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The APhA Academy of Pharmacy Practice and Management (APhA–APPM) has officially launched Special Interest Groups (SIGs) for Medication Management, Nuclear Pharmacy, and Preceptors as the move to transition to the new Academy structure continues.
Members can opt in to any of these SIGs for networking opportunities and work on potential projects. Several other SIGs are in various stages of development.
The following thoughts will be published as my January 2012 editorial in Pharmacy Today.
We all know about the fight-or-flight response from pharmacology class. When threatened, though, the turtle exhibits a third response—retreating into its shell and waiting for the world to get better on its own. The ostrich, head in sand, provides another passive option for dealing with problems.
As pharmacists move into the pivotal election year of 2012, we have much to feel threatened by. Whether health care reform survives the Supreme Court and the presidential election, the inexorable wheels of change will continue turning in our professional world. As they do, we have a number of responses we can take, some more effective than others.
We can disengage from the conversation surrounding changes in health care, retreat to our caves, and hope the storms will pass, or just go through our daily motions as if nothing is happening. But what will those options achieve? As one of the mice in Who Moved My Cheese said, “I guess we resist changing because we’re afraid of change.” That’s true, but do we want to be sitting around in a few years talking about Old Cheese, or feasting on the New Cheese we’ve found?
APhA members are laser focused on finding and, when needed, fighting for the New Cheese. We see opportunity in change. We work together well, and we are capable of leading from where we stand. I’m proud of members like Sandra Leal, a Tuscon, AZ, pharmacist we featured in last month’s mini-profile in Today’s Pharmacists in Action section. She singlehandedly launched a change.org petition asking for the federal government to recognize the knowledge and capabilities of the nation’s third-largest profession by making pharmacists eligible to bill for clinical services provided to Medicare patients. Just 5 weeks later, she had nearly 13,000 signatories to her petition, including pharmacists, physicians, other health professionals, and patients. That’s the kind of response to change that characterizes APhA members. That’s leading from where you stand.
Leal’s zeal for change won’t take root without strong advocacy from organized pharmacy. We need your strength and your numbers to succeed as your advocates! The largest association of pharmacists in the world, APhA has grown well above 60,000 and our average member’s age is younger. We need your support now—that of people who care about pharmacy and want to make a difference in years to come. When we talk to Congress about provider status, we need stories and we need numbers. It will be a fight, but it’s a fight we can win if pharmacists across America are willing to support the effort. Whatever other New Year’s resolutions you’re working on this year, please add this one to your list: I will support my profession by joining and getting involved in APhA, my state association, and another pharmacy group that supports my practice setting.
In turn, and along with the incredible APhA staff team, we promise that we will make the most of APhA members’ time, money, and energy as we fight for a better world for pharmacists.
This is a busy time for pharmacy, especially for those in community practice who will barely have time to catch a breath as patients rush to get their year-end meds. Yet we all typically find a few minutes to breathe and reflect.
As we look back on the past year and anticipate the next, I “zoom in” to recalling the many conversations, e-mails, and letters this past year from individuals in all walks of pharmacy who have expressed the full range of emotions about our profession. As we “zoom out” to look at the macro view, we see huge challenges in the economy and old business model for pharmacy, while also witnessing major positive changes in the attitudes of policymakers and those in our colleague professions. And we see pharmacy systems and business changes that bode well for pharmacists and the patients we serve, if we can step up when the opportunities arise. Payers will increasingly turn to pharmacists to help them meet quality goals, and pharmacy employers are really gearing up with new technology, services, training, store configurations, and systems to make the conversion from buy low, sell high to the provision of enhanced patient care.
Yes, we’ve got a long way to go, and that’s where the frustration arises, at all levels. But in this season of thanks, hope, and new beginnings, I look forward to learning from you as we continue our path of advocacy and innovation. We will continue to highlight exemplary practices in our publications and meetings, and we’ll be driving for changes that empower you to provide the kind of care Americans deserve. We must succeed! Our patients are waiting.
On behalf of the staff and volunteer leadership at APhA, I hope you and your families enjoy a healthy, happy and prosperous New Year!
