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An Eye-Opening Experience

A student hotspotting program gives future pharmacists and healthcare providers insight into how to care for patients with complex needs and encourages interprofessional collaboration.

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East Tennessee State University Receives USPHS IPEC Award

The university is recognized for its collaborative efforts and work with the community to curb opioid use.

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An Eye-Opening Experience

A student hotspotting program gives future pharmacists and healthcare providers insight into how to care for patients with complex needs and encourages interprofessional collaboration.

East Tennessee State University Receives USPHS IPEC Award

The university is recognized for its collaborative efforts and work with the community to curb opioid use.

By Emily Jacobs

Even as health experts and community leaders across the country launch various initiatives to address the ongoing opioid crisis, the situation remains dire. In Tennessee, more than 1,186 state residents died from opioid overdoses in 2016, a rate of more than three deaths every day, according to the Tennessee Department of Health. Physicians prescribed state residents a total of 6.9 million prescriptions for pain medication that same year. Law enforcement officials have seen a rise in heroin and fentanyl use, while hospital staff witnessed increased emergency room visits related to opioid use. Fragmented resources and a lack of coordination have hindered the state’s attempts to resolve this wide-reaching problem.

East Tennessee State University’s multidisciplinary opioid program recently received the 2018 Public Health Excellence in Interprofessional Education Collaboration Award. Given by the U.S. Public Health Service (USPHS) and the Interprofessional Education Collaborative (IPEC), the award (now in its second year) recognizes collaborators in health professional schools that take a unique approach to addressing public health issues. ETSU researchers have found that both collaboration and community focus are two major factors in curbing the opioid crisis.

ETSU’s program began in 2012, when a small group of experts gathered to discuss and brainstorm the region’s opioid problem, forming the Prescription Drug Abuse and Misuse Working Group. The working group applied for and received a five-year grant from the National Institute on Drug Abuse.

“That was a game-changer for us,” said Dr. Nicholas Hagemeier, associate professor at ETSU’s Gatton College of Pharmacy and a member of the original working group. “It facilitated infrastructure growth here at the university and on three research projects. From there, things just took off.”

The program now has more than 250 members, including clinicians, nonprofits, insurance company representatives, ETSU faculty and students and community members. Through its working group and two-year-old Center for Prescription

Drug Abuse Prevention and Treatment, ETSU has received more than $2.4 million for opioid-related research, hosted numerous presentations about the crisis and launched a formalized opioid treatment program with the support of local health systems and government. The variety of perspectives has contributed to the value of the working group, said Hagemeier.

Partnerships Are Key

Collaboration through research is one of the factors that contributed to the program receiving the USPHS IPEC award. Many states have multiple, competing programs aimed at reducing opioid dependence. The ETSU program, however, is focused on partnerships. The program’s collaborators include not pharmacists in the geriatric clinic but this new position focuses on transitions of care. Another hire was for a brand new internal medicine clinic that never had clinical pharmacy services before, and the other hire is a hybrid model providing clinical pharmacy services for some of our smaller clinics, the WISH Clinic, which is comprehensive care for women, as well as for a family practice.”

USPHS and IPEC recognized ETSU’s exemplary efforts to fight the opioid crisis with their submission, East Tennessee State University Responds to the Opioid Epidemic Through Interprofessional Education, Community Engagement, Research, and Clinical Care.

Danielle Fixen, Pharm.D., BCGP, BCPS (left) conferring with Maria Vejar, DNP, GNP-BC at the University of Colorado Hospital Seniors Clinic.

Moore said the geriatric clinic reached out to the school, recognizing the need for a pharmacist’s skills to help treat its patients’ complex needs. With other partnerships, the school moved slowly, integrating into a physician practice by starting an anticoagulation clinic, where the physician quickly realized the potential of pharmacists and asked the school how they could find more funding for pharmacists to help the practice with other disease states. “Integrating pharmacists has been relatively easy because the physicians have really bought into the value of the clinical pharmacists,” Moore said. “We probably get more demands than we can fill.”

The challenge is the funding, which leads to innovative thinking, such as a new project at the University of Colorado where physicians and providers in primary care can consult with specialists via the electronic health record. Clinical pharmacists are on the list of specialists, so physicians can consult with them on questions about drugs or drug regimens. “It’s great that physician practices recognize the need,

so I think we have to be nimble and creative with some of the models of care,” Moore said.

Moore thinks having access to the electronic medical record may be an embedded pharmacist’s most important resource. Having a template for the pharmacist’s patient notes provides ongoing documentation in the medical record of any changes to the medication regimen. Electronic health records are also key for measuring impact.

