Archive for the ‘Immunization’ Category

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APhM: Visiting CVS for my annual influenza vaccination

Monday, November 7th, 2011

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.

Tom gets his flu shot from a CVS pharmacistGetting immunized at CVS

In 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!

Posted in American Pharmacists Month, Immunization, Pharmacy Practice | 7 Comments »

Physician leader supports vaccinations in pharmacies

Friday, September 16th, 2011

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.

Posted in Immunization, What Tom is Reading | No Comments »

APhA to be featured in NQF case study

Thursday, May 26th, 2011

Anne Burns, our Senior Vice President of Professional Affairs, reports that the National Quality Forum (NQF) has officially accepted a PQA/APhA case study as one of five case studies to be profiled in a national evaluation of the NQF National Priorities Partnership. PQA is a pharmacy quality alliance headquartered in Fairfax Station, VA.

Our case study highlights the work of the PQA Population Health Workgroup (on which APhA representatives Kelly Goode and Brian Hille served as Co-Chairs) and APhA’s immunization program. The submission was selected from 20 nominations overall, and it’s notable that a pharmacy submission is in the mix of accepted case studies for this important quality-related organization. In early May, representatives from NQF spent several days at APhA headquarters to interview PQA and APhA representatives for the case study. We will let you know when the case study is published.

Posted in APhA News, Immunization | No Comments »

More than 147,000, plus 1

Tuesday, April 19th, 2011

The number of pharmacists trained to immunize has recently been increased by one more person—me! More than 147,000 pharmacists have been trained to immunize in the United States. On April 9, I completed my training in Barboursville, WV, in a program licensed from APhA and conducted by the West Virginia University School of Pharmacy Office of Continuing Education.

As APhA CEO, I knew that we had an outstanding program, but had not had the opportunity to complete the training. I was impressed with the rigor of the program. So impressed—that I was the last person to finish the test at the end. The good news is that I passed! I was so relieved that I wasn’t going to embarrass my organization by failing. It just would not have looked good.

Our clinical pharmacist instructor, Dani Dolin, and Adrienne Tucker, did a great job of teaching the 26 participants the material, as well as providing real examples where pharmacists can make a difference. Most of the participants in the program were students rounding third and headed toward graduation, although there were a few veterans who were looking at ways to change their practice to provide greater access for consumers to vaccines.

So, as the most recently trained pharmacist immunizer, I applaud the more than 147,000 pharmacists who came before me for the important work you do every day to promote public health, awareness, and access to vaccines. Keep up the good work!

Posted in Immunization, Tom's Travels | No Comments »

Where’s Tom? Not with Waldo, but on the road

Friday, April 15th, 2011

Last week was a busy week for me. I was on the road promoting business and policy interests.

On Monday, April 4, I flew to Denver for the Department of Veterans Affairs (VA) National Pharmacy Conference. That evening, APhA hosted a reception for attendees. Then on Tuesday, April 5, I participated on a panel with several of my national colleagues, including Judy Cahill of the Academy of Managed Care Pharmacy, Lucinda Maine of the American Association of Colleges of Pharmacy, Mike Maddux of the American College of Clinical Pharmacy, and Henri Manasse of the American Society of Health-System Pharmacists (ASHP). I had the opportunity to paint the broad picture of APhA’s initiatives on the profession’s behalf and collaborations with the other organizations.

Henri announced that his successor at ASHP will be named in the next couple of weeks. I noticed he completed his comments 5 minutes early, so I claimed to be the first to diagnose him as suffering from “short-timer’s syndrome.” This meeting was probably the last time I’ll share a stage with him. He’s a real pro, and an excellent leader.

Following the VA conference, I flew to Philadelphia for the first annual PharmEHR Summit, sponsored by PDR Network. I participated on a panel on the morning of Wednesday, April 6, with Roger Pinsonneault from RelayHealth/McKesson to discuss pharmacists, electronic health records (EHRs), and e-prescribing.

This was a great opportunity to talk with vendors, insurers, and physician groups about the need for pharmacists to be “plugged in” to EHRs as well as the reductions in errors and rework associated with e-prescribing. This invitation was an important component of the growing business relationship we have with the PDR Network and the iHealth Alliance. I had a chance to discuss the “interruptions” that physicians experience in the course of their days related to pharmacy calls about e-prescriptions. When I shared with them that those calls often stop errors, I think they saw their concept of “interruptions” in a new light. I also had a chance to talk about the prospects of practice accreditation with several payers, who saw the effort as valuable. It was a very productive exchange, and I think the alliance is doing excellent work.

