Experts | University of the Sciences

CER Lectures and program

University of the Sciences is hosting an informative three-part lecture series focusing on Comparative Effectiveness Research (CER).  The aim of the lecture series is to introduce the campus to the concept of CER and build a foundation of knowledge.  The lectures scheduled for January 30th, February 28th and March 28th.  The topics include CER and health information technology, CER and the use of real-world data and the future of CER.  Speakers include Dr. Jean-Paul Gagnon, Dr. Marcus Wilson and Dr. Sandy Schwartz.  All lectures will be held on campus.  For more information on the lecture series, go here.

This lecture series is a prelude to Mayes' College annual Making the Connections  program.  The Making the Connections program will highlight a panel of speakers from the pharmaceutical industry, payers, providers and patients who will be speaking about the impact of CER on their sector of health care.  The  Making the Connections program will be held April 16th, from 5:30-7:30 at USciences campus.

New Medication Bottles and Labels Improve Patient Compliance/Adherence

So does a new and improved label for a prescription bottle really improve patient compliance?  Similarly, does a flattened (versus a round) bottle make a patient take their medication more consistently? Would having all medications packaged in a blister pak alleviate the ailment of medication forgetfullness?   This Wall Street Journal article suggests that it does.  In fact, the research it points to does show that there is improved medication taking behavior.  But hold on, for those patients on multiple medications multiple times a day, would having 5-10 different sets of blister packs really help?  It might, but then again so would a well designed pill box with the days/times labeled and a translucent cover so that you can see if the medications were taken or not fairly readily.  These inexpensive boxes are reusable and do not increase the carbon footprint already associated with medications. 

As for the improve labels and bottles that are more easily readable - I am all for it!  As my eyes tire from writing this blog, I can only imagine how difficult it is to read the label on an 8 dram (very small) prescription bottle that is only ~2 inches high. 

My recommendation to anyone who takes a medication - be sure to incorporate it into your daily life - leave it near your toothbrush or take it with your meal (if OK with your pharmacist) or leave it by your bedside.  And if you need help on how to take your medication, ask your pharmacist. 

Brand Name and Generic Drug Manufacturers Teaming Up? Proper Drug Disposal as the Common Thread

Brand name and generic manufacturers are finding a reason to team up...against a local California municipality.  Alameda County passed a law requiring drug manufacturers to establish, and fund, a mechanism for consumers to properly dispose of their medications.  Proper disposal of medications will help minimize the environmental exposure to potentially harmful chemicals such as hormones, antibiotics and other drugs.  Most experts agree that a majority of the medications get into the environment through human and animal urine/feces containing the drugs or their metabolites.

Currently, sewage treatment plants are not designed to remove these substances so another strategy is to limit the exposure by preventing the drugs from getting into the environmnet.  Drug take-back programs, such as the one called for by Alameda county, are costly.  A similar program in British Columbia costs about 1/2 million dolllars a year to run, for about a population of 4 million people.  If this catches on, this would be a costly venture for drug manufacturers, to say the least

PhRMA, the Generic Pharmaceutical Association and the Biotechnology Industry Organization are jointly filing a lawsuit in the United States District Court in Oakland on Friday.   Only time will tell how this shakes out.  For more information, see the New York Times article . 

Pharmacy-Assisted Suicide - at CVS, Rite Aid, Walgreens, Walmart, etc.

By Dr. Daniel A. Hussar is 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.

Suicide by smoking cigarettes! "Warning: Smoking Can Kill You," is the title of an editorial in The New York Times (August 27, 2012). It is a slower death than what we usually associate with the word "suicide." But premature death is the consequence for many smokers. More than 400,000 Americans die each year as a result of disease and complications from smoking. Smoking cuts lives short an average of 13 years. Suicide is intentional, not accidental. As one smoker has noted, "I never smoked a cigarette by accident."

Physician-assisted suicide prompts emotional debate, and even outrage. Pharmacy-assisted suicide - selling cigarettes - is ignored by most and is an outrage to only a few. The use of the word "Pharmacy" rather than "Pharmacist" is intentional. The vast majority of cigarettes sold in pharmacies or retailers that include pharmacies are sold in chain pharmacies, grocery stores, and retailers like Walmart. It is not the pharmacists who work in these locations who personally sell cigarettes or who have the authority for the decision to sell them. Indeed, it is my opinion that an overwhelming majority of the pharmacists employed in these stores would not permit the sale of these products if they were able to take that action without fear of retaliation from management. Rather, it is corporate management, most of whom are not pharmacists, and specifically the CEOs, who are responsible for the decision to sell cigarettes (please see my editorial, "Merchants of Death - Chain Pharmacy CEOs Must Stop the Sale of Cigarettes!" in the November 2011 issue of The Pharmacist Activist).

