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9 posts from October 2013

10/31/2013

Mayes Students 'Already Know More About ACA than Most Docs'

MetrauxLed by Stephen Metraux PhD, interim director of the Health Policy Program, masters and doctoral students in the Department of Health Policy and Public Health are examining the Patient Protection and ACA as it evolves in real time. Here's what he has to say about the course:

Last summer, the faculty the Department of Health Policy and Public Health at University of the Sciences decided to implement a seminar course devoted to the Affordable Care Act for the Fall 2013 semester.  We realized with the exchanges set to come online in October, this would be a unique opportunity to observe and assess policy as it unfolded, and that it would likely entail a wild, unpredictable ride.  As the person who first pitched this idea, I got to facilitate the class.

The course consists of three touch points – studying the nuts and bolts of the ACA based on reading about the act and its implementation; a series of speakers who would come into the class and give in-depth presentations  related to specific aspects of the ACA; and taking time each class to discuss the week’s events related to the ACA.  Taken together, the class has been exciting, interesting and informative. 

The speakers so far have included community perspectives from hospitals, physicians and public health providers, as well as University faculty talking about the economics, political science and occupational therapy perspectives of the ACA.  The nine students enrolled in the class have each taken one of the nine titles (i.e., sections) of the original ACA and have delved into the details.  And finally, the government shutdown, the debacle of healthcare.gov, and the individual policy cancellations have been the backdrop behind a greater awareness and a greater understanding of the headlines.

Based on this, students from the class will, in the upcoming days, provide brief entries for this blog related to specific ACA-related topics upon which they are focusing.  The first entries in this series came from Tom Godfrey, a physician and PhD Health Policy student:


My contribution to this is a top-ten list of general themes about the ACA that have become clear through this course. 

10. To focus on the individual mandate is to miss 90 percent of the ACA.
  9. If you are sick and poor before the ACA you will likely remain sick and poor after the ACA.
  8. The ACA is sitting on the shoulders of over a century of health care reform efforts.
  7. It is possible to have too little income to benefit from the ACA.
  6. Public health never gets the money it needs.
  5. The ACA just ain’t socialized medicine in any form.
  4. To work, the ACA must hit the health care trifecta: simultaneously expanded coverage, improved quality, and reduced costs.
  3. Opponents hate the ACA; proponents see it as a set of necessary compromises.
  2. No one knows whether and how the ACA will work.

[insert drum roll…]

  1. Students in the class already know more about the ACA than most physicians.

Stay tuned.


10/28/2013

Mission Impossible: How to tell if your patients are taking their medications

As a pharmacy student, I’ve been drilled rigorously that medication adherence is a vital cornerstone to effectively treating patients and achieving positive clinical outcomes. Yet with so much emphasis dedicated to ensuring that patients are taking their medications, it is estimated that approximately 20-50% of patients are non-adherent. With such high numbers of patients not adhering, it is crucial that pharmacists find tools and strategies to monitor and improve adherence.

The simplest way to find out if a patient is taking a medication is to ask.  There is a simple 4 question assessment to better gauge whether or not patients take their medications. This scale, the Morisky scale, allows for pharmacists to not only interact with their patients, but also allows him to ‘score’ the interaction and get a better idea of their patient’s compliance. A study using the scale observed that if a patient was found to be compliant, there was a 93% chance that they were indeed compliant (high sensitivity). But the study does lack specificity as indicated by the finding that if a patient was found to be non-compliant, there was a 53% chance that that was indeed the case. The Morisky scale is a great tool to use when interviewing a patient, but again, the low specificity leaves a level of ambiguity.

A more direct, but still primitive method of determining patient compliance is a pill count. While the method is simple, the accuracy of the information gathered is directly dependent on the patient.  Unfortunately, patients could manipulate the number of pills in the vial and you still aren’t certain whether the medication is being taking as directed.  However, one study showed that unannounced pill counts by phone improved compliance in AIDs patients and this method could feasibly be applied to other realms of practice.  While pill counts are an acceptable first line of defense against non-compliance, more advance methods are available.  

