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

April 23, 2021

Hospital Pharmacy Leader Makes Mentorship a Top Priority

Vickie Powell, Pharm.D., M.S., FASHP

WITH A PASSION FOR MENTORSHIP and a dedication to her community and the pharmacy profession, Vickie Powell, Pharm.D., M.S., FASHP, is a pharmacist to emulate. Dr. Powell, site director of pharmacy for New York-Presbyterian Hospital, first thought about a pharmacy career during high school, where she had an interest in and maintained good grades in science. A guest speaker encouraged her and some of her high-achieving classmates to pursue careers in the medical field.

“I did not want to be a doctor because I didn’t like blood,” she said. “I didn’t want to be a dentist. So I thought pharmacy would be the best profession for me because I wouldn’t have to come in contact with all of those things. I love pharmacy. I’m glad I took that path.”

After completing pharmacy school at Xavier University of Louisiana in New Orleans, Dr. Powell got married and moved to New York City’s Harlem neighborhood, where she took a pharmacist position at a drug store downstairs from her apartment. While she found it rewarding working in the community, she wanted to do more. Then one of her customers, a pharmacy director at Harlem Hospital, encouraged her to try hospital pharmacy.

Dr. Powell applied for and was offered a registered pharmacist job with St. Luke’s/Roosevelt Hospital Center. She threw herself into work with enthusiasm, volunteering for everything from backing up computerized pharmacy records to learning all about then-upcoming USP <797> regulations and developing plans for a compliant I.V. room. She soon moved up to an inpatient pharmacy supervisor and developed numerous specialty satellite pharmacies throughout the hospital.

Valuable Mentorship

Because of her expertise, Dr. Powell found herself giving talks to the New York City Society of Health-System Pharmacists. At first, she wasn’t sure how to balance work and being involved in professional pharmacy societies with family life. But her supervisor and mentor, Harvey Maldow, R.Ph., believed it was so important she participate that he told Dr. Powell’s husband that he had to watch their young children while she attended meetings. She became the second African-American president of the group.

During her acceptance speech, Dr. Powell discussed mentoring and her philosophy of “Each one, teach one,” based on every mentee helping pull up someone behind them. The vice president of pharmacy at New York-Presbyterian Hospital was impressed and approached her about a director job. Maldow encouraged her to apply.

Today, Dr. Powell oversees pharmacy operations for three of the health system’s 11 hospitals, and oversees around 600 pharmacy employees. Besides her work tasks, Powell continues to make mentoring a priority, promoting good communication skills and lifelong education. She’s proud to have encouraged many technicians to become pharmacists.

“We meet on a regular basis because I don’t want to just tell people something and then hope they’ll follow it through; I try to work with them one-on-one to help them achieve whatever goals we’ve set out for them,” she said.

Community Service

Dr. Powell also maintains close ties to her community, serving for many years as a Sunday school teacher and member of the health committee at her church. Powell brings in guest speakers on topics important to their membership, such as hypertension and diabetes. One speaker, celebrity cardiothoracic surgeon Mehmet Oz (TV’s “Dr. Oz”), awarded free gym memberships to a few audience members. She also has been a special events coordinator for the Harlem Little League. More recently, Powell supervised a COVID-19 vaccine clinic at her church run by her hospital.

“I try to do a lot of things to help our community, and I do whatever I can to propel the practice of pharmacy,” she said. To that end, Dr. Powell serves on the Board of Directors for Long Island University’s College of Pharmacy and has given guest lectures at Touro College of Pharmacy. In 2009, she was the first African-American president of the New York State Council of Health-System Pharmacists.

ASHP Leadership       

Dr. Powell also has been very active in ASHP, serving over the years as a delegate as well as on several committees, including the Council on Education and Workforce Development and the Committee on Nominations. In 2020, Dr. Powell was honored to be invited to join ASHP’s Task Force on Racial Diversity, Equity, and Inclusion.

Dr. Powell and her colleagues celebrate receiving the first dose of the COVID-19 vaccine.

“Our social and justice systems are broken, and conscious and unconscious racism exists,” she said. “We talked a lot about institutional racism, which sometimes has been embedded as a normal practice within a society or organization. We made some changes in the structure of how things will be done to assure equity for all members. I don’t think people realize how institutional racism can lead to such issues as discrimination in employment, health care, and even with access to the [COVID-19] vaccine.”

