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September 28, 2021

Pharmacogenomics: Trailblazers Welcome

Amanda Elchynski, Pharm.D.

AMANDA ELCHYNSKI, PHARM.D., HAD AN ‘AH-HA’ MOMENT in her third year of pharmacy school. During her studies, she worked as a community pharmacy intern, counseling patients, and performing all of the other duties of a pharmacist. Like many other pharmacists and health care providers, she also became frustrated seeing patients respond inconsistently to their medications.

A New Career Direction

“During that same year, I took a course on pharmacogenomics, and it really opened my eyes as to why the patients I was seeing were having these variable responses,” said Dr. Elchynski, who at the time, was a clinical pharmacogenetics fellow at the Center for Pharmacogenomics and Precision Medicine, Department of Pharmacotherapy and Translational Research at the University of Florida (UF) College of Pharmacy. She pointed to research showing that genes may account for up to 95% of the variability in response to medications and that a growing number of gene-drug pairs can help guide prescribing to optimize treatment efficacy and safety.

After realizing the value of pharmacogenomics in patient care, Dr. Elchynski completed a rotation in pharmacogenomics in the outpatient setting, where she reviewed results directly with patients and found that many patients were relieved to understand why their medication wasn’t working or was causing side effects.

“Finding out the results also made patients more amenable to changing medications,” noted Dr. Elchynski, who is now a Pharmacogenomics Coordinator at Arkansas Children’s Hospital. “I want to deliver this up-and-coming care approach and also help expand it from being available only to select groups and locations to being widely used as a standard of care,” she said.

While pharmacogenomics is an exciting and cutting-edge field, one of Dr. Elchynski’s preceptors said that, partly because they have limited exposure to the topic during their studies, only a small subset of students wants to enter a career in the field.

Educational Programs in Pharmacogenomics

Emily Cicali, Pharm.D

“It’s hard to think about pursuing something as a career path if you only hear about it for two or three hours in your entire pharmacy curriculum,” said Emily Cicali, Pharm.D., clinical assistant professor in the department of pharmacotherapy and translational research at UF College of Pharmacy.

She said pharmacogenomics is spread throughout the didactic pharmacy curriculum at UF because “it is a concept that transcends any specific disease state.” UF pharmacy students learn about the topic through core courses as well as elective opportunities, like a clinical application course, a summer intensive research program for students in the Pharm.D. program, a fourth-year pharmacogenomics elective advanced practice rotation, and pharmacogenomics residencies and fellowships, she said. The residency/fellowship offers pharmacists the opportunity “to live and breathe everything pharmacogenomics,” Dr. Cicali explained.

“Once residents gain baseline knowledge of the topic, they start writing consult notes, either in the form of recommendations for clinical interventions or as part of a clinical trial,” she explained. “And every resident does a deep dive into one gene-drug pair and creates a best practice alert for providers in the electronic health record, and they participate in a research project that’s pharmacogenomics related.”

Pharmacists considering a career in pharmacogenomics can look forward to employing both clinical and research skills, Dr. Cicali enthused. “It’s an evolving field, so you can combine skillsets in really interesting ways, like collecting metrics for clinical practice in order to show growth and sustainability of the program,” she said. “Every day is different, which is one of my favorite things about this work.”

Encouraging Patient-Learners

To help pique his own students’ interest in the field, ASHP Fellow George E. MacKinnon III, R.Ph., Ph.D., M.S., Founding Dean of the School of Pharmacy and professor in the genomic sciences and precision medicine center at the Medical College of Wisconsin, Milwaukee, and his colleagues have created a first-year pharmacy class on pharmacogenomics that turns students into “patient-learners.”

Julie Johnson, Pharm.D.

In addition to presenting the course material through conventional pedagogical approaches, students submit their own saliva for pharmacogenomics testing if they are willing to do so. They then discuss the results with their peers, focusing on the relevance of the results to their or their families’ medication histories, Dr. MacKinnon explained.

“Getting some perspective as to what this testing really means gets students very excited about the topic,” he said. “The reality is that 97% of us have a clinically significant gene variant that could result in sub-optimal therapy or side effects, and these could be mitigated if we guide treatment with pharmacogenomics.”

MacKinnon is confident the field will attract an increasing number of students and pharmacists, given the growing importance he expects it to play in clinical practice.

“I think it will become our bread and butter and no different than what we started doing 30 years ago in the hospital setting, when pharmacists began pharmacokinetic monitoring in our patients receiving anti-infectives, theophylline, and other agents that were managed for optimal outcomes and reduced toxicities,” said Dr. MacKinnon.

Opportunities and Professional Growth

Trained graduates with expertise in pharmacogenomics can expect a growing number of job opportunities, agreed long-time ASHP member Julie Johnson, Pharm.D., Dean and Distinguished Professor of the UF College of Pharmacy said.

“The number of health systems hiring people with this expertise in the field is rapidly expanding,” she said, noting that UF has 16 faculty members focused on the clinical and research aspects of pharmacogenomics.

