Archive for the ‘Pharmacy Practice’ Category

At Thanksgiving, rough seas and a nearing shore

Wednesday, November 23rd, 2011

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!

Visiting the University of Florida MTM call center

Tuesday, November 8th, 2011

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.

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!

President targets drug shortages

Thursday, November 3rd, 2011

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.

Pharmacists are more than just medication dispensers

Tuesday, October 25th, 2011

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:

  • We counsel patients on drug interactions, side effects, safety, and efficacy of the medications they take.
  • We advise patients on how to use OTC medications and supplements safely and effectively, often in conjunction with prescriptions.
  • We hold conversations with patients on why they have to take a medication as directed and why the medication is important.
  • We evaluate medication histories and catch potentially serious dosing and interaction problems.
  • We counsel on managing chronic conditions.
  • We immunize.
  • We work with the patient’s physicians to clarify, adjust, and advise regarding therapy, and to help problem solve when patients can’t afford their medications.

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:

  • Developing business models for patient care that promote collaboration between payers who have an interest in improving care and lowering all costs, not just medication costs, and the pharmacists who can help achieve those goals
  • Supporting community pharmacy residency sites that often serve as incubators for innovative practices
  • Publishing the research and stories of innovative practitioners so others can learn and adopt new strategies for improved safety and outcomes
  • Promoting the essential role of the pharmacist to the public, so that the cognitive and special services you provide are fully known to the patients who walk into your pharmacy
  • Advocating for the pharmacist among regulatory and legislative bodies to make sure your work is recognized in health care bills and with regulatory bodies including CMS and FDA
  • Providing you with continuing education opportunities, so that you may continue to provide new and innovative services to your patients as our industry changes
  • Working with the Pharmacy Technician Certification Board to make sure that U.S. pharmacy technicians are highly trained and qualified

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.

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.

Thank you to students, residents

Wednesday, September 14th, 2011
CEO Tom Menighan with U.S. Surgeon General Regina Benjamin, head of CDC Dr. Tom Frieden, and students from DC-area pharmacy schools

Yesterday was a good day for raising America’s consciousness about the value of pharmacists with U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius and many others in the Obama administration. My blog post yesterday provided some background on the Million Hearts Initiative that HHS launched with our support. Today’s photo shows how well pharmacy was represented at the meeting. You’ll notice, in front of the group of students and residents, U.S. Surgeon General Regina Benjamin, MD, MBA, and Tom Frieden, MD, MPH, the head of CDC. Both were impressed that we got so many students to the event, and both had great things to say about the essential role that pharmacists play in the promotion of cardiovascular health in this country.

I’d like to thank each of the students and residents who participated. As is always the case in advocacy work, just showing up is huge! I listened to a number of conversations that were going on around me after the formal event, and I was highly impressed with how well our students can speak about patient services with Don Berwick, MD, MPP, from CMS and Janet Wright, MD, a cardiologist who has been tapped to lead this initiative. Here’s a tip of the hat to all those who have a role in teaching these wonderful representatives of our profession.

Million Hearts Initiative: Call to action

Tuesday, September 13th, 2011

APhA received the call from the U.S. Department of Health and Human Services (HHS), CMS, and CDC to partner with them on the Million Hearts Initiative, a program launched today to prevent 1 million heart attacks and strokes over the next 5 years. In turn, I’m calling on pharmacists to support this initiative and save people’s lives.

As part of the Million Hearts Initiative, pharmacists can help monitor blood pressure and cholesterol medication refill patterns, as well as alert physicians and patients when patients stop following their prescription regimen. Cardiovascular disease causes one of every three deaths. We need to teach people about the ABCS (aspirin for people at high risk, blood pressure control, cholesterol management, smoking cessation).

Pharmacists can play an important role in the prevention and management of cardiovascular disease. Studies have shown the value of pharmacists in improving cardiovascular outcomes. In 2009, a trial published in the Archives of Internal Medicine demonstrated that pharmacists collaborating on a health care team with physicians and nurses resulted in better blood pressure control. And an article published yesterday in the Archives of Internal Medicine highlights the “Impact of Pharmacist Care in the Management of Cardiovascular Disease Risk Factors” in a very positive way.

Here at APhA, the Academy of Student Pharmacists takes the lead on a national patient care program called Operation Heart in which students go out into the community to address and prevent cardiovascular disease. Our APhA Foundation in June started a 1-year demonstration project with Wayne State University in Detroit involving adherence to medication therapy for hypertension, Project ImPACT: Hypertension. More than 90 patients are enrolled and receiving care from pharmacists.

We are pleased to partner with the federal government and numerous other stakeholder and fellow health professionals on the Million Hearts Initiative, and excited about mobilizing pharmacists to support this important 5-year program.

It will be important for us to capture information on your efforts. So, for now, please let us know about your practice. What current or new initiatives do you have that would support the overall goal of improved heart health? Meanwhile, we’ll be working on other ways to promote all the good things that pharmacists do to save lives every day.

Curtis Woods celebrates 25 years at Pace Alliance

Friday, September 9th, 2011

This month, an old friend celebrates 25 years as the leader of the Pace Alliance, a corporation owned by 19 state pharmacy organizations, in Lawrence, KS. Curtis J. Woods, who began his career with Pace in 1986, has been instrumental in shaping thousands of pharmacies’ business practices, and along the way has also encouraged excellence in pharmacy practice, and active participation by pharmacists in their associations. During his tenure, he has served on special committees for the National Community Pharmacists Association (NCPA), provided expert testimony to the Federal Trade Commission, and worked with APhA. He was selected as the Kansas Pharmacist of the Year in 2004 and received the Spirit of Independence Award from NCPA. I’m proud to know him. Congratulations, Curtis!

Pharmacogenomics continues to emerge

Friday, September 2nd, 2011

A recent article in the Wall Street Journal summarizes how Pfizer is targeting use of a new cancer drug to patients with a particular genetic anomaly. Are you listening, pharmacists? This is an opportunity for us! I’ve written about this before, as I believe we’re the ones who can help patients understand the implications for them, and we can, through developing systems, help find patients who will be candidates for certain drug therapies. In late November, APhA, together with several other pharmacy organizations, will be working with the National Institutes of Health on strategies for pharmacy education in genomics. The long-term implications for our profession are huge. I would welcome your thoughts on the topic.