The group suggested some changes to ASHP policies, Dr. Powell said, one being that a person can only run for a board position if they had just been a delegate. “That eliminates a lot of people,” she said. The group recommended that members did not have to have delegate experience to run for a board office. They also changed governance so the chair of the house of delegates no longer presides over the nominations committee, which could be a conflict of interest.

“We opened it up so that more people would have the opportunity to run for office,” she said. “We’re going to make mentoring a big part of the process.”

Dr. Powell stands out because of her intelligence, her mentorship, her compassion, and her ability to listen to people and understand their needs, Maldow noted.

“She’s one of the best people I ever worked with in terms of how she managed both down and up, and the staff adored her,” he said. “When I look at the people I mentored in my career, she’s on the top in how successful she has been, and it’s a credit to her, not me. The only thing I take credit for is being able to identify her potential. She’s a great health-system pharmacist and someone people should model themselves after.”

 

By Karen Blum

March 17, 2021

Kurt Kleinmann: From WW2 Refugee to Pharmacy Innovator

The Kleinmann family in April 1938. Left to right: Herta, Gustav, Kurt, Fritz, Tini, Edith

PIONEERING PHARMACIST KURT KLEINMANN, R.PH., HAS SEEN the worst and best sides of humanity. In 1938, as Hitler rose to power in Europe, his family was among the millions of others to bear the brunt of a growing tsunami of anti-Semitism.

“I remember as a child in Vienna having a Hitler youth push my head into the snow,” recalled Kleinmann, now 91 years of age. The Kleinmann family’s situation worsened in 1939 when his father, Gustav, and his older brother, Fritz, were arrested and sent to the Buchenwald concentration camp in Germany and eventually to the Auschwitz concentration camp.

Then in 1942, Kleinmann’s mother, Tina, and his sister, Herta, were rounded up and shipped to Minsk. Kleinmann’s father and brother survived seven years of forced labor at the concentration camps, but his mother and sister were killed three days after arriving in Minsk.

Fortunately for Kleinmann and his elder sister, their mother had the foresight to send them both off to the United States and England, respectively. This heart-wrenching decision was likely made knowing she may never see her children again.

Arrival in the States

Kleinmann’s time in Europe, which is written about in a recent book titled “The Boy Who Followed His Father into Auschwitz,” was the dark side of humanity, but when he arrived in the United States at age 11, Kleinmann was shown a level of generosity that he has reciprocated in equal measure, both inside and outside of his profession.

“I was taken in by a wonderful family in New Bedford, Massachusetts, and they really saved my life,” Kleinmann said. “Judge Samuel Barnet and his three sisters became like a new father and three new mothers. I always kidded that I had to behave so as not to spoil their reputation.”

Kleinmann was given all the opportunities that a child his age could hope for: summer camp and afternoons playing baseball, “which I enjoyed even though I wasn’t good enough to make the high school team,” he said.

As a high school student, Kleinmann set his sights on a career in aeronautical engineering but soon realized that pursuing this path required an element of tedium that wasn’t for him.

“My high school counselor said I needed to take mechanical drawing if I wanted to become an aeronautical engineer. The first nine weeks of the class were very boring and involved perfecting your handwriting, writing the letters of the alphabet over and over and over again in lower case and upper case,” Kleinmann recalled.

When he spoke to his counselor about dropping the course, she reiterated that mechanical drawing was a requisite for college studies in aeronautical engineering.

“I looked at her and said, ‘ok, so I’ll become a pharmacist!’ and that’s how I ended up with a wonderful career which I’ve loved ever since,” Kleinmann said.

Pharmacy Studies Interrupted by Military Service

Kleinmann spent 16 months as a hospital pharmacist in the military.

Kleinmann completed his undergraduate pharmacy studies in 1952 at what was then the Rhode Island College of Pharmacy, continuing on to graduate studies at Ohio State University with the intention of getting a job in pharmaceutical manufacturing. However, a year into the program, Kleinmann was drafted into military service and sent to Germany and Austria, where he spent 16 months as a hospital pharmacist.

