ASHP InterSections ASHP InterSections

September 28, 2010

Health Care Reform: What’s Next For Pharmacists?

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

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

AS WE GO TO PRESS with the fall 2010 edition of InterSections, nearly 100 ASHP members have just finished an intensive day lobbying congressional representatives and their staff members on issues critical to our profession.

It has been a busy, but important, time for ASHP members and the patients they serve. With the passage of the Patient Protection and Affordable Care Act, as modified by the Health Care and Education Reconciliation Act, Congress showed its support for expanding access to affordable health care, improving quality, and reducing health care costs.

Health care reform offers pharmacists a number of great opportunities to expand patient-care services. It specifically addresses delivery systems reform, payment reform, and quality, comparative effective- ness research, work-force issues, and the 340B Drug Pricing Program.

When you look through the proposed delivery models, almost all of them mention the need to involve pharmacists in solving medication-related issues. That is an exciting change in perception on the national level and one that will help ensure that patients receive better, safer care. ASHP played a vital role for inclusion of pharmacists throughout the legislation.

At ASHP, our efforts to get the legislation passed have now evolved into a focus on working with the federal agencies responsible for developing the regulations to implement the law. We are keeping in close contact with members of Congress to encourage them to sufficiently fund the programs included in the law. We have nominated pharmacists to serve on the newly created Health Care Workforce Commission and other committees. And we are continuing our efforts to expand funding for postgraduate pharmacy residency training.

Although we don’t yet have a clear sense of how the entire process will play out, health-system pharmacists will have many opportunities over the next several years to influence how reform is implemented within their own institutions.

For example, begin a conversation with your institutional leaders and administrators about the importance of improved quality and reduced costs. What is your hospital doing or planning to do to implement reform-related changes, and what can you do to make those changes come to life?

Seek opportunities to include pharmacists in efforts by your organization to create accountable care organizations and “medical homes,” and to meet quality improvement requirements that align payment with quality.

Just as important is staying engaged in the public discourse surrounding health care reform. We all need to be more aware of and get more involved in the regulatory process. Although the new law is a complex document (nearly 2,000 pages with about 400,000 words), it is actually only a skeleton of what is to come. Regulators will flesh out the law, and we need to have a voice in that process to ensure that there are no negative consequences for patient care or for our profession.

Every ASHP member can be a player in this next phase of health care reform by participating in a number of ways:

  • Stay informed about the law’s progress both by connecting to your state affiliate and signing up for ASHP’s Grassroots Network,
  • Join ASHP’s Political Action Committee and help support members of Congress who understand pharmacists’ critical patient-care role,
  • Get to know your federal and state representatives, and invite them to your institution to demonstrate what you do each day to care for patients, and
  • Work within your own spheres of influence to ensure that your hospital or health system involves pharmacists in efforts to improve quality and reduce costs.

Please know that ASHP is behind you every step of the way, as a national advocate for the profession and as a resource for you to advocate for pharmacy within your own hospital or health system. Together, we really do make a great team!

June 1, 2010

Not Your Average Pharmacy Job

Left to right: James A. Jorgenson, M.S., Vernie R. Coleman Daniels, M.S., Laurel Kinosian, FSVHP

PRACTICING PHARMACY IN A HOSPITAL OR HEALTH SYSTEM is a challenging and exciting field with abundant career opportunities. But have you ever wondered what it would be like to pursue a nontraditional career path? Although most ASHP members practice in hospitals and health systems, some clinical pharmacists work in unexpected places.

“There are so many things pharmacists have the skill sets to do,” said Vernie R. Coleman Daniels, M.S., a research pharmacist employed by acontractor who does pharmaceutical research at Johnson Space Center in Houston. “I never would have imagined when I was in pharmacy school that I’d be doing what I’m doing today,” Daniels said, adding that opportunities for pharmacists exist in a broad range of alternative environments.

Out of This World
For Daniels, working with NASA is a path of discovery. “Medications and drug delivery systems work differently in a weightless environment,” she said. “The information in the literature about standard forms and doses may or may not be applicable. The setting is harsh.”

Zero gravity is the most obvious difference between earth and space, Daniels said, but temperature, humidity, radiation, vibration, and storage logistics are also variables that can influence a medication’s performance in space.

“We have to become creative when considering dosage forms and dosage delivery systems, which may not work the same way in the space environment as they do on earth,” Daniels said. “The blessing is that our patient population is healthy, requiring little or no pharmacotherapeutic intervention. However, should the need arise, our job is to ensure that safe and effective medication is available.”

Going for Gold
James A. Jorgenson, M.S., executive director of pharmacy at Clarian Health Methodist Hospital’s Department of Pharmacy, Indianapolis, also had the opportunity to work with patients who, though quite healthy, came with their own set of challenges: He provided pharmacy services on-site at the 2002 Olympics in Salt Lake City. At the time, he was employed at the University of Utah, whose campus served as the Olympic Village. Having played college ice hockey and being a fan of numerous sports, Jorgenson jumped at the opportunity.

From the get-go, Jorgenson and his team had to tap into their own resources of ingenuity. “We thought there would be data from previous Olympics, but there wasn’t,” he said. “We had to design the forms and create the list of banned substances from scratch. “We had to work with about 20 different pharmacopeias in addition to learning which drugs might get an athlete into trouble.”

They also worked with Pfizer Inc. to create a drug information center for the athletes, their families, and visitors from all over the world—a potential patient population of nearly 250,000 people. “Fortunately, the Olympic Committee provided interpreters,” Jorgenson said.

Although no one can be sure when the U.S. will host the Olympics next, there are opportunities to get involved in pharmacy for athletes, Jorgenson said. “There are banned substances in every major sports league, which creates an opportunity for education,” he said. “In fact, I don’t know of any league that has a good education program, so that’s something to explore.”

All Creatures Great and Small
Interpreters may have helped Jorgenson at the Olympics, but they wouldn’t be of much assistance to Laurel Kinosian, FSVHP. As a clinical instructor of pharmacy with the University of Wisconsin-Madison School of Veterinary Medicine and president of the Society of Veterinary Hospital Pharmacists, Kinosian works with patients that bark, yip, growl, meow, squawk, hiss, or simply look at her.

Veterinary pharmacists have many of the same clinical and administrative responsibilities as their counterparts in hospital pharmacy. Compounded medications must comply with requirements of state and provincial boards of pharmacy, federal regulations, and legislative statutes, much like those created for human patients.

However, animals present a plethora of unique challenges. For one thing, many veterinarians prescribe human medications for use in animals. Because of this cross-species use, veterinary pharmacists must be research-oriented and curious, said Kinosian.

“How do I get this drug into this animal? Is there any dosing information? Is there anything in the literature about this drug in this species?” she said. “You can’t make assumptions from one species to another, and the answers aren’t necessarily written in a book somewhere.”

To that end, veterinary pharmacists often turn to one another. “Veterinary pharmacy is a smaller world than human pharmacy,” Kinosian said. “That’s one of the best parts about it for me. We all get to know each other, and everyone helps.”

Getting Started
If you are interested in exploring all the options available for pharmacists who practice within hospitals and health systems, take a look at ASHP’s CareerPharm website or the information and resources on ASHP’s website.

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