“I see a lot of demand moving forward, but if pharmacists are not there to lead pharmacogenomics at an institution, [administrative] leaders will turn to nurses or physicians or genetic counselors to do so,” she noted. “For people who are creative, innovative, and entrepreneurial, I think there are a ton of ways to be a trailblazer, like implementing pharmacogenomics in the healthcare setting, being a leader in research or working in the private sector to develop tools to help advance the field.”

 

By David Wild

 

 

August 31, 2018

Pharmacy Technician Untangles Knots in the Supply Chain

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.

 

AS A PHARMACY TECHNICIAN WHO WORKS AS A  SUPPLY CHAIN CONSULTANT for McKesson Pharmacy Optimization, Cindy Jeter, CPh.T., solves problems. She uses 20 years of pharmacy expertise, her Lean Six Sigma training, and specialized interviewing techniques to help hospital pharmacies across the country optimize workflow, reduce drug expense, and maintain optimal medication inventory levels.

 

Cindy Jeter, CPh.T.

Super Sleuth

On one assignment, Jeter was asked to use her supply chain knowledge to solve a mystery at a large teaching hospital in Texas. More than half of the IV bags prepared in the hospital’s pharmacy were being sent back to the pharmacy at the end of the day. “This meant that roughly 400 bags of IV solution were unused, resulting in thousands of dollars’ worth of medication being thrown in the trash every day,” explained Jeter. “In addition, pharmacy technicians spent four to five hours every day updating the computer system to make sure patients weren’t being charged for unused IV medication.”

After conducting an in-depth analysis, she identified one major cause, observing that when patients were moved to a different area of the hospital, their IV medications weren’t moving with them. The medication was being reordered once the patient was on the new floor and the IV medications on the old floor were then returned to the pharmacy. With more than 250 intensive care unit beds, the number of transfers among floors each day was substantial.

Once Jeter identified the problem and the causes, pharmacy leadership revised their processes and reduced IV bag returns to the pharmacy by 91%. “Consequently, they saved a lot of money, and staff morale increased because technicians didn’t have to spend so much time at the computer updating patient charges,” said Jeter. The pharmacy staff appreciated that I did the investigative work and removed the problem from their plates so they could concentrate on patient care.”

 

Why Pharmacy?

The satisfaction that comes with solving problems is one of the reasons why Jeter went into pharmacy. Jeter, who resides in Springdale, Ark., has a bachelor’s degree in general science from West Texas A&M University. She landed a job as a pharmacy technician at a community hospital pharmacy in 1998. “I didn’t know anything about pharmacy,” she recalled “But they were willing to teach me and invest time in my development for a six-month trial period.” She passed the National Pharmacy Technician Certification exam and, with her aptitude for business, she found her niche in supply chain pharmacy.

Reflecting upon her career accomplishments, Jeter is most proud of winning an innovation award for a McKesson competition in October 2017. The award will fund an online training course for pharmacy buyers, inventory coordinators and supply chain. It is comprised of courses in key areas that are pertinent to pharmacy purchasing such as inventory management, drug shortages, purchasing analytics, emergency preparedness, and pharmacy regulations. “There is a lack of formal training for this vital staff position,” she said. “The world of pharmacy purchasing has increased in complexity over the last decade and requires more skills than before to navigate the challenges associated with pharmacy purchasing.”

 

Inventory Control

In addition to solving supply chain mysteries, Jeter finds fulfillment in helping pharmacy purchasers with inventory management. “In a hospital pharmacy, it’s imperative that you have needed medications in stock,” she said. “You also need to be prepared to treat many patients at the same time. This differs from retail pharmacies, which don’t have to be equipped with products for emergency situations such as a mass shooting or traffic accidents.”

By helping hospital pharmacies control inventory costs, Jeter believes she saves pharmacy jobs. She explained that there are generally three expenses in a hospital pharmacy: medications, staff compensation, and automation expenses. When hospitals are struggling financially, they either have to cut drug costs or employees. “It’s rewarding to help customers more efficiently manage inventory so they can maintain a full staff,” she said.

Jeter is also passionate about being an advocate for pharmacy purchasers. She noted that purchasers have a difficult job trying to manage drug shortages and provide for patient needs. “It takes a lot of dedicated time and effort to keep the hospital pharmacy supplied with the right drugs at the right time,” Jeter said. “Pharmacy purchasers do not always receive training or professional development opportunities.”

She added that being a purchaser is a complex, complicated, and demanding job. Purchasers have tremendous responsibility in providing for patients and do not have the option of simply being out of a medication or a product. Bringing awareness to the position is critical.

 

Advanced Opportunities

With pharmacists taking on more direct patient care roles, there are more advanced opportunities for pharmacy technicians than ever before. Examples include being a supply chain consultant like Jeter, a pharmacy purchaser, a data analyst, a business manager, or a quality assurance specialist.

