ASHP InterSections ASHP InterSections

May 6, 2021

Pharmacy Teams Lead Telehealth Expansion Efforts

Caroline Pitney, Pharm.D, BCACP

WHEN THE COVID-19 PANDEMIC erupted last March, clinicians with the University of Washington (UW Medicine), the Seattle Cancer Care Alliance and their four medical centers, and many other health systems across the country quickly amped up their provision of telehealth services to continue meeting patient needs. Pharmacists were key players in this activity, said ASHP member Caroline Pitney, Pharm.D., BCACP, a clinical pharmacist with UW Harborview Medical Center.

Telehealth Growth

Prior to the pandemic, federal regulations had limited the scope of telehealth pharmacist services, leaving it mainly for patients in rural areas far from clinics or who had limited access to healthcare. However, the Coronavirus Preparedness and Response Supplemental Appropriations Act enacted on March 6, 2020, loosened restrictions on telehealth services. Then, on March 17, 2020, CMS announced its telehealth waiver had been expanded to cover diagnosis and treatment of COVID-19 and other conditions.

With UW pharmacists already embedded in ambulatory care settings as providers seeing their own patients with various disease states, it only made sense for them to jump on the telehealth bandwagon as well, Dr. Pitney said. The organization credentialed 69 pharmacists to offer comprehensive medication management via telehealth to patients in their primary care and specialty clinics. Pharmacists and other clinicians then completed learning modules on obtaining informed consent, videoconferencing etiquette, documentation, billing, adverse event reporting, and risk management. The health system selected Zoom as its secure telehealth platform, integrating it within the electronic medical record system.

Typically, at Dr. Pitney’s medical specialties clinic, doctors refer patients to pharmacists to help initiate new therapies or monitor ongoing treatment and chronic diseases. Dr. Pitney and her colleagues offered telehealth, along with in-person or telephone visits, to their patients as soon as it was available.

One benefit to video has been in face-to-face demonstrations of proper use of injectable medications, Dr. Pitney said. “It’s really challenging to try to do that over the telephone,” she said. “Before the pandemic, we would always recommend the person come in for an in-person teaching visit.”

Overall, she said, telehealth has provided a modality for pharmacists to see patients and their medications. We can ascertain patients’ ability to administer and take those medications. “Having this option in the future will only allow us to reach more patients. Not just for pharmacists but for all providers, it’s a step in the right direction,” Dr. Pitney added.   

Technology Bridges Barriers

Some health systems using telehealth found themselves upgrading technology as time went on. In the very early stages of the pandemic, pharmacists with Tampa General Hospital in Florida first moved some patients’ in-person visits to telephone calls, later shifting everyone to telehealth during April, May, and June while pharmacists worked from home, said ASHP member Jessica Bianco, Pharm.D., C.Ph., BCACP, CACP, a pharmacotherapy specialist in ambulatory care for the medical center. Their patient caseload includes people with diabetes and other chronic diseases, in addition to those taking anticoagulant medications.

By summer 2020, the hospital adopted a new platform with better video quality and the option to use translation services, Dr. Bianco said. Through a collaborative practice agreement there, pharmacists change or start medications and adjust doses between physician visits.

“Interestingly, I think some patients like it more,” Dr. Bianco said of telehealth. “It’s really bridged the barriers that there are for patients being able to make it to the clinic, such as transportation or parking issues.”

Streamlining Care     

Baptist Health South Florida, in the Miami area, sees many patients in their 70s, 80s, and 90s, so when the pandemic hit, clinicians and pharmacists were worried about putting them at risk. Fortunately, many patients were tech-savvy, or had family to support their adoption of telehealth, said ASHP member Jennifer Miles, Pharm.D., C.Ph., BCACP, BCMTMS, a clinical coordinator in ambulatory pharmacy there.

Jennifer Miles, Pharm.D., C.Ph., BCACP, BCMTMS

“Our patients were really happy there were minimal interruptions in their care because a lot of folks were really worried about offices shutting down and concerned with their safety and being able to get care,” Dr. Miles said. “We didn’t want to delay that.”