Some chain updates

Various recent events and situations call further attention to the hypocrisy of the largest chain pharmacies that try to create an image of being interested in the health of their customers while continuing to sell the product that is the most preventable cause of death.

CVS - Dr. Terence Gerace is the National Coordinator of the CVS Sells Poison Project. The "Poison" is cigarettes. He has conducted 122 peaceful protests outside of CVS pharmacies in the Washington, D.C. area to publicize the harm that is caused by their sale of cigarettes (www.Toxic-TobaccoLaw.org/13news.shtml#CVS). Protests 121 and 122 were held outside of the Four Seasons Hotel because the CEO of CVS was to participate in The Wall Street Journal's annual meeting of the CEO Council. Information regarding the discussions that occurred at this forum is included in the November 19 issue of The Wall Street Journal. The CVS CEO is identified as a co-chair of the group addressing the topic, "Remaking Health Care." The summary of the discussion of this topic refers to ideas such as "...looking at the agricultural subsidies that might contribute to bad habits like smoking..." However, there is no reason to think that anyone mentioned or dared question the CVS CEO about the role of his company in the distribution of the product that causes more harm and death than any other product. Dr. Gerace is to be commended for his commitment to increase public awareness of this hypocrisy. CVS ignores him but hundreds of passersby applaud his concern.

Rite-Aid - Earlier this fall it was announced that Rite Aid was unveiling the next generation of wellness store. A ribbon-cutting ceremony that included company and community officials was conducted at the grand re-opening of the store located near Rite Aid headquarters in Pennsylvania. Among the areas featured are an expanded men's grooming area, a nail bar, a hair care aisle, and a grab and go cooler ("for quick pick up of milk, eggs, and other convenience items"). Identified at the end of the announcement are "expanded clinical pharmacy services with pharmacists specially trained in diabetes care, immunizations and medication therapy management," [editor's note: assuming the pharmacists have the time available after dispensing the number of prescriptions management expects before more personnel are provided.] Reference is also made to the newly designed smoking cessation department (it is an exaggeration to call this display a "department"), but it is much smaller and less prominent than the area where cigarettes (featuring Marlboro) are sold at the check-out at the front of the store. The Rite Aid chief operating officer is quoted as saying, "We know our customers' health and wellness needs are always changing." That is fine but there is one health fact that doesn't and won't change - Smoking kills! However, Rite Aid ignores its role in encouraging smoking and continues its charade of pretending to be interested in the wellness of its customers.

Rite Aid management gives every appearance of taking positions based exclusively on the financial implications for the company. In a recent situation, Rite Aid took a position that essentially denied that pharmacists are health care providers. Fortunately, a Superior Court judge, based on her determination that pharmacists are health care providers, ruled in favor of the plaintiff and against Rite Aid (Landay v. Rite Aid). I have tried to meet with Rite Aid executives to discuss this situation, as well as its sale of tobacco products. They do not respond, which is perhaps an understandable strategy if there is not a valid response.

Walgreens - In addition to conducting protests outside of CVS stores, Dr. Terence Gerace has communicated his concerns to Walgreens regarding the sale of cigarettes in its pharmacies. He received a response from a customer relations specialist identified as Wendy B. Apparently the level of guilt associated with efforts to defend their management's decision to sell cigarettes has resulted in the respondents not wishing to identify their last name. Aside from not disclosing her last name, Wendy B. is candid. She notes that "Many of us at Walgreens have personally lost good friends to smoking and cancer." She further notes, "While we've made a business decision (but not a personal one) to continue selling cigarettes, it's a decision we constantly review." Her letter continues: "If Walgreens stopped selling tobacco products, we'd lose sales from the other convenience items that smokers normally would purchase while at our stores. That's not good for our employees, our shareholders or the convenience of the more than 20 percent of Americans who still smoke." With a response like this, I can better understand why Wendy B. does not identify her last name. Walgreens' concern for the convenience of its customers who wish to buy cigarettes can't justify its lack of concern for their health.

