77 posts categorized "Pharmacy Practice"

02/19/2014

First Pharmacy Students Now Trained in Advanced Life Support

BinghamWith critical care pharmacy surfacing as a staple in intensive care, prospective pharmacists now complete high levels of life support training to increase patient survival.

Advanced Cardiovascular Life Support (ACLS) is a team-based response strategy used to optimize the survival of patients in life-threatening cardiac emergencies. Pharmacist participation on these rapid-response teams is associated with lower mortality rates, emphasizing a need for future pharmacists to get trained.

“Pharmacy students on their Advanced Pharmacy Practice Experience rotations in the hospital setting will likely encounter code situations. Many of the treatment algorithms require pharmaceutical intervention, and it is valuable for pharmacy students to be involved and educated on how to treat patients in these situations,” said Meghan Tolan PharmD’14, who became ACLS certified in 2013.

Prior to taking the course, students are expected to understand pharmacological aspects specific to cardiopulmonary arrest and reach proficiency in identifying cardiac arrhythmias. Basic Life Support for Healthcare Provider certification is also required.

“As part of the curriculum at USciences, student pharmacists receive didactic education regarding ACLS that is reinforced through high-fidelity mannequin simulation,” said Angela L. Bingham PharmD, BCPS, BCNSP, (pictured above) an assistant professor of clinical pharmacy at USciences' Philadelphia College of Pharmacy (PCP).

To achieve ACLS certification, students must then complete a 12-hour training program through the American Heart Association. Developing their skills, students practice and perform these life-saving interventions at an on-campus simulation laboratory.

Three PCP students have completed the certification thus far, including Tolan, Julia Weiner PharmD’14, and Michael Flacco, Jr., PharmD’15.

“By developing fundamentals in basic life support, management approaches for various life-threatening situations, related pharmacology, and effective resuscitation team dynamics, Julia, Meghan, and Michael are ready to save lives when they become licensed pharmacists,” said Dr. Bingham.

Trained critical care pharmacists will use their expertise to assist in a variety of scenarios as part of an interdisciplinary team. To find more information on ACLS certification, email Dr. Bingham at [email protected]

Article written by Christine Luczka
University of the Sciences Marketing and Communications Dept.

Pharmacy Student Values MLK Day of Service Experience

Mlk dayAditi Bhogal PharmD'17 shares her experience from the University’s MLK Day of Service on Jan. 20.

Martin Luther King, Jr., Day commemorates a national leader who helped our overcome segregation, ignorance and prejudice. This year was the first year Philadelphia College of Pharmacy, and the entire University, celebrated MLK Jr., Day, by cancelling classes and encouraging students to develop and/or participate in volunteering events. Generation Rx, a patient care initiative developed by The Ohio State University College of Pharmacy and funded by the Cardinal Health Foundation, is an educational program that increases public awareness of prescription medication abuse and encourages health care providers, community leaders, parents, teens, and college students to actively work to prevent abuse.  APhA-ASP partners with Cardinal Health on this educational program to expand the breadth and depth of this important initiative to the communities surrounding our nation’s schools and colleges of pharmacy. 

At our PCP-APhA chapter of Generation Rx, we tried to carry on the message of MLK. Jr., of overcoming segregation, ignorance, and prejudice by having an interactive workshop with pharmacy students and faculty about prescription drug abuse. The workshop was titled “Be Part of the Conversation.” The workshop included a presentation, which presented facts, ideas about preventing drug abuse, pharmacist roles in preventing prescription drug abuse, and the importance current trends and data surrounding this. This was followed by an interactive activity including drug abuse questionnaires and pretend patient counseling. The purpose of this was to get the conversation going about the unique position pharmacists are in to help prevent prescription drug abuse.


The most rewarding activity in this workshop was the discussion component. We discussed important questions such as policy changes that could be needed, efforts that could be taken at a nationwide, local, and campus level. One of the primary activities we found needed to be focused on was just an awareness of the physiological and medical effects of the body when prolonged drug use occurs. Another issue we focused on was the stigma attached to mental illnesses and addiction, as opposed to conditions like diabetes and heart disease.  One of the key components we realized we could do on a campus level is to have presentations/awareness on the pathophysiology of addiction, both mentally and on the body and how that ties into the most commonly abused drugs. Another idea we had was to integrate conversation and steps towards intervention in our Pharmacy jobs/rotations/volunteering. The Generation Rx “Be Part of the Conversation” workshop was the perfect way for students and faculty to come together, discuss, and take steps towards a more knowledgeable, cohesive, and tolerant society, much like the vision Martin Luther King, Jr., had for our society.

02/06/2014

The Biggest Mistakes Transfer Students Make

Viggiani_aimeeChoosing which college to attend is a huge decision for students. Whether they’ve earned their associate’s degrees from community colleges and ready to move on to earn their bachelor’s degrees, or currently enrolled in four-year schools that aren’t the right fit, one-third of all students transfer at least once before earning a degree.

