Is your pharmacy an outpost?

August 28th, 2010

Recently, I received an e-mail from a new practitioner whose family I’ve known a long time. This young pharmacist was frank enough to share the following observation with me:

About ways to improve my chain pharmacy, I think one of the main components that is missing is professional connection. I think a lot of pharmacists like me feel isolated out in the field, with no one to bounce ideas off of except your partner. Maybe my chain could hold continuing education programs or meetings within the market to discuss pharmacy issues so that the pharmacist has the opportunity to build relationships with other pharmacists who do the same job. I think that hospital pharmacists get this already because they are in daily contact with health care staff, whereas the community pharmacist usually works solo.

Here’s what I shared with this new practitioner:

I hear your comments about feeling isolated as aspirational—you aren’t complaining, but rather aspiring to find a better way, and you’ve got some ideas about how that could happen. Your view is your own, and you are entitled to it. As you consider how you might lead change within your organization, acknowledge other perspectives too. It makes your own opinions more influential. But you don’t need a title to lead. With the right approach, and if others feel the same way, you can make a difference.

Also, when I was in chain practice, and for that matter when I practiced by myself in my Medicine Shoppe, I found my connection to my peers when I was in practice first through my local (Huntington) association, the Southern West Virginia Pharmacists Association, through the West Virginia Pharmacists Association, and through volunteer groups. From there, I got involved in APhA and have really enjoyed all aspects of our profession through those venues.

As I’ve thought more about my response to this new practitioner, I might have also shared that I recognize how busy folks are just living—raising a family, having a life outside of work, paying new bills or a mortgage, or helping aging parents. I hear from many that their employer doesn’t give them time off or pay their way to meetings. Clearly, in my role today, I’m a fan of employer-supported professional activities. However, there is room for another way of thinking. I submit that not having employer support is not a reason to drop out of or not participate in the profession. Every networking opportunity can teach things that may help in a career or may help in the care of patients. Local association meetings, state association meetings, and our own APhA Annual Meeting & Exposition are tremendous ways to learn (or teach) how others’ experiences can help you grow as a professional. There are also tremendous networking opportunities on the Internet. You can find many of them at Pharmacist.com

I’ve also seen major growth in the professional opportunities available to pharmacists, often through their employers, for certificate programs or other ways to differentiate oneself in an increasingly competitive job market. We at APhA try to do our part to create those opportunities. While it’s not always possible or available, we get industry support for these programs when we can to help pharmacists lower their costs of participation.

On Tuesday of this week, I had the privilege of participating in the Duquesne University Mylan School of Pharmacy White Coat Ceremony in Pittsburgh. I gave a speech to 2010 first professional year pharmacy students and their families. It was a wonderful opportunity for me to feed off their energy, and hopefully I helped Dean [Dr. J. Douglas] Bricker and his team at Duquesne launch a new generation of professionals in the right way. During a faculty and leadership dinner, I also gained some insights into programs that the school is engaged in. I invited some folks to write to me about their experiences so I could share them. I hope they took me seriously.  

Finally, I also looked this week at the lineup of educational sessions being planned for the 2011 APhA Annual Meeting & Exposition in Seattle this coming March. Thanks to the many volunteers who have worked with our staff to develop what I can only describe as a phenomenal array of opportunities. I truly hope you will join us as you continue on your own professional path. You won’t be sorry.

Honoring women in pharmacy

August 26th, 2010

Last week, I received an e-mail message from Bill Ellis, the head of the APhA Foundation. He pointed out the opportunity to participate in honoring Women in Pharmacy. Many of you may have received the same message. I’ll quote a bit of it below, along with the links that help you connect if you’re interested.

I was proud to be one of the early contributors to the cause, and I encourage you to do the same. My good friend Karen Reed will help you out if you contact her via the email address below. This initiative got me thinking about Sarah Haverstraw, the first female pharmacist I knew, who practiced at Phillips Pharmacy in Sistersville, WV. She was a wonderful mentor to me.

Women have played an increasingly prominent role in the evolution of pharmacy and currently impact virtually every area of the profession and continue to be an increasingly powerful force in healthcare. While we cannot recognize the numerous contributions made by each and every woman who has positively impacted the practice of pharmacy, we can collectively recognize their contributions by establishing the Conference Room within APhA Headquarters on the 6th floor, overlooking the Lincoln Memorial.