Earlier communications

My first communication with the CEOs of CVS, Rite Aid, Walgreens, and Walmart encouraged them to be a leader among chain pharmacies in discontinuing the sale of tobacco products, and also requested the opportunity to meet with them. None of those individuals, or their successors in the position of CEO, has been willing to meet with me, although I was able to speak with an executive (without decision-making authority) at three of these organizations (Walmart being the exception). In these discussions I encouraged the consideration of strategies through which the loss of revenue resulting from the discontinuation of cigarette sales would be replaced or exceeded by the sale of products or services that have health benefits. I encouraged them to involve their pharmacists in submitting recommendations and provide a bonus for the best ideas. I observed that a decision by the first, and probably the second, of these companies to discontinue the sale of cigarettes would result in more positive national publicity than even their large company could afford to buy. These efforts have failed but the experience has made me all the more determined.

It is noteworthy that, during this same period of time, a very important pharmacy initiative - immunization - has been implemented that has been not only of great value in protecting public health but also has been a source of substantial revenue for pharmacies. Some chain pharmacies have viewed the provision of immunizations at any time a customer requests one to be so important that they have required every one of their pharmacists to become certified to provide immunizations. The revenue to be generated from immunizations must be substantial because some chains have fired pharmacists who do not obtain this certification.

I have learned that there is only one thing that gets the attention of the CEOs of these chain pharmacies - MONEY! And when professional initiatives like immunization generate revenue, the obsession becomes MORE MONEY, rather than a willingness to discontinue the sale of the product that causes addiction, disease, and death. I do not like calling these individuals merchants of death or referring to their decisions as pharmacy-assisted suicide. I would be very pleased to applaud and congratulate them if they stopped the sale of cigarettes. However, I consider the current situation to be a huge contradiction and embarrassment for the profession in which I am proud to be a member. I have become convinced that nothing short of the strongest of terms and outrage from the profession of pharmacy and the public has any chance of convincing the CEOs of these chains to stop selling cigarettes.

New strategies are needed

Bolder and widely-publicized strategies are needed to get cigarettes out of pharmacies.

The following ideas come to mind:

A public opinion survey with the question - Which of the following retailers sells the most cigarettes in the United States (and, therefore, is responsible for the most smoking-related deaths)?

1. CVS
2. Rite Aid
3. Walgreens
4. Walmart

Highway billboards identifying the estimated number of smoking-related deaths in 2011 in a particular state based on the number of cartons of cigarettes sold by a particular chain pharmacy in that state during that year.

I have additional ideas but have run out of space in this issue. I know that readers will also have strategies to suggest.

Proper Disposal of Medications - New Law in New Jersey

Governor Christie recently signed a bill put forth by Somerset County Sen. Christopher "Kip" Bateman (R-Somerset), requiring the state Department of Environmental Protection (DEP) to issue recommendations for the proper disposal of unused medications. Further, the bill requires health care institutions to submit to the Department of Health and Senior Services and the DEP a plan for proper disposal of unused prescription medications. Failure to implement these rules will result in fines for the health care institution.

Remember the following guidelines when disposing of personal medications:

1. Mix medicines (do NOT crush tablets or capsules) with an unpalatable substance such as kitty litter or used coffee grounds;

2. Place the mixture in a container such as a sealed plastic bag; and

3. Throw the container in your household trash For most medicines, DO NOT FLUSH them down the toilet. There are a few you can flush down the toilet - check with your pharmacist if yours is one of them.

The Meningitis Tragedy – More Regulation is Not the Answer

By Dr. Daniel A. Hussar is 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.

Twenty-four deaths and 317 people ill with meningitis at the time I prepare this commentary.  And the story is far from complete. Meningitis, Deaths, Compounding Pharmacies, New England Compounding Center (NECC) have dominated the media headlines in recent weeks.  Most of the deaths and illness from meningitis are considered to be attributable to a heretofore obscure fungal organism (Exserohilum rostratum) that was a contaminant in presumably sterile formulations of methylprednisolone that were administered by epidural injection for the treatment of back pain.  The product was prepared by the New England Compounding Center in Massachusetts and distributed to physicians and hospitals in numerous state.