Aimee Viggiani, associate director of transfer admissions, was recently featured in two articles which provide helpful tips for transfer students. She said, "All too often, students wait until too late in their college careers to ask why a certain class didn't transfer. Even if you don't need the credit right away, you may need it in the future. So ask transfer credit questions as soon as possible."

01/30/2014

What can Obamacare do for you?

               Over the past several months, we’ve delved into two separate yet very important aspects of healthcare and pharmacy practice. We have followed the birthing pains of President Obama’s signature legislation some weeks while discussing the importance of medication adherence other weeks. We will now discuss how these two seemingly isolated realms of healthcare are indeed intertwined.

               The goal of the Affordable Care Act (ACA) is to improve the well-being of American citizens, rein in costs associated with healthcare in our country, and provide health insurance to those that could otherwise not afford it. As a future pharmacist, I will focus on the goal I perceive to be most important to my chosen profession: improving the well-being of my fellow Americans.

As we’ve discussed in previous posts, medication adherence is paramount in the constant battle to improve patient care. In the past, topics such as technology and techniques to monitor patients were assessed in Mission Impossible: How to tell if your patients are taking their medications; as well as why patients don’t take their medications in Why Don’t You Take Your Medication? in Part I and Part II installments. While it is the responsibility and duty of us as pharmacists to make sure that patients are taking their medications as directed, Uncle Sam has taken matters into his own hands by passing legislation to encourage health care professionals to improve outcomes.

Why has Washington taken such an interest in medication adherence? The reality is that medication non-adherence is estimated to cost $290 billion per year in additional healthcare costs. With almost 13% of the total yearly expenditure in healthcare being spent on preventable diseases and procedures, law makers and healthcare professionals alike see an opportunity to make medicine more affordable to the American patient.

The ACA has multiple provisions aimed at improving patient outcomes. Under the ACA and Medicaid expansion, hospital re-admission for certain conditions will result in penalties to the institution. With the real threat of not being compensated for services provided to re-admitted patients, hospitals across the country are revising procedures and doing their best to increase medication adherence and lower re-admission rates. As pharmacists, we will have a pivotal role in this revision of policy.

Along the same lines as re-admission rates, hospitals will now be subjected to quality assurance measures to hold them accountable. The Pharmacy Quality Alliance (PQA) is a non-profit organization that has developed measures related to medication use; PQA has adopted ten such measures that will cover a range of services, including medication adherence.  In addition to such assurance measures, there is something known as Medicare Advantage “Star” ratings that will provide financial incentives to plans in the Medication Advantage (MA) program. In the Star Ratings system, medication adherence is weighted HEAVILY because of its importance (medication adherence accounts for 11% of the total star score). This “Star” rating system has the opportunity to influence the care of over 12 million Medicare beneficiaries.

Three models being experimented with now are patient-centered medical homes, accountable care organizations (ACOs), and episode-based payments. These models are intended to lower health care costs and improve the overall quality of care being distributed to patients. And as is the case with hospitals, they will be evaluated on measures established by the ACA. ACOs for example will be assessed by the same kind of quality assurance measures as previously discussed. And as discussed before, medication adherence is a number one priority in those measures with 20 of the 33 measures relating directly to medication adherence.

When we discussed in previous posts why patients don’t take their medications, cost was a major factor. An important aspect of the ACA is to lower costs that would deter a patient from seeking care or filling a potentially life-saving prescription at a pharmacy counter. A portion of the ACA that doesn’t get much publicity is that it has a provision that impacts Medicare and Medicaid benefits. Under the new healthcare law, the threatening “doughnut hole” has been closed. This effort to close the gap in Medicare coverage is estimated to save beneficiaries $3.4 billion in prescription drug costs which comes out to $837 per person, per year. This is no small amount of money and could indeed encourage people to get that necessary prescription filled. When the decision for a retired individual on a fixed income to choose between their groceries or medicine is no longer necessary, everybody wins.

While this is an exciting time for healthcare, we as pharmacists are entering a brave new world. As I’ve discussed, the ACA calls for many changes in the way healthcare will be administered with an emphasis on medication adherence; and with pharmacists being the medication experts, we will be expected to lead the charge in making many of these changes a reality. This presents our profession of choice with an opportunity to not only create value as health care professionals, but also put our foot in the door and establish ourselves as vital cogs in the 21st century healthcare machine. At this time the ACA does not establish a system by which we as pharmacists will be compensated for our increased duties and responsibilities which is obviously not a desirable situation. But don’t be discouraged. We as pharmacists should take this opportunity to not only elevate the prestige of our profession, but also establish value that will positively impact the way we are compensated in the future. Pharmacists are no longer ‘pill counters.’ We are well respected experts in a vital facet of medicine and it is time we are recognized as such. As Horace so eloquently put it: Carpe diem!

Mackenzie F. Blair, PharmD '15

01/20/2014

We Will Try Resolutions Again but Pharmacy May Need a Revolution!

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.

