Iowa pharmacy road trip

November 9th, 2011

On Friday, October 28, I was hosted by APhA Trustee Matt Osterhaus on an outstanding tour of Iowa pharmacies. After watching an exciting sixth game of the World Series on Thursday night, we had breakfast with Bob and Ann Osterhaus before visiting Osterhaus Pharmacy in Maquoketa. From there, we headed to Mount Vernon to visit Shepley Pharmacy and pharmacist Amy Jackson, and then to a Hy-Vee pharmacy and pharmacist Thane Kading in Iowa City.

While in Iowa City, we visited Randy McDonough’s pharmacy (see his great column in October Pharmacy Today on page 50). We also stopped for lunch at the University of Iowa College of Pharmacy with Bernard Sorofman, Executive Associate Dean; Mike Kelly, Associate Dean; Susan Vos, the APhA-ASP advisor; Brandon Patterson, a former APhA-ASP President and current APhA New Practitioner Advisory Committee member; and two student officers, Page Crew and David Huhtelin.

From Iowa City, we drove to Drake University in Des Moines, where we participated in a panel discussion with a large student group on career pathways. The panel included Becky Snead, National Alliance of State Pharmacy Associations; April Shaughnessy, Academy of Managed Care Pharmacy; and Mindy Smith, APhA Foundation. Thanks to Associate Dean Renae Chesnut and Dean Raylene Rospond for hosting us.

We took a breath, and then finished the evening celebrating with almost 300 Tom Temple well wishers at his retirement fête in West Des Moines. The event was a celebration of Tom’s lifetime of service and accomplishment. It was also a fundraiser to support an outstanding leadership development program that the Iowa Pharmacy Association and the Pharmacy Society of Wisconsin have been doing for years. I was so grateful to be there to support the event and to recognize the many contributions of my friend, Tom Temple, to our profession.

Throughout the day, I was impressed with the sophistication and focus each pharmacist had on the provision of medication therapy management and other patient care services. While the pharmacies were efficient, high-volume operations, they were each definitely focused and structured to provide excellent patient care. I’d like to extend my thanks to the Osterhaus clan for being such gracious hosts.

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Visiting the University of Florida MTM call center

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.

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APhM: Visiting CVS for my annual influenza vaccination

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 »

APhA summer intern reflects on her experience

November 4th, 2011

Recently, I received the following letter from Kelley Ratermann, a student pharmacist at the University of Kentucky College of Pharmacy who spent the summer working with us as the 2011 Carl F. Emswiller Summer Intern. I have a feeling that she, and the other incredible interns and residents we see each year, are destined for greatness.

Anyway, I enjoyed reading her observations, which are sprinkled with wisdom and humor. I hope you enjoy her letter, too.

Dear Tom,

After spending some time reflecting, I can say with certainty that the Carl F. Emswiller Summer Internship in Association Management has been one of the greatest blessings in my life thus far. There are countless tangible reasons that have made my time in DC remarkable—both personally and professionally—but there are also many indescribable feelings that have made this a summer to remember. I will try my best to express that which I can, and where plain words cannot fully capture my experiences, I will simply have my memories to suffice.

I want to start with the things I know for certain after spending 10 short weeks at APhA headquarters.

Staff

  • APhA staff are a unique group; every person I met greeted me with a smile and was genuinely interested in learning more about who I am
  • The family-friendly atmosphere at work made APhA a very pleasant place to be every day
  • If you are willing to learn, the professionals at APhA are more than willing to teach
  • The value of each publication and resource that APhA provides for its members, as well as the different writing styles and amount of planning involved by dedicated APhA staff

Students

  • The optimism and motivation of APhA–ASP student leaders are contagious and the future of the profession looks bright
  • The Student Development staff work hard every day to ensure that student pharmacists have the tools available to mold themselves into the best possible future practitioners and leaders
  • The student representation in APhA’s House of Delegates and on the Board of Trustees is extremely unique, meaningful, gratifying, and unmatched in the profession

Association/Operations

  • The view from the Potomac Terrace at APhA headquarters is breathtaking
  • Hill visits are an adrenaline rush and everyone should try it—if not for the betterment of our profession, then for your own personal experience
  • Although working in association management did not provide direct patient interaction, the work being done here on the front end translates to direct patient care on the back end through the education and professional development resources we provide our members
  • It takes time to learn the workflow of the office and it is important to be able to adapt quickly
  • The history of this Association and building is something to be proud of
  • The security guards are very helpful and nonjudgmental when your badge doesn’t work for weeks on end
  • Whoever makes the coffee in the kitchen each morning is a saint

Future plans/Lessons learned

  • I will be doing a residency of some kind upon graduation
  • Being a leader for pharmacy involves so much more than what meets the eye
  • The importance of networking cannot be expressed in words
  • Attention to detail is imperative no matter how big or small the task may be
  • I will be a member of APhA for life