Tragedy
I do not use the word “tragedy” lightly.  It is the strongest word that I think of to describe the consequences of the situation that has occurred.  It is an appropriate description for one death that was preventable, but this situation is multiplied many times over.  In addition, hundreds of patients have been diagnosed with meningitis, and thousands of others have received injections from the same lots of medication and not experienced complications but are fearful that they will. There are many components of this experience that will continue to be examined and discussed in depth.  However, none of them should be allowed to diminish the concern and compassion for the families of those who died, and the efforts to accomplish the recovery of those who are ill with meningitis.

The New England Compounding Center
Information provided by the Food and Drug Administration and other agencies, as well as news reports, strongly suggest that there were multiple failures on the part of the NECC with respect to compliance with standards, procedures, and safeguards that are applicable to the preparation of sterile products.  I can’t explain the reasons for these failures and will not attempt to defend them.  Extensive discussion has centered around the questions as to whether NECC should be considered a compounding pharmacy or a pharmaceutical manufacturer, and which regulatory agency is responsible for monitoring its operations.

Compounding pharmacies
At one time all pharmacies compounded prescriptions but, at present, most pharmacies do little or no compounding.  However, in recent years there has been an increased awareness that the health needs of many patients can be best served by combinations of medications and inactive ingredients and/or special dosage forms that are not commercially available.  Compounded prescriptions can be considered to be the original personalized medicines.  Accordingly, many pharmacists have emphasized compounding as an important component of their practice and the practices of some pharmacists are entirely committed to the compounding of prescriptions and related services.  In addition to being licensed by a state board of pharmacy, there is a voluntary accreditation process in which many of these pharmacies participate and are evaluated.

Some pharmacists limit the extent of their compounding to non-sterile formulations whereas others have the facilities, equipment, and procedures to also prepare sterile products and other specialized formulations.  The number of prescriptions dispensed by most compounding pharmacies is relatively small when compared with the number of prescriptions dispensed in traditional pharmacies, and the patients served are in the local community.  A smaller number of compounding pharmacies prepare a much larger number of prescriptions for patients in a larger geographical area.  However, regardless of whether the number of compounded prescriptions is small or large, a central tenet of a compounding pharmacy practice is that each prescription is prepared for a particular patient.

Manufacturing
The manufacturing of pharmaceutical products has been the responsibility of pharmaceutical companies that then provide the products to pharmacies, physicians, or others that are authorized to provide the medications to patients.  The Food and Drug Administration (FDA) is the agency that has the authority to regulate pharmaceutical manufacturers.  However, the FDA does not have the authority to regulate the practice of pharmacy or the practice of medicine.  This is the responsibility of the state licensing boards.

An important question that has emerged in the tragedy resulting from the use of contaminated injections is whether the NECC functioned as a compounding pharmacy and supplied medications for individual patients, or whether it functioned as a manufacturer that supplied products for subsequent use in individuals for whom it did not have names or records.  Three lots of methylprednisolone injection, representing a total of 17,676 vials, have been implicated in the occurrence of meningitis that has been attributed to contamination of the product.  This large number of vials coupled with the apparent lack of patient names on the labels of vials, as well as additional information derived from the multiple investigations that are underway, give every appearance that NECC was engaged in manufacturing.         


More regulation is not the answer!
State Boards of Pharmacy have regulations that are applicable to the practice of pharmacy and the operation of pharmacies, and the FDA has regulations that are applicable to the companies that manufacture pharmaceutical products.  Some of the news reports of the meningitis tragedy have made reference to the “loosely-regulated” area of compounding pharmacy, and some legislators and others are calling for tighter regulations for these pharmacies.  However, I would contend that the current regulations are sufficient and provide appropriate authority for the regulatory agencies.

News reports indicate that both the FDA and the Massachusetts Board of Pharmacy had communicated concerns to NECC on previous occasions.  Apparently there was an awareness of existing problems or the potential for such.  In my opinion, the problem in the current situation is that existing regulations were not adequately monitored and enforced with appropriate actions.  I feel that the FDA and boards of pharmacy do not have adequate resources and staffing to appropriately fulfill their responsibilities and this situation must be addressed.  More regulation is not the answer – instead, we must direct our efforts to increase the monitoring and effective utilization and enforcement of regulations we have now.

In an area such as compounding pharmacy, it is unlikely that the officials and investigators of the FDA or a board of pharmacy will have significant experience and expertise in the operations and responsibilities being evaluated.  I recommend that these agencies appoint advisory panels of pharmacists, and others as appropriate, with pertinent experience and expertise who can provide objective recommendations that will be of value to the agencies in making the most appropriate decisions.  The current use of advisory committees by the FDA to make recommendations regarding the approval of new drugs provides a model that can be considered.