For many individuals and organizations, the arrival of a new year is the time to determine resolutions to be accomplished. Although I have not designated them specifically as "resolutions," some of my editorials in the Pharmacist Activist have addressed what I consider to be the priorities for our profession of pharmacy (please see "The 'Tyranny of the Urgent' Must Not Compromise our Commitment to our Priorities," [May 2012 issue] and "Priorities for our Profession" [February 2011 issue] of the Pharmacist Activist).

Most of the priorities/resolutions I have identified in earlier editorials have been recognized as challenges for decades and could be recited on an annual basis. As I again read the two editorials mentioned above, my assessment is that there has been very little progress made in addressing important issues. I accept my share of the responsibility for this limited progress—I need to do more!

I recognize that pharmacists and the leaders of our profession do not have any obligation to read or agree with anything I write or recommend. And often they don't. There can very well be concerns and priorities that are more important than the ones that I identify, and/or I may not be clear enough, persuasive enough, or bold enough in communicating my recommendations. However, I continue to contend that there are challenges that pharmacy must effectively and urgently address. This time I will call them "Resolutions" and many of my comments that follow will be very familiar. I have limited this commentary to five areas. There are many more that are also deserving of our attention. They are provided for the purpose of generating discussion, action, and better ideas and recommendations.

Resolutions for pharmacy

  1. Individual pharmacists must demonstrate more commitment, passion, and activism on behalf of our profession. It starts with me/us! What have we done as individuals to advance our profession and to address the problems that exist? If we have done nothing, we forfeit our right to complain about or criticize what others are doing or not doing. We must start by being members and, optimally, active participants in our professional associations. In my opinion, every pharmacist and pharmacy student should be a member of the American Pharmacists Association, the one national pharmacy organization that is positioned to represent the entire profession. We also have a responsibility to be members of the state and local associations of pharmacists that represent the entire profession. In addition, there are many other associations with focused/specialized programs and services in which membership and participation will be of great value for pharmacists with specific practice interests and responsibilities.

    I strongly encourage not only involvement but activism of pharmacists as individuals in programs and initiatives that will promote and advance our profession. However, as active as we may be as individuals, our sphere of influence is limited, and the resources and strength of associations with a large membership is essential.

  2. Our national pharmacy associations must be more effective and more accountable. Our profession needs an organizational structure that will serve and advance the interests of pharmacy in a much more effective manner than is being accomplished through our current system. Our national associations give primary or exclusive attention to self-preservation and growth of their individual membership, programs, and finances. As important as these things are, not enough attention is being given to identifying and taking action on the issues that are of the greatest importance for the profession as a whole. Indeed, it often appears as if the national associations are competing with each other more than they are collaborating with each other.

    Our national associations and our leaders need to be more accountable by responding to concerns experienced by tens of thousands of practicing pharmacists such as understaffed and stressful workplace environments that increase the risk of errors and harm to patients. Issues such as the abuse and overdose deaths from prescription products containing hydrocodone or oxycodone cry out for leadership and initiatives that will greatly reduce these tragedies. But how does pharmacy respond? With conflicting opinions from the national organizations as to whether hydrocodone combination products should be transferred from Schedule III to Schedule II. Our profession and the public deserve better!

    The importance of building the strength and effectiveness of pharmacy at the national level can't be overstated, as this will also be essential for success with respect to the following resolutions.

  3. The Vision for 2015 must be implemented. In late 2004 the Joint Commission of Pharmacy Practitioners (JCPP), comprised of the leaders of the national pharmacy associations, developed the following vision statement that was endorsed by all of the major national pharmacy practitioner organizations:

    "Pharmacists will be the health care professionals responsible for providing patient care that ensures optimal medication therapy outcomes."

    This vision statement is followed by a discussion titled, "Pharmacy Practice in 2015," that embraces the patient-centered role of the pharmacist, and pharmacists doing in practice what we have long been saying we are capable of doing. This is a bold initiative from which patients and the profession of pharmacy can greatly benefit, and which demonstrates a positive outcome when our national associations work with each other.

    The year 2015 is a goal and not a rigid deadline. However, we are only one year away from 2015, and it is appropriate to assess what progress has been made over the last 10 years. There are patient-centered practice accomplishments of individual pharmacists and individual associations. However, these accomplishments are for the most part isolated and few in number compared with what needs to be done to implement the vision. What happened to the progressive vision for which there was such agreement in 2004? It would appear that the national associations that developed the vision statement did not continue to collaborate, but went their separate ways. They should be accountable in explaining why there has not been substantive progress in working together and attaining this vision. Instead, the priority of the JCPP appears to be to revise the vision statement. The new statement is reported to be:

    "Patients achieve optimal health and medication outcomes with pharmacists as essential and accountable providers within patient-centered, team-based health care."

    Will JCPP be accountable to pharmacists in describing its lack of involvement/progress in attaining the vision for 2015? Will the national associations be as accountable with respect to their responsibility in attaining the revised vision as they are in expecting their members to be accountable in providing the health care described?

