March 2011 Florida Pharmacy Journal by Florida Pharmacy Today

The Official Publication Of The Florida Pharmacy Association MARCH 2011

Battle Wages On Over Immunization Registries PRSRT STD US POSTAGE PAID TALLAHASSEE, FL PERMIT NO. 801

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florida PHARMACY TODAY Departments 4 Calendar 4 Advertisers 5 President’s Viewpoint 7 Executive Insight 23 Buyer’s Guide

VOL. 74 | NO. 3 MARCH 2011 the official publication of the florida pharmacy association

Features

The Pros and Cons of Immunization Registries and the Impact on Providers and Patients

121st Annual Meeting and Convention

FPA Officer and Director Nominations

MARCH 2011

FPA Calendar 2011

MARCH

of the Florida Pharmacy Today Journal MAY

15-16 Pharmacist Days at the Legislature

1-3

Pharmacist Mutual Leadership Conference

Legislative Session Ends

Law and Regulatory Continuing Education Jacksonville

Pharmacists Health Fair at Florida's Capitol

19-20 FPA Council and Committee Meetings 25-28 APhA Annual Meeting Seattle, Washington April 9-10

FPA Law Conference Tampa, Florida

12-13 Board of Pharmacy Meeting, Jacksonville, Florida 22

Good Friday, FPA Office Closed

23-25 NCPA Legislative Conference Washington, DC 30

Memorial Day, FPA Office Closed June

7-8

Mission Statements:

Board of Pharmacy Meeting Ft. Lauderdale

22 - 26 FPA Annual Meeting and Convention Aventura, Florida July 4

Independence Day FPA Office Closed

Legislative Committee Meeting Orlando, Florida

For a complete calendar of events go to www.pharmview.com CE CREDITS (CE cycle) The Florida Board of Pharmacy requires 10 hours LIVE Continuing Education as part of the required 30 hours general education needed every license renewal period. Pharmacists should have satisfied all continuing education requirements for this biennial period by September 30, 2011 or prior to licensure renewal. *For Pharmacy Technician Certification Board Application, Exam Information and Study materials, please contact Ranada Simmons in the FPA office. For More Information on CE Programs or Events: Contact the Florida Pharmacy Association at (850) 222-2400 or visit our Web site at www. pharmview.com

The Florida Pharmacy Today Journal is a peer reviewed journal which serves as a medium through which the Florida Pharmacy Association can communicate with the profession on advances in the sciences of pharmacy, socio-economic issues bearing on pharmacy and newsworthy items of interest to the profession. As a self-supported journal, it solicits and accepts advertising congruent with its expressed mission.

of the Florida Pharmacy Today Board of Directors

The mission of the Florida Pharmacy Today Board of Directors is to serve in an advisory capacity to the managing editor and executive editor of the Florida Pharmacy Today Journal in the establishment and interpretation of the Journal’s policies and the management of the Journal’s fiscal responsibilities. The Board of Directors also serves to motivate the Florida Pharmacy Association members to secure appropriate advertising to assist the

Journal in its goal of self-support.

Advertisers Cerner Etreby............................................. 24 EPC........................................................................ 6 Healthcare consultants........................ 3 Kahan ◆ SHIR, P.L.......................................... 13 MCKESSON.......................................................... 2 PPSC.................................................................... 10 Rx RElief.......................................................... 13

CONTACTS FPA — Michael Jackson (850) 222-2400 FSHP — Michael McQuone (850) 906-9333 U/F — Dan Robinson (352) 273-6240 FAMU — Leola Cleveland (850) 599-3301 NSU — Carsten Evans (954) 262-1300 DISCLAIMER Articles in this publication are designed to provide accurate and authoritative information with respect to the subject matter covered. This information is provided with the understanding that neither Florida Pharmacy Today nor the Florida Pharmacy Association are engaged in rendering legal or other professional services through this publication. If expert assistance or legal advice is required, the services of a competent professional should be sought. The use of all medications or other pharmaceutical products should be used according to the recommendations of the manufacturers. Information provided by the maker of the product should always be consulted before use.