The experience left him wanting to work in hospitals rather than industrial manufacturing. Kleinmann, who had applied for a residency at the Johns Hopkins Hospital prior to serving in the military, was offered a staff position in the pharmacy department on his return to the United States. He took up the offer and was eventually promoted to serve as the supervisor of their compounding operations. After two years there, Kleinmann decided he needed to get back on track with graduate-level hospital pharmacy studies.

He was accepted to the St. Louis College of Pharmacy’s residency program. He completed a placement at the St. Louis VA Medical Center–John Cochran Division, where he got a flavor of the possibilities within hospital pharmacy.

“My preceptor wrote a letter to every hospital in St. Louis saying, ‘I have a resident here, and I’d be happy to share him with you for a month, and you can work him as hard as you want, but you have to teach him something,’” Kleinmann recounted.

Big Break

It was at the tail end of his residency that Kleinmann had a career-boosting meeting with Paul Parker, a pioneer in hospital pharmacy who at the time was the executive secretary for ASHP, then known as the American Society of Hospital Pharmacists.

“Paul was asked to man the ASHP booth on his own at a convention for the Catholic Hospital Association, which had their headquarters in St. Louis, and my preceptor knew Paul and sent me to keep him company at the booth,” Kleinmann said.

The new graduate left a strong impression on Parker. After the meeting, the elder pharmacist introduced his colleagues at Grant Medical Center in Columbus, Ohio, to Kleinmann because they were searching for a new pharmacy director.

“Paul had received a call from the hospital administrator at Grant that they were seeking a new pharmacy director. He indicated to them, ‘I just met a young fellow in St. Louis, and you should give him a call,’” Kleinmann recounted.

Innovator

Kleinmann was hired for the job and went on to develop their pharmacy program. He and was also given the freedom to flex his muscles as an innovator. “In those early days, doctors on the floor wrote medication orders in the patient’s chart, and nurses would copy those by hand and send the copies to the pharmacy,” Kleinmann explained. “Needless to say, there were numerous transcribing errors and dispensing errors.”

Kleinmann has become a beacon of light to those around him.

To improve the safety of the prescribing process, in 1965, Kleinmann developed a standardized approach for physicians to send their original orders directly to the pharmacy. The published protocol touched on everything from the essential components of an order form to considerations around the color of the paper being used.

Marvin Lew, M.S., who worked at Montefiore Medical Center in New York, with Kleinmann during his 30 years as pharmacy director there, said Kleinmann was relentless in his efforts to advance the profession of hospital pharmacy.

“Kurt pushed innovative programs year after year, and when a project was successfully completed, we would all breathe a sigh of relief and say how thankful we were that it was over, only to find out there was an even greater project for the upcoming year,” he said.

Recognition

Kleinmann’s order entry innovation won him national recognition, and he was invited by ASHP to do a speaking tour across the country. Nearly 30 years later, Kleinmann’s ongoing contributions – including early advocacy for pharmacy specialization and greater pharmacist involvement in the continuum of care – were again recognized by ASHP, this time through the prestigious Harvey A.K. Whitney Lecture Award.

“ASHP and I have been very good partners,” Kleinmann told ASHP InterSections. “In fact, if you make a list of every committee that ASHP ever had, at one time or another, I chaired it.”

Giving Back to the Refugee Community

During his time at Montefiore Medical Center, Kleinmann also had the opportunity to pay forward the generosity he received from Judge Barnet when he arrived in the United States. While working at Montefiore, Kleinmann helped refugees from the former Soviet Union who had been nurses and doctors to re-integrate into the healthcare field in the United States.

“They did not meet the licensure requirements to practice their profession in the States, but I developed a program where they received English lessons at the local college and then completed a 10-week technician training program,” said Kleinmann. “I was able to place most, if not all, of these individuals at hospitals in the metropolitan New York area, where they re-entered the health care workforce and gave hospitals and pharmacy directors the chance to augment their pharmacy program.”

As Kleinmann’s list of deeds shows, despite his direct experience with the sinister side of humanity during his childhood, he has not only transcended the effects of the Holocaust, he has become a beacon of light for those around him.