  4. The profession of pharmacy must establish a model prescription benefits and services program. The vast majority of prescription benefit programs administered by pharmacy benefit managers, insurance companies, and government agencies are seriously flawed. They fall far short in using the knowledge and skills of pharmacists and in assuring optimal effectiveness and safety of drug therapy for patients. Numerous efforts to improve these programs have failed, and many programs are getting worse. We can't depend on others to design a program that will assure the quality of medications and the services of pharmacists that will also be cost-effective. We must do it ourselves!

    Many of our national pharmacy associations do not presently provide a prescription benefit program for their own employees that includes the services and other quality measures that they expect their pharmacist members to provide to patients. This situation should be given immediate attention. The national associations should work together to identify the resources and expertise needed to establish a model prescription benefit program and network of participating pharmacists in the Washington, D. C. area. This program would first be made available to employees of the national pharmacy associations. As soon as possible, it should be made available to legislators and government officials and their staffs. There would be a considerable cost to establish such a program but I can't think of a more important investment for our national associations. I have full confidence that the quality and value of such a program would be quickly recognized and publicized to the extent that others would also adopt it.

  5. The profession of pharmacy must do much more to provide fulfilling employment opportunities. Several factors (e.g., national economic challenges, many new colleges of pharmacy) have converged to create a situation in which many pharmacists are having difficulty in obtaining employment. Colleges of pharmacy and the pharmacy associations must do much more to assist pharmacists in obtaining positions. Some contend that when the Vision for 2015 is implemented there will be a shortage of pharmacists. However, that is not the reality now and will not be soon. But it does provide all the more reason to move as quickly as possible to implement the Vision.

    Additional strategies must be developed to assist pharmacists and students who will be graduating soon to have fulfilling employment responsibilities. For example, two independent pharmacies might each fund one-half of a full-time position. Also important is the recognition that some employers of pharmacists will reduce the staffing of pharmacies with the expectation that pharmacists will not leave because employment may not be available elsewhere. It is very difficult for employee pharmacists to challenge management regarding understaffing or a stressful workplace environment because they might be placing their job at risk. The pharmacy associations and colleges of pharmacy have a responsibility to do more to assist pharmacists in obtaining employment in which they can provide the expertise and services that patients need.

The list goes on but these five resolutions will suffice for now. Not only are they important but there is an urgent need to be effective in addressing them. Changes in health care are occurring at an unprecedented pace. If we are not successful in responding to these challenges soon, a revolution in our profession will be needed!

12/05/2013

First Impressions of the Affordable Care Act Rollout

The rollout has been a bumpy ride to say the least. The website still has its glitches, and the problems are being labeled President Obama’s Hurricane Katrina by many political pundits. In this week’s entry we will try to separate fact from fiction and take an objective view at the law and where we go from here.

The October enrollment numbers were only 20% of predicted targets. More than 106,000 people enrolled, but only 27,000 of those did so by way of the federal website; the vast majority of those that enrolled utilized the state ran exchanges. To put the 106,000 person total in perspective, this is only 1.5% of the anticipated enrollee total at the end of the 2014 period. To bring things closer to home with regards to our local states, Maryland had 1,700 enroll while Pennsylvania enrolled 2,207. These totals are considered low across the board but enrollment numbers seem to be improving with the November enrollment period now concluded.

While these numbers are disconcerting, optimists and supporters of the law stress for us to look at the precedent set by Massachusetts’s model in 2007. The Affordable Care Act relies on young and healthy people (those under 35 years of age) to enroll to offset the cost of those that are older and more prone to illness. If the trends seen in the MA plan stay consistent, these healthy individuals will procrastinate until the last possible second (March 31st deadline) to enroll so as to avoid the financial penalties. Jonathan Gruber, an architect of the Massachusetts plan, advisor to the President on the implementation of the federal system, and proponent of the individual mandate, stresses us to ‘be patient.’

In contrast to the multitude of issues encountered by those enrolling through the federal website, the poster boy for the state ran exchanges appears to have gotten it right. Kentucky enrolled approximately 15,000 people only 21 days after the exchanges opened on October 1st. Governor Steve Beshear heralds their website a success and claims that close to 1,000 Kentuckians enroll every day. The success of Kynect.Ky.gov highlights the advantages of a state-ran exchange and provides a framework for the federal program to glean vital information to ensure its own success.

With the November 30th deadline now past, reports are coming in that healthcare.gov is indeed improved over the debacle that was the October 1st launch, but it is not yet perfect. Concerns are that the very people the ACA relies upon for its success, the young and tech savvy generation, will be turned away if the website does not meet their expectations. This fear has increased the urgency to get the portal working as smoothly as possible, as soon as possible.

As with most laws, the Affordable Care Act is not a perfect law. It has its opponents and it has its obvious flaws. But instead of throwing in the towel, I’d like to see our nation’s leaders work together and find solutions to this law’s problems. Millions of Americans don’t have adequate health insurance and this law was intended to help those people, and those people still need health care now.

Mackenzie F. Blair,  PharmD ’15 Candidate

12/04/2013

Inspiration!

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.

My students are a continuing source of inspiration who make it a pleasure to continue teaching on a full-time basis even though many of my contemporaries have retired. My students keep me young, at least young at heart if not chronologically. Often there are additional opportunities for professional stimulation and encouragement, and sometimes these situations even occur in bunches as they did this past week.