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E-mail your suggestions/ideas to dave@fiorecommunications.com

The Presidentâ&#x20AC;&#x2122;s Viewpoint Guest Columnist Suzanne Kelley, BPharm, CPh

More Members Means More Influence at the Capitol

s your president, I have traveled throughout the state attending functions on your behalf. I have spoken to many pharmacists about what is troubling them about our profession. Many are complaining about their current jobs, and that is not the way it used to be. The recent recession has brought many changes in our pharmacies statewide. Companies have to make a profit to survive, and they have made many changes in the way we practice our profession. Some changes have been good and others are not. New technologies and automation have been used to free up more time for the pharmacist to do other things. Pharmacists are now talking more to patients and providing immunization services. Some pharmacists have told me that management has cut back on their supportive help and they have to work more than ever before. I have been asked about what the FPA is doing about these new issues. First of all, most of the pharmacists asking for our help are not FPA members. The FPA does not work on employer issues and can only help our profession in the way we practice pharmacy. There are over 25,000 in-state licensed pharmacists in our state, and only about 2,000 of them are members of the FPA. When we go to the Florida Legislature and advocate for our profession, the question will always come up of how many pharmacists we represent. With a membership of less than 10 percent, it is amazing that we can get anything done for the betterment of our profession. This legislative session, we are monitoring and advocating for several

things that our members have found important for them in their practices. One of them is expansion of our immunization authority (HB585). Many patients have been asking for other vaccinations after we provide them with the flu vaccine. Many have asked for pneumonia, herpes zoster and others. Also,

When we go to the Florida Legislature and advocate for our profession, the question will always come up of how many pharmacists we represent. With a membership of less than 10 percent, it is amazing that we can get anything done for the betterment of our profession. intern pharmacists are currently not allowed to provide this service. We feel that they should be able to provide this service as well. The current law requires us to have an Epi-Pen available in case of an allergic reaction to the Flu vaccine. But, the current law does not allow us to administer this injection. How can a person who is experiencing an aller-

Humberto Martinez, 2010-2011 FPA President

gic reaction self-administer this epinephrine? The FPA is advocating for this expansion of our authority to include all of this. There is some opposition for this expansion of our immunization authority, and we need support from all pharmacists who have an interest in this. We are also looking at MTM services to continue to be provided by pharmacists and are monitoring several bills that may affect our profession. The Legislature is looking at the state budget and trying to make cuts and changing the way things are. It has been suggested that the Medicaid program go to the HMOs for administration, and we are advocating that any willing provider pharmacy is included in this network. We also support the â&#x20AC;&#x153;My Script My Choiceâ&#x20AC;? social media campaign at the www.myscrpitmychoice.com website. We have support from the Florida Independent Pharmacy Network and PPSC MARCH 2011

for this campaign. The state employees now have to get their refills by mail order or a PBM pharmacy for their medications, and some pharmacies have lost longtime patients to this program. If any of this things interest you, then be involved in your professional association and help make a difference. We just had the Miami Pharmacists Health Fair, and it was even more of a success than last year. The FPA has a large booth at this event and we provide health screenings for over 2,000 attendees. We again had the most popular health screening with the bone density machine, with over 110 people screened. Our Cholestech machine was used for over 30 people that had high levels in the preliminary check with the Cardio Chek machine used by the student nurses. We also provided blood pressure monitoring and MTM services from our pharmacist at the booth. We estimated that we saw over 300 people at our FPA booth. I would like to thank NSU for providing the screening machines for this event. The Tallahassee Pharmacists Health

Fair and Legislative Days are coming up this month. We have over 160 people registered for this event, and we hope that this will be a great success. The chair of our Public Affairs Council, Suzanne Kelley, has been coordinating this event. Her council has been working hard on the logistics for this health fair. I know that it will be a great success and better than last year. This year the FPA and FSHP have collaborated to make this program successful. The pharmacists and students provide a multitude of health screenings. We are providing blood pressure monitoring, glucose, lipid, bone density, body mass composition, and dermatological screenings. Cardiac risk assessment and MTM services are also provided. If any members are interested in helping us with this event, feel free to contact us and volunteer for the health fair next year. The legislators who attend this event are sometimes surprised that pharmacist can provide this service. We also have legislative visits coordinated by our lobbying firm Prieguez

and Weems. Here is where the pharmacists and students can make a difference in the things that we are advocating for the profession of pharmacy. Talking points and appointments will be provided for all those attending this event. We are also looking at having a pharmacist on call for every week of the legislative session. We are the only health profession that has not done this at all. If you want to volunteer your time to be in Tallahassee during a week of the legislative session, please contact our FPA office. This is where our members can be very helpful to our profession. We have also been contacted by several members who have had a negative audit from some PBMs using current Florida law. An example of one of these is that current law states that needed information must be on the FACE of the prescription. If your pharmacy system prints a label with the needed information and you place this on the back of the prescription, then you are not following current Florida law and the auSee "Viewpoint", continued on page 14

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Florida Pharmacy Association

Executive Insight Guest Columnist, PharmD byAndrew michaelMegna, jackson, RPh Candidate, 2011 Michael Jackson, FPA Executive Vice President/CEO

