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Building Bridges to Pharmacy’s Future: Optimizing Patient Outcomes

Jun 09, 2015
John A. Armitstead, M.S., R.Ph., FASHP

John A. Armitstead, M.S., R.Ph., FASHP

Editor’s Note: The following inaugural address was given by new ASHP President John A. Armitstead, M.S., R.Ph., FASHP, at ASHP’s Summer Meetings in Denver, June 9, 2015. Armitstead is System Director of Pharmacy, Lee Memorial Health System, Fort Myers and Cape Coral, Fla. The address will also be published in the August 15th edition of AJHP.


Good morning!

To say it is an honor to serve as your president is an understatement. I am so grateful for this opportunity to serve our patients, our profession, and our society.

Ever since my introduction to ASHP during my college years at Ohio Northern and my ongoing training at Ohio State, I have been intrigued and invigorated by this great professional society. Its influence on my career has been remarkable. ASHP has opened my heart and my mind to opportunity and action. The examples set by many of our profession’s finest leaders have created pathways and bridges to grow professionally and realize dreams.

I have many individuals to thank, starting with my wife, life partner and best friend—also a pharmacist—Ima Darling Armitstead. Thank you for your love, support, and guidance. You have given me infinite refills on our prescription for life.

I want to thank my children Jaclyn and Jonathan; my parents, Austin and Bianca; my sister Nancy, brother Alan, and my parents-in-love, Frank and Pat. My inner circle of love also includes Armitsteads, Haydens, and, of course, the Darling sisters. The support of my family, from birth and through marriage, from student to practitioner and leader, has been a bedrock of joy for me.

As I was considering what I wanted to speak about today, I discovered an insightful poem called “The Bridge Builder.” In it, an elderly man crosses a lazy stream and then turns around to construct a bridge to provide others with safe passage. When the man is asked why he built a bridge when he had already safely crossed the wide chasm, this is what he said:


The builder lifted his old gray head;
“Good friend, in the path I have come.”
He said, “There followeth after me today
A youth whose feet must pass this way.
That chasm that has been naught for me
To that fair-haired youth may a pitfall be.
He, too, must cross in the twilight dim;
Good friend, I am building the bridge for him.”

As I reflect on the profession of pharmacy, and specifically pharmacy in health systems, I am thankful for the past leaders—bridge builders for all of us—who have created a vision, sought consensus, and made the act of patient care delivered by pharmacists what it is today.

These leaders have advanced our profession and patient care by publishing, presenting, and developing practice guidelines and policies. They have advocated for pharmacy and for patients. They have precepted, networked, and mentored the next generation. They have built the bridges that we easily cross today.

In my career of 35 years, many bridge builders have paved the way for me. I especially want to thank Ivey, Latiolais, Sherrin, Parker, Hunt, Schneider, Silvester, Colgan, Manasse, Abramowitz, Zellmer, Eckel, Rough, Smith, Jolowsky, Hynniman, Theilke, Ashby, Lazarus, White, Godwin, Anderson, Zilz; and my Florida colleagues and dear friends, McAllister and Rapp.

Thanks also to my colleagues throughout the years at some of the nation’s finest healthcare institutions, including the U.S. Public Health Service, Riverside Methodist Hospitals, Ohio State University Hospitals, University of Cincinnati Hospital, University of Kentucky Healthcare, and my present team at Lee Memorial Health System.

These institutions and their staff have allowed me to apprentice and engineer improved patient care outcomes.

Bridges for Our Patients

Verrazano -1

The Verrazano-Narrows Bridge under construction, c. 1960. Image courtesy of Barton Silverman/The New York Times

When I was a child living in New York City, I watched the building of the Verrazano Narrows Bridge connecting Staten Island to Brooklyn. Before the bridge was built, you could only cross the choppy waters of the Hudson River by ferry. There was a gap called “The Narrows”; the gateway to New York Harbor, a chasm of two miles created 18,000 years ago at the end of the ice age. When the Verrazano was completed in 1964, it connected these lands to development, commerce, expansion and growth. The chasm was bridged.

Today, I want to talk to you about the importance of bridging the gaps in continuity of care… in our relationships with patients and peers… and in the work that ASHP is doing every day to further our professional aspirations and goals.

We have come so far on the road to improved patient outcomes and enhanced opportunities for pharmacists as key members of the healthcare team. We must continue to build bridges for patients in transitions of care and in ambulatory care. We must forge ahead and continue to redefine our profession, strengthen our workforce, and nurture and maintain our relationships and connections.