They started with my class on Wednesday afternoon from 4 - 6 pm. My former student, Steven Chang, owner of Parkway Pharmacy in Atlantic City, was the guest speaker in the course. In addition to being actively engaged in our profession and his community, Steven has attained credentials in the area of nutrition that he applies in seminars and personal consultations based in his second practice site, Essential Elements. One of the most satisfying parts of being a faculty member is to invite accomplished pharmacists whom I first came to know when they were my students to speak in my current course in which I am among those learning from them. On this occasion, however, I had informed Steven that I would be introducing him to the class and would then have to leave for the airport to catch a flight to Seattle.

I had been invited by my former student Joe Gerber, Senior Director of Educational Affairs of the American Society of Consultant Pharmacists (ASCP), to speak at the ASCP annual meeting in Seattle. My presentation was at 8:15 am on Thursday morning and I arrived at the room one-half hour early. I was surprised by the large size of the then unoccupied room and wondered how many pharmacists would be attending my session. By 8:15 am, several hundred pharmacists filled the room and most had already attended another educational program earlier that morning. I started by commending them on their professional commitment to extend their personal education and for their support of ASCP.

I wish that I could have stayed for the entire ASCP meeting as there were so many programs that I would have liked to attend. However, I needed to return to Philadelphia on Thursday for a commitment the following day. And fortunately, my flights were uneventful and on schedule, something I do not take for granted.

On Friday morning I drove to Chambersburg Hospital in central Pennsylvania. I had been invited to give a Medical Education presentation on the topic of New Drugs. Most of those in attendance were physicians and I couldn't help but reflect on my early years in pharmacy when only a few would have ever anticipated that physicians would attend an educational program presented by a pharmacist. It was a pleasure to observe the positive dialogue among the physicians and pharmacists at this hospital and recognize the substantial progress that has been made in interprofessional communications and practice.

A tour of pharmacies

My travel to central Pennsylvania provided the opportunity to visit some pharmacists whom I do not often see. My first stop was at Park Avenue Pharmacy in a quiet residential section of Chambersburg. Tom Stonesifer owned the pharmacy for many years and, in addition to providing a highly professional practice environment and services, he was a mentor for numerous individuals including his son Ben who is also a community pharmacy owner, and also Jenny Hopple. Jenny started working at Park Avenue Pharmacy when she was in high school, was inspired to study pharmacy, came back to Chambersburg to practice in this pharmacy and, several years ago, purchased the pharmacy from Tom. She is thrilled that her daughter who is now a high school senior is planning to study pharmacy.

My next stop was at Carl's Drug Store in Greencastle, PA. Owned by Frank Ervin for many years, Carl's Drug Store has the distinction of being the oldest continuously-operated pharmacy in the United States, having been founded in 1825 (only 4 years after the founding of the Philadelphia College of Pharmacy in 1821Ñand, no, I was not on the faculty then). Following decades of distinguished service to the Greencastle community, Frank has sold the pharmacy to Rodger Savage, another community pharmacy owner who is committed to continue this service to the community and preserve the historical legacy of Carl's Drug Store.

Dave and Jeanne Lutz own Rhoads Pharmacy and Gift Shop in Hummelstown, PA and I arrived there shortly after 4 pm. Dave provided me with a demonstration of his new RxMedic robot with many state-of-the-art features. As impressive as the pharmacy and pharmacy staff are, it is impossible to capture the magnificence of the gift shop with just words (and The Pharmacist Activist [for free] can't afford photos). Under Jeanne's capable and loving attention, this is a decorative showplace of unique gifts and displays that attracts individuals from all over central Pennsylvania. If you are anywhere close, you must visit! Among their collectibles are the Byers' Choice Carolers of which my wife and I have a small collection. I commented to Jeanne that it was unfortunate that Byers did not have a pharmacist among its hundreds of different figures. Jeanne responded, "I have a surprise for you." Soon thereafter, she and Dave presented me with the new Byers pharmacist, complete with mortar and pestle and bottle of leeches. A perfect gift for your favorite pharmacist! In their brochure, Dave and Jeanne include the statement, "If you don't say ÔWOW' when you enter or leave our store, we haven't done our job." "WOW."

Detour to Mt. Joy

Not far from Hummelstown is the community of Mt. Joy. There is no mountain but there is a lot of joy to which my son and daughter-in-law (Eric and Terra) and their five children (ages 7 to 1) greatly contribute. I knew that my grandchildren would be delighted if I surprised them with a visit. However, just to be sure they would be, I stopped at the nearby bakery to buy some cookies to take with me. It was a delightful visit (even before they knew I had brought cookies).

While in Mt. Joy I stopped at Sloan's Pharmacy in which three generations of the Sloan family have served this community. There are now five Sloan's Pharmacies in this region that are owned by Jake Sherk who has extended the excellent reputation established by the founding family.

