especially good news for hospital and health-system pharmacists. That’s because we are uniquely positioned to provide the kind of medication therapy management that would save money and dramatically increase quality.

In this new legislative reality, ASHP has a number of priorities, including adding annual medication therapy review and assessment by a pharmacist to all Medicare Part D plans and including pharmacists as providers under Medicare Part B.

We are also moving forward with legislation drafted late last year to restore Medicare funding for postgraduate year two (PGY2) pharmacy residency programs. As you’ll read in the cover story in this issue of InterSections, ASHP has a long history of supporting and cultivating residency training for pharmacists.

When the Centers for Medicaid & Medicare Services (CMS) cut funding for PGY2 programs in 2004, it was a real blow to pharmacists everywhere who wish to pursue this important specialty training. The new “Medicare Specialized Pharmacy and Health Care Improvement Act” seeks to restore this funding. Sen. Tim Johnson (D.-S.D.) has signed on as the bill’s chief sponsor.

Of course, given the current global economic crisis, we know that securing new Congressional appropriations will be a challenge and that we will be just one of many organizations seeking Congressional support in this move toward universal health care. But we are very excited about the possibilities for patient care and pharmacy’s future. And we are more committed than ever to moving pharmacy’s agenda forward in this new political environment.

Henri R. Manasse, Jr., Ph.D., Sc.D.

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