With the level of automation in pharmacy nowadays, digital records of refill and prescription pick-ups are simple to compile and interpret. A pharmacist can easily access a patient’s records and observe their refill habits.  It can be determined if the patient is picking up their medications on time and in line with when their quantities should be depleted if the drug is being taken as directed. But as with the pill count, the use of a pharmacy record is limited. The patient could be using multiple pharmacies and the patient’s actual habits cannot be assessed by simply looking at when they come in for a refill. Records are important, but what if a doctor or pharmacist could actually verify the exact time when their patient takes their medication?

The future of medication adherence monitoring could come in the shape of a digital pill. A transmitter the size of a grain of sand can be embedded inside a pill which then can send a text, email, or  tweet to the patient/health care provider when it was taken. This technology could do wonders for patients with high risk disease states like cancer or HIV. While this sounds like science fiction, Proteus Digital Health claims that this incredible technology will be available to
drug companies within the next three years.  

While it seems like a daunting task at times, medication adherence monitoring is an important aspect of what we do as pharmacists. By utilizing the tools discussed, we should be able to improve ompliance and make a positive impact on patient outcomes.

Mackenzie F. Blair, PharmD '15

10/23/2013

PCP Students Participate in River City Festival for Fourth Year

Blog post submitted by Dr. Grace Earl and Brian Nguyen PharmD’14.

The River City Festival is held each year in the Fishtown section of Philadelphia.  Students enrolled in the Doctor of Pharmacy program have participated for the fourth year in a row on Saturday, Oct. 5.  The students were invited to participate as part of Hahnemann University Hospital’s “Wellness Tent.”
 River City Festival 2013
Five students in their fourth professional-year from the Philadelphia College of Pharmacy at University of the Sciences participated in educating festival-goers about a variety of healthcare topics.  The students seen in this picture, from left to right, include: Samantha Bryant PharmD’14, Kyle Flannery PharmD’14, Brian Nguyen PharmD’14 (standing), Judy Parks PharmD’14, and Vivi Jung PharmD’14.

Samantha Bryant, of Baltimore County, Maryland, presented an informative and interactive display about poison prevention.  One of the major goals of poison prevention presented was to prevent children from taking their parents’ medication.  A poster was made with both common candies and medicines that one would take.  Many participants had difficulty differentiating between the candy and the medicine.  This display highlighted the importance of child safety and proper storage of medications from children.
 
Kyle Flannery, of Lakewood County, New Jersey, highlighted smoking cessation through medication education.  Kyle differentiated between many approaches that one could take to quit smoking and highlighted the most effective approach, which is through the use of smoking cessation medications.  Judy Parks, of Bucks County, presented the steps to take for osteoporosis prevention.  Judy emphasized osteoporosis prevention in women over the age of 50 and reached out to that audience.  She emphasized that adequate intake of calcium and vitamin D was necessary for the maintenance of bone structure.  
 
Vivi Jung, of Delaware County, spoke about one of the biggest healthcare topics affecting Americans today: hypertension.  Vivi offered free blood pressure monitoring for all participants and counseled participants about good lifestyle habits to maintain a normal blood pressure.   Brian Nguyen, of Delaware County, focused on heart disease prevention awareness and he noted the risk factors that one could control to prevent heart disease. He also focused on counseling participants about medications that could be used to prevent a heart attack or stroke such as aspirin. 
 
Students from the Philadelphia College of Pharmacy were pleased with the knowledge they imparted on festival-goers and look to be participating in the River City Festival next year.  Sandy Scholtz, Experiential Field Supervisor, and Yvonne Phan, PharmD, assistant professor of the Department of Pharmacy Practice and Pharmacy Administration participated at the event.  Grace Earl, PharmD, assistant professor, coordinated the event.

10/18/2013

The Government Shutdown from a Pharmacy Student's Perspective

With the government shutdown finally being resolved this Thursday, the affect it has had on the American public has taken the form of closed National Parks and a bickering Congress. But the impact of the shutdown goes far beyond what the media and pundits are discussing in their daily rundowns. As healthcare professionals, there are serious ramifications that endangered the public health and the ability of us to treat patients who desperately need care.