According to the Bureau of Labor and Statistics, there will be a 12% job growth rate for pharmacy technicians between now and 2026. “It’s an exciting time for pharmacy technicians to find their niche,” Jeter said. Her best advice for technicians is to be an advocate for yourself, make a plan to reach your goals, and let your manager know what you’d like to achieve.

 

ASHP Endeavors

Jeter, an ASHP member since 2003, finds the organization’s education and networking opportunities invaluable. “Being able to present to my peers about projects I have worked on has helped me increase my leadership skills,” she said.

From 2010 to 2014, Jeter served on the Section Advisory Group on Pharmacy Support Services. As chairwoman of the group from 2011 to 2012, she advocated for the development of new opportunities for pharmacy technicians. She is excited about ASHP’s Pharmacy Technician Forum, which developed from these discussions, and the future of pharmacy technicians as integral members of ASHP.

More recently, Jeter served from 2015 to 2017 on the Pharmacy Technician Certification Board Task Force for Advanced Technician Certification, which is working to advance opportunities for technicians to become certified in expanded roles.

“There has never been a more exciting time to be a pharmacy technician and involved in ASHP,” Jeter concluded. “There are practically endless ways technicians can help patients and provide important care.”

By Karen Appold

 

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July 1, 2013

Oklahoma Community Recovers Through Pharmacists’ Help

Filed under: Current Issue,Feature Stories — Tags: , , , , , , , — Kathy Biesecker @ 3:38 pm
Barbara Poe takes a break in the medication area of the Heart to Heart International's mobile medication unit. Photo courtesy of Nina Morris.

Barbara Poe takes a break in the medication area of the Heart to Heart International’s mobile medication unit. Photo courtesy of Nina Morris.

BARBARA POE NO LONGER WORKS as the lead pharmacist at 45-bed Moore Medical Center in Oklahoma. A tornado destroyed the building on May 20. But in the days that followed, the Norman Regional Health System employee volunteered at one of the mobile medical units in Moore and scheduled other volunteer pharmacy personnel to assist.

The response to her two e-mails requesting volunteers to work six-hour shifts was overwhelming, Poe said. So was the flatbed truck with 18 pallets of donations from a small hospital in Nebraska where the pharmacy director decided to take action.

“We are so grateful for all of the people who supported us,” Poe said. “I mean it is just truly heartwarming.”

A Group Effort

Kansas-based Heart to Heart International, a relief organization, had its mobile medical unit in Moore by 1 a.m. on May 21, Poe said.

One of the organization’s personnel contacted Norman Regional for pharmaceuticals, Poe said. By the midday of May 23, she and Darin Smith, the assistant director for pharmacy services and performance improvement, had delivered albuterol inhalers, ceftriaxone injection, and other pharmaceutical items. She had also ordered additional pharmaceuticals for a return trip the next day.

Poe, after that first visit to the mobile medical unit, said she “may ultimately end up doing some volunteer work.”

What caught her interest in the mobile medical unit was a small area at one end. It had an under-the-counter refrigerator and shelves with bins of medications. She said a pharmacist from a local community pharmacy happened to be onsite.

Poe said the unit’s volunteers “jumped” at the idea of her arranging to have a pharmacist onsite for all the hours the medical clinic operates.

With that approval, Poe said later, she e-mailed the president of the Oklahoma Society of Health-System Pharmacists and the executive director of the Oklahoma Pharmacists Association “just asking for volunteers.” Her intent was to have two six-hour shifts per day—8 a.m. to 2 p.m. and 2 to 8 p.m.—with each shift staffed by two pharmacists or a pharmacist and a pharmacy technician.

She estimated that 50–60 pharmacists from all over the state volunteered to work at least one shift.

A Personal Crusade

One of those volunteers was Chelsea Church, the 2010–11 president of the Oklahoma Society and now the Oklahoma State Board of Pharmacy’s pharmacist compliance officer for the southwestern region.

“It was personal,” Church said of her volunteer work on May 30.

She and her husband formerly lived in Moore and her husband still works there. Church said a former house of theirs was severely damaged by the May 20 tornado.

So when Smith e-mailed on the morning of May 30 asking if she could fill in for someone who had canceled, Church said, she took a vacation day to help out.

Church said she dispensed about 10 prescription medications—mostly antiinfectives for wounds and corticosteroids for rashes—and filled syringes with tetanus vaccine.

When no pharmacist was present in the mobile medical unit, she learned, patients received prescriptions to take to a community pharmacy.

The mobile medical unit stocked maintenance medications, such as antidepressants, antihypertensive agents, and diabetes treatments, for people who had lost their supplies in the disaster, Church said.

But most of the patients, she said, actually were out-of-the-area people who had come to Moore to help clear the debris. They came to the mobile medical unit after stepping on rusty nails or otherwise hurting themselves while helping others.