From Philadelphia, I briefly returned to APhA on Thursday, April 7, as we wrapped up a half-day Days of Learning session for our staff. Then, we conducted a debriefing on the 2011 APhA Annual Meeting & Exposition and the Board of Trustees meeting before I boarded my last plane of the week for Columbus, OH. There, I surprised APhA President Marialice Bennett at the Ohio Pharmacists Association (OPA) Annual Conference & Trade Show. Marialice was presented with OPA’s highest honor, the Beal Award, for her outstanding contributions to the advancement of the pharmacy profession. This trip was the highlight of my week as I had the honor of introducing Marialice at the awards ceremony where she received her recognition.

The Beal Award is named for James Hartley Beal, a pharmacist–educator who had strong ties to both APhA and Ohio. He was born and educated in Ohio, where he was active in state pharmacy activities. He was also active in APhA, where he ultimately made two significant contributions. He was not only instrumental in the founding of the House of Delegates. He also called for the establishment of “an Association home” to house its archives, library, and a “suitable laboratory for the National Formulary.”

The afternoon of Friday, April 8, after the OPA awards luncheon, I drove from Ohio to West Virginia, where I attended an immunization certificate training program in Huntington. I did my home study on airplanes in preparation for the course and took great pleasure in passing the final exam and the hands-on portion of the training. Now, I can tout that APhA has trained 147,001 pharmacists to immunize.

Posted in Federal Pharmacy, Immunization, Tom's Travels | No Comments »

Stuck in the middle with you

Tuesday, October 19th, 2010

Well I don’t know why I came here tonight
I got the feeling that something ain’t right
I’m so scared in case I fall off my chair
And I’m wondering how I’ll get down the stairs
Clowns to the left of me
Jokers to the right, here I am
Stuck in the middle with you.

—Stealers Wheel, “Stuck in the middle with you”

“Stuck in the middle” is where community pharmacy is right now. Whether you’re a staff pharmacist or management, we’re stuck with each other, so we have to find ways to make it work. The “it” is the challenge we have to meet the public’s growing demand for medications delivered to patients together with information and services to help patients use those medications effectively and safely. Margins on products have dwindled as austerity measures by states are implemented, managed care payers have leveraged purchasing power into lower cost reimbursements, and reference pricing (average wholesale price/average manufacturer price/actual acquisition cost) continues to change. At the same time, we’ve seen training, systems, and demand grow for the provision of pharmacists’ services (medication therapy management, immunizations, and various chronic disease management programs, for example). But demand for services is growing faster than compensation for those services. As a result, pharmacists and their employers are feeling the pinch.

Pharmacists feel it when they’re asked to fill hundreds of prescriptions per shift, provide immunizations on demand, make outbound calls to promote adherence with patients and to do so with less technician help because management just saw another big contract pricing level get cut. And pharmacists are feeling less respected as the supply of pharmacists has increased and employers find positions are easier to fill.

As you know, APhA has members from every corner of the profession, so we hear from all sides about the above challenges. We’re the association of pharmacists—for pharmacists. As your association, we are doing everything we know to advance medication use and improve patient care by creating and promoting new opportunities for pharmacists, from new roles and access as primary care providers to electronic health records (EHR). Access to EHR will improve care and facilitate documentation that will lead to additional reimbursement for our services. We’ve proven that if pharmacists get involved in medication use, quality goes up and costs go down.

We don’t mind being “stuck in the middle with you,” but we’re eager to find solutions that keep our profession growing and relevant to patient care. I’ve talked with enough pharmacists to know the frustration level is rising for those who go home exhausted and unfulfilled. And the urgency is rising as well for those investing in and building the capacity to provide pharmacy services. We all are working to ensure sufficient revenues begin to flow for the services being provided.

One thing we learned in our work in the APhA Foundation with HealthMapRx and the Diabetes Ten City Challenge was that it takes large groups of patients enrolled in programs in a pharmacy to make the services financially viable. Without that critical mass, the cost per service is prohibitive and disruptive to workflow. I believe we’re currently in that middle state. We are growing the numbers to a point where compensation for a specific service can fully support that service, but the process is painfully slow. During this growth period, there will be a lot of grinding it out for both pharmacists and management. We must work together to address workflow and patient safety issues until compensation allows sufficient support staff and pharmacists dedicated to those services. Right now, pharmacists are split four different ways as we build demand for services and promote improved adherence.

I would ask pharmacists to hang in there and to be as constructive and creative as possible to address workflow issues. Management: Please do your best to stay aware of and attendant to the challenges you are asking your pharmacist to meet. Pharmacists only have patients’ best interests in mind.

If readers will send best practices to us, we’ll spread the word so your fellow pharmacists can benefit. As technology continues to facilitate product delivery, our profession must succeed as a provider of services. We will only succeed if we work together.