Great examples abound of how pharmacists are moving into direct patient care in ambulatory settings. At Avera Behavioral Health Center in Sioux Falls, S.D., pharmacists have transitioned to clinical services and patient-specific care by focusing on medication reconciliation, patient education, targeted medication therapy protocols and managing drug-induced adverse effects in their mental health patients.

At Palomar Health in Escondido, Ca., pharmacists are working throughout the continuum of care by developing an effective transitions-of-care program that emphasizes medication safety and individual patient outcomes. They accomplish this through a community-based transitions program.

Effective transitions from hospital to home or from a community setting into the hospital are key areas in which pharmacists can make a difference. Pharmacists can bring value in both guarding against newly emerging medication-related problems and the potential for an escalation of adverse conditions as patients transition to home settings.

Care transitions with a focus on medication management are essential to improve health outcomes. The distinct medication expert on the multidisciplinary team is the pharmacist. In concert with physicians, nurses, and others who contribute to the overall care of patients, pharmacists can develop care plans that translate into reduced readmissions and improved outcomes.

Results of ASHP’s recent National Survey show that practice is evolving and that pharmacists are becoming more and more involved in transitions of care.

Although this progress has been good, pharmacists must do better, and we must do it much quicker. Incremental change will no longer suffice.

Over 60 percent of responding health systems task pharmacists or pharmacy technicians with taking medication histories at admission. And over 60 percent have pharmacists conduct discharge medication counseling, and discharge planning.

Although this progress has been good, pharmacists must do better and we must do it much quicker. Incremental change will no longer suffice.

We need to take responsibility for our patient’s medication education and their ongoing care. We must begin to care about the whole life of the patient rather than just the episodic care we provide at different points in the care process. It is time to accelerate our incremental efforts into monumental success for our patients.

We must ensure continuity of care during patient transitions between care settings, and we must manage care effectively.

We must be the key provider following up on drug-related problems, and we must effectively conduct medication education to promote patient self-care.

Let me give you a personal example of what I’m talking about. Recently, I had a patient who had gone home after surgery and was prescribed an analgesic. Because my contact information is included on the discharge patient education information, the patient called me.

His question? Not something related to pain control or medication interactions. He wanted to know why he was hadn’t had a bowel movement in over three days. Now, that may seem like a low-level concern for a pharmacist with years of clinical experience and training. But, for this patient, constipation was the driving concern. His issue was resolved after daily consultation with his pharmacist… three, four, and five days post discharge.

If you’re sitting there wondering if something this mundane is important to the whole life of your patient, I’m here to say emphatically, “yes.” We have to be ready to manage everything related to our patients’ medication regimens beyond their hospitalization.

Bridges to Ambulatory Care and Primary Care

As you can see, bridges are not simply a metaphor to me. They are connections that link one place to another. They stand as a testament to our ingenuity. This pharmacist-to-be was born and raised in New York City, and there certainly is no more iconic bridge than the Brooklyn Bridge. Completed in 1883, it was truly a magnificent feat of engineering, a wonder of the world. It stands strong today.

Brooklyn bridge-1

The Brooklyn Bridge under construction, circa 1880. Picture courtesy of Wikipedia.

Pharmacy practice is synonymous with bridge building. Today, we have new opportunities to step into ambulatory and primary care settings, working on healthcare teams in accountable care organizations, physician’s offices, hospital outpatient clinics & pharmacies, patient-centered medical homes, and community healthcare centers.

Indeed, one of the most exciting recent developments has been the increasing number of pharmacists who are becoming part of patients’ medical homes. Patients are welcoming us into that space because of our critical role in medication therapy management to optimize outcomes.

As electronic medical records continue to advance, they will eventually become patient-owned and held. Once that happens, I believe patients will see clearly what an essential role we play, and patients will have their own pharmacists.

It is truly an exciting time! We can find examples everywhere of how far pharmacist care has come.

Pharmacists at Kimbrough Ambulatory Care System in Fort Meade, Md., are providing primary care services to military veterans. Pharmacists manage patients’ lipids and anticoagulation, and assist with post-deployment care of soldiers. Kimbrough pharmacists are building bridges of care for our military heroes and their families.

At the Diabetes Medical Management Clinic in the VA San Diego, the clinic is run by pharmacists and provides integrated care that covers not only diabetes, but hypertension, lipids, food choices, activity, adherence, and motivation as well.

Pharmacists at the VA San Diego are helping patients improve their personal goals. These pharmacists are bridging the care gaps and changing lives as a result.