Florida Pharmacists Take Action for Prevention

revention, prevention, prevention! Prevention is a word that is attracting much attention among today’s health care providers and policy makers, as disease prevention is a top priority in all professions across all fields in our health care system. The term “prevention” embodies a wide scope of meaning, from promotion of a healthy lifestyle to early detection and diagnosis of medical conditions. Which area of prevention are we, as pharmacists, involved in and how can we become more active within our community to ensure prevention of disease? The administration of vaccines, such as the influenza vaccine, plays a crucial role in preventing the spread of many diseases. For the past three years, Florida pharmacists have been successful in administering the influenza vaccine. In 2007, a law was passed that allowed pharmacists in Florida to administer the influenza vaccine to adults. However, before that law was passed, pharmacists had to overcome some harsh criticism and tough challenges. One major challenge that we overcame was legislators’ initial inclinations that pharmacists are nothing more than pill counters and dispensers. One could assess that the Florida legislators have the wrong diagnosis of the impact a pharmacist has on patient care. Therefore, concerned pharmacists, the Florida Pharmacy Association, and other important groups, worked collectively to educate those at the Capitol. Their main focus was to make it clear that pharmacists play a vital role in drug therapy management. This management includes, but is not limited to, drug utilization review, drug-drug in-

teractions, review and monitoring of drug therapies through interpretation of laboratory values, and communication with prescribers to ensure that patients receive the proper medication at the safest and most effective dose for the proper length of time. Another educational point was that pharmacists in other states across the nation were allowed to vaccinate and have done so successfully. After almost

One major challenge that we overcame was legislators’ initial inclinations that pharmacists are nothing more than pill counters and dispensers. 10 years of active advocacy, the bill was finally passed in 2007, allowing Florida pharmacists to administer the influenza vaccine. Since its passing, millions of flu vaccinations have been administered by trained and certified pharmacists in Florida and no major adverse events have been reported. Not only has this had an impact on health care costs, it has prevented the spread of the flu virus and prevented death among those who are most vulnerable within the communities they serve — something you cannot put a price tag on. The positive impact phar-

Andrew Megna, PharmD Candidate, 2011

macists have had thus far while having the authority to administer the flu vaccine in Florida brings a question to mind: Why should pharmacists be limited to the administration of only the influenza vaccine? During Florida’s 2011 legislative session, which began this month, a new bill has been proposed to amend the current law that allows Florida pharmacists to administer the flu vaccine. If passed, this bill would add Pneumococcal and Varicella Zoster vaccines to the list of vaccines that a certified pharmacist can administer. Also included in this important bill is supervised pharmacy intern vaccine administration, as well as epinephrine administration via an autoinjection delivery system as epinephrine is an important part of a vaccination protocol in case of anaphylactic reactions to any vaccine administered. These diseases can be devastating to the public and are completely preventable. MARCH 2011 |

FPA Staff Executive Vice President/CEO Michael Jackson (850) 222-2400, ext. 200

Director of Continuing Education Tian Merren-Owens, ext. 120 Controller Wanda Hall , ext. 211

Membership Coordinator Ranada Simmons , ext. 110

Educational Services Office Assistant Stacey Brooks , ext. 210 Florida Pharmacy Today Board Chair..................................Betty Harris, Lighthouse Point Vice Chair.................................. Jennifer Pytlarz, Brandon Treasurer...............................Stephen Grabowski, Tampa Secretary.........................Stuart Ulrich, Boynton Beach Member................. Don Bergemann, don@bceinfo.com Member..................................... Joseph Koptowsky, Miami Executive Editor.........Michael Jackson, Tallahassee Managing Editor.........................Dave Fiore, Tallahassee

This is a peer reviewed publication. ©2011, FLORIDA PHARMACY JOURNAL, INC. ARTICLE ACCEPTANCE: The Florida Pharmacy Today is a publication that welcomes articles that have a direct pertinence to the current practice of pharmacy. All articles are subject to review by the Publication Review Committee, editors and other outside referees. Submitted articles are received with the understanding that they are not being considered by another publication. All articles become the property of the Florida Pharmacy Today and may not be published without written permission from both the author and the Florida Pharmacy Today. The Florida Pharmacy Association assumes no responsibility for the statements and opinions made by the authors to the Florida Pharmacy Today. The Journal of the Florida Pharmacy Association does not accept for publication articles or letters concerning religion, politics or any other subject the editors/ publishers deem unsuitable for the readership of this journal. In addition, The Journal does not accept advertising material from persons who are running for office in the association. The editors reserve the right to edit all materials submitted for publication. Letters and materials submitted for consideration for publication may be subject to review by the Editorial Review Board. FLORIDA PHARMACY TODAY, Annual subscription - United States and foreign, Individual $36; Institution $70/year; $5.00 single copies. Florida residents add 7% sales tax. Florida Pharmacy Association