Other

  • Every person has a story to share and is unique in how they got to where they are today
  • Do not be afraid to ask questions because some of the best opportunities arise out of simple curiosity
  • Interprofessional collaboration on issues such as MTM [medication therapy management], HIT [health information technology], prescription drug monitoring, public/media relations and much, much more is essential for the progression of the profession
  • It takes many experts and professionals besides pharmacists to successfully run an association
  • The lobster food truck lived up to the hype

Some things that I am still unsure of …

  • Where my career path will lead
  • How my experiences here will influence choices I make in the future
  • The impact of the pharmacy advocacy APhA is doing today and how it will shape the practice of pharmacy tomorrow
  • The best way for our profession to continue to embrace technology and make the transition from an emphasis on dispensary services to more clinical services and patient interaction
  • How to get more practitioners to push the envelope and be innovators/agents of change for pharmacy practice, as Carl Emswiller and Gene White were during their careers
  • What pharmacy will look like 50 years from now, in 2061 (I will be 74!)
  • If I will ever be half as good as Hazel Pipkin

Thank you to everyone who has helped to guide me along the way. No matter how big or small our interaction may have been, I am forever grateful and will always look back on my time here at APhA and smile. The work you do here affects pharmacists, student pharmacists, and so many other health care professionals in a positive way. Ultimately, what you do serves to better the quality of patient care across the nation. For that, I take my hat off to each of you, and ask that you please continue the great work you do in the name of pharmacy.

Pharmaceutically yours,

Kelley L. Ratermann
University of Kentucky College of Pharmacy
PharmD candidate 2013

 

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President targets drug shortages

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.

Posted in Pharmacy Practice, Policy & Advocacy | 1 Comment »

Congratulations to Tom Temple

October 27th, 2011

APhA announced yesterday that we’ll be working with our colleagues at the National Association of Boards of Pharmacy to develop a program for community pharmacy accreditation. Leading that project is Tom Temple, who’s retiring from the Iowa Pharmacy Association. We’re fortunate to be working with him.

As I write this, I’m sitting at the airport, waiting for my flight to Iowa to participate in Tom’s farewell event. Along the way, I’ll be visiting several Iowa pharmacies and both the Drake and Iowa schools of pharmacy, thanks to our Board of Trustees member Matt Osterhaus and a host of his fellow Iowans.

Below is a speech given by Rep. Bruce Braley of Iowa on the House floor in honor of Tom and his many contributions to pharmacy in Iowa.

Mr. Speaker, today I’d like to congratulate my good friend Tom Temple on his upcoming retirement from the Iowa Pharmacy Association. Tom has served in his current role at the Iowa Pharmacy Association since 1980, and has become a friend and adviser to me.

Tom has dedicated his life to medicine, and has been a leader on pharmaceutical issues across the state of Iowa. He has served as CEO of the Iowa Pharmacy Foundation and the Collaborative Education Institute. He has assisted numerous professional organizations including the American Pharmacists Association, the National Alliance of State Pharmacy Associations, and the American Society of Association Executives.

Tom has also been active in the higher education community, advising universities on current issues affecting the pharmaceutical industry. He served on the Advisory Committees for Drake University, the University of Iowa, and the University of Illinois College of Pharmacy.

Tom has been a tremendous advocate for Iowa pharmacists. When I was traveling in Afghanistan earlier this year, and came across a tiny pharmacy in a village there, my first thought was, “wouldn’t Tom Temple get a kick out of this?”

Tom will be missed very much by his colleagues and peers in the coming years, but his influence and leadership will never be forgotten. I congratulate him on all of his success and wish him a rewarding and relaxing future.

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Pharmacists are more than just medication dispensers

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.

Posted in APhA News, Pharmacy Practice, Policy & Advocacy, What Tom is Reading | 3 Comments »

Opportunity knocks: CMS Innovation Advisors Program

October 25th, 2011

Are you innovative? Do you influence the care patients receive in a health system through quality initiatives? You’re invited!

A new initiative announced by the CMS Center for Medicare and Medicaid Innovation is accepting applications for the Innovation Advisors Program from providers in health systems and any professional employed by a public health or health care facility, institution, or department.

The idea is to engage folks to refine, apply, and sustain the managerial and technical skills necessary to drive delivery system reform. Medicare, Medicaid, and Children’s Health Insurance Program beneficiaries want your help. The program will allow skilled individuals in the health care system to deepen key skill sets, including health care economics and finance, population health, systems analysis, and operations research.

The selection criteria for applicants include career achievements; their pre-existing skill set and its relevance to transforming the health care system for these beneficiaries; the quality of a proposed innovation project in their home organization; their organization’s explicit commitment to their work; and management experience.

As many as 200 Innovation Advisors around the country will be selected and developed in the program’s first year, and their home organization or group will be eligible to receive a stipend of up to $20,000 to support their activities, including travel.