“I can honestly say that if one were in Kurt’s presence and were willing to meet him halfway, he would make them a better individual and person,” said Lew, Kleinmann’s former colleague. “Indeed, being close to him on a daily basis for many years made me a happier and more positive person.”

An ASHP news article provides additional details about Kleinmann’s family and their experiences in Nazi Germany.

By David Wild

February 17, 2021

Pharmacy Leader Promotes Diversity, Mentorship, and Community Service

Vivian Bradley Johnson, Pharm.D., M.B.A., FASHP

On her 60th birthday, Vivian Bradley Johnson, Pharm.D., M.B.A., FASHP, senior vice president of clinical services at Parkland Health and Hospital System in Dallas, performed the kind of selfless acts that have marked her career to date.

“I wanted essential workers to know how much I appreciated the work they’ve been doing during the pandemic, so I gave them certificates and gift cards, and I also prepared baskets for the homeless and the elderly,” she said. “It was a full day all about others, not me.”

A life of service is what brought Dr. Johnson to pharmacy in the first place. Originally from Lake City, Florida, she was inspired by several members of her community, including a couple of retail pharmacists her family entrusted with their health, and a Black community pharmacist within her church whom she admired.

Thirty-five years after starting out as a practicing pharmacist, Dr. Johnson has become an ASHP fellow with a career distinguished by numerous successful initiatives. For example, she helped launch ASHP’s investigational drug service network after identifying a need for such a group.

Since taking up employment at Parkland Health and Hospital System, Dr. Johnson established the health system’s first central fill pharmacy, which processes 6,000 outpatient prescriptions daily. She also developed several medication safety programs, created a variety of pharmacist-led clinical initiatives, and helped bring pharmacists to the patients’ bedside.

Pharmacist Diversity

One of Dr. Johnson’s greatest passions and a principle that has guided her work has been increasing diversity within the pharmacy workforce, among pharmacy leaders, and in academia. That focus on diversity recently earned her a spot on ASHP’s Task Force on Racial Diversity, Equity, and Inclusion (DEI), where Dr. Johnson said she is eager to help find ways to enhance ASHP’s diversity on every level, from governance to products, services, and member communication.

According to Carrie A. Berge Pharm.D., M.S., vice president of pharmacy services at Parkland Health and Hospital System, Dr. Johnson is the right person for the job, having helped ensure leadership and staff at her health system represent the community they serve.

Dr. Johnson completed her undergraduate pharmacy degree at Florida A&M University, a HBCU.

“Vivian has spoken about leadership development and diversity to the entire organization throughout her career, and she has mentored many students, residents, and college interns and supports her community through extensive work with various charitable and social organizations,” said Dr. Berge.

Something Dr. Johnson hopes to help ASHP do in the coming years is recruit more individuals from historically Black colleges and universities (HBCUs), a source of talent that Dr. Johnson said has been historically neglected.

“There’s a bias and belief that I think some people still carry, which is that the quality of education at HBCUs is not equal to other colleges and universities. I strongly disagree with that, and we need to overcome that bias,” Dr. Johnson insisted, noting that she herself completed her undergraduate pharmacy degree at Florida A&M University, a historically Black university.

While a sizeable portion of ASHP members are Black, Indigenous, and People of Color (BIPOC), Dr. Johnson said she wants to “reach out a little further to minority practitioners and students so they know how ASHP membership can benefit them.”

In addition to better communicating membership benefits, Dr. Johnson would like to offer additional services, which include helping students and young practitioners find mentorship opportunities. “I didn’t go from being a staff pharmacist to senior vice president of clinical services on my own,” she said. “It was so important for me to have leaders and mentors to guide me.”

Dr. Johnson recalled that as a new practitioner she would attend ASHP Midyear meetings with the intent of connecting and finding support from others who had been in the profession for longer. She saw this as a benefit of ASHP membership.

“I was very self-motivated and reached out to leaders in pharmacy that I looked up to, but others may not feel as comfortable approaching people, so we need to offer resources and avenues to facilitate mentorship relationships,” Dr. Johnson said.

Diversity and Patient Care

Ensuring more BIPOC community members take pharmacy leadership positions will also be critical to sharing important insights into the culture and the types of challenges that diverse communities face, Dr. Johnson noted. “We need to know where there are health care disparities and how pharmacists can help eliminate those disparities,” she said.