Read the small print

On Saturday morning I had an errand to do in my home community of Newtown Square. A new free-standing Rite Aid had been constructed to replace one in a strip mall across the street, and it had just celebrated its grand opening. I needed a can of shaving cream and thought this would be a good opportunity to visit the newest pharmacy in our area (as a matter of principle I do not obtain prescriptions or other medications in places that sell cigarettes). The store is impressiveÑvery spacious and colorful, well lit, and well-marked sections and aisles. The one prominent blemish is the cigarette section featuring Marlboros.

After finding the shaving cream I passed a candy aisle and noted a special price for bags of Life-Savers bags for $3.00. Not being one to resist such a bargain (or candy), I picked up two bags and proceeded to the cashier. As I was waiting for the cashier, I noted the size and clarity of the monitor on which customers, as well as the several people standing behind them, could view the names and prices of each of their purchases. As my purchases were being entered on the cash register, I observed that each bag of Life-Savers was being recorded at a price of $2.39. I stated to the cashier that the sale price was two bags for $3.00. She called the manager over the loudspeaker who came over and explained that the sale price was only for customers who have a Rite Aid Wellness Card. Oh, the humiliation of not having a Wellness Card! The woman waiting behind me wanted to help and said that I was welcome to use her Wellness Card. However, I politely declined her kind offer (I could envision Rite Aid charging me with fraud for using another customer's Wellness Card) and told the cashier that I did not want the Life-Savers at the higher price. By this time there were four customers waiting behind me so I resisted the temptation to ask whether customers who have Wellness Cards receive large discounts on cigarettes, or whether Wellness Cards have expiration dates.

When my purchase was completed I went back to the candy aisle to check again about the special price for Life-Savers. There it was in small print that the lower price was only for customers with Wellness Cards. I also looked at my cash register receipt to confirm the accuracy of the information printed on it (everything was accurate). The reason I did this was that about two years earlier a new CVS had opened up in our community. When I visited soon after the CVS opened, I bought a bottle of soda and happened to look at the receipt as I was leaving the store. It was very surprising to note that both the name of our town and the name of the street were spelled incorrectly. I periodically returned to make small purchases and it wasn't until about 8 months after the store opened that the mistakes on the cash register receipts were corrected.

Renewed inspiration

Following my Rite Aid experience, I was all the more appreciative of the services and professionalism of the pharmacists at Paoli Pharmacy that I and my family use. Paoli Pharmacy and Gateway Pharmacy are owned by two husband-wife pharmacy couples Henry and Patty Katra and Mark and Sandy Szilagyi. Their children, Nick and Krissy Katra and Mark and Jenn Szilagyi are also pharmacists in these pharmacies that provide very comprehensive pharmacy services including compounding and medical equipment/supplies. Paoli Pharmacy has recently moved to a new larger facility in which the entire second floor is devoted to medical equipment/supplies and services. Henry and Krissy recently gave a presentation on this topic at a meeting of the student chapter of the National Community Pharmacists Association at the Philadelphia College of Pharmacy (PCP).

I serve as the faculty advisor for the organizations of Christian students at our University and each semester my wife and I host a dinner for these students at our home (to give credit where credit is due, my wife does all the meal preparation and other work). On Saturday evening, 60 students visited with us. It was a wonderful time of fellowship and the courtesy, personal qualities, and enthusiasm of these students was a source of encouragement and inspiration for both Sue and me.

And, in my mail, is a letter with a check representing a substantial gift from Mark Lawson. Mark received his Doctor of Pharmacy degree just 11 years ago. He now owns or is a partner in three pharmacies. He recently contacted me to indicate that he wants to give something back to the profession that has provided him with excellent opportunities. He has chosen to do this by paying the membership dues in the Pennsylvania Pharmacists Association for all of the PCP students in the P3 and P4 years who are Pennsylvania residents. What a wonderful investment in our students and in their future involvement in our professional associations!

Although there are issues and challenges facing our profession and individual pharmacists, we have so much for which to be thankful every day, but especially as we celebrate Thanksgiving.

Daniel A. Hussar

11/20/2013

Why Don’t You Take Your Medication? Part II

In our previous blog, we delved into how fear and confusion can negatively impact medication adherence. Now we will examine how health beliefs and finances can influence patients and a service we as pharmacists can provide to improve outcomes.

Health Beliefs. A difficult barrier pharmacists must overcome to improve adherence is the health beliefs our patients have towards medications, their disease states, and health care in general. A study examined how health beliefs impacted medication adherence in patients being treated for HIV/AIDs and discovered that those patients who were asymptomatic were more likely to be non-adherent, while those who experienced negative effects from their disease were more likely to be adherent to avoid such negative effects. Pharmacists must stress that even if a patients are feeling well and does not physically feel sick, they must continue to take their medications. This challenge arises with disease states like hypertension or mental illness where the person may feel fine after taking their medication for a while and then discontinue there medications thinking that they are now cured.