610 N. Adams St. • Tallahassee, FL 32301 850/222-2400 • FAX 850/561-6758 Web Address: http://www.pharmview.com 8 |

Flor i d a Pharmac y To d aY

Pneumococcal disease kills more people in the U.S. each year than any other vaccine-preventable disease.¹ The CDC estimates that there are nearly 1 million cases of shingles in the U.S. each year, and almost half of the patients are older than 60 years of age.² Florida has one of the largest populations of elderly people in the nation, and this number continues to grow. With this in mind, it is necessary to have access to trained health care professionals to meet the needs of our growing elderly population. The elderly population is already saddled with countless doctor appointments and other obligations to ensure that their health status remains up to par. Patients often go to the doctor when they are healthy just to learn that their doctor may not have the vaccine in stock or does not administer a certain vaccine due to low reimbursement from third-party payers; meanwhile, the local pharmacy down the street is more than willing to meet this need. Unfortunately, under the current law, the pharmacist cannot provide such care. This is an injustice to those seeking adequate health care. Having access to vaccinations at a local pharmacy where people more than likely pick up their medications, not only ensures a high quality of care, but also adds to a pharmacist’s multi-disciplinary role as a healthcare provider within their community. Out of all of the health care professions, pharmacists are the most accessible to the public. A pharmacy can be found on almost every corner of Florida, including those rural and underserved areas, and, in most communities, the pharmacist is available 24 hours a day with no appointment necessary. Anne Schuchat, M.D., the assistant surgeon general and the director of the National Center for Immunization and Respiratory Disease, recently wrote in a letter to the American Pharmacist Association that, “Pharmacists, working with the public health community, can assist our nation in meeting its major public health challenges.”³ Pharmacists who are active in the role of immunizer can have a tremendous impact on the challenges we face in preventing the spread of communica-

ble diseases. Today, according to APhA, all 50 states have granted pharmacists the right to administer vaccines under certain conditions, which vary from state to state. Thirty-eight states allow pharmacists to administer any vaccine, and just three states, including Florida, allow them to administer only the flu vaccine. Pharmacists in Florida are trailing behind the nation in our statewide health care system, but we should be leading. If passed, the proposed bill to amend and add the Pneumococcal and Varicella Zoster vaccines to the list of services that pharmacists and supervised interns can provide the public will be a giant step in the right direction to provide higher quality of care for all Floridians. An increase in the number of administered vaccines because of the accessibility will result in reductions to health care costs, hospitalizations and death associated with these diseases. But this bill, along with subsequent bills associated with our profession, will not pass if our state legislators do not hear our voices or the voices of our concerned patients within the communities we serve. Every pharmacist in the state should take a moment to contact their state legislators via phone, letter or email and inform them about the importance and impact a pharmacist can have in providing vaccinations to the public. Dr. Michael Thompson, professor at Florida A&M University College of Pharmacy and Pharmaceutical Sciences once said, “Not getting involved in public health care policy empowers others to decide your future.” One voice can be heard next door, but a thousand voices can be heard in the Capitol. To ensure a high quality of care to every community in Florida and to positively impact the evolution of pharmacy practice, this bill must be passed. 1. http://www.vaccineinformation.org/ pneumchild/qandadis.asp 2. http://shinglesinfo.com/what-isshingles.html 3. http://www.pharmacist.com/AM/ Template.cfm?Section=Pharmacist_ Immunization_Center1&TEMPLATE=/ CM/ContentDisplay. cfm&CONTENTID=24387

The Pros and Cons of Immunization Registries and the Impact on Providers and Patients Shirin Abdel-Jawad, Student Pharmacist Dalita Bouchakjian, Student Pharmacist Marianne Mallouh, Student Pharmacist N. Megan Sadoughi, Student Pharmacist Faculty mentor: Nancy Borja-Hart, Pharm.D., BCPS (corresponding author) Assistant Professor Nova Southeastern University College of Pharmacy 3200 S. University Dr. Ft. Lauderdale, FL 33328 Work (954)262-1372 Fax (954)262-2278 Disclosure statement: There are no conflicts of interest to report. Acknowledgments: We would like to thank Donald Lawler, Medical Health Care Program Analyst for Florida SHOTS Program, Bureau of Immunization, Florida Department of Health, for interviewing with us about the Florida SHOTS program and Angela Garcia, Pharm.D. for her careful review of this manuscript.