While pharmacists provide direct care for chronic diseases and medication therapy management, she said not everyone gets equal access to this care. “A better understanding of the populations that are at risk of being underserved and the social determinants that affect their access to resources will help us make sure they get the best possible pharmaceutical care,” Dr. Johnson said.

Pursue Your Ambitions

Although there is much more work to do to improve diversity in the pharmacy community, Dr. Johnson hopes her own career growth can inspire BIPOC students and practitioners to strive towards their ambitions, “even when it may not appear that an opportunity is there for you.”

She believes that each person should go after whatever they would like to do within the pharmacy profession. “If that means reaching out to a person you’d like as a mentor, reach out to them,” Dr. Johnson explained. “For example, if you want to write an article, take the initiative and connect with someone who has published, and ask them for help. There are leaders in pharmacy who are willing to help and guide you.”

 

By David Wild

 

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January 12, 2021

Pharm.D. Candidate is a Long-Time Champion for Diversity

Jeffrey Clark is a fourth-year Pharm.D. Candidate at the Philadelphia College of Osteopathic Medicine School of Pharmacy.

AFTER GRADUATING FROM a Bachelor of Science program, Jeffrey Clark was torn between applying to pharmacy school or medical school. As fate would have it, that hesitation dissipated when Clark entered the post-undergraduate working world.

While working as a program and wellness manager at the University System of Georgia, Clark was surprised to find out that pharmacists worked in managed care positions. “I’d always thought of pharmacists as being limited to the retail setting,” Clark said.

Discovering the range of options available to pharmacists and feeling gratification from helping individuals achieve better health through the wellness programs inspired Clark to pursue a career in pharmacy.

Diversity Leadership

As a fourth-year Pharm.D. Candidate at the Philadelphia College of Osteopathic Medicine School of Pharmacy in Suwanee, Georgia, Clark’s professional interests include pharmacy operations management, medication safety, and quality assurance. His plan at the moment, however, is to pursue a two-year residency in health-system pharmacy administration and leadership.

That choice of specialization is a natural one for Clark, who serves in several leadership roles, including Chair of the ASHP Pharmacy Student Forum Executive Committee and as a student representative to the ASHP House of Delegates.

Clark is perhaps most passionate about being a leader in diversity. This interest was sparked in high school, where he spearheaded the formation of diversity groups, and a task force. “I remember explaining to [my high school’s] administration that we didn’t have a diversity-focused organization and that we needed to hold a conversation around the topic,” he said. After speaking up and voicing his concerns, Clark was asked to start a campus diversity organization.

Clark was called on again to lead diversity initiatives at college, where the campus president asked him to facilitate a task force on the issue, with the goal of finding ways to recruit individuals from underserved communities to college positions. “Those discussions ultimately led us to build awareness among faculty and staff and promote discussions on matters related to race,” he recalled.

Clark’s rich history of diversity leadership has led him to his current position as a member of the ASHP’s Task Force on Racial Diversity, Equity, and Inclusion (DEI). His mentor, Joshua Blackwell, Pharm.D., clinical pharmacy manager, ambulatory services, at the University of Texas Southwestern Medical Center in Dallas, is excited to see what Clark will help achieve during his tenure on the ASHP DEI Task Force.

“When the call to action came from ASHP, Jeffrey immediately contacted me and expressed interest in serving as the student voice on the DEI Task Force,” said Dr. Blackwell. “I think one of Jeffrey’s greatest strengths is that he understands and listens to what other students around the country say their challenges and opportunities are within pharmacy schools. He wants to help them at every stage of their journey.”

Diverse Mentors, Leaders, and Students

Clark has reached impressive heights as a leader, but the path as a black male has come with some challenges. “I initially struggled to find a leader in pharmacy that I really connected with and felt comfortable telling my life story to, and I partly attribute that to not having someone who looks like me,” Clark said.

Although he eventually found leaders who supported and guided him, that lack of an early connection may have translated to some missed opportunities, he believes. “There are lots of opportunities available to pharmacy students, but you have to know about them and figure out where to put your time and effort,” Clark said. “If you don’t have a mentor to guide you, that can be difficult.”