Poe estimated that Norman Regional Hospital had sent at least 1000 doses, perhaps 1500, of tetanus vaccine to the mobile medical unit in the first 10 days after its arrival.

“I know the hospital has been hit financially,” she said, “but whatever they’ve needed to shore up this [mobile medical] clinic, the hospital has just said, ‘Go do it.’”

Poe said one pharmacist who showed up unexpectedly at the mobile medical unit wanted to help even though there was no room for a third pharmacist.

This pharmacist, Poe said, asked about administering vaccines in the field and walked to the building of the nearby county health department, but she learned that it lacked tetanus vaccine.

“So, we supplied 150 doses of tetanus vaccine for her to go out into the field with one of the teams that [the health department] was sending out,” Poe said.

Feeling Compelled to Help

Another unexpected arrival, she said, was the pallets of donations that a flatbed truck delivered to Norman Regional Hospital.

Rachel Forster, pharmacy director at 25-bed Sidney Regional Medical Center in Nebraska, said The Weather Channel’s footage on Moore after the tornado struck her emotionally.

“I just felt compelled that we had to do something to help,” she said.

It was the everyday person in Moore, Forster said, for whom she felt compassion. “What do you do when everything you have is gone?”

Fortunately for her, she said, the pharmacy had recently expanded to “24-7-365” service through the hiring of direct employees. There were now two day-shift pharmacists, two night-shift pharmacists, and a full-time pharmacy technician in addition to Forster.

On obtaining approvals from her supervisor, chief financial officer, and chief operating officer and e-mailing Poe and Smith, Forster said she made appeals for donations of tangibles on the radio and in the local newspaper.

Forster said she used her local connections in the community of roughly 6000 to arrange the logistics. Sidney-based Adams Industries Inc. agreed to provide a flatbed truck and driver. A local farm implements company, 21st Century Equipment Inc., donated 18 pallets, shrink-wrap, and a location to store the donations.

“We kind of challenged the community to make it a success,” she said. “And everybody here wanted to do something.”

Forster said the first donation was toys from a Sidney Regional employee’s five-year-old granddaughter who was told that the images of Moore on television meant the community’s children no longer had toys of their own.

The donations, Forster said, ran the gamut of things that Sidney residents thought they would need quickly if they lost their home.

Poe, when interviewed by happenstance several hours after the arrival of the truck from Sidney, said “I about passed out.” She had imagined four or five boxes that could fit in the SUV that is substituting for her own, which was destroyed in the tornado while in the parking lot at Moore Medical Center.

Heart to Heart’s mobile medical unit left Moore on June 2, said Dan Weinbaum, director of communications. The county health department at that time took over operations from the relief organization whose personnel and volunteers, he said, function as “early responders.”

As of May 30, according to Smith, Norman Regional’s pharmacy personnel had donated $1000 and the pharmacy had received $500 from the Oklahoma Society of Health-System Pharmacists and $1800 from elsewhere to cover the costs of medications in the relief effort in Moore.

—By Cheryl A. Thompson

Editor’s Note: This article, which was originally published in the online version of the American Journal of Health-System Pharmacy, is reprinted with permission.

Moving Closer to Achieving Our Vision

Abramowitz-PREFERRED-Featured

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

In the last 20 years, the ASHP House of Delegates has debated and passed important proposals like support for the entry-level Pharm.D., universal health insurance, mandatory reporting of medication errors and “just culture,” collaborative practice, and the implementation of health information technology.

In recent years, the ASHP House of Delegates has approved policies that set future goals for residency training for all practitioners in direct patient care roles; defined the role of pharmacist prescribing in interprofessional patient care; called on federal officials to take action on compounding, drug shortages, REMS, and meaningful use standards; and pushed for standardized education, certification, registration, and licensure requirements for pharmacy technicians.

These policies touch every facet of pharmacy practice and have a profound impact on medication use in this country. ASHP’s professional policies offer a vision for the future of the profession in which pharmacists are essential members of every health care team and where medication use is optimal, safe and effective for all people, all of the time.

Last month, the ASHP House of Delegates approved more than 20 new professional policies during its session at the 2013 Summer Meeting in Minneapolis. Along with passing measures that support training in team-based patient care for student pharmacists and residents and the reclassification of hydrocodone combination products under the Controlled Substances Act, delegates also took strong positions on compounding safely and achieving provider status for pharmacists.

These actions are emblematic of the leadership that ASHP has taken on key medication-use issues throughout its history. ASHP’s professional policies provide a solid foundation for the Society to pursue transformative solutions to the issues that affect our ability to care for our patients.

In particular, the newly approved policies on compounding by health care professionals and pharmacist recognition as health care providers highlight this principle.

Compounding

ASHP is actively engaged in federal efforts to close gaps in the regulatory oversight of pharmaceutical compounding activities. We’ve worked closely with members of Congress and congressional staff on legislation that we expect the Senate to vote on this month; namely, the Pharmaceutical Quality, Security, and Accountability Act. While this legislation addresses federal authority, our new policy focuses on the laws and regulations that govern traditional compounding that occurs in hospitals, clinics, and other areas within health systems. It advocates for the adoption of applicable standards of the United States Pharmacopeia by state legislatures and boards of pharmacy.