The first group of Innovation Advisors will start a 6-month intensive orientation and applied research period in December 2011. During the initial 6-month period, advisors will commit up to 10 hours per week, with similar or less involvement thereafter. They’ll meet together at the regional level each quarter and at CMS in Baltimore once each year. Advisors will not be employees of CMS or the government.

The deadline to apply is November 15. Innovation Advisors will be notified of their selection by mid-December 2011.

It’s critically important that pharmacists from a variety of practice settings apply for this program. APhA encourages pharmacists to participate. Please let us know at iqi@aphanet.org if you intend to submit an application!

Posted in Health Care Reform, Policy & Advocacy | 2 Comments »

Visiting Walter Reed for APhM

October 19th, 2011

I had the pleasure of visiting the pharmacy team—both pharmacists and pharmacy technicians—at Walter Reed National Military Medical Center (WRNMMC) last week to celebrate American Pharmacists Month (APhM). CDR Gary West and LTC Aatif Sheikh lead this group of dedicated individuals as they provide medication therapy services to service members, military retirees, and their families. As you may know, Walter Reed Army and Bethesda Naval Medical Centers are merging on one campus. Despite the challenges of building construction and renovation, the team provides inpatient and outpatient medication needs and services for the large number of beneficiaries within the national capital region and those returning home from combat.

I am always humbled when I visit our military hospitals; I’m so grateful for our service personnel’s willingness to serve our country. I was impressed with the multidisciplinary approach and their significant contributions to achieve positive medication outcomes for warriors with devastating injuries and often complicated medication regimens. Pharmacists such as Dr. Chengqing Li (she calls herself CiCi), Clinical Coordinator, serve as valued members of the care TRIAD Team that includes the nurse case manager, the primary care physician, and the service member’s supervisor, squad leader, and family, to ensure oversight and management of complicated drug regimens, pain management, monitoring medication adherence, and coordination of care.

Dr. Lisa Oh, the Patient Safety and TJC Pharmacist, explained the Department of Defense’s new Patient Safety Reporting System (PSR). The PSR is a Web-based tool that enables military health system–wide reporting of both medication and nonmedication-related patient safety and adverse events. The tool will provide critical information on how to effectively improve patient care through data analysis and enhanced data collection, ultimately improving patient safety in the military health system.

We all know of the challenges associated with transitions of care from hospital to home. This particular issue is a major focus in the Affordable Care Act (the health care reform law). WRNMMC is addressing the issue with discharge pharmacy counseling as an important aspect of Walter Reed’s medication therapy management process. Pharmacist Diana Lalchan works with various health professionals involved in patient care to reconcile previous outpatient and inpatient medications with those received at discharge. She also provides in-depth bedside counseling to patients prescribed and dispensed discharge medications to reach their in-house goal of medication reconciliation for 75% of discharges.

Harold Vizian serves as the patient advocate pharmacy technician, the first-line responder to resolve the patient’s questions and concerns related to their medication. His goal is to ensure patients have a safe, informative, and positive pharmacy experience. In the military system, technicians are empowered to provide many functions not yet available to them in the private sector.

This was my third year to visit at least one of our military hospitals. The highly motivated spirit of our wounded warriors and the health care personnel who serve them should be an inspiration to us all. I come away from these visits with a renewed drive to share their stories as examples of how collaborative care can work.

Hopefully, as we embark on consensus building of community pharmacy standards, we can use the insights gained from our military colleagues to inform the process.

Thank you to all who serve in the military, Public Health Service, Indian Health Service, Department of Veterans Affairs and other federal programs that support our public servants.

Happy American Pharmacists Month!

 

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APhM: Inspiring activities for Association staff

October 13th, 2011

American Pharmacists Month (APhM) is in full swing, and I can’t believe how fast it’s going! In past posts, I’ve told you about APhA’s media and community outreach activities. But we cannot forget the activities APhA is conducting for its own staff throughout the month. To recognize APhA staff, who work hard all year long to make sure pharmacy is celebrated and promoted, the APhM team and Work–life Enhancement Committee worked together to prepare activities to inspire our staff. Last year’s staff activities were well received. This year, APhA focused its events around health and wellness.

Events for APhA staff include:

  • A blood drive
  • The Health Fair for staff and the neighboring U.S. State Department
  • Celebratory lunch
  • A fun walk around the National Mall
  • Introductory Zumba sessions

I would like to thank each of you for all you do to improve medication use and advance patient care. The important message of “Know Your Medicine—Know Your Pharmacist” is being seen in hundreds of activities during October, and the message is really reaching the public. APhA also thanks McNeil Consumer Healthcare, national founding sponsor of APhM, for their continued support of the pharmacy profession.

As always, make sure to send all your celebration photos and videos to aphm@aphanet.org or APhA’s Facebook Page.

Posted in American Pharmacists Month, APhA News | No Comments »

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