The recently launched fundraising campaign is the first of its kind: created and run by APhA members who are all women pharmacists. This is your opportunity to recognize the female role models, mentors, trailblazers and innovators who have influenced or supported your career in pharmacy:  your professor, teacher, wife, mother, supervisor, colleague, sister, or yourself!

For more information, to donate or volunteer, please contact Women in Pharmacy Conference Room chairperson, Karen Reed, who can be reached at klr@suddenlink.net,  304-255-0766, or online at www.aphafoundation.org. The first 250 contributors who donate $1,000 or more will be named and recognized as Founders of the Women in Pharmacy Conference Room.

Looking for patients? Get your MTM practice “on the map!”

August 19th, 2010

Several of my recent blogs have shown how consumers and the marketplace are warming to medication therapy management (MTM). If you’re ready to make the connection with real patients, then we have a website you need to see.

APhA and the Academy of Managed Care Pharmacists have teamed up to create a locator map that shows MTM practitioners in every state. Don’t be a needle in the haystack—make yourself easy to be found by managed care, patients, and other pharmacists who want to learn how you’re doing it.

Below, I’ve provided easy steps to get yourself on the map! What are you waiting for?

APhA and the Academy of Managed Care Pharmacy offer a great way to “get connected” through the AMCP/APhA MTM Connections®. APhA member pharmacists are able to create a profile so that managed care insurers who contract with pharmacists to provide MTM can identify and contact them. Pharmacists can search the database of managed care payers to identify the names and contact information of payers contracting with pharmacists in their state. The site also offers a database of searchable annotated bibliographies of published articles and reports on MTM and other patient care services.

Being listed as a pharmacist provider in the AMCP/APhA MTM Connections® database is a valuable APhA member benefit!

APhA member pharmacists can register their profile by:

  • Logging-on to MTM Central located at www.pharmacist.com/MTM
  • Clicking on the AMCP/APhA MTM Connections® icon in the Featured Items Section (right hand column of main page)
  • Clicking on Create a New Profile (Pharmacist)
  • Entering  your APhA Member ID
  • Completing all requested information
  • Hitting submit

Not an APhA Member?  Not a Problem?

  • Join APhA today by visiting www.pharmacist.com/join
  • Go to AMCP/APhA MTM Connections® as above
  • When completing profile check box for “Awaiting new APhA Member ID”

Trifecta: Pharmacy is pouring it on

August 16th, 2010

If the two New York Times articles I blogged about recently were not enough, now comes another very positive mention of pharmacy in the media. This third article in our trifecta is not from the consumer media—it’s directly from the American Medical Association (AMA).

In a posting today on the website of American Medical News, Ardis Dee Hoven, MD, Chair of the AMA Board of Trustees, writes: “The AMA recognizes the important contributions that pharmacists provide to patients in institutional and community settings, and at [a recent] meeting, it was evident that our pharmacist colleagues saw value in developing further collaborative partnerships with us in drug and disease management.”

I’ve previously shared information about our work with AMA on Collaborative Drug Therapy Management (CDTM) agreements, and this editorial is just the latest—but not the last—fruit from our efforts. Hoven recounts in her article how CDTM has worked so effectively in hospitals and clinics. She cites her own experiences in Lexington, KY, as an example:

“Every day in the hospital and other controlled settings, such as my own outpatient HIV clinic, physicians and pharmacists work together, and we value those relationships. In the community, some of us also participate in both formal and informal collaborative practice agreements, and have for years. These agreements can, but do not necessarily, include management and monitoring of medications, patient counseling and adherence counseling.”

Such efforts need to be extended in the community, Hoven writes, because “50% of patients may not take their medications as prescribed, and as many as 25% never fill their prescriptions.” She adds: “This, of course, ricochets back onto physicians and hospitals, with costs estimated at more than $100 billion in caring for people who get sicker because they did not obtain their medications or did not follow their prescribed treatments.”

Our hats are off to all the pharmacy practitioners who had a hand in creating this spate of positive news, including those who work with Hoven in the Bluegrass Care Clinic. As an association, our job at APhA is to call attention to the great things pharmacists are doing every day, promote those good works to others, and advocate for a system that recognizes pharmacists’ contributions. You make it easy!