While the shutdown didn’t interrupt vital services provided by Medicare, Medicaid, and Veterans Affairs, agencies like the Center for Disease Control (CDC) and Food  and Drug Administration (FDA) were forced to furlough the majority of their employees. The FDA had been forced to furlough 60% of their inspectors which  prevented the FDA from effectively being able to inspect the companies that prepare the food we eat every day. The CDC was unable to monitor outbreaks of disease in the country and even led to 300 people falling ill with salmonella. In addition to  hamstringing the ability of government agencies to protect citizens from disease and contaminated food, the government shutdown also had a negative impact on how clinical trials were being conducted. 

With so much vital research being funded by government grants, and overseen by government agencies, the country’s medical researchers took a serious blow. The National Institute of Health (NIH) in Bethesda, Maryland was being described as a ghost town with countless experiments that relied on live animals and cell lines being put in jeopardy after 73% of its staff were furloughed. With the government shutdown, NIH scientists were not permitted to work and were only given 4 hours to mothball their laboratories at the beginning of the shutdown. From October 1st to the end of the shutdown this Thursday, only 12 patients with extreme circumstances were permitted to enter clinical trials at NIH. A program that accepted hundreds of patients a week was being forced to turn those people away. One such patient who was turned away was Michelle Langbehn. Diagnosed with a rare cancer, Michelle’s only hope for treatment was a study being conducted by NIH; but with the shutdown, NIH simply could not afford to start new trials or support the addition of new patients.

In addition to NIH, college research and academia were also affected. The impact was so great that the University of Michigan created a Q&A page for their researchers which now states that everything is back up and running as of October 17th. Visitors to the vital resource PubMed were greeted by this: “PubMed is open, however it is being maintained with minimal staffing due to the lapse in government funding. Information will be updated to the extent possible, and the agency will attempt to respond to urgent operational inquiries.” PubMed is a resource that is used by thousands of healthcare professionals and students and its limited capacities, as caused by the shutdown, could have very well negatively influenced a pharmacy student’s education or more importantly a clinical decision.

With the shutdown finally over and the Nation’s leaders continuing to point fingers of blame as the media attempts to assign winners and losers in the battle that raged on Capitol Hill, what seems to be lost in all the rhetoric is that patients were denied treatment and researchers were being prevented from discovering tomorrow’s cures. The shutdown might be over for now, but its impact on our public health and medical fields could be felt for years to come.

Mackenzie F. Blair, PharmD '15

10/10/2013

The Pennsylvania Insurance Marketplace

In our last blog, we discussed the state-run exchange operating in Maryland.  In contrast, Pennsylvania, home to some 1.3 million uninsured, is letting the federal government run the exchange.    Back in 2011, it seemed as though PA would be taking the same approach as Maryland by developing its own insurance exchange system.  In 2012, they even went as far as developing a  conceptual draft for a state-run exchange and went even further by putting forth a request for quotations to implement such an exchange.   However, just before the decision to run a state-based exchange was to be filed with the federal government, Gov. Tom Corbett announced that it would be irresponsible to “put Pennsylvanians on the hook for an unknown amount of money to operate a system under rules that have not been fully written.”   As such, PA residents in need of health insurance must use the federal marketplace.    

Uninsured Pennsylvania residents are able to purchase health insurance through Insurance Market place at www.healthcare.gov.   Navigating through the federal marketplace, a family of 4 making $50,000 a year and living in Philadelphia will be able to purchase a Silver level plan for $9,216 annually.   With the appropriate tax credits, the same Silver plan premium becomes $3,365, for a tax-credit savings of $5,851.  The same family could choose a lower-level Bronze plan for only $1,446 annually, still taking into account the $5K+ tax credit.  Taking this lower level plan might save money in premiums, but is likely to result in higher out-of-pocket costs.   For a calculator to help figure out the costs without registering through the Market Place, see here.