The laws and regulations governing compounding vary from state to state. It is essential for the safety of all patients that all pharmacies that compound medications, regardless of the setting, adhere to the very highest standards. A uniform standard will help to ensure that the medications our patients receive are safe and that they are not harmed by agents that are intended to help them.

Pharmacist Recognition as a Health Care Provider

Pharmacists are health care providers. You demonstrate that each day. But we have some work to do to fix antiquated federal and state laws that place unnecessary limits on patients having access to the care we provide.

Our new policy on pharmacist recognition as a health care provider makes a strong case for changing the status quo. It points to the pharmacist’s role as a medication expert who provides safe, accessible, high-quality, cost-effective care. The policy also highlights that, as health care providers, pharmacists improve access to patient care and bridge existing gaps in care.

Achieving recognition as providers for pharmacists is ASHP’s top advocacy priority. We are devoting substantial time and energy with our partner pharmacy organizations to push for changes in the Social Security Act that will recognize the valuable role we play in the health care system.

Please take a look at the summaries of these policies below, and review the other professional policies that were recently finalized by the ASHP House of Delegates:

Pharmacist Recognition as a Health Care Provider

To advocate for changes in federal (e.g., Social Security Act), state, and third-party payment programs to define pharmacists as health care providers; further, to affirm that pharmacists, as medication-use experts, provide safe, accessible, high-quality care that is cost effective, resulting in improved patient outcomes; further, to recognize that pharmacists, as health care providers, improve access to patient care and bridge existing gaps in health care; further, to collaborate with key stakeholders to describe the covered direct patient-care services provided by pharmacists; further, to pursue a standard mechanism for compensating pharmacists who provide these services.

Compounding by Health Professionals

To advocate that state laws and regulations that govern compounding by health professionals adopt the applicable standards of the United States Pharmacopeia.

___________________________

I also encourage you to spend some time thinking about what you envision for the future of practice and what is needed to bring us closer to that goal. Share your thoughts with me in the comments section of this column or by sending an email to ceo@ashp.org. Members serve as the catalyst for our policy initiatives. Your input can help bring us even closer to achieving the vision we have for patient care.

June 4, 2013

Courage

Gerald E. Meyer, Pharm.D., MBA, FASHP

Editor’s Note: The following inaugural address was given by new ASHP President Gerald E. Meyer, Pharm.D., MBA, FASHP, at the Opening Session of ASHP’s Summer Meeting in Minneapolis, Minn.,  June 4, 2013. Dr. Meyer is director of experiential education, Jefferson School of Pharmacy, Philadelphia. His full address will appear in the August 15 issue of the American Journal of Health-System Pharmacy. To watch the speech in its entirety, click here.

GOOD MORNING, AND THANK YOU for that warm welcome!

I would like to begin by acknowledging you—our members. I want to personally thank all of the members who have participated in ASHP’s state societies.

ASHP could not fulfill its mission without the support and inspired leadership of our affiliates. Yes, being president of ASHP involves a lot of time and travel. But, it also comes with a large support staff.

Local volunteer leaders, on the other hand, do it all. You are the membership committee, the program committee, the finance committee, and the professional advocacy committee. So, to all of you, a great big thanks!

A Rich Pharmacy History

Many of you may know that I am from Philadelphia. And I am proud of it.

Philadelphia has a very rich pharmacy history. We have the first hospital in the United States—Pennsylvania Hospital, founded by Benjamin Franklin in 1751. We have the first college of pharmacy in the United States—the Philadelphia College of Pharmacy, which opened in 1821. And we had the first hospital pharmacist in the United States—no, not me. His name was Jonathan Roberts.

We also lay claim to the first Hospital Pharmacy Residency Program to be surveyed for ASHP accreditation and the first accredited Pharmacy Technician Training Program–both at Thomas Jefferson University Hospital.

We have four past-presidents of ASHP currently working in Philadelphia and a fifth in retirement nearby. I won’t tell you who they are—that’s a quiz.

I have been truly fortunate to have had access to so many health-system pharmacy leaders. They, together with many other professional colleagues, have been invaluable as I charted a course through my career. And, of course, I have the most wonderful personal support from my wife, Cheryl, and my family.

I want to extend my personal thanks to all of them for their encouragement and support.

Top Priorities

In writing this speech, I definitely had a lot of people to call upon. Yet, as much as I value their wisdom, I did not ask a single one of them for guidance on what I should talk about today.

Rather, I asked you, the members. ASHP is a membership organization. It is owned by you, its members. So I felt it was appropriate to focus our discussion today on those issues that are of greatest importance to you.