Dr. Miles and her colleague Faaria Quadri, Pharm.D., BCPS, work with the health system’s lipid clinic and congestive heart failure clinic. In their model, pharmacists see patients in tandem with advanced practice providers such as physician assistants or advanced practice registered nurses. Under telehealth, the provider sees a patient over telehealth for the medical portion of the visit and explains a pharmacist will call them next to go over medications and how they work, explain any potential drug interactions, help establish medication schedules, and talk about covering the medications, Dr. Miles explained.

Pharmacists also follow up with patients on a regular basis if they don’t have clinic visits scheduled to ensure they are adherent to medications. The heart failure clinic even provided bathroom scales to patients so they could continue to record their weights and blood pressures at home, Dr. Quadri noted.         

“Some patients, despite their age and risks, adamantly want to be seen in a clinic because they like that comfort of knowing they’re checked out physically,” Dr. Quadri said. “But another set is so nervous to come in, and so grateful for the opportunity to have a telemedicine visit.”

Overcoming Challenges        

Even as clinics nationwide have slowly resumed seeing patients in person, many have continued their telehealth appointments. About a third of patients at UW are still seen that way, Dr. Pitney said. At Tampa General, it’s more than half, said Dr. Bianco.

Jessica Bianco, Pharm.D., C.Ph., BCACP, CACP

There are some limitations to telehealth that clinicians still need to work through, Dr. Pitney cautioned. Not every patient has access to a computer or secure video device. Some patients, depending on their disease states, still need periodic, in-person physical exams. And while pharmacists are considered providers in Washington and many other states, CMS currently does not reimburse for pharmacist visits, whether telehealth or in-person.

Pharmacists should look at telehealth as an opportunity to highlight their clinical skills and knowledge to the general population, Dr. Quadri said.

“It’s a great opportunity to show what we’re capable of,” she said. “In the past, I think patients did not see our contributions to their medication regimens because we were making those to the providers and patients would assume it was from them. Now, they see firsthand that pharmacists can do this.”

The pharmacists offered the following tips for optimizing telehealth:

  • Know your audience. Telehealth should not be a one-size-fits-all option, Dr. Bianco said. Some patients are not comfortable with video and prefer a phone call, while others will appreciate telehealth for more of a face-to-face visit. Be aware that some patients may not have access to a computer or a secure location to do a telehealth visit, added Dr. Pitney. In those cases, a telephone visit is a good alternative to an in-person one.
  • Shed your fears. There has been some trepidation among pharmacists that this will be a big change and patients won’t like it, Dr. Miles said. Find a secure platform to continue your visits and set up infrastructure for training.

“We live in a society where our patients really want this to close the gap on the care they need, and limitations they have with their busy lives and now a pandemic keeping us all separate,” she said. “We can find creative ways to still be connected to one another…I don’t think anything will ever fully replace that human touch and being there face-to-face in the examination room with our patients, but it helps provide our presence in a way that is still supportive.”

Telehealth pharmacy practice is one of five areas of focus in ASHP’s Innovation Center. For more information, visit ASHP’s Telehealth Resource Center or listen to ASHP’s telehealth management pearls webinar. Be on the lookout for a special telehealth theme issue of AJHP later this year and a report summarizing the outcomes from the ASHP Pharmacy Executive Leadership Alliance’s virtual conference on Telehealth Innovations.

By Karen Blum

March 17, 2021

Upcoming ASHP Events Focus on Innovation in Pharmacy Practice

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

Dear Colleagues,

This past year was like no other. The challenges that our country has and continues to face are unprecedented. Yet, the relentless dedication and commitment I have seen from pharmacy professionals during the pandemic are valiant and inspirational.

As we step forward into 2021, ASHP remains committed to supporting the incredible work that our members are doing on the front lines of the COVID-19 pandemic. We are also working hard to provide the latest innovative approaches, tools, and resources to support patients across the full spectrum of medication use. I want to share some important new initiatives that ASHP created to help move pharmacy practice forward.

ASHP is pleased to announce the upcoming ASHP Specialty Pharmacy State of Practice in Hospitals and Health Systems – Future Directions Summit. The summit, scheduled for Feb. 1-4, will bring together more than 100 hospital and health-system pharmacy professionals, nurses, payers, and others to develop recommendations that advance patient outcomes through specialty pharmacy designated medications. The invitation-only event will include Q&As with speakers, virtual breakout groups, and much discussion and debate. It will address measures involved in diagnosis, medication management, payment, and reimbursement, as well as the impact on affordability, accessibility, and outcomes related to specialty pharmacy. Outcomes and recommendations from the summit will be published in a future issue of AJHP and support the development of upcoming ASHP educational content and tools.