If you’re not already an APhA member but you believe in this mission, we hope you’ll join us today. The future for pharmacists is bright, but not certain. With your help, the voice of pharmacy is collectively that much stronger. Do your part today, so that we can be even more effective in ours!

Doubting pharmacists, read on

August 16th, 2010

For any pharmacist in America who is not convinced that APhA and our profession are on to something by training thousands of pharmacists in medication therapy management (MTM), take a look at this New York Times article published this weekend.

“Pharmacists Take Larger Role on Health Team” describes from a consumer’s view what folks are seeing increasingly in pharmacies throughout America. I wish I could just paste the entire article into this blog—it’s one of the best presentations in the mainstream media of pharmacy’s new services that “reflect the expanding role of the nation’s pharmacists in ways that may benefit their customers and also represent a new source of revenue for the profession.”

The article focuses on Barney’s Pharmacy in Augusta, GA, where owner Barry S. Bryant and pharmacist David Pope offer classes on managing disease with medications, diet, and exercise. The pair have created their own education company, CreativePharmacist.com, to teach others how to begin offering such services, the Times reports.

Reporters Reed Abelson and Natasha Singer, with whom APhA worked for some time to provide contacts and sources, also interviewed Fred Eckel, Executive Director of the North Carolina Association of Pharmacists, about the Asheville Project, and Michelle Chui, of the University of Wisconsin–Madison, who “said that pharmacists do not want to compete with doctors, but merely provide more information ’so the physician has a more in-depth picture.’”

Abelson and Singer wrote, “This evolving use of pharmacists also holds promise as a buffer against an anticipated shortage of primary care doctors.”

A photo with the story shows pharmacists Brittany and Stephanie Bryant leading chair aerobics classes at Barney’s Pharmacy. In a second article in the Times, Singer describes the two generations of Bryants who work at this pharmacy, including dad Barry, those two daughters, and their older sister, Vanessa Hoffman.

Hats off to those pharmacists, pharmacies, and health plans profiled in the stories.  We’re proud of you!

Finding something in nothing

August 12th, 2010

Nothin’ from nothin’ leaves nothin’
You gotta have somethin’
If you wanna be with me
Nothin’ from nothin’ leaves nothin’
You gotta have somethin’
If you wanna be with me

A few (well, maybe more than a few) years ago, Billy Preston sang the above song. The lyrics came to mind during a staff discussion yesterday where APhA staff was discussing blogs, comments, and a pharmacist.com article about a program at a major food chain that provides at no cost a small number of antidiabetic drugs.

Contrary to the “nothin” this deal implies, I believe we pharmacists “have somethin” that can make patients “wanna be with us.”

Comments and blogs are raising concerns about the “devaluing” of pharmacists when prescription medications are given away. In recent years, we have seen more and more stores instituting discount programs with the stated goal of improving patient access to medications. The intent—and I’m sure often the impact—of these efforts can be laudable when persons who cannot otherwise afford their medications get the right medicine to meet their needs. But the real value arises when patients get the full benefit of their pharmacists’ counsel and the best information and advice available about how to use these medicines.

The other expressed concern I’ve read in the blogs and comments is that these programs devalue the role of the pharmacists and affect patient safety by encouraging “pharmacy shopping.”

As members of the pharmacy profession, we know that access is a component of appropriate medication therapy and that every day, thousands of patients are served by dedicated pharmacists working to ensure that all patients have the medications they need and know how to use them.

Pharmacists not only dispense the right medication, but very often, we help patients navigate the health care system, serve as referral sources when problems arise, and provide essential information and advice without which many would not do nearly as well with their therapy. We also know that equally important to access is making sure that the patient is taking the best medication to meet their individual health care needs. When a medication is free, but isn’t the right medication, then the price is too high. The drug product may be free, but the opportunity is lost to control the patient’s diabetes, and that will almost certainly lead to other unnecessary health care costs and a shorter, less healthy life.