Abstract Background: Over the past twenty years, immunization registry development and expansion has occurred in the United States. The registry allows practitioners to input vaccine records into a database to document vaccine information. There have been many advocates for this transition to an electronic system; however, some downfalls have been identified. The primary objective of this review is to evaluate advantages and disadvantages of the participation in and usage of immunization registries throughout the healthcare system, further focusing on the pediatric population of Florida. Methods: A literature search was conducted through five databases: MEDLINE, EMBASE, International Pharmaceutical Abstracts (IPA), MDConsult, and Google. Search terms included immunization registries, immunization information systems, vaccines, vaccine registry, immunization programs, and Florida SHOTS. Results: We compared benefits and limitations of selected publications. For many patients, this immunization registry will provide easy access to their vaccination records. With over 12 million practitioners registered in the state of Florida, 6,000 of their patients are enrolled in the database called Florida SHOTS. Most results pertained to a specific subset of the pediatric population, while other age groups were not represented in the literature. Conclusion: The pros and cons of immunization registries have to be assessed by providers so that biased decisions will be kept to a minimum. Practitioners should find ways to overcome the lim-

itations associated with registries for the benefit of patients. The use of Florida SHOTS has allowed the state to be inter-connected into one database, however the registry still requires constant vigilance by active participation from providers. If practitioners take the initiative to participate in these registries, it may significantly contribute to the prevention of certain diseases and duplication of vaccinations. Further research should include all age groups while also including the role of pharmacists in immunizations. Background Immunization registries are defined as confidential, population-based computerized systems for maintaining information regarding childrenâ&#x20AC;&#x2122;s vaccinations.1 Over the past several years there has been an increase in use of these computerized databases throughout the United States.2 These databases have helped increase the vaccination rate in the U.S. from 76% in 1997 to 80% in 2007 for children 19-35 months of age.2, 3 This technological advancement is a way in which practitioners keep track of patientâ&#x20AC;&#x2122;s vaccines and also allow patients to have a record of their vaccine history. Immunization registries have been established in all 50 states, and yet no state has fully utilized this system to its maximum capacity.1,4 Immunization registries are often developed by state funded programs and each state has one or more computerized registries for their geographical location.5 In 1974 Delaware became the first state to create a population-based registry for managed care. Throughout the 1980s, the use of registries was not fully implemented for vaccine documentation. It wasnâ&#x20AC;&#x2122;t until the next decade (1991) that advancements in the use of immunization registries occurred, due largely to a program initiated by the Robert Wood Johnson Foundation known as All Kids Count. This program MARCH 2011

granted funds to initiate registries. Later, in 1993, funds from the federal government were put into place, supported by President Bill Clinton, to develop the Childhood Immunizations Initiative, which allowed resources to be channeled to required state run registry programs. The Centers for Disease Control and Prevention’s (CDC) National Immunization Program also promoted the development of these registries. In the late 1990s, states started to further develop and require computerized vaccine registries for practitioners.1 The prevention of disease is one of the primary goals of the U.S. health care system.4 The relevance of these programs is to help prevent or eradicate diseases, like measles, chicken pox, rubella, and others. Registries are essential in increasing immunization coverage rates.1 Over the past years, established registries have helped to increase immunization rates.3 One goal of Healthy People 2020 is to increase the proportion of children under age

6 years who participate in fully operational population-based immunization registries.6 Studies have shown that immunization information systems have many benefits and limitations in their application. The benefits of immunization information systems include reducing duplicate vaccinations and saving time.7 Health practitioners continue to have frustrations with registries, some of which include training, data entry and software problems.1 It has also been shown that there have been missed opportunities to immunize because records have been incomplete or providers do not have access to information at the time of doctor’s office visit.2 It has been reported that with the proper use of immunization information databases, patients appreciate the extra effort and choose to participate in the programs.8 In the state of Florida, vaccines are required for entry into daycare, camps and schools.4 Florida SHOTS, established in 2000, began actively enter-

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Flor i d a Pharmac y To d aY

ing birth records in January 2003.9 Currently, Florida SHOTS has 12 million providers registered in the database.10 Through this database, registered providers can enter patient’s vaccine information. In order for practitioners to use this system, they must sign up and register with the program which is known to be “fast, easy, and free.” Once the practitioner implements this program in their practice, it is their responsibility to inform their patients of this offer. From the Kaiser Family Foundation website, 82% of children ages 19-35 months in Florida are immunized as compared to the national average of only 78% (data reported for 2008).3 Florida is surpassing the national average, but with the implementation of Florida SHOTS it is hoped that this percentage will increase further.9 The use of computerized immunization registries has the potential to impact several aspects of health care. Providers, patients and the health care system as a whole benefit from having this organized database, however,