Posted in Immunization, Medication Therapy Management, Pharmacy Practice | 3 Comments »

Pharmacists continue to gain recognition

Monday, April 19th, 2010

In thanking all immunization stakeholders today at the CDC National Immunization Conference in Atlanta, HHS Secretary Kathleen Sebelius specifically mentioned pharmacists as key providers in the nation’s immunization efforts.

Although we’ve been working for years to get pharmacists recognized, we’ve typically been left out of the list when “doctors, nurses, and other health professionals” were called out. After this past influenza season, it is gratifying to see our key officials beginning to recognize our contributions. At the meeting many individuals have commented on their collaborative work with pharmacists to Mitch Rothholz, APhA’s representative at the conference and our top immunization advocate.

Our work this past year positions us well for continued improved access to immunizations through their pharmacists. The 2009–10 influenza season was notable for the number of consumers who saw pharmacists in a new way for the first time. Sitting with a pharmacist to receive an immunization is a very tangible and real way for consumers to awaken to the possible caregiving roles of pharmacists. While we know we’re not just dispensers, having millions of consumers receive their flu vaccine in our pharmacies helps to make an indelible impression on their psyche that pharmacists can do more than they ever imagined.

Let’s keep up the momentum!

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Should pharmacists immunize?

Friday, August 21st, 2009

A number of pharmacists commented on my blog the other day about novel H1N1 influenza immunizations. Thanks to all of you who responded. This is a great way to have a dialogue with colleagues.

Some of the comments questioned whether pharmacists should immunize in the first place. Let me address a few of the points made to provide some clarity. Pharmacists are not generally “forced” to immunize. However, many pharmacists (80,000 trained in the US by year’s end using APhA programs) have seen both the public health and the professional benefits offered by this service.

In APhA’s discussions with the various governmental entities (CDC, Homeland Security, FDA, others) involved in preparations for H1N1 immunizations, we are seen as equals with other health professionals and also as having tremendous advantages in providing access to the 100 million plus (big number) of Americans who those groups hope will be immunized against H1N1. America needs our help — else the mass immunization program will have barriers that turn people away and people may die.

To answer the question above regarding compensation, see my note above about being seen as equals. This will not be a windfall for any health care providers, but it is an opportunity to bolster our collaborative spirit and to be fairly compensated in the process.

Let’s keep the dialogue going. If you are a pharmacist doubtful of the need or wisdom to become an immunizer, have a conversation with a few folks who already provide this service before dismissing it as a possibility for yourself. As always, thanks for participating in the blog.

Posted in Immunization, Pharmacy Practice | 7 Comments »

Pharmacists are a critical part of vaccine pharmacovigilance

Wednesday, August 19th, 2009

A study from today’s JAMA, while not directed at pharmacists, illustrates our important role not only as immunizers but as information sources for our patients and the public at large. The JAMA article points out that during the first couple of years of marketing of Merck’s quadrivalent human papillomavirus recombinant vaccine (Gardasil), more than 12,000 adverse events (including 32 deaths and numerous other serious adverse events) were reported to the CDC’s Vaccine Adverse Event Reporting System (VAERS) . Based on 23 million administrations of the vaccine since its licensure, this comes out to a rate of 53.9 reports per 100,000 doses distributed, a level that led CDC and FDA to conclude that the vaccine is safe and continued use is in the best interests of Americans.

I see this as a good time to remind immunizing pharmacists of our role as patient information providers. APhA has been promoting and educating pharmacists as immunizers for years. We also maintain the most up to date information on www.pharmacist.com and via the Immunization Listserve. If you are not currently on the list, you can send Mitch Rothholz an email and you will be included.

We also have an important role to play in making sure that our nation’s health authorities have adequate information on which to base their decisions. Without that, the products that we supply and administer to our patients could be the wrong ones, and our long-term credibility as the drug experts on the health care team would be in jeopardy. Be sure you are doing all you can to help your patients and your professional colleagues to contribute to our databases that are so important in pharmacovigilance efforts.

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If you want to immunize with novel H1N1 vaccine, read this…

Wednesday, August 12th, 2009

If you are a community pharmacy pracititioner interested in providing novel H1N1 vaccine to your patients this fall, you should advise your local public health office now of your interest.  APhA recently surveyed our members and determined a high interest, which validated our place with public health. We are working with Department of Homeland Security, NACDS, the Association of State and Territorial Health Officers, Centers for Disease Control and Prevention, National Alliance of State Pharmacy Associations, NCPA, and other immunization stakeholders.  We are developing streamlined systems for pharmacy’s involvement.  Please monitor www.pharmacist.com for updates.

Posted in Immunization | No Comments »

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