 No matter, by January 1st, 2014, all citizens will be required to maintain health coverage in some fashion – if not a penalty will be levied.  For 2014, the penalty will be 1% of income to a maximum of $95 and $47.50 per uninsured adult and child, respectively.   By 2016, these penalties will rise to 2.5% of income or a maximum of $675 per adult ($347.50 per child).  

During its first week of operation, the website users have experienced trouble registering.  The troubles were largely due to high traffic and site overload – a statement in-and-of-itself that Americans are looking for a better way to obtain health insurance.  Once these glitches are resolved, we will get a chance to really see how America is taking to the new age of healthcare
purchasing.

10/05/2013

Boards of Pharmacy Should Discontinue Issuing Licenses to Pharmacies that Sell Tobacco Products and to Pharmacies that are in Facilities that Sell Tobacco Products

By Dr. Daniel A. Hussar, the Remington Professor of Pharmacy at University of the Sciences' Philadelphia College of Pharmacy. He serves as the author and editor of The Pharmacist Activist newsletter (http://www.pharmacistactivist.com) from which this editorial was taken.

You have heard the number before, perhaps to the point that it is no longer shocking to the extent that it must continue to be. More than 440,000 Americans die each year as a consequence of the medical problems resulting from smoking cigarettes. I do not have sales statistics but I have to think that CVS, Rite Aid, Walgreens, and Walmart sell more cigarettes than other retail organizations and, therefore, have facilitated the occurrence of early deaths of many of their customers. What hypocrisy for organizations who want consumers to view them as providers of health care! And what an embarrassment for the profession of pharmacy that organizations that call themselves pharmacies persist in selling products that have such deadly consequences! To their credit, the vast majority of independent pharmacies, as well as large retailers like Target and Wegmans, do not sell tobacco products.

I and others have sent communications to the CEOs of CVS, Rite Aid, Walgreens, and Walmart to urge them to discontinue the sale of tobacco products. Early communications were respectful requests, but these were ignored or rejected. More recent commentaries have been stronger (please access the website www.pharmacistactivist.com for my editorials, "Pharmacy-Assisted Suicide - at CVS, Rite Aid, Walgreens, Walmart, etc." [November, 2012] and "Merchants of Death - Chain Pharmacy CEOs Must Stop the Sale of Cigarettes!" [November, 2011]). These efforts have been an exercise in futility. The CEOs of these companies are obsessed with just one thing - MONEY - (which must include the revenue from cigarette sales) and do not care about the health of their customers! Other strategies are needed.

Boards of Pharmacy

State boards of pharmacy have a responsibility to the citizens of their states to protect their interests and safety with respect to the licensure and operations of pharmacies, and the licensure and practices of pharmacists. Consumers have a right to expect that pharmacies are health care facilities in which there is a commitment to promote and improve the public health, as well as to assure the most effective and safest use of medications that is possible. I would contend that the sale of cigarettes in pharmacies is contradictory to the role, products, and services of a facility expected to have a commitment to health care. I would also contend that the sale of cigarettes is not consistent with the responsibility of a board of pharmacy to protect the interests and safety of citizens with respect to products sold in facilities that it licenses.

On August 20, 2013, I attended the meeting of the Pennsylvania State Board of Pharmacy for the purpose of submitting the following recommendation (with pertinent background information):

"It is recommended that the Board of Pharmacy take action to 1) discontinue issuing and renewing licenses to pharmacies that sell tobacco products and to pharmacies that are in facilities that sell tobacco products and, 2) establish the rules and regulations that will enable implementation of this action."

In my opinion, the Pennsylvania Pharmacy Act currently provides the authority for the State Board of Pharmacy to take this action by revising regulations. However, a question exists that such an action might be challenged if it is not specifically enabled by legislation. This will take longer but I and others will review this further and propose appropriate new legislation if considered necessary.

The Pennsylvania Board initiative

The National Association of Boards of Pharmacy (NABP) and the American Association of Colleges of Pharmacy (AACP) facilitate regional joint meetings of their members by dividing the country into eight districts. NABP/AACP Districts 1 & 2 (comprised of boards and colleges of pharmacy in the New England and Mid-Atlantic states) will be holding their annual meeting in mid-October.