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many obstacles still stand in the way of its full execution. The purpose of our literature review is to report the advantages and disadvantages of having an immunization information system and how registries influence the overall healthcare system in regard to physicians, pharmacists and patients in Florida. Methods A literature search was conducted through five databases: MEDLINE, EMBASE, International Pharmaceutical Abstracts (IPA), MDConsult, and Google. Search terms included immunization registries, immunization information systems, vaccines, vaccine registry, immunization programs, and Florida SHOTS. Results Benefits of Registries Immunization registries were developed to record administered childhood immunizations, track immunization coverage, generate reminders when immunizations are due, assure safety and accuracy to prevent over-immunization, and track post effects of vaccines. Immunization registries are defined by the National Vaccine Advisory Committee (NVAC) as being, “confidential, computerized information systems that contain information about immunizations and children.” 8 The key point of this definition is that immunization records are to be kept confidential. Using immunization registries also helps immunization timing due to the complexity of these schedules. Vaccine scheduling helps to keep track of patient history and new requirements of immunizations. Accurate immunization scheduling will allow patients to keep track of their schedules and will ultimately allow them to save time and avoid frustrations.8 Cost is a factor that can affect participation in immunization registries, but in the long run, cost is ultimately insignificant.1 Overall, costs are minimal (enrollment is free) and the outcomes have proven to be cost-effective. One study in which parents’ opinions were taken into consideration about immunization registries found

that parental support for registries was high, despite their unawareness of the immunization registries’ existence.8 In this study, it was found that a majority of parents in four different states (Colorado, Massachusetts, Missouri and Washington) were supportive of laws that mandated providers to report to registries. One of the benefits of immunization registries is the efficiency in the delivery of services. Efficiency of computerized systems is superior to the time consuming paper system. Computer-based immunization registries are highly efficient in terms of saving time, preventing future disease states and preventing duplication of vaccines.1 There are benefits for the pharmacist’s participation as well. These include involvement in direct patient care, less paper work and possible reimbursement depending on corporate policies. Through these immunization registries, the acknowledgment of pharmacy as a profession has been recognized by other health care providers and patients. Florida SHOTS offers many benefits to pharmacists through a simple system in which it links the existing billing and practice management to the statewide immunization registry. It is convenient for pharmacists and many healthcare professionals as well as time saving and efficient in minimizing the manual search of paper files. This system allows for records to be accurately reported to registries, since this is mandated by law. These interconnections within the immunization registry database allow access to the physician’s offices, managed care organizations and other health systems. The major benefits that immunization registries offer, according to Florida SHOTS, are quick access to a child’s immunization status and computer-generated reports that are accepted by schools, daycares and camps as valid documents. Drawbacks of Registries There are factors that limit the use of immunization registries. It was found that parents tend to follow their physician’s advice regarding participation in immunization registries.8 Parent’s par-

ticipation in those registries is highly affected by the physician’s opinion of registries. Therefore, when physicians don’t participate in immunization registries, parents are less likely to participate in the registry as well. Another major limitation seen with immunization registries is who should pay for them. From the day of its development, registries have been financially supported by federal funding, state funding, local funding, private foundations and some managed care organizations.1 The majority of the costs of these registries were associated with the development of the electronic data system and its technical feasibility. According to NVAC, more contributions should be made by those who benefit from immunization registries, including health care providers, vaccine manufacturers and patients.8 In addition, some technical limitations are associated with the use of immunization registries. For example, any system that is slow or difficult to use will not be accepted in clinical settings, especially retail pharmacies or busy pediatric centers with high patient volumes and limited time. Even with the presence of electronic accuracy, some entry error by personnel could occur. Approximately 75% of children less than 6 years of age still need to be included in an immunization registry in order to meet the national health objective.5 Provider participation in public practices was higher than participation in private settings. This is an issue because more immunization services are shifting away from public sectors. In 2000, it was evident that four major issues may affect immunization participation and development, including ensuring privacy and confidentiality, encouraging provider’s participation, dealing with technical and operational difficulties and determining resources to develop and maintain registries.5 Florida SHOTS has several pitfalls. For providers these include the time and cost of training personnel and loss of productivity as a result of the training.9 Patients might also be concerned with confidentially issues that may come up as a result of information input. Florida pharmacists are limited in MARCH 2011 |