Another critical undertaking, under the umbrella of our ASHP Innovation Center, is our new partnership with the American Medical Association to create a series of six Pharmacogenomics Virtual Summits focused on exploring the potential of pharmacogenomics-based selection, dosing, and monitoring of medications to improve health outcomes. The first summit, which takes place on Feb. 9, explores the pharmacogenomics landscape. Leading experts from pharmacy and medicine will introduce pharmacogenomics and the value it can bring to patient care, examine its benefits, and discuss the economic and health equity aspects of pharmacogenomics. Registration for the Pharmacogenomics Virtual Summit Series is currently open. The summits will run through March 18 with topics that include the current state of pharmacogenomics, the integration and implementation of pharmacogenomics into practice, clinical guidelines, and adoption drivers. I encourage you to register for this innovative and informative series to learn how pharmacogenomics can bring value to your practice.

I also wanted to remind our members that the application deadline is quickly approaching for a competitive grant program from the ASHP Foundation in collaboration with the ASHP Innovation Center to support projects that demonstrate the impact that health information technology and digital transformation can have on safe and effective medication use. Applications, due on Feb. 4, are open to interprofessional healthcare teams with a pharmacist as the principal investigator. Be sure to also check out our new ASHP Innovation Center infographic to learn more about the center’s mission, goals, and resources.

Additionally, the first episode of “Season 2” of our ASHP Leadership podcast will be published on Feb. 1. February is Black History Month, and in this episode, I discuss the preliminary recommendations from the ASHP Task Force on Racial Diversity, Equity, and Inclusion with ASHP President Tom Johnson and Paul Walker, chair of the task force. We talk about the inclusive process used to develop the draft recommendations by incorporating feedback from members and how the recommendations will continue to advance ASHP’s strong commitment to addressing the range of current and historical issues facing Black, Indigenous, and People of Color in ASHP’s membership and the profession of pharmacy. The preliminary recommendations will be presented to the ASHP Board soon, and we will post the final recommendations on ashp.org once they are approved. I hope you join us for this important discussion on our ASHP Official Podcast.

I’d be remiss if I didn’t mention ASHP’s latest innovative COVID-19 resources and tools. Earlier this month, ASHP released a new resource guide on the security, cold-chain storage, and handling of COVID-19 vaccines currently authorized by the Food and Drug Administration (FDA). The guide offers current information and guidance from the FDA emergency use authorization letters and Healthcare Provider Fact Sheets from Pfizer-BioNTech and Moderna COVID-19 vaccines, and general best practices from other reputable sources. I encourage you to review this important tool, which will be updated regularly.

Other valuable resources from our dedicated COVID-19 vaccine webpage and COVID-19 Resource Center include ASHP’s Assessment of Evidence for COVID-19 Related TreatmentsASHP COVID-19 Vaccine Candidate Tracking Table, and the COVID-19 Vaccine Assessment Tool.

Finally, I invite you to join our COVID-19: Immunizing Efforts From Three States webinar on Feb. 10, when Brian Bothwell, director of pharmacy at San Juan Health in Monticello, Utah, Mohammad (Mo) Kharbat, vice president of pharmacy services and health research at SSM Health – Wisconsin Region, and Sarah Stephens, system medication safety officer at the HonorHealth Corporate Office in Scottsdale, Arizona, share their experiences with vaccine delivery, patient education, administration, and follow up.

ASHP remains committed to supporting you in every way we can during this pandemic, and through all you do in support of advancing healthcare. Thank you for being a member of ASHP and for everything that you do for your patients and our profession.