Financial Constraints. An estimated 14 million Americans with chronic medical conditions cannot afford their medications. Doctors may not consider the price of a drug when prescribing and as pharmacists, we are at the point of care when a patient must make the difficult decision to pay for this month’s supply of medication or food for their family. Pharmacists must take due diligence to discover whether their patients are adherent as result of financial hardship. It can be a difficult subject to approach, but there are some questions that can be asked to indirectly ascertain this information; examples of such questions include: “Are there circumstances that make it difficult to fill your prescriptions?" or "Are you testing blood glucose less often because you're trying to conserve supplies?" If it is discovered that a patient cannot afford their prescriptions, we as pharmacists could contact the prescribing physician and request a generic alternative or contact the pharmaceutical company for possible discount/assistance programs. Medication adherence is a significant barrier to achieving positive therapeutic outcomes in our patients, but there is a tool that has been developed over the last several years that will make the task of overcoming these barriers much more attainable.

Medication therapy management (MTM) was developed in response to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. MTM provides pharmacists the unique opportunity to be the ‘medication expert’ and improve patient adherence, and thus outcomes. With pharmacists now becoming more integral in the health care team, and being able to interact with patents in a more prominent role, we are now in a great position to correct the factors that interfere with a patient being adherent. By using tools like the interview a pharmacist can glean valuable information from their patient and make adjustments when necessary before the patient is potentially harmed. Communication and information gathering are valuable in improving overall outcomes and MTM gives pharmacists the necessary means to not only communicate but do something about it.

It is our role as pharmacists to communicate, educate, and in turn ensure that our patients take their medications as prescribed. We’ve discussed why a patient might not take their medications and how to counter such obstacles to adherence as well as the ever evolving role of MTM in healthcare.

Mackenzie F. Blair, PharmD ‘15

11/13/2013

Why Don’t You Take Your Medication?

It is a question that thousands of pharmacists and health care professionals ask their patients on an almost constant basis; but many times this inquiry falls on deaf ears and the patient remains noncompliant. It is a frustrating reality that approximately 50% of patients are non-adherent to their medication regimens. It is common knowledge that these patients can’t achieve their therapeutic goals if they don’t take their medications as prescribed and adherence is the key mediator between medical practice and patient outcomes. As pharmacists, we should take a closer look at WHY our patients don’t take their medications, and what we can do about it.

Fear:   While modern medicine can save lives and cure disease, the fears many have towards medications can prevent these people from being helped. Fear is a powerful influencer and it can manifest itself in many ways. A patient could be afraid of a startling side effect, the risk of drug addiction, fear of needles, or even the negative stigma that taking a medication has in society as is the case for drugs associated with mental illnesses. Culture can even have an impact if the prescribed medicine is in contradiction to the patient’s religious beliefs.. As pharmacists, it is important for us to interact with patients and assess their attitude towards their therapeutic plan. It is vital to identify fears they may have and help alleviate their anxiety or hesitation. For example, if a patient is frightened of a rare side effect, framing the risk of developing the side effect with real data may reduce the fear.  If the patient has a phobia of needles it might be possible to alter the therapy so that injections or needles can be avoided. While it is unrealistic that we can calm all the fears patients may have, it is possible that with proper communication and education, many of these fears can be minimized.

Confusion and poor health literacy:   "Take two tablets by mouth twice daily." To a trained pharmacist or student like myself, those instructions appear clear and concise, yet a study revealed that nearly half of all people who read them misunderstood them. And with 81% of older adults taking one medication with 29% of them using five or more prescription medications, confusion can easily arise from multiple drug regimens and multiple disease states. It is the pharmacist’s responsibility to limit confusion as much as possible. This can be achieved by writing simple instructions on prescription labels and communicating with the patient in a counseling session. Nothing should be assumed and every aspect of the medication should be addressed with the patient. It should be stressed to the patient that there is no such thing as a stupid question. It is a fact that a poor patient-pharmacist/physician relationship hurts the chances of patients actually taking their medicine as prescribed.

Fear and confusion are only a few of the barriers that pharmacists encounter when trying to improve medication adherence. In the next blog we will examine and discuss health beliefs as a barrier to medication adherence and what we as pharmacists can do to improve outcomes.

Mackenzie F. Blair, PharmD ‘15

11/08/2013

Obtaining Health Insurance that Isn't Understood Using a System that Isn't Working - And the Situation Will Get Worse if there is not Compromise!

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.


The "old" health care system had serious deficiencies. Almost every participant (e.g., pharmaceutical companies, hospitals, physicians, pharmacists) could determine the prices to be charged for products and services and expect to be compensated in the amounts requested. However, there were valid questions as to whether this health-care model was financially sustainable. In addition, there was little or no attention given to assessing the quality of health care provided and the outcomes for patients.

The "new" health care system (i.e., the Affordable Care Act [Obamacare]) that is being implemented has serious deficiencies. The health-care providers who provide services, care, and products for patients have little participation or influence in the determination of the scope and terms of the program or the compensation they will be provided. Instead, government agencies, insurance companies, and organizations such as pharmacy benefit managers are making these decisions. The scope and services of the new system raise valid questions as to whether this health-care model is financially sustainable. In addition, there is inadequate attention given to assuring the quality of health care provided and the outcomes for patients.