Daniel A. Hussar

Medication Disposal and Drug Take Back Days

Failure to dispose of unused/unwanted medications, particularly controlled substances, presents a significant risk for drug diversion - theft from a medicine cabinet. Get rid of excess medications at the upcoming DEA Drug Take Back Day, scheduled for September 29th, 2012 from 10AM-2PM. See the website, www.deadiversion.usdoj.gov/drug_disposal/takeback/ for locations near you.

If you can't get there, at least follow these simple directions:
1. Mix medicines (do NOT crush tablets or capsules) with an unpalatable substance such as kitty litter or used coffee grounds;
2. Place the mixture in a container such as a sealed plastic bag; and
3. Throw the container in your household trash

For most medicines, DO NOT FLUSH them down the toilet. There are a few you can flush down the toilet - check with your pharmacist if yours is one of them.

Accreditation of Community Pharmacies Can Have Important Benefits - But the Program Must Have Credibility and Value for the Participants!

By Dr. Daniel A. Hussar is 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.

During the last several months two documents containing proposed accreditation standards for community pharmacies have been published with a request for public comment. The Center for Pharmacy Practice Accreditation (CPPA), a joint initiative by the American Pharmacists Association (APhA) and the National Association of Boards of Pharmacy (NABP), has developed "Draft Standards for Community Pharmacy Practice Accreditation," and invited public comment during the period June 30 - August 15, 2012. URAC, formerly known as the Utilization Review Accreditation Commission, has developed "Community Pharmacy Accreditation Proposed Standards," and invited public comment during the period July 6 - August 17, 2012.

The participation of a community pharmacy in an accreditation program would be voluntary.

Initial questions
With these announcements of accreditation programs, some questions come quickly to mind, including the following:

What is the intent of community pharmacy accreditation?
The materials provided by CPPA include frequently asked questions in which this is the first question that is addressed, in part, by the following response:

The program "…will be focused on accrediting community pharmacy practices to recognize quality, enhance patient safety and provide a mechanism for excellence-committed pharmacy practices to distinguish themselves.

A community pharmacy practice accreditation program may provide the means:

• to ensure measurable, safe and effective patient care is being provided.
• to empower pharmacists to practice at a higher level.
• for a critical mass of pharmacy practices to achieve the JCPP 2015 Vision for Pharmacy Practice.
• for pharmacy practice networks to recognize and provide consistent care to patients."

These are laudable goals, as is the JCPP 2015 Vision for Pharmacy Practice. Attainment of these goals will be of great benefit for individual patients, society, community pharmacists, and the profession of pharmacy. However, success in attaining these goals is dependent on the extent to which the accreditation program is recognized by community pharmacists as having value, the effectiveness with which the program is developed and implemented, and the credibility of the program both within and outside of the profession.

Are two community pharmacy accreditation programs necessary?
In a word, my response is an emphatic "No!" The most likely outcomes of having two programs are competition, confusion, and lack of credibility.

Who are the organizations and individuals who have proposed the accreditation programs?
URAC describes itself as a health care accreditation, education, and measurement organization with programs across the health care continuum. A pharmacist serves as a senior manager of product development and a pharmacist serves as chairman of the advisory group for the accreditation program. CPPA is a partnership between APhA and NABP, two long-established organizations within the profession.

I consider it very important that pharmacy accreditation programs, whether they be for community pharmacies, colleges of pharmacy, or other pharmacy initiatives, be developed and administered within the profession of pharmacy. Accordingly, it is my strong opinion that it is the CPPA initiative that should be supported by the profession of pharmacy. Not only is a second program, whether developed by URAC or another organization, not necessary, but it creates the potential for compromised validity and credibility for both programs. (In the interest of full disclosure, I am the Honorary President of APhA for the 2012-13 year but I was not a participant in the planning or decisions regarding the accreditation program.)

The pharmacists who have participated in the early phases of the accreditation initiatives include leaders from many areas of pharmacy practice. However, it is noteworthy how few of them own a pharmacy or otherwise practice in a community pharmacy on a full-time basis (nor do I as an individual offering opinions regarding this issue). The National Community Pharmacists Association (NCPA) is conspicuous by its absence as a partner in this accreditation initiative, a situation that is probably due to divided opinion among community pharmacists as to whether accreditation of their pharmacies will be of benefit.