“A lot of times you can track clinical outcomes via the electronic health record and that’s really important to understand, particularly as we move to value-based reimbursement, that your practice can document the better care that comes with a clinical pharmacist,” Moore said. “It’s better for the pharmacist and for the physician audience to understand things like, how many changes did the pharmacist really make? How important was that? Did they really identify patients, perhaps with compromised renal function that needed a dosage adjustment to their medication? Oftentimes, physicians might think, ‘I get along just fine, I’ve done this for years,’ but then when they see the changes that a pharmacist can make to really improve that patient’s medication regimen, they truly understand the impact that that pharmacist is having.” P able to help with setting up access to financial resources that would be more sustainable for the patient. All students on the team support patients in accessing all of their benefits and accompanying them to primary care doctor visits. Students help work with the primary care provider in terms of establishing patient-specific goals, and then provide additional support to the patient between visits to help the patient achieve those goals, which might mean getting lab results completed or accessing transportation services.”

Athena Ponushis is a freelance writer based in Ft. Lauderdale, Florida.

Frueh added that the student hotspotting program was also appealing because it meets the school’s interprofessional education objectives. “Within our curriculum, we’ve really focused those IPE experiences on the four core competencies from IPEC,” she said. “It’s not just about doing something together, it’s about really building students who can practice together. Student hotspotting fits all four of those competencies that IPEC has put out.”

Camden compiled data to share this fall regarding student satisfaction with the program and how it’s helped prepare participants for healthcare careers. In terms of patient clinical outcomes, the program has been an obvious success for the Springfield area. Frueh said that in the past two years, the hotspotting program has saved the two local hospital systems about $2 million.

Frueh received feedback from student pharmacists indicating that this experience has been the most challenging aspect of their training but has also helped them feel more connected to other healthcare professionals and made them more resilient. “In order for healthcare to transform, to be more sustainable financially and also to be seen as more of a partner by patients, we will need to find solutions together,” she pointed out. “The way student hotspotting is designed, it touches on all the things that are going to be important in healthcare transformation. Many community pharmacy practices are in a silo of healthcare delivery. Student hotspotting allows student pharmacists to experience how to build relationships with colleagues, how to work together and how to face challenges they will face in practice. If they’re able to do that together now, with the toughest patient population they have experienced, even if they end up in a practice that looks like a silo, it will better prepare student pharmacists for how healthcare delivery can be simply redesigned or how to work collaboratively with others in their communities.”

Tuesday’s General Session took a further look into the future, as Dr. Bertha Madras, professor of psychobiology at Harvard Medical School, called upon pharmacists to continue their work fighting the ongoing opioid crisis. “Pharmacy has many roles to play,” she stated. “But above all, they are at the intersection of physicians and patients.”

Addressing the Academy specifically, Dr. Madras told the crowd, “You are laying the groundwork for future pharmacists,” and preparing them to face the opioid issue head-on.

Above: Immediate Past President Dr. Steven A. Scott gives his final remarks during the Tuesday General Session. “Meeting good people is like walking into a perfume store. Whether you make a purchase or not, you will still receive the fragrance.”

Below: Pharmacy Education 2018 set a record for AACP Annual Meeting attendance, with more than 2,600 registrants.

Raising the Bottom Line

Pharmacy Education 2018 partnered with the organization Bottom Line to support low-income and first-generation-to-college students with donations and postcards of support. If you’d still like to make a donation, please visit: bit.ly/AACPBottomLine.

Social Academy

Pharmacy Education 2018 represents a community coming together, and that’s no more apparent than on social media. Members shared resources, live-tweeted sessions, took selfies and more across Twitter, Facebook and Instagram with #PharmEd18. Relive some of the highlights:

@BRileyPharmD: “Your best friend started as a stranger” @RobbieSamuels Learning the art of the schmooze. #pharmed18

@TweetTheADean: President Scott states that student mental health is not just the responsibility of counselors and advisors - it is the responsibility of each and every one of us. #aacp2018 #pharmEd18 @AACPharmacy @sascottrx

@AACPharmacy: “Although it isn’t a spa vacation, #PharmEd18 is a time to learn from master educators such as @RunBlue @DrJeffCain @drceciliaplaza [and others!] ...How you teach makes a lasting impact,” says Dr. Medina.

@MargaritaDiVall: “The egg (happiness) comes before the chicken (success)” - absolute truth @anniemckee #pharmEd18 @AACPharmacy

@AACPharmacy: “We must consider the diversity of our profession at every turn. Not only will the profession benefit, but #publichealth will benefit from a diverse #pharmacy workforce,” @DavidDAllen at #PharmEd18. – at Hynes Convention Center

@librarianem: The LIS section of @AACPharmacy immediately gave members stickers to decorate their name badges for #PharmEd18 “so everyone knows how awesome we are.” I have found my people.

@David_Steeb: Struggling with how to help students meet face to face throughout the world? Consider virtual opportunities for student driven collaboration #PharmEd18

@adampate_hepate: Packed talk on resilience in students and breaking the stigma of mental health. Maybe an opportunity for a community to start? #pharmed18 @AACPharmacy @stuartthaines @DrJeffCain

@UK_COP: Nothing like getting a bunch of competitive faculty in a room to see whose team escapes first. @DrJeffCain looks like he might be having a little too much fun. #PharmEd- Breakout #PharmEd18

Kyle R. Bagin is Digital Media Manager at AACP.