The old and new systems are markedly different, yet many of the questions and concerns are very similar. Is progress really being made or have we just replaced one set of problems with other problems of equal or greater importance? I do not defend or advocate the return of the old system. However, the new system is seriously flawed and will collapse as a consequence of the problems and concerns with which it is burdened unless major changes are made. We can and must do better!

Continuing concerns: The current problems that individuals have encountered in attempting to learn more about the health-care benefit options and to choose a particular type of coverage are just the latest of a long series of concerns regarding the parameters and implementation of Obamacare. Indeed, the secrecy surrounding the development and approval of the legislation that has enabled the changes in the health care system was an early indicator of the problems ahead (Please see my editorial, "Health Care Reform - Let's Start Over and Do It Right!" in the January 2010 issue of The Pharmacist Activist).

The current problems have, however, greatly increased the awareness of the public of the challenges that exist. These challenges include, but are not limited to, employers reducing the number of full-time positions and increasing the number of part-time positions; decisions of employers to change health benefit programs for employees and retirees; insurance companies canceling policies; the President making changes in the terms and implementation of the program without accompanying legislative authority; whether individuals can continue to use the same physicians and pharmacies; other terms of the health coverage options; access to needed information using the online network; and the cost of the coverage options.

Positives of Obamacare: The sharp differences of opinion that exist regarding certain provisions of Obamacare have polarized discussions and precluded consideration of areas of agreement and constructive change. I would identify the following as components of the legislation for which I feel there is strong support:

  • The opportunity for many individuals who do not currently have health insurance to obtain such coverage at an affordable cost or, if necessary, have the coverage subsidized.
  • The provision that individuals with pre-existing conditions would be able to obtain health insurance at an affordable cost.
  • The increased age at which young adults are permitted to be included in their parents' health insurance coverage.
I would like to think that a focus on these areas of general agreement could be a starting point for constructive discussion of the issues on which there is disagreement. However, the acrimony and polarization that have resulted from the differing philosophical, ideological, and political positions on these issues, make it difficult to be optimistic that agreement regarding a health care system can be reached.

Is compromise possible?: To date, it has not been possible to reconcile the two markedly different positions regarding Obamacare. Advocates extol the benefits and claim the authority of the legislation that established it. Opponents have such strong concerns that they strive to defund the program and/or repeal the legislation. There is seemingly no hope for compromise. However, this impasse is a "lose-lose" situation for both advocates and opponents, Democrats and Republicans.

Advocates for Obamacare have the position of strength and some feel there is no need for any compromise. But hardly a day goes by without an announcement that a large employer is making substantial changes in its health-care benefits or that an insurance company is canceling thousands of policies. Does anyone really think that these changes will be of greater benefit for employees and/or individual policy holders? Of course not! The employers and insurance companies are making these changes to protect their own interests.

The implementation of the early phases of Obamacare has revealed serious conceptual and operational flaws and limitations. And consumers are not yet even close to learning the options regarding health care providers and services and the cost of the insurance coverage. In my opinion, there will be additional problems that will be worse than the ones that are recognized now. The problems and challenges may be of a magnitude that the program will fail. Advocates for the program must be willing to compromise.

Opponents of Obamacare must also be willing to compromise. Their criticisms of the program have not been accompanied by suggested revisions or recommendations of viable alternatives. Their position would maintain the present system, and that should no longer be considered acceptable. There is an important need for progressive changes in the provision of health care services and insurance, and compromise will be essential for the attainment of this goal.

I would like to think that there are legislators who have the personal character to rise above partisan politics and provide bipartisan leadership for the Congress and Administration in forging a compromise on these issues. To not do so risks the failure of Obamacare and the possible development of alternative health care systems and insurance coverage that are even more problematic and divisive.

Where are the health care providers?: Health care services and insurance coverage for such are of the greatest importance for the recipients of these services. But these issues are also of great importance for the providers of health care services (e.g., pharmacists, physicians, nurses). To what extent have health care providers and our professional organizations been involved in the development and implementation of Obamacare, as well as active participants in the discussion/debate regarding the benefits and deficiencies of the program? Our involvement and influence have been limited at best. Some would suggest nonexistent or ineffective.

Our organizations of health professionals must do more! We are in the best position to identify the parameters of a program that would assure the effectiveness, safety, and quality of health care. We can work effectively with those with administrative and financial expertise in developing those components of the program. However, experience has demonstrated that when health professionals are not involved and/or effective in the development of health care benefit programs, important decisions are made by others and we must cope with the consequences.

If the current impasse among our legislators continues and a compromise is not reached, there could be an even greater opportunity for our organizations of health professionals to fill the void with progressive recommendations.

Even if the legislators do reach a compromise, it is essential that our organizations become more involved, both independently and in collaboration. To address just one of the important issues, I recommend that the American Pharmacists Association and the American Medical Association work together to introduce and seek support for a provision that patients have freedom of choice in selecting their physicians and pharmacies in health care programs that are funded by the government. I am certain that there would be strong public support for this recommendation.

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