Ed Bechtel owns a community pharmacy in Slatington, Pennsylvania and is the Chairman of the Pennsylvania State Board of Pharmacy. He developed the following resolution that was approved by the Pennsylvania Board at its meeting on September 17 and has been submitted to NABP/AACP Districts 1 & 2 for consideration and action at its upcoming meeting:

"Whereas, in the United States, tobacco use is responsible for nearly 1 in 5 deaths; this equals about 443,000 early deaths each year (Source: Cancer Facts & Figures 2013), and

Whereas, state boards of pharmacy are charged with protecting the public health, safety and welfare as related to services provided by pharmacies and pharmacists; and

Whereas, it is an inherent conflict of interest for pharmacies to dispense the medications that treat heart disease, lung disease, and cancer - and then also sell tobacco, and

Whereas, San Francisco, Boston and other municipalities have enacted ordinances making the sale of tobacco products illegal in their jurisdictions, and

Whereas, in 1988 the National Association of Boards of Pharmacy adopted a resolution encouraging pharmacies to stop selling tobacco products and work toward a Smoke Free Society, and

Whereas, in 2008 the National Community Pharmacists Association adopted a resolution which states that any law or regulation prohibiting the sale of tobacco products apply to all entities operating a pharmacy, and

Whereas, the American Pharmacists Association adopted a policy in 2010 urging "State Boards of Pharmacy to discontinue issuing and renewing licenses to pharmacies that sell tobacco products and to pharmacies that are in facilities that sell tobacco products',

Therefore be it Resolved, that the National Association of Boards of Pharmacy revise the Model State Pharmacy Act and Model Rules of the National Association of Boards of Pharmacy to include language which would prohibit the licensure of pharmacies that sell tobacco products and pharmacies that are located in facilities that sell tobacco products."

Congratulations to Ed Bechtel and his colleagues on the Pennsylvania Board of Pharmacy for this excellent initiative. We should encourage the members of the boards and colleges of pharmacy of Districts 1 & 2 to strongly support this resolution with the anticipation that it will then be forwarded for consideration and action at the NABP annual meeting next year.

The Great American Smokeout

More than 40 years ago pharmacist Fred Mayer of California started the Great American Smokeout. To expand the impact of this initiative, he transferred the responsibility for this event to the American Cancer Society, and it is held on the third Thursday of November (i.e., November 21, 2013). To this day, Fred is a tireless advocate and leader for smoking cessation and other public health programs. Plan to honor his efforts and help your family members, friends, and others who currently smoke by being proactive in assisting them in stopping smoking, at least on November 21 and, hopefully, forever after.

Daniel A. Hussar

10/04/2013

The Maryland Health Connection is Coming to an Insurance Plan Near You

While many states chose not to act after the passage of the Affordable Care Act to see if the  legislation would get the Supreme Court’s seal of approval, Maryland jumped into action.  Being one of the first 6 states to have their insurance exchanges approved by the federal government, Maryland should have been more than ready for the October 1st deadline that passed this Tuesday.  Spearheaded by Governor Martin O’Malley, Maryland opted to assume the responsibility of operating a state-run system versus a federally managed  exchange. While Maryland chose to operate their own exchange, states run by more politically conservative legislatures have generally opted to let the federal government operate their state exchanges.  State-run exchanges allow for more tailored programs to address the needs of individual states and those people that reside in them, but put the burden of running the program on the state rather than the federal government.   

Branded as the Maryland Health Connection, the Maryland exchange is expected to provide approximately 150,000 of Maryland’s 770,000 uninsured citizens and save the state $850 million over a 10 year period. Maryland’s exchange is governed by a nine member board composed of both experts and representatives for those who will be covered by the exchanges. Maryland Health Connection gives purchasers the ability to compare approximately 45 plans from six different carriers and determine their eligibility for financial assistance to lessen the monthly cost of having insurance. Maryland even opted to expand their Medicaid coverage. Marylanders living at, or slightly above, the poverty line  will be automatically enrolled in the program, and at no cost.  To enroll an individual, a family or a business, one can go to Maryland Health Connection and follow the prompts as instructed.