Today I participated in an invitational roundtable discussion on clinical leadership in health care reform at the Brookings Institution, a leading think tank in Washington, DC. The other invitees were primarily physicians from 12 leading physician organizations, as well as nurse practitioners and nurses.
I shared with the group that, while the number of pharmacists in the US is only about one-quarter that of physicians and about one-tenth that of nurses, most Americans are in a pharmacy several times a month and have ready access to us. While we are in an uncomfortable place between building service offerings (medication therapy management) and finding payment for those services, we have a medication use crisis and there are very few incentives to fix that crisis, despite pharmacists being readily accessible and well trained. Also, we typically make a significant number of referrals to our medical colleagues in the course of our practice.
I further shared that I’ve been encouraging pharmacists to “walk across the street” and talk with physician colleagues about their approach to accountable care organizations and medical homes or medical neighborhoods. We should consider organizing joint listening sessions to learn more, and then to discuss in an interdisciplinary way the best approaches to integrated care delivery. It will only change if it changes at the practice level. I also shared that we have a growing workforce, well trained to integrate with physicians in medication management, but that we need help and cooperation among our physician colleagues to build the business models.
We MUST agree on principles for collaborative practice if we are going to avoid the typical turf wars that occur in state houses around the country when one discipline or another wants to change a practice act. And we must create incentives for all. I shared that incentives are not just about driving selfish action, but are primarily about a system describing through incentives the behaviors and outcomes desired.
I shared, too, how the lack of provider status was not only hurting our profession, but also the medical profession and health care in general. If we pursue it, we will face a major war absent up-front agreement in principle, but all have much to gain, as many of the services we provide will likely be done through physician practices and will lead to gains in improved patient care.
We had a chance to discuss each of these points, and I felt there was agreement that all of these topics were worth continued dialogue. I did not hear any disagreement. While there’s no cause for celebration just yet, I think it’s fair to say that pharmacy is at the table.
Thought you’d like to know.
There were several emotive responses to one of my recent blog posts. I read each comment several times to not only get the words, but to put myself in the place of the writers. The general point made was that front line pharmacists face difficult challenges in their long shifts. They have to balance the demands of management, the requests of patients and caregivers, the endless stream of phone calls, and the constant denials and information requests of third-party payers, all while supervising the work of pharmacy technicians and student pharmacists. When I suggested that a large pharmacist employer was pursuing new initiatives, several folks took issue.
At this time of thanksgiving, I’m grateful for these comments and have great respect for the perspectives of my colleagues. It wasn’t that long ago that I was there. At different times in my career, I have been an employee, a manager, and an owner. As an employee, I too sometimes felt I didn’t have the help and support I needed. Even in management and ownership, life as a pharmacist can be challenging, and at times overwhelming.
Despite our challenges, I hope we can all see that we have the talent, insight, and innovative spirit to create a better world. My sole purpose in sharing my observations was to stimulate others to think about their own opportunities. Change is never easy, and we all know how hard it is, for example, to add immunization services on top of everything else we do as pharmacists during our 12-hour shifts. MTM programs take time to develop and even more time once implemented. But we know—somewhere deep inside—that while we continue to dispense safely and accurately, our pharmacy services must grow. “Buy low, sell high” is broken. Margins will never get better on either brands or generics. Chains, independents, and specialty pharmacy owners need to find other ways to pay for the services we know patients need. While we fervently pursue recognition and value (read “compensation”) for our services, we must embrace technology and certified paraprofessionals to give pharmacists the time needed to develop new services and new skills for the pharmacy workplace of the future, if we are to have a relevant role there.
As I wrote in Chain Drug Review earlier this year, we in pharmacy are in an uncomfortable place. Times are challenging, and we’re not yet where we need to be. We have the opportunity to be the disruptive positive force in health care. We have the skills and ability to address the medication-use crisis in this country. I hope we can continue to talk about our profession’s internal challenges while simultaneously pursuing change in the system to allow us to practice the way we’ve been trained. We have a bright future as a profession. The question is not whether change is real or inevitable—it’s how are we going to manage that change.