We sent out a survey to a random sample of ASHP members and asked: “What question would you like to ask Gerry Meyer?” Well, you did not disappoint. We received 130 questions, many of which spoke to the concept of courage. So, settle back and relax. This may take awhile. (OK, for the sake of time, we did narrow it down a bit.)

For our first question, Fred Bender, Pharm.D., FASHP, director of pharmacy services at Greenville Health System in Greenville, S.C., asked, “What will be your top priorities as incoming president of ASHP?”

Fred, I have a list of priorities to share with you. But my priorities are of little value unless they become our priorities. My top priority, therefore, is to be the best leader I can possibly be. And you can’t lead without a vision. So, let’s start there.

What makes a good leader?

  • The ability to articulate a vision,
  • The ability to motivate others toward that vision, and
  • The ability to remove obstacles to promote achievement of the vision.

Now, who among you can recite ASHP’s vision? ASHP’s vision is that medication use will be optimal, safe and effective for all people, all of the time. There’s no mention of “hospitals” or “health systems.” There’s not even mention of “patients.” It says “all people, all of the time.”

So, Fred, here is my list of priorities for the year. I would suggest that we view most of the individual items on this list as obstacles confronting us in our efforts to accomplish ASHP’s vision:

  • Build coalitions,
  • Implement the recommendations of the Pharmacy Practice Model Initiative,
  • Pursue provider status,
  • Promote interprofessional education and practice,
  • Expand training and certification for pharmacists and pharmacy technicians,
  • Position ASHP to be as nimble as possible in a rapidly changing environment, and…
  • World peace!

I’m somewhat serious about that last item on the list. Creating an environment in which medication use will be optimal, safe and effective for all people, all of the time is a bold and expansive vision. And just because it is hard to conceptualize, we cannot be deterred from putting our energies towards its achievement. (So, in that respect, our vision is a bit like world peace.)

Becoming Strong Advocates for Patients, Profession

Kevin Aloysius, who just graduated with his Pharm.D. last month from Texas Tech University Health Sciences Center, in Lubbock, (congratulations to all new graduates, by the way!), asked the next question: “How do we prevent doctors’ comments such as, ‘Well, if you wanted to give me recommendations on how to treat a patient, why didn’t you go to medical school?’ “

Kevin, there is a serious answer to your question, but if I wanted to be flippant, I’d say to the physician in question: “If you wanted to be a medication-use expert, why didn’t you go to pharmacy school?” That is an accurate, patient-centric response, isn’t it? A pharmacist’s unique education focuses on the optimal, safe and effective use of medication for all people, all of the time.

Having said that, let’s remember that physicians build their reputations on high-quality outcomes. Why, then, don’t physicians seek the counsel of pharmacists in all matters of medication use? After all, the rate of medication misadventures in the current system is well-documented and not acceptable.

I believe their hesitancy relates to the element of trust. Physicians trust pharmacists to prepare and dispense medications accurately. They trust pharmacists to offer advice on proper administration. They expect pharmacists to offer suggestions on medication compatibility and dosage adjustments.

But, some may not trust pharmacists to create optimal, safe and effective medication-use plans for all people, all of the time. How, then, do we build this trust?

We must aggressively pursue all avenues to modify the perceptions of physicians. And not just physicians, but also health care policy makers, decision makers, and providers, as well as  the general public about the unique education and training possessed by pharmacists. We must have the courage to be strong advocates for our patients and for our profession. Historically, we have been far too passive in promoting our value.

Antagonism vs. Synergism

Our next question comes from Jamie Ridley Klucken, Pharm.D., MBA, BCPS, an assistant professor of pharmacy practice at Shenandoah University, Ashburn, Va., who asked, “We see a push to work collaboratively with other health care providers but seem to have a difficult time putting this into practice. Are there ways to accelerate this interprofessional practice? Perhaps through pharmacy education and post-graduate residency programs?”

Jamie, by definition, interprofessional activities cannot be accomplished by one profession. Each profession must be willing to participate.

The good news is that in May 2011, a group called the Interprofessional Education Collaborative—consisting of educators representing pharmacy, medicine, nursing, dentistry, and public health—released a report that summarized the core competencies needed for interprofessional collaborative practice. Those core competencies fell within four domains:

  • Values and ethics,
  • Roles and responsibilities,
  • Interprofessional communication, and
  • Teams and teamwork.

What this report says is that to build an efficient and effective health care system, health care providers need to:

  • Have a common understanding of health care ethics and values,
  • Understand one another’s roles and responsibilities,
  • Learn how to communicate with one another, and
  • Learn how to be part of effective teams and how to play well together in the sandbox.

For two years, we have had this guidance document that delineates the curricular components that should be taught to health care students, interprofessionally. Jamie, I agree with you. Our profession needs to take a leadership position in incorporating interprofessional competencies into our formal education and training standards. These changes cannot occur fast enough.

Furthermore, to develop this set of skills and knowledge within practicing pharmacists, ASHP must incorporate this critical content within our continuing professional development offerings.