In my opinion, the active support and participation of a large number of owners of independent pharmacies are essential if the community pharmacy accreditation program is to have validity and credibility.

Why is the comment period so brief and so lacking in opportunity for open discussions?
The scheduling of the comment period in both programs for such a short period of time (approximately 6 weeks) in the middle of summer is a mistake. I can only assume that this is a consequence of the competition between the two programs, and it represents an early indicator of the importance of not having more than one program. It is my impression that a large majority of community pharmacists and many leaders within the profession have not even seen the proposed standards and are not aware of the invitation to comment.

During the comment period identified, there was only one meeting held by a national pharmacy organization (American Association of Colleges of Pharmacy). A session was held to consider the proposed accreditation standards and the discussion was productive. However, the attendance was low because this was not a topic of high interest or priority for most of those at the meeting, and the session was held from 6:45 - 7:45 am. Open forums to discuss this topic should be held at meetings of organizations at which large numbers of community pharmacists will be in attendance. At the very least, such a forum should be included as part of NCPA's annual meeting in October.

Eligibility for accreditation
Although the proposed standards for accreditation of community pharmacies are specific and comprehensive, some important basic questions exist regarding the eligibility of a pharmacy to be considered for accreditation. I am assuming that a mail-order pharmacy would not be eligible for several reasons. First, it is not community-based but at a remote site. Secondly, the lack of personal face-to-face communication of pharmacists and patients precludes the provision of patient services that are inherent in certain of the practice standards. It is my understanding that URAC already has accreditation programs for mail-order pharmacies, suggesting that it makes a distinction between mail-order and community pharmacies.

Should a community pharmacy that sells tobacco products and/or alcoholic beverages be eligible for accreditation? My response is an emphatic "No!" A pharmacy that sells these products increases health risks for its patients in a manner that contradicts the intent of the proposed accreditation standards. The accreditation of such pharmacies would seriously compromise the credibility of the accreditation program. The response to one of the frequently asked questions in the materials provided for the CPPA program addresses the distinction between licensure and accreditation as follows:

"Licensure ensures minimal practice standards, while accreditation distinguishes a commitment to enhanced safety and improved quality of care delivered within the practice."

Accreditation suggests, if not requires, a commitment to the highest standard of safety for the patients served. The sale of tobacco products and/or alcoholic beverages must not be considered an acceptable activity for a pharmacy that wishes to have the distinction of being accredited.

At its June meeting, the American Medical Association (AMA) expanded its previous policy opposing the sale of tobacco products in pharmacies by adopting policy that would create a recognition program for pharmacies that voluntarily eliminate the sale of tobacco products. It would be a very unfortunate irony if pharmacy organizations somehow considered the sale of tobacco products to be compatible with accreditation at the same time the AMA is recognizing pharmacies that discontinue such.

Should an individual pharmacy in a large chain be eligible for accreditation if its parent company has policies/positions that increase risk for patients or demean the professional role of pharmacists? For example, should any CVS pharmacy be accredited when CVS/Caremark administers prescription benefit programs that steal patients from local pharmacies and fragment the care of patients, thereby placing them at increased risk of drug-related problems?

For many years, the profession of pharmacy has sought recognition for pharmacists as health care providers. However, in a recent situation, the management of Rite Aid took a position that essentially denied that pharmacists were health care providers. Fortunately, a Superior court judge, based on her determination that pharmacists are health care providers, ruled in favor of the plaintiff and against Rite Aid (Landay v. Rite Aid). To comply with the proposed accreditation standards, pharmacists fulfill responsibilities of a health care provider. Should any Rite Aid pharmacy be eligible for accreditation when its management does not even want its own pharmacists to be recognized as health care providers, and thereby places this recognition in jeopardy for all pharmacists?