I recognize these challenges and those faced by those who commented about my blog. I hope we can all focus our passions on positive change. We need all pharmacists as members of APhA, and I wish everyone could attend one of our meetings to see people being the change they want for our profession.
It’s not easy, and APhA will be there to help with this transition. The tide is rising and people are noticing. If we can keep our boats intact as we navigate these rough waters, we will all find ourselves in a much more comfortable place than many imagined.
Happy Thanksgiving, everyone!
As I’ve visited and talked with pharmacists all over America, I’ve learned that there are many delivery models for medication therapy management (MTM). I visited one novel operation on October 26 in Gainesville, FL, where the University of Florida College Of Pharmacy operates a freestanding business and simultaneously trains students to deliver comprehensive medication reviews under contract with a major benefits manager. (Pharmacy Today profiled the program in February 2011.)
Dean Bill Riffee and David Angaran, Director, Medication Therapy Management Call Center, hosted me. I met with the MTM team, including Heather Hardin, Teresa Roane, Anna Hall, and Michele Lawson. I also heard from Karen Whalen, Vinita Patel, and Kim Barimo (a student and veteran of the program).
Students from the University of Florida rotate through the call center on 10-week rotations, with the first 2 weeks spent in training and the remaining 8 weeks spent telephonically conducting approximately 80 comprehensive 45-minute medication reviews with patients referred to them by their health plan client. Students are monitored and supervised by pharmacists and faculty, and numerous techniques are employed to ensure effective oversight and excellent service. The supervising pharmacist can be summoned by the student through various “channels” that allow everything from a back-channel “chat” to the pharmacist taking over the call if issues arise beyond the student’s capabilities.
These intense interviews teach many aspects of patient care, while establishing a relationship between the student and the patient. At the same time, early results suggest great outcomes in working with the most complex patients in the plan’s program. I look forward to hearing more as results get published.
Recently, Megan Sheahan, Michelle Fritts, Erika Trevino, Olivia Putman, and I visited a CVS Caremark pharmacy in the Dupont Circle neighborhood of Washington, DC, where I received my annual influenza vaccination. We had a chance to see their advances in patient care, including numerous systems upgrades to assist pharmacists in identifying, monitoring, assisting, and documenting patient care activities and outcomes.
The CVS team of Papatya Tankut, Cherise Wilson, Scott Staso, and Rosaline (Rosy) El-Khoury showcased recent patient care initiatives the company has implemented to allow pharmacists greater opportunities to interact with patients and prescribers. CVS recently rolled out the Pharmacy Advisor program, an initiative aimed at strengthening pharmacy care for diabetes patients. A patient savings program had been implemented to automatically prompt the pharmacy technician to engage a patient in the potential savings of an equal and alternate medication; once authorized, the pharmacist would then engage the patient’s physician about the medication switch. To address problems with adherence, the pharmacy also had implemented ReadyFill, a free opt-in program that allows customers to sign up to have their maintenance prescriptions filled automatically, and receive a phone call from CVS to remind them that their medication is ready to be picked up.
Getting immunized at CVSIn addition to all the medication adherence programs CVS has recently rolled out, this particular location alone had delivered more than 200 influenza vaccinations this season, just by the time we visited the pharmacy in early October. To promote the effort of pharmacist-administered influenza vaccinations, I was pleased to pay for and receive my very own vaccination from CVS’s pharmacist Rosy.
By improving patient engagement through enhanced interactions, pharmacists have created new ways to improve clinical care and provide counsel that can improve adherence. By using increased technology and maximizing the use of pharmacy technicians in the pharmacy, CVS pharmacists are improving the health of patients while lowering the overall cost of health care. It’s clear to me that the organization is taking enhanced pharmacists’ services seriously.
What’s even more exciting is that we’re seeing many organizations commit to a service model, rather than continuing to rely solely on dispensing fees. There will be fits and starts, and there will be pain as we seek reimbursement for services rendered (see my November 2010 Pharmacy Today editorial “Getting Above the Storm”). But I’ve never seen so many organizations and individuals working so hard to establish pharmacists’ services as a major component of their business as I did during this American Pharmacists Month (APhM). And seeing policy makers taking us seriously serves as a great motivation to keep the momentum!