Making a determination of whether a medication will best meet the needs of a patient requires a comprehensive review of a patient’s entire medication regimen whenever a new medication is added or changed. The effectiveness of a medication review becomes more challenging anytime patients use more than one source to obtain medications. It’s a fact that many patients move from pharmacy to pharmacy on their own. As economic pressures grow, this dynamic also grows and we see more patients “shopping.” So the challenge we face is managing this growing dynamic.

This is not a new conversation for APhA. We have several policies that to one degree or another touch upon these challenges, the most recent of which was debated and approved in our 2010 House of Delegates. That policy states, “APhA advocates the elimination of coupons, rebates, discounts, and other incentives provided to patients that promote the transfer of prescriptions between competitors.”

In this hypercompetitive world, where market share is so important, I can’t put APhA in the position of criticizing business decisions. I don’t “make stuff up” about why a company promotes one way or another. We have members on all sides of this equation. Rather, our challenge as a membership organization with a public mission to Improve Medication Use and Advance Patient Care is to inform, educate, and advocate so that pharmacists will practice in a world that values their services and where patient safety is the absolute top priority.

A study published last year in Circulation showed veterans were more adherent to their lipid-lowering medications when copayments were lower. So, yes, economics 101 works for medications. But even when the medications were free, a substantial number of patients were still not adherent. Cost is not the only factor.

We must be vigilant in our message to patients: Wherever they obtain their medications, they must talk to their pharmacist. And finally, we must be vigilant with ourselves: We must talk with the patients whom we serve.

APhA works every day to promote the value of pharmacists’ services to whomever will listen—legislators on Capitol Hill, consumers groups and staff in government agencies, payers, PBMs, and others. We support efforts to expand patient access to medications. Medications play an important role in managing and preventing disease. The value of those medications (regardless of the cost to the consumer) increases when patients take advantage of the dispensing and clinical services of their pharmacist and benefits from the medication expertise this health professional provides.

The part about this issue that I like most is that the chain involved, Giant Eagle, is one that is ensuring patient access to a pharmacist trained in diabetes at every one of its pharmacies. This is a great step toward improving the care provided to patients with diabetes. Giant Eagle is on to something with this valuable MTM program. But giving the drugs away for nothing could well send the wrong message about medication therapy and those pharmacists who work hard every day to manage it.

Footnote – APhA is working with 9 other pharmacy organizations to lead the development and approval of a standard data set that will allow pharmacists to play an even more relevant role by receiving and writing into electronic health records across enterprises (hospital, lab, medical offices, chain, independent, mail) so even when patients shop multiple pharmacies, pharmacists can do their best to manage patient care with full knowledge of a patient’s record. More on that later….

Medication therapy management: Patients will reimburse you

August 9th, 2010

If you are wondering what your next strategic move should be in your community pharmacy practice, and if you are not currently providing medication therapy management (MTM) privately to patients, I have a testimonial to share with you from one of our members. This information is applicable whether you practice in chain, independent, ambulatory care, or clinic pharmacy, or see patients every day in some other type of pharmacy.

I am moved to share this quotation from a member with you because it is concise and speaks to a couple of the FAQs I get when speaking to pharmacists about starting their own MTM practice—part time or full time.

What about physician support? Will patients pay fair office fees?

Dr. MA e-mailed this to me yesterday after referring Mr. M to me:

“Mr. M is a lovely person (so is his wife). You can do so very much for them.

“Glad you are with me on this case. M”

This physician has asked me about my rates previously. She was kind enough to include an estimate of my fee in the conversation with her patients. I say kind because we have grown a respectful relationship. She wanted to know my rates so she would not misspeak. How many times have physicians misquoted a prescription price, leaving us with egg on our faces?

When a physician refers MTM patients to us in this way, the patients are ready to go by the time they call us. No PR needed. If they call with a realistic price in mind, the question about fee disappears.

When Mr. M spoke with me, he did not ask questions (not that I mind them). He said with determination, “I want a thorough assessment of my medicines, including drug interactions and any education you think that I need. So let’s schedule it.”

I wanted to share this because a version of this happens to me all the time.

Physicians are ready for us to participate. Consumers are ready to pay appropriately for it out of pocket!

When I did my homework to decide on fee level many, many years ago, I wanted my fees to approximate what I have to pay my lawyers, accountants, and architects. Do not undervalue the importance of pharmacology in today’s world.