Additional issues/recommendations
Numerous other important issues and questions exist, some of which are identified below:

• Pharmacies must be accredited on an individual basis and not via accreditation of a parent organization (e.g., a large chain pharmacy).
• The pharmacist manager of an accredited pharmacy must have the authority to make decisions that pertain to the ability to be in compliance with accreditation standards (e.g., professional services provided, level of professional staffing).
• Many of the accreditation standards require policies, procedures, descriptions, documentation, etc. that will require, particularly for a small pharmacy, an extensive amount of time to develop and implement. Templates and "model" forms/documents should be developed (e.g., by CPPA, APhA, NCPA) to facilitate qualifying for accreditation and easing the administrative burden. The documentation of outcomes is very important but the highest priority must be given to the scope and quality of patient care services.
• Notwithstanding the fact that pharmacy benefit managers (PBMs) do what they want to do and usually get away with it, the PBMs must not be permitted to reduce the size of their pharmacy networks by including only accredited pharmacies when the mail-order pharmacies they own and to which they direct patients do not meet the standards by which community pharmacies will be accredited.
• The financial records of the accreditation program must be transparent.

The accreditation of community pharmacies has exciting potential to be a force for positive change and to accelerate the implementation of programs through which the actions and services of pharmacists enhance drug therapy outcomes for patients. However, it is imperative that the distinction of accreditation and the process through which it is earned are recognized to be of value and credible. This must start with the community pharmacists who are needed to be the participants, and whatever time and actions are necessary to obtain their enthusiastic participation are essential.
Daniel A. Hussar

Perspectives from the Visiting International Pharmaceutical Students’ Federation Exchange Program

Philadelphia College of Pharmacy played host to Tony Liu, a visiting student from Taiwan, as part of an International Pharmaceutical Students’ Federation (http://ipsf.org/) exhange program. Liu and and two of his hosts provided their thoughts and experience of the visit that compared and contrasted the different teaching and learning cultures of the United States and Taiwan.

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Hello, my name is Tony Liu and I come from Taiwan. I study at the China Medical University(CMU), and I’ll become 4^th year next semester with 2 years left in earning my Bachelor’s in Pharamcy.

Tony Liu with Elizabeth Coleman P'86 (right) and Maria Centore P'86 who were involved in organizing the International Congress held at PCPS in 1989.

I’m really glad I applied to the Student exchange Program this summer. I debated for a long time and wondered what new experiences this program bring to me, and if I really needed to try and go abroad to further my knowledge. I remembered when I was a 2^nd year, some foreign students came to Taiwan. I really had a good time with them, so I decided to apply and put America as my first choice. I believed I could learn and experience new things on this trip. After receiving my acceptance letter, I was excited to go, but also a little bit worried. Schoolwork was stressful, and I also had school clubs to attend at the time. I also needed to prepare documents for the trip abroad and pack all my luggage. Fortunately, I passed all my subjects, so I didn’t have to worry during the trip!

Before coming here, I knew that pharmacists in the USA  got doctorate degrees, so they will be studying more in-depth material than we were since Taiwan only offers a bachelors. The main purpose of this trip was to learn how pharmacy  is done in the States and see if any ideas could be brought back to Taiwan to perhaps be used there.

Today (July 27, 2012) was the last day of my experience and overall I went to three retail pharmacies, one industry, one clinic, and some pharmacy classes at the University of the Sciences. Three different types of pharmacy give me a chance to compare pharmacies here and also in Taiwan.I especially enjoyed my time at Johnson & Johnson during my Industry experiential.  J&J is a big company, and they have a great environment for employees to work and grow. The Clinic was different from Taiwan’s, but I liked following the preceptor to talk to patients. I also saw some interesting and inspirational teaching methods in classes! It was interesting learning how Pharmacy is practiced in the States, and I hope I can come back to learn more. I also hope to help my fellow Taiwan pharmacy students learn ways to become more involved in Pharmacy. The Philadelphia College of Pharmacy has many different student pharmacy organizations and events that encourage students to become involved with the practice early on. I hope to take these ideas and bring them back to my school. My school’s pharmacy program is only 7 years old, and I hope to help improve it from the knowledge I obtained from my experience here. 

I really adapted the life here although before I came here, everyone told me Philadelphia is a dangerous place. However, I enjoyed every day, and if I didn’t have anything to do, I loved walking around UPenn’s campus. Philadelphia is a very convenient city; I can take transportation everywhere and it’s fairly simple to figure out. Best of all, there are many different cuisines to try and I’ll miss the food here. I feel as if I did a lot of eating on this trip!

My biggest challenge was the English language. It’s one thing to learn the language in a class, and another to actually put it to use. I hope I improved my speaking skills during my stay here! I don’t think it is a big barrier for me, and I’ll keep learning and improving.