On Monday, President Obama signed an executive order directing FDA to take steps to curtail prescription drug shortages. Highlighting the potential serious and growing threat to public health, the order focuses on getting manufacturers to provide FDA advance notice of shortages, accelerating FDA regulatory reviews for drugs that can help with existing or potential shortages, and requiring FDA to report drug stockpiling or price gouging related to shortages to the Department of Justice for possible prosecution.
APhA is very concerned about drug shortages and their effects on patients. APhA supports both FDA’s work on addressing drug shortages as well as the American Society of Health-System Pharmacists’ (ASHP) efforts in leading pharmacy on this issue. Additional information on drug shortages is available on FDA’s and ASHP‘s websites. For more information, read these articles on APhA’s pharmacist.com:
• Obama executive order addresses shortages
• Drug shortages bill considered by Congress
Trustee Dan Buffington of Tampa was interviewed on local television about the shortage issue as part of the ABC affiliate’s coverage of the presidential order. In the segment, Dan provided a broad overview of the shortage problem, and Brian Coleman, pharmacy buyer at Florida Hospital Tampa Bay Division, told viewers about the impact of the shortage on patients at his facility.
My thanks to APhA staff member Diana Yap for actively monitoring the release of this information and Tiffany Bridge for live-tweeting as HHS Secretary Sebelius, FDA Commissioner Hamburg, patient Jay Cuetara of San Francisco, and pharmacist Bonnie Frawley of Boston were speaking in advance of signing of the executive order.
Recently, some high-profile, controversial comments were made regarding automated dispensing technology and the role of community pharmacists.
On the surface, it may seem that comparing an automated machine with a real, live human is just about efficiency. But these comments are just one piece of a much larger conversation about how we can increase accuracy and reduce medication errors through the adoption of empowering technology and thus allow pharmacists to do all the great things we can do to improve patient care.
The reality is that, as all pharmacists know, machines are only as efficient and accurate as the humans who program and use them. As our colleagues at the National Community Pharmacists Association point out, there are many things pharmacists can do, and are doing, that a machine simply cannot. While nearly all pharmacies in America use Certified Pharmacy Technicians to hand prescription medications to patients, others use mail carriers. All pharmacies use pharmacists—and only pharmacists—to provide patient counseling, and often to each others’ patients.
Community pharmacy plays an important role in patient care. Pharmacists are more than just medication dispensers, or as aptly put by a major chain CEO in Monday’s Wall Street Journal, we’re about more than pills in a bottle—we’re about improved patient outcomes:
Community pharmacies are handling dramatically increased volumes by adopting enhanced technology, employing and training highly qualified technicians, and adopting systems to identify opportunities for assisting prescribers in recognizing opportunities to optimize therapy. In short, there’s more than one pharmacy in America that is focused on accurate dispensing and making difficult calls to prescribers.
At APhA, we are here to work for you by doing the following:
The conversation about how to decrease medication errors is an important one that must continue. Automation technology is an important tool that can increase accuracy and keep patients safer. However, it’s just an adjunct, not a substitute, for the judgment, training, and care of patients’ most accessible health care provider: their pharmacist.
We have many friends in our continued efforts to raise public awareness and improve public health with higher immunization rates. Today, we read a blog post from Dr. Bill Schaffner, President of the National Foundation for Infectious Diseases and a physician leader, which calls for collaboration among physicians and pharmacists to increase vaccination rates. Here’s a tip of the hat to Dr. Schaffner!
Dr. Schaffner’s blog post reminds us of the essential need to keep our patients’ needs as our focus. If we continue to do so, we will only see growth in this kind of support. Health information technology will assist in this growth by allowing the sharing of immunization information between pharmacists and physicians, thereby better coordinating patients’ care. This shouldn’t be a turf war when we have many individuals going around unprotected and vaccine sitting idly on shelves. At the local level, we encourage all pharmacists to continue the dialogue with physicians and other immunization stakeholders regarding the role that each of us can and does play in improving the public health of our communities.