Clark hopes to dedicate part of his time on the ASHP DEI Task Force to ensuring that other potential and current pharmacy students do not similarly miss out on opportunities. Promoting awareness to communities and schools that have historically been less of a focus for pharmacy schools is one way he believes this can be done. Sharing the stories and achievements of diverse members of the pharmacy community should also make students feel more comfortable and interested in getting involved with pharmacy organizations, Clark believes.

“People of color sometimes don’t feel like they stand a chance, and they don’t see how they’re going to find a mentor or some kind of connection to break through racial barriers,” he said. “We need to be proactive in seeking out people from diverse backgrounds and to communicate better with them to let them know, ‘Hey, you can do this!’”

Practitioner Diversity Improves Patient Care

Clark is a member of the ASHP Task Force on Racial Diversity, Equity, and Inclusion.

Clark believes that having practitioners that represent the mirror the diverse range of patient backgrounds – whether it is race, sex, or socioeconomic level – can help improve the quality of care that individuals receive.

For example, he recalls finding some patients from minority backgrounds reluctant to share information with the hospital rounding team during some of his patient rounds. While the sheer size of a large medical team may have intimidated them, “in some cases where the patient we treated was black, I noticed that when I went into the room alone, they would be much more open to talking,” Clark recalled. “There are some people that feel more comfortable talking to a person who is like them.”

For all the reasons that diversity is so important to him, Clark is excited about the changes he and his peers stand to make through ASHP’s DEI Task Force. “Diversity is already happening,” he said. “We’re working hand-in-hand with ASHP staff to make sure we find every opportunity to grow, and to develop policies and accountability systems that keep us expanding our diversity, not just once, but on an ongoing basis.”

By David Wild

 

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November 13, 2020

Pharmacists Take the Lead in Providing Vaping Interventions

Kimberly Novak, Pharm.D., BCPS, BCPPS, FPPA, with PGY2 residents Becca Wytiaz and Mara Rubin.

AN INCREASE IN THE USE OF E-CIGARETTES AMONG adolescents in the U.S. is erasing recent progress in reducing overall tobacco use in this population, according to alarming statistics from the Centers for Disease Control. Some 27.5% of high schoolers and 10.5% of middle schoolers reported current use of e-cigarettes, the CDC reported in a recent issue of the Morbidity and Mortality Weekly Report, creating an immense opportunity for pharmacists to get involved.

Vaping and COVID-19

In 2019, there was a surge in E-cigarette or vaping product use-associate lung injury (EVALI) which was particularly noted in adolescents and young adults. Interestingly, there was an observed decrease in EVALI cases early in 2020, explained Kimberly Novak, Pharm.D., BCPS, BCPPS, FPPA, an advanced patient care pharmacist in pediatric and adult cystic fibrosis at Nationwide Children’s Hospital in Columbus, Ohio. “This was originally attributed to increased public awareness of vaping and strategies aimed at reducing marketing and access of flavored vaping products of preferred by this population,” said Dr. Novak. “However, this decrease also corresponded with the initial surge in COVID-19 cases and many state-mandated stay-at-home rules as well as increased implementation of work-from-home and virtual school policies.”

As many of these policies were loosened in the summer months, health care practitioners have noted an increase again in EVALI cases, perhaps due to less supervision as parents returned to onsite work, she added.

Pharmacist roles

In general, e-cigarette usage in adolescents “has blown up among this population way more than people suspected, particularly because it’s so easy to hide, and it doesn’t smell,” said Dr. Novak. “This snuck up on us as a society with very little regulation, and now we’re working backward, trying to catch up to this epidemic that got out of the bag before we got a hold on it.”

Kyle Mays, Pharm.D., BCPPS, discusses cessation options with a teenage patient.

Pharmacists can play several important roles in patient care regarding e-cigarette usage and related lung injuries, said Dr. Novak, an ASHP member since 1998. In teaching hospitals like hers, pharmacists provide continuity where attending physicians and residents may change over. They also can monitor trends in nicotine usage, and, because patients view pharmacists differently than their physicians, they may share more information about medication histories with them.