the use of Florida SHOTS, specifically for pediatric patients because they cannot provide vaccinations for adolescents at this time. Discussion The purpose of immunization registries was established by NVAC in order to introduce registries to health care professionals. By doing so, many providers are better able to understand the application of these registries to their patients. In making use of these registries, participants in the health care system (both patients and providers) are able to take advantage of these useful resources. Impact on Providers Provider participation in the registry is a requirement that must be met to ensure its success. In a practice setting such as pediatric health care centers and retail pharmacies, lack of time is always an issue. Immunization registries provide a time-saving program in which access to records is easily obtained. It is easy to identify immunizations that are needed and avoid duplications of vaccines during health checkups. The program allows for automatic notifications to providers which in turn alert parents when immunizations are due. When developing and operating immunization registries, cost can be an issue. A fully operational populationbased registry will offset many other costs in the long term. Avoiding the cost of duplicate immunizations, limiting the cost of missed appointments, preventing diseases or hospitalizations are just some of the long term benefits offsetting the issue surrounding the immediate costs.5 Financial support of immunization registries continues to be a major debate. In order for these immunization registries to succeed, health care providers, vaccine manufacturers and even patients must also provide funding. More funds and resources must be dedicated to improve the existing immunization registries and generate new ones. Computerized records, when compared to manual records, allow health care providers to save time.9 Electron12

Flor i d a Pharmac y To d aY

ic records are more convenient due to the increased amount of data that needs to be processed. The software for these registries is specifically designed to allow more precise and easier access of vaccination information. However, these systems can be slow or difficult to use, which discourages health care professionals from continual use. Technical software problems can be reported to the registries’ help desk and are addressed on a regular basis.10 Therefore, immunization registry databases, such as Florida SHOTS, should request feedback from different healthcare providers. Furthermore, technical and operational challenges can be barriers that limit the efficient use of immunization registries. To solve this problem there must be a standardized system to enhance the communication between the central registry and participating providers. Immunization registries require minimal software training for office personnel. Training will take time and effort and will result in loss of productivity. On the other hand, the benefits in the long term will outweigh the loss of productivity during the training period. Impact on Pharmacists Only certified pharmacists can immunize patients and enter immunization records into the database. Pharmacists are mandated by law to document immunizations through an integrated database that is connected to the registries. This linkage from a pharmacy to the registry allows the pharmacist to be an active participant in this health care process. Pharmacists will help protect patients’ privacy and ensure the confidentiality that is a major concern for patients. In general, pharmacists can play a role in reminding patients to keep track of their immunization records by also advising them to inform their primary care providers of these registries. In regard to the state of Florida and its computerized database, pharmacists can properly follow the Florida statute S. 465.198 which grants them access to forward information to the registry.9 Impact on Parents Parents can rest assured that privacy

of health documents are kept because these systems are designed to maintain confidentiality. Access is limited to authorized health care personnel with password protected logins.9 Another issue for parents is the lack of a nationwide, centralized system. It is important for parents to understand the benefit of keeping track of their children’s immunizations when moving from state to state, especially for schools. Conclusion The use of immunization registries is highly encouraged within the healthcare system. There is the potential for growth of these types of programs, which will lead to an increase in the accuracy of maintenance of immunization records. In the pediatric population, it is fundamental that we assure patients’ safety by keeping upto-date information available. Florida SHOTS was created for the convenience of health care providers and patients. Furthermore, Florida SHOTS is intended to increase Florida’s immunization rates. Patients and caregivers should be aware of these immunization registries and have a proactive approach in maintaining their vaccination records. Providers have a role in educating parents about these registries and ensure concerns are subsided. Future goals of immunization registries should include laws that practitioners must follow in order to use and sustain data registries. Since pharmacists are eligible to be certified for vaccine administration, it is vital that they actively participate in documenting immunization records as well. This responsibility is essential for the wellness of patients and will allow the profession to expand. Studies should incorporate the pharmacists’ input on these immunization registries. In general, health care practitioners are already accountable for patient vaccine records in their daily practice, and registries will ameliorate record keeping. Conclusion Immunization registries can be complex to manage and put into practice because of several barriers. However, the benefits associated with immunization

registries, which include computerized record keeping and time saving strategies, are reasons why both practitioners and patients should advocate for such registries. Immunization registries provide a method of documentation, which will help increase patient adherence to recommended vaccine schedules. More studies are needed in order to assess how immunization registries can be successfully incorporated into practice for both pediatric and adult populations. Studies should also be published on the significance of the pharmacist’s role in immunization efforts through registries. Overall, the benefits of immunization registries could positively impact patient care and documentation in healthcare services.