In both the ambulatory and primary care space, we are accomplishing great things. But we need to continue to push for progress in this area…

In both the ambulatory and primary care space, we are accomplishing great things. But we need to continue to push for progress in this area, particularly on the issue of provider status for pharmacists. We all must get behind ASHP’s assertive advocacy in Congress and reach out to our own senators and representatives to make sure they know that pharmacists can improve patient care.

We must achieve provider status recognition for pharmacists’ critical role in ambulatory care, primary care, immunizations, and medication therapy management.

And we must create the kinds of sustainable business models that ensure pharmacists are compensated for their expertise and training.

Bridges to Interdisciplinary Care

We are now carving out our essential roles in patients’ lives as well as our place in patient-centered medical homes. But we need to build more bridges to interdisciplinary care. Team-based care will require patients to actively participate in their own health and wellness through disease prevention, treatment, and monitoring to ensure the best outcomes.

Ladies and gentlemen, you can’t build a bridge without architects, engineers, builders, and inspectors. Likewise, patient care cannot be effectively rendered without physicians, nurses, pharmacists, care management, the entire allied health team.

Consider the work of the healthcare team at the Mountain Area Health Education Center in Asheville, N.C. Pharmacists there manage specialty clinics in anticoagulation, osteoporosis, and care transitions. Multidisciplinary teams collaborate, and pharmacists expertly manage drug selection, titration, and monitoring. Interdisciplinary care and optimal patient outcomes are the drivers for everything this team does.

Bridges Within Our Profession

This example raises the obvious question. How can we inspire our future leaders to provide this kind of care? How can we energize accomplished clinicians with new insights? And what must we do to equip our successors so that they can become leaders, coaches, teachers, motivators, and strategists?

We must clear out any barriers that block both their individual growth and our progress as a profession. Every pharmacist must be prepared to lead.

It is clear to me that simply relying on a pharmacy education that is years behind us and only investing in modest continuing education efforts will not be enough to help us become optimal patient care providers.

Pharmacists must begin to care for the whole life of the patient.

Pharmacists must begin to care for the whole life of the patient.

As a strong supporter of Continuous Professional Development—or CPD—for all members of our workforce, pharmacists and pharmacy technicians, I believe each individual must play an engineer’s role in the construction of new bridges to our future.

CPD is the means by which people maintain, develop, and advance their professional skills and knowledge. It is a structured approach to learning that helps ensure advancement of competencies to practice, taking in new knowledge, skills, and practical experience. CPD is a way to practice at the top of your license.

At my institution, I ask that every pharmacist and pharmacy technician develop his or her own Continuous Professional Development Plan. Individuals are encouraged to stretch beyond their reach to develop skills for future practice.

This includes innovations related to practice advancements, lean transformation activities, practice-related competencies, specialty certifications, preceptor development, and teaching certificates. These activities are designed to enhance the training, competency, and performance of every pharmacist and technician.

As a guide for your individual CPD plan, I am reminded of a quote by Arthur Ashe: “Start where you are. Use what you have. Do what you can.”

Lee Memorial’s support and encouragement of CPD plans is helping to enhance pharmacists’ and pharmacy technicians’ contributions to patient care, and it is propelling our profession forward.

Bridges We Must Build

The message I want to leave you with today is that it is time for all of us to build bridges to the future… connections that will allow us to take on new roles that will benefit our patients.

It is time for full utilization of pharmacist skills as THE medication therapy expert.

It is time to create seamless delivery of care to our patients.

Pharmacists and pharmacy technicians are poised to optimize patient outcomes through inter-disciplinary medication management. As you attend the rest of the Summer Meetings then head back to your practice sites, I hope you’ll keep the following in mind as we all work to advance the care of patients:

1) We must improve continuity of care for every patient through advancing pharmacists’ role in ambulatory and primary care.

2) We must become team based, collaborative care leaders.

3) We must achieve provider status for pharmacists.

4) We must individually dedicate ourselves to robust continuing professional development.

If you were to ask me to pick the most important of these four, it would be CPD. That’s because continuing professional development will help us to maintain practice excellence, will enhance the chances for achieving provider status, and will elevate pharmacists’ role as patient care providers.

In closing, I will paraphrase a portion of the poem “The Bridge Builder” that I mentioned at the start of today’s remarks:

“To our patients may a pitfall be.
They, too, must cross in the twilight dim;
Good friend, pharmacists are building the bridge for them.”

Let’s build those bridges!

Thank you!


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