There is no longer any need to hold off starting your own MTM practice, even with one or two cases a month.

I totally agree with this pharmacist. With the passage of the Affordable Care Act, changes are coming.

Your first move could be as simple as having a professional sign printed that offers your medication review and counseling services on appointment for a stated fee. I’ve been suggesting to pharmacists that it’s time to connect with local physician practices. Talk with them and their management about ways to respond as medical homes begin getting “built.” Talk in concrete terms, in many states via a collaborative practice agreement, about how you can support their practice and help keep their patients on their medicines.

How can you share medical records for the benefit of your patients? Your pharmacy management system vendor may be able to help, as can the practice management system vendor for the prescribers you talk with. Approach the company in a collegial way.

You have a lot to offer! As anyone in practice knows today, it’s a competitive world. If you don’t make the connection soon, someone else might.

Medication adherence: Raising consumer awareness

August 5th, 2010

For years, I’ve heard pharmacists say things like, “If patients only knew…,” meaning that if consumers only knew what we as pharmacists have to offer, we would be overwhelmed with support and payment for our services. If every pharmacist in America were an APhA member, we would have the resources to mount a major consumer campaign on our own. The challenges of cutting through all of the noise in consumer advertising would be hard to overcome, but at least we could try to reach every patient with important messages about their medications.

One of the ways we try to get the word out about pharmacists’ value is through coalitions such as one organized by the National Consumers League (NCL). This group is leading a multiyear campaign to raise awareness of the importance of good medication adherence. The campaign targets consumers and health practitioners nationwide.

This national campaign is expected to launch publicly in early 2011. The campaign’s integrated education and outreach strategy will include a mix of communications tactics and vehicles, such as a core-message framework, campaign brand identity, earned and paid media, public service advertising (PSAs), and three interactive websites. The group has a budget of at least $5 million for a 3-year campaign.

Special outreach efforts to people with chronic conditions—particularly cardiovascular disease, respiratory conditions, and diabetes—and to health practitioners will enhance the reach of the campaign.

NCL has brought together APhA and more than 100 public and private stakeholder organizations, including health practitioners, caregivers, employers, researchers, government agencies, and patients to plan, develop, and implement the campaign. AHRQ, the U.S. Agency for Healthcare Research and Quality, has provided planning support for the campaign.

GMMB, a full-service strategic communications firm specializing in issue advocacy and cause‐based campaigns, was hired to administer the campaign.

The campaign-planning process has featured three main elements: stakeholder meetings, research, and working groups. The three working groups are developing and informing campaign strategy around chronic condition and health care practitioner outreach, as well as evaluation:

Chronic Condition Outreach: This group’s objective is to identify how best to convey the messages and tools of the campaign to those with or closely affected by chronic conditions. Criteria developed by this group identified cardiovascular disease, respiratory conditions, and diabetes among the primary target conditions. This working group will identify and collect information about tools that promote and improve adherence, and establish the criteria and process for vetting these tools. Cochaired by Brenda Hindle (American College of Cardiology) and Ray Bullman (National Council on Patient Information Education—APhA is a founding member).

Health Care Practitioner Outreach: This group’s objective is to identify how best to build campaign awareness among health practitioners before and during the campaign, and how to prepare practitioners to support patients to be more adherent. This group is collecting adherence resources and tools for health practitioners to help them gain a better understanding of adherence. Cochaired by Laura Cranston (Pharmacy Quality Alliance—APhA is a founding member) and Donna Sweet (American College of Physicians).

Evaluation: This group’s objective is to identify the best mechanisms to evaluate the campaign’s impact and effectiveness, in addition to assessment of the campaign’s reach and impact by GMMB. This group is developing a campaign evaluation design. Cochaired by Lee Rucker (AARP) and Gary Persinger (National Pharmaceutical Council).

APhA will be working closely with NCL on this important effort. I encourage all pharmacists to do the same.

How to care for 30 million more patients

July 23rd, 2010

That was the title of an opinion piece published on July 19 in the Wall Street Journal (subscription required). We all have Dean Pete Vanderveen of the University of Southern California School of Pharmacy to thank for this very succinct, articulate viewpoint.