Typical agents prescribed to help curb nicotine cravings, like varenicline (Chantix) and bupropion (Zyban, Wellbutrin), are not indicated for people under the age of 18, noted Justin Reinert, Pharm.D., BCCCP, a clinical assistant professor at the Ben and Maytee Fisch College of Pharmacy at the University of Texas at Tyler. This doesn’t mean physicians aren’t prescribing them for this population, he said, but pharmacists can employ motivational interviewing techniques and assess patients’ readiness to change.

Interventions to reduce usage

In addition, pharmacists can use their medication expert hat to advise primary care teams on different vaping products used by teens, said Kyle Mays, Pharm.D., BCPPS, a critical care pharmacist with SSM Health Cardinal Glennon Children’s Hospital in St. Louis. When his hospital saw a recent surge in illnesses among patients using THC-related vaping compounds, some of his colleagues weren’t aware these products were linked to lung injuries because of the solvents and vitamin E they contained. If patients are admitted with severe lung illnesses and are intubated and can’t speak, Dr. Mays and colleagues play detective, eliminating potential causes or ordering urine toxicology screens.

Justin Reinert, Pharm.D., BCCCP

In an effort to address e-cigarette usage in his area, Dr. Reinert is directing a two-fold intervention. Pharmacists and doctoral pharmacy students are providing educational in-services and assemblies in local schools, as well as surveying high school students about their use of nicotine products. Then, beginning this fall, pharmacy students will provide nicotine cessation programs in schools, targeted to high schoolers who may have violated a tobacco or nicotine use policy.

Among over 100 students they surveyed so far, about 78% reported using these products, said Dr. Reinert, an ASHP member since 2013. “Students are primarily into vaping, but it’s important to be cognizant of other things out there,” he noted. “Kids are still smoking cigarettes, they’re still using cigar wrappers for marijuana. The addictive component of the devices remains nicotine.”

Dr. Reinert tries to use shock value to educate the students, asking how many of them who drive and pump gas would stick the gas nozzle into their mouths and inhale. “There are components in these vaping cartridges that are identical to components of unleaded gasoline—lead, mercury, nickel, cadmium and heavy metals, etc.,” he said. “The students have no idea, which is terrible, but it also highlights the need for targeted education at this age group, which I think pharmacists are uniquely positioned to accomplish.”

Strategies for pharmacists    

The pharmacists offered advice on working with adolescent patients and their families:

  • Take an objective yet compassionate stance. “Don’t tell them they’re [doing something] wrong,” Dr. Novak said, as that can cause the patient to shut down and not disclose information. Instead, acknowledge that they may have made an unhealthy choice but keep the lines of communication open. “Your job is to treat the patient and make them better, not ridicule what they were doing that brought them in,” added Dr. Mays, an ASHP member for the past 10 years.
  • Put your message in terms relative to adolescents. Dr. Reinert’s cessation curriculum discusses the financial, health and psychosocial ramifications of nicotine use at a level appropriate for adolescents, not adults or younger children.
  • Offer resources for quitting. Educate adolescents that, similar to cigarettes, it’s hard to quit cold turkey, Dr. Mays noted. Encourage them to seek appropriate help through their pediatrician or another primary care provider, and work with them to develop a plan.
  • Try to talk to the patients without their parents. Patients may not want to fully admit to using these products, especially if their parents are present, Dr. Mays said.
  • Keep current on your knowledge. People tend to think JUUL devices are the e-cigarette of choice for teens, but new ones are popping up all the time, said Dr. Mays. “You have to stay trendy with what’s going on in a teenager’s mind,” he added.

Patient impact

Vaping devices essentially are nebulizers that deliver a drug, Dr. Novak said. But they haven’t yet been adequately studied to determine what products should go in them, what the safety margins are, or if chemicals put into them are altered by heat that the devices generate. Hopefully, with time, she said, the medical community will learn better safety information about these devices and their related products.

Meanwhile, pharmacists should stay involved, such as working with ASHP to advocate for more regulation around vaping and nicotine products. “The more we can do this on an individual level, whether in our own institutions, providing education or working with poison centers, we can make a pretty positive impact wherever our patients are,” said Dr. Novak.

 

By Karen Blum

 

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