While the websites were intended to streamline the process and limit confusion, initial reports are coming in that there are glitches in the websites that have hindered peoples’ attempts to enroll; Maryland’s exchange website experienced ‘technical difficulties’ opening day as reported by the Baltimore Sun. Other obstacles include lack of education regarding the law. One such account was documented by the Huffington Post about a Hagerstown, Maryland man, Joseph Kriner, who didn’t know what he was required to bring to enroll himself and his two granddaughters. Armed with only pictures of his family and the wish to get his granddaughters medical attention, he was told to return with the proper documentation. The story of Mr. Kriner is a somber one, but it brings to light the kind of conditions many Americans find themselves in from day-to-day. These people need help and it is the goal of the Affordable Healthcare Act to make quality healthcare available to those who could otherwise not afford it. While the law has its flaws, and the websites are not currently working optimally, it is difficult to deny that this is indeed a step in the right direction.

In future posts we will be examining Pennsylvania’s federally-run exchange program and gauge the impact the opening of the exchanges has had thus far.

Mackenzie F. Blair, PharmD  ’15

10/02/2013

Dean of Mayes College Weighs In on Affordable Care Act

APeterson_250x350Andrew Peterson PharmD, PhD, John Wyeth Dean of Mayes College of Healthcare Business and Policy, recently published an article titled, "Healthcare Exchanges Open for Business" in the Star Life Sciences Medical Monitor.

As of Oct 1, 2013, many U.S. citizens will be able to purchase health insurance through an online marketplace called the Healthcare Exchange. Purchasing insurance through this mechanism is not available to employees who choose to receive insurance through their employer, or citizens who receive Medicare or Medicaid. 

Click here to read the entire article...

As of today, Oct 1st, 2013, many US citizens will be able to purchase health insurance through an online marketplace called the Healthcare Exchange. Purchasing insurance through this mechanism is not available to employees who choose to receive insurance through their employer, or citizens who receive Medicare or Medicaid. - See more at: http://www.starlifebrands.com/healthcare-exchanges-open-for-business/#sthash.6jehUNdO.dpuf

The MarketPlace is Open!

Despite all the ongoing debate in DC over the Affordable Care Act, (ObamaCare),
implementation of a key component rolled out yesterday.   Now, US citizens are be able to purchase health insurance through an online marketplace called the Health Care Exchange.  Purchasing insurance through this mechanism is not available to employees who choose to receive insurance through their employer, or those citizens who receive Medicare.

A key aspect of the law is that each state has the option to setup their exchange (marketplace) or have it partially or fully run by the Federal Government.  Twenty-four states will have a State run or Partnership run marketplace and the remaining states will have a Federal Marketplace.  To qualify for as a member of the marketplace, each plan must offer a minimum set of benefits.  These benefits include Ambulatory/outpatient care, Emergency services, Prescription drugs and Preventive and wellness services as well as other essential health services.

The benefit designs are organized into one of four tiers – also called metal levels: Bronze, Silver, Gold and Platinum – each differ in costs and provider networks.. In terms of deductibles, co-payments and other charges, the Bronze plan covers 60% of a patient's health costs, the Silver 70%, the Gold 80% and the Platinum 90%.    The lower tier plans offer more restrictive plans, such as HMOs (Health Maintenance Organizations) and the higher tier plans use less restrictive networks such as  PPOs (Preferred Provider Organizations).  Patients can go to the HealthCare.gov to find out specifics for their own state. 

The purpose of the marketplace is to encourage competition, reducing the cost of health insurance all the while improving access to health care to all citizens.   However, we will not know until 2014 if the competition aspect worked and not likely for several years if the marketplace translated to more affordable insurance and cheaper health care.   See here for an entertaining and informative video of the Health Care Exchange.

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