Sincerely,

Paul

November 30, 2020

ASHP’s Midyear Clinical Meeting is Unstoppable

Dear Colleagues,

The 55th Annual Midyear Clinical Meeting and Exhibition is about to kick off! We have a wonderful week ahead packed with world-class educational programming, exciting speakers, and opportunities to connect with colleagues and enrich your practice. This year’s theme is “Unstoppable,” and more than 23,000 attendees will have the opportunity to come together, Dec. 6 –10, on our virtual platform to knowledge share, network, and experience the largest gathering of pharmacists in the world in a new and unique way. Registration will remain open through Dec. 10, so there is still time to register and take advantage of everything the meeting has to offer.

We are delighted to welcome our keynote speaker, award-winning actor, producer, director, and COVID-19 survivor, Tom Hanks, on the morning of Monday, Dec. 7. We are also very pleased to welcome Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, joining us on Wednesday, Dec. 9. Please note that these special events will only be available for viewing during the scheduled session days and times. You don’t want to miss these extraordinary speakers.

The 2020 Midyear also features:

  • More than 175 hours of continuing education
  • More than 4,600 posters
  • 1,328 booths in the Residency Showcase (29% increase over 2019)
  • 132 exhibitors/booths

The Midyear Clinical Meeting is the longest, continually running clinical pharmacy meeting in the world. This year, against the backdrop of a global pandemic, ASHP promises to bring you an unstoppable Midyear, offering the most timely and relevant content to support contemporary practice and the best possible patient care.

Our 55th meeting brings together our profession’s best and brightest subject matter experts who will share their knowledge about current pharmacy practice in an ever-changing healthcare landscape.

The distribution and administration of the anticipated COVID-19 vaccines are top of mind and on Monday, Dec. 7, ASHP will hold the first of two late-breaking COVID-19 vaccine sessions. Monday’s session will focus on clinical considerations. A second session will be held on Wednesday, with a focus on operational considerations. In addition to the late-breaking vaccine sessions, we have 18 relevant and informative sessions that will keep you up-to-date on the latest developments related to COVID-19 response and recovery.

Monday will also feature a special Town Hall hosted by Paul C. Walker, Pharm.D., FASHP, chair of the ASHP Task Force on Racial Diversity, Equity, and Inclusion. Dr. Walker will present the Task Force’s draft recommendations for new and enhanced efforts ASHP should take to address issues of racial diversity, equity, and inclusion impacting Black, Indigenous and People of Color. The Task Force will consider feedback from the Town Hall and other channels in preparing a final report and recommendations to submit to the ASHP Board of Directors in January 2021.

This year’s Midyear marks the first anniversary of the ASHP Innovation Center. The center seeks to elevate the vital role hospital and health-system pharmacy practitioners play in new and emerging science, and position pharmacy practitioners as influencers in developing systems that advance patient safety and quality care. This year’s Midyear offers a wealth of programming dedicated to implementing and using innovative strategies and solutions to further pharmacy practice, including two critical on-demand sessions: Innovations in Drug Information Practice and Research; and Advanced and Innovative Roles in the Specialty Pharmacy Setting. Later in the week, on Thursday, Dec. 10, we have a session highlighting the pros and cons of new technologies that have improved patient care safety and efficiency.

As part of the ASHP Innovation Center, the ASHP Foundation is currently accepting applications for a competitive grant program to support projects that demonstrate the impact of optimizing health information technology and digital transformation that enhance safe and effective use of medications. The grant program is available for interprofessional healthcare teams with a pharmacist as principal investigator. The deadline for applications is Feb. 4, 2021.

I encourage attendees to check out the ASHP Midyear Virtual Posters. With our virtual platform, you can review poster PDFs and audio clips summarizing each project. Authors will be available for real-time video Q & A chats alongside their virtual posters.

These are just a handful of the highlights from the largest gathering of pharmacists in the world. Be sure to follow us on social media @ASHPOfficial and #ASHP2020 on Twitter, Facebook, Instagram, and LinkedIn, and look for News & Views, the official Midyear newspaper, which will be delivered digitally to all attendees via a daily e-mail. Also, be sure to check out ashptv.com for daily interviews, member stories, and content.

The success of this unstoppable Midyear Clinical Meeting is due to the tremendous work of hundreds of ASHP members and staff, and we are pleased to showcase their efforts and share this event with you.

Finally, I would like to wish all of our members a safe and healthy holiday season. Thank you for being a member of ASHP and for all you do for your patients and our profession during these very challenging times.

Sincerely,

Paul

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