Dean Vanderveen describes to the world what many of us in pharmacy have been saying—that pharmacists can play a major role in the provision of primary care, especially for the millions of new folks who will be enrolled in health plans as the Affordable Care Act is implemented. You may recall that we met last summer with the White House to pitch pharmacists’ role in primary care, and we’ve continued to work with medicine to ensure there’s no worry regarding “scope creep.” We are emphasizing that our goal is to improve patient care, not usurp physician authority.

To quote Dean Vanderveen, “Pharmacists are not spoiling for a turf war with physicians. The two professions already team up under ‘collaborative practice’ agreements as in Asheville and Los Angeles that clearly define what the pharmacist can and cannot do.”

For our part, we’ve got a lot of work to do if this vision is to become a reality, but we’re working on it. I believe we are doing that as collaboratively as possible.

I would love to have more examples like the ones cited in the opinion piece that describe the safety-net clinics in major metropolitan areas where physicians, pharmacists, and nurses are teaming up to improve care and lower costs in a world where the medically underserved address chronic homelessness, low literacy, and unemployment. Please let us know if you are aware of practice models that are working.

Let’s continue to spread the word about how pharmacists can help fill the gap in the number of primary care providers for our nation’s population!

A glimpse into the future

July 20th, 2010

This past Friday was one of those special days that makes serving as your CEO a real treat. I caught a glimpse of pharmacy’s future, as 180 APhA-ASP Chapter leaders began the weekend-long professional development and leadership training program known as the APhA Summer Leadership Institute.

After kicking off the event with a welcome message, sitting in on the early sessions, and mingling with the student pharmacists during a barbecue at our headquarters, I can confidently say the profession we all cherish will be in good hands down the road.

Enthusiasm was at a high level as the sun set. I sat with many students and listened to their stories about patient care. One young pharmacist from Connecticut told me of her experience in a community pharmacy where she had firsthand experience with overcoming health literacy issues with a family befuddled by their complex regimens. Others talked of how they found pharmacy as their professional goal. Others talked of experiences in cardiac care units, emergency departments, and group projects.

Enthusiasm was evident in their smiles when they told me about the APhA–ASP patient care projects they participate in back at school. I heard excitement in their voices when they spoke of the day when they enter practice and make a difference in their patients’ lives. I even saw it in their eyes as they took in the breathtaking view of the nation’s capital—and the Capitol—from our rooftop terrace.

The enthusiasm of these young people is contagious. I wish I could bottle some of it and share it with all of you. This is the same kind of group enthusiasm that we soak up at our annual meetings. Seeing a microcosm of it this weekend was awesome!

An added bonus this weekend was that several members of the APhA New Practitioner Advisory Committee (NPAC) were in town to lend their expertise to the weekend’s proceedings. If student pharmacists are our future, these recent graduates are the ones leading the way and reporting back that pharmacists are indeed making their mark on health care in this country. I huddled with NPAC Chair Vibhuti Arya (who is profiled in this month’s Pharmacy Today), Chair-elect Brent Reed, and Member-at-large Meghan Sullivan to discuss their goals and objectives for the year. This bright group provided me with food for thought on new membership ideas, improving our communication vehicles, and enhancing the New Practitioner experience at APhA2011 in Seattle.

The New Practitioners asked me a meaningful question. I want to share my answer with you.

“Why should students continue their membership after graduation?” I thought for a moment and responded: “APhA and its members are building a vision around the services pharmacists provide and their impact on patient care. New Practitioners are the change agents in this process. By renewing their APhA membership after graduation, they will be armed with the tools, the skills, and the confidence to be successful as the change agents that pharmacy so vitally needs. New practitioners are the ones who will pollinate new practices into more traditional practice settings. These folks can get continued renewal at our meetings and with the information and programs we deliver.”

I hope those attending this weekend and those of you out there reading this blog believe in this sentiment, as I truly mean it.

This weekend proved to be a memorable one for those in attendance at our Summer Leadership Institute. Kudos to APhA’s Student and New Practitioner Development staff for developing and leading another dynamite program, and as always, a big thank you to Procter & Gamble for their support of this event. And while I am no psychic, I can predict the future looks bright because we have a fabulous group of student pharmacists who are learning all that their schools and APhA–ASP are offering. It is truly great to be able to see tomorrow’s leaders today!