References

1. Freeman VA, DeFriese GH. The challenge and potential of childhood immunization registries. Annu Rev Public Health. 2003;24:227-246. 2. Wood D, Saarlas KN, Inkelas M, Matyas BT. Immunization registries in

the United States: implications for the practice of public health in a changing health care system. Annu Rev Public Health.1999;20:231-255. Kaiser State Health Facts: Percent of children age 19-35 months who are immunized, 2008. Available at: http:// statehealthfacts.org. Accessed August 3, 2010. Center for Disease Control and Prevention: IIS States and Territories. Available from: http://www.cdc. gov/vaccines/programs/IIS/statesterritories. Accessed January 29th, 2010. Centers for Disease Control and Prevention. Progress in development of immunization registries --United States, 2000. MMWR Morb Mortal Wkly Rep. 2001;50(1):3-7. Healthy People 2020: Objectives of Immunization and Infectious Disease. Available from: http:// www.healthypeople.gov/HP2020/ Objectives. Accessed January 29th, 2010. Adams WG, Conners WP, Mann AM, Palfrey S. Immunization entry at the point of service improves quality, saves time, and is well-accepted. Pediatrics. 2000;106(3):489-492. Linkins RW, Salmon DA, Omer SB, Pan

WK, Stokley S, Halsey NA. Support for immunization registries among parents of vaccinated and unvaccinated schoolaged children: a case control study. BMC Public Health. 2006;6:236. 9. Bureau of Immunizations. Florida SHOTS. Available from: http://www. flshots.com Accessed January 29th, 2010. 10. Lawler, Donald. (2010, March 12). Telephone interview.

EXECUTIVE EDITOR’S NOTE: Dear readers of Florida Pharmacy Today. We generally try to get comprehensive articles reviewed however this particular article is of general interest to the membership and is timely for publication in the Journal. The Journal does wish to express to the readers that the opinions and findings of this article’s content are those of the author and have not been evaluated. If you have expertise in a pharmacy practice discipline and you are interested in being a reviewer for the Florida Pharmacy Today please contact the FPA or the managing editor at (850) 222-2400 or (850) 668-0510

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"Viewpoint", continued from page 6

ditors will do a charge back for the entire prescription. There have also been some charge backs for prescriptions not written in an approved format under current law. Current law states that all prescrip-

allows the pharmacist to call the prescriber and correct the prescription so that it conforms to current law. Some of our members have had charge backs for this written format error. The FPA is working on correcting some of these outdated laws to conform to the cur-

cists. We listen to our members, and with more members we should have more input as to what we need to change to make our profession one of the best that can ever be. Thank you for your support for the last few months, and I am here to serve. n

None of these things are easy to do without the support of the licensed pharmacists in the state of Florida. We need more members so we can in turn, work more effectively for the pharmacists. tions must have the month written out in text form not in number format. But, controlled substances prescriptions can have the month in abbreviated text form and the quantity written out in text and number form. This law

rent practice of pharmacy. None of these things are easy to do without the support of the licensed pharmacists in the state of Florida. We need more members so we can in turn, work more effectively for the pharma-

Humberto “Bert” Martinez

Florida Pharmacy Association Law and Regulatory Conference Intercontinental Hotel 4860 West Kennedy Blvd Tampa, Florida 33609 April 9 - 10, 2011

Nominations Now Being Accepted for the

FLORIDA PHARMACY FOUNDATION ALTON TOWER PHILANTHROPY AWARD The Florida Pharmacy Foundation is pleased to present this award in honor of Al Tower. Please follow all of the required criteria. The Selection Committee will review all applicants and make the final decision. Only the winner will be notified. There is a cash award of $500 presented to the winner’s choice of charity/ organization and a plaque presented to the winner at the Annual Meeting of the Florida Pharmacy Association Awards Night at The Fairmont Turnberry Isle Resort & Club, Aventura, FL, June 25, 2011.

I nominate___________________________Philanthropist of the Year for his/her involvement in a ■■ ■■ ■■ ■■ ■■ ■■ ■■

Charitable organization/s that meets the criteria below: Elaborate reason for nomination: motivation, enthusiasm Membership/ serving as an officer, committee chair Effort to inform community about organization Community service project/s participation Contributing factors of success with project/s Speaking engagements

Please limit your typed submission to 3 pages. Send 4 copies to: Patsey J. Powers, Executive Vice President Florida Pharmacy Foundation 610 N. Adams Street Tallahassee, FL 32302 Deadline for submission is April 15, 2011

Flor i d a Pharmac y To d aY

Having Difficulty with Electronic Prescriptions? As you know, E-prescribing is on the rise as more providers