It’s important to consider what this report does not say. Nowhere does it say that interprofessional education should encompass getting health care students into the same classroom to teach them pathophysiology, pharmacology, diagnosis, or treatment. So, if those are not our commonalities, then those must be our differences. Exactly.

Let’s look at this in pharmacologic terms. Sometimes, we administer two very effective drugs that may compete for the same receptor, and the result is that they become less effective. We call that phenomenon “antagonism.” On the other hand, sometimes we prescribe two drugs and the positive effect is greater than the anticipated sum of their individual effects. We call that “synergism.”

Let’s move past interprofessional antagonism. Let’s have the courage to promote an efficient and effective health care system comprised of interdependent, synergistic health care providers.

Practicing at the Top of Our Education, Training

The next question comes from Cassie Heffern, Pharm.D., a PGY2 ambulatory care resident with CoxHealth, in Springfield, Mo., who asked: “In some more rural hospitals, change is almost feared. Despite [the fact] that no one will lose a position by  including more PPMI, the subject is still feared. How would you suggest to keep moving forward with PPMI?”

As you may know, ASHP’s Pharmacy Practice Model Initiative—or PPMI—envisions a future in which pharmacists practice at the top of their education and training. The model identifies the roles that pharmacists must assume and then describes the need to maximize the incorporation of enablers—notably, technicians and technology—to help achieve those roles.

Earlier, I stated that leadership encompasses stating a vision, engaging others to embrace the vision, and removing obstacles toward accomplishing the vision.

For 71 years, ASHP has been a leadership organization. This professional leadership continues. Through the PPMI, ASHP members created a bold vision, and ASHP is committing significant resources to help our members achieve their vision.

Cassie, your question alluded to challenges faced by rural health care providers. We recognize that many of our members are not able to leave their workplace to attend live educational offerings. We have begun, and will continue to accelerate, the delivery of educational programming in formats that offer accessibility to all of our members.

The PPMI envisions advancing pharmacy practice beyond pharmacists offering recommendations for others to implement. It envisions pharmacists as interdependent prescribers who accept accountability for the patient-care plans that they personally initiate.

The willingness to expand our scope of accountability to improve our patients’ health is the essence of our envisioned pharmacy practice model. Are we prepared to expand our scope of practice? Are we prepared to accept accountability for prescribing decisions?

Doing so requires courage. It requires the courage to challenge the status quo. It requires the courage to practice at the top of our education and training, not just at the top of our licenses. It requires the courage to practice beyond the borders of established practice.

The Future of Residency Training

Among the questions I received, more related to residencies than to any other topic. Two members, Kent Montierth, Pharm.D., director of pharmacy for Banner Estrella Medical Center, in Phoenix, Ariz., and Erica Maceira, Pharm.D., BCPS, CACP, clinical pharmacy specialist and student and resident coordinator at Albany Medical Center Hospital in Albany, N.Y., asked: “How does ASHP plan to help grow the number of residency programs and the number of available positions? And, how can the accreditation process be simplified?”

Although it sometimes may feel like we are making little progress in this area, the numbers tell a different story. From 1995 to 2006 (a 12-year period), the number of available accredited residency programs and the number of available positions in those programs doubled. From 2006 to 2012 (a subsequent six-year period), the number of accredited residency programs and number of positions doubled again.

Part of the reason for this rapid growth is that the value proposition for residencies is easily developed for residents,  employers, patients, and the profession. The ASHP website contains a number of documents that can assist practitioners in justifying, designing, and conducting residency training programs.

However, one of the greatest barriers to increasing the number of residency training programs cannot be overcome with guidance documents  alone. A good training program requires a solid infrastructure.

Pharmacy services must meet contemporary standards of practice. Preceptors must have the ability to impart knowledge and develop critical reasoning skills. Residency program directors must be able to mentor and  inspire those entering the profession. And an organization’s culture must be supportive of the training mission.

We cannot, and we should not, compromise on these foundational pillars.

There are now more than 1,000 residency programs in the United States that have a solid infrastructure. I call on those programs to consider expanding. For those institutions without a sufficient infrastructure currently in place, consider collaborating with an existing residency program.

In the 1970s, and then again in the 1990s, my institution offered joint residency positions with neighboring institutions. Those joint programs continued until our partners had developed sufficient infrastructure to conduct their residencies independently.

Kent and Erica, you also asked about simplifying the accreditation process. I agree that we must critically evaluate the current standards to ensure that each requirement contributes to the quality of the training process.

Both the PGY1 and PGY2 standards for accreditation are currently under revision, which presents us with just such an opportunity. As drafts of proposed revisions to those standards are circulated, I encourage all residency program directors to provide your feedback.

Many of the questions I received about residency training referred to ASHP’s member-developed policy that, by 2020, all pharmacists involved in direct patient care must complete a residency.

Let me be clear. Residency training is a critical element in enhancing patient care by expanding pharmacists’ responsibilities. Residencies instill the confidence in young practitioners to have the courage to drive the profession past its current borders.