Time flies! I cherish everyone I met, everything I learned, and appreciated everything all my new friends did for me. This summer will become an unforgettable memory. I’d like to thank everyone for making me feel so welcome, and I wish everyone else to have an exciting and fun-filled summer! If any one of my new friends were to come visit me in Taiwan, I’d happily welcome you here!

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 by Vivi Jung and Jennifer Wang

It’s not always easy playing the host to someone from another country, but for a month that is what  we did. Through IPSF’s student exchange program, Tony Liu was chosen to come to the Philadelphia College of Pharmacy from Taiwan to see what pharmacy was like here. As hosts, we were to make Tony feel welcome at the school, and also give him the experience of a lifetime.

Tony Liu with PCP students Vivi Jung and Jennifer Wang

It was a rewarding and humbling experience. Talking to Tony and comparing the similarities and differences in curriculum and career paths was quite interesting. A memory that stuck with us for a while was when Tony was introduced to several professors during his tour through the school. He thought it was so great that students could see a professor and interact with them aside from class time. We had always seen dropping into chat with professors as a given, but Tony told me his professors in Taiwan do not support students and their professional organization activities as avidly as our professors do. This made us renew our appreciation in our professors and showed us how supportive they are in our school. Tony also loved the interactive classes and labs. He wishes Taiwan will someday do the same with their classes, and this experience made us re-appreciate how much work and effort is put into making the most of my education.

Being hosts means being understanding and welcoming. Tony has never been to the States before, and many things were new and foreign to him. It took a lot of patience to explain certain topics to him several times in different ways such as pharmacist state licensing and intern hours to make sure he understood. We also learned a lot about how Taiwan’s pharmacy schools are evolving and what it entailed to be a pharmacist there. It opened our eyes to what other possibilities the pharmacy profession could lead to. We also tried to gear our city adventures towards his interests, and took into consideration what he might enjoy the most. Some of the places we visited might not have been very exciting for us, but  if Tony enjoyed it, so did we.  

We planned different places for him to visit around the city. The trips made us rediscover what a beautiful city Philadelphia is and the many things it offers. The murals, museums, festivals, events, and delicious foods were a fun way to take a step back from being immersed in studying and taking time to enjoy our summer. It took some planning, maybe a few times of getting lost, and more than few “essential” snacking stops, but we’d like to think it was a fun and enjoyable month together. Overall, it was great experience, and we hope Tony would agree he had a great time being shown how hospitality is done in the city of brotherly love. Tony left after a month, but we had made a new friend and a fellow future pharmacist colleague for life.

Shedding a New Light on Medication Safety

Left to right: Assistant Professor of Clinical Pharmacy Dr. Laura Bio, Annette Lista PharmD'14, and Meghan Tolan PharmD'14.

By Annette Lista PharmD’14

The Pediatric Pharmacy Advocacy Group (PPAG) student organization, recognized by the Philadelphia College of Pharmacy, is one of the first student chapters that is a branch of the national pharmacy organization.

One of the organization’s objectives is to provide medication safety education to student pharmacists, patients and their caregivers, and pediatric practitioners. By working with the faculty advisor, Dr. Laura Bio, the organization was able to coordinate its first community outreach program with the Children’s Regional Hospital at Cooper University Hospital and the Cooper Medical School at Rowan University.

In honor of National Asthma and Allergy Awareness Month on May 31, Cooper’s Asthma Care Committee held its sixth annual Asthma Care Health Fair for 80 students from Lanning Square School in Camden, NJ.  The health fair consisted of 10 booths, ranging from asthma education to exercise activities.

The PPAG student organization’s goal was to educate the students about medication safety through a fun interactive game at their booth. The game consisted of 10 scenarios in which the students responded what they would do if put in that situation. For example, one scenario consisted of sharing a classmate’s asthma inhaler, and the discussion was to never take someone else’s medication as it can be harmful. With take home prizes and worksheets, our organization encouraged students to discuss these scenarios with their parents, guardians, and teachers at school. By teaching the students the basics of medication safety at a young age, the foundation was built to prepare them for situations in the future.

At the end of the day, all of the students gathered for lunch and were asked about one thing that they learned.  It was a proud moment for the PPAG student organization when one student raised her hand and said, “I learned not to share my friend’s medication.” With this being the first of many future outreach events that the PPAG student group will be participating in, the organization can truly see the impact it’s already made.