Please remember that ASHP’s residency policy is aspirational in nature. The decision about whether to pursue a residency is  a career decision. You do not need a residency to obtain a pharmacist license. But you do need a residency to pursue and advance along certain career paths, and the number of those career paths continues to grow every year.

There are four stages to the education and continued training of a pharmacist: pre-pharmacy undergraduate education, professional doctorate education, formalized training, and continuing professional development.

Coordinating the outcomes of each of these four stages is a professional imperative. While the requirements for the pre-pharmacy and pharmacy curricula will evolve, we must recognize that there is only so much that we can accomplish in the classroom because (1) contact time is limited, and (2) students do not have pharmacist licenses.

At some point in time, the profession will need to address the question: Should residency training be required for pharmacists to meet their obligation to  their patients? At some point, that answer will be “yes.” Whether this happens by 2020 or not, it is far better for the profession to prepare for that future than to be unprepared when that future arrives.

Gaining Provider Status

Zina Gugkaeva, Pharm.D., a PGY1 resident at the University of Iowa Hospitals and Clinics, in Iowa City, asked our sixth and final question: “When are pharmacists finally going to be recognized as providers, and what will it change?”

Many of you may have attended the Provider Status Town Hall at this Summer Meeting where this very issue was discussed. Much of what we heard, we already knew:

  • The health care environment is changing.
  • Emerging practice models are focused on integrated health care delivery systems.
  • Policymakers are seeking ways to make health care more affordable for more people.
  • Payment will be focused on quality, not quantity, of care.
  • Consumers will demand transparency in the cost of their care.

So, what will happen when pharmacists are recognized as health care providers?

  • Pharmacists’ patient care services will improve access.
  • Pharmacists’ patient care services will improve quality.
  • Pharmacists’ patient care services will help control costs.

Access—quality—cost. There is substantial documentation to support the positive impact of pharmacists on access, quality and cost of care. We know it. Now we have to sell it. We must have the courage of our convictions.

The first step is to ensure that the profession moves forward with this common message by solidifying these basic principles within the existing coalition of pharmacy organizations. Then, we need to expand the coalition to include other critical stakeholders, including health care provider groups, payers, and patient advocates. We need to draft legislation and seek support by educating legislators, both on a state and national level.

ASHP will serve as your collective voice in formulating the message. ASHP will develop the materials needed to deliver that message. ASHP will tailor those materials for different audiences. And ASHP will train you.

But, we need you to deliver the message to your legislators, to your C-suite, to your health-system’s lobbyists, to your health care colleagues, to your complacent pharmacist colleagues, to your local media, and to your patients.

Access—quality—cost. The message is clear. The message is focused. The message meets society’s needs.

Gaining provider status will ensure that pharmacy is at the table when regulators and other policymakers invite health care providers to help construct new delivery models. And that is why ASHP, the American Pharmacists Association (APhA), the American College of Clinical Pharmacy (ACCP), and other health care organizations have committed significant resources to achieving provider status for pharmacists.

Zina, while no one can predict when we will finally succeed, I am confident that we will succeed if we have the courage to stand strong and united on this issue and if our members get personally involved.

I call upon all pharmacists who believe they are health care providers, on all student pharmacists who believe they are training to become health care providers, on all people who want their medication use to be optimal, safe and effective all of the time. I call on everyone to send the message: “Pharmacists are medication-use experts. Pharmacists improve access, improve quality, and control the cost of health care. Pharmacists are health care providers.”

In closing, I want to thank everyone who took the time to submit questions. I invite you to continue to send me your comments and suggestions over the next year. Finally, I want to thank you for the courage you show every day toward advancing ASHP’s vision: that medication use will be optimal, safe and effective for all people, all of the time.

Thank you.

June 3, 2013

New CE Service for Techs Features Webinars

Filed under: Current Issue,Feature Stories — Tags: , , — Kathy Biesecker @ 3:44 pm

ASHP’S NEW ONLINE LEARNING PORTAL for pharmacy technicians, PharmacyTechCE.org, is hosting a number of webinars as part of a monthly series. The subscription service, which is available to individual pharmacy technicians, pharmacies, and pharmacy departments, will offer over 20 hours of continuing pharmacy education (CPE) annually.

photo by Matthew LesterEducational categories on the site include automation, sterile compounding, medication and patient safety, pharmacy operations, pharmacy law, professional practice, and quality improvement.

“ASHP is making this investment in quality education and professional development for pharmacy technicians because we believe that well-trained pharmacy technicians can help us advance pharmacy practice and improve quality for all patients in all health care settings,” said ASHP CEO Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP.

Subscriptions to PharmacyTechCE.org are available both to employers investing in these critical members of the pharmacy team and to individual pharmacy technicians looking for technician-designated education. Most topics are available in podcast, CE monograph, and on-demand formats, providing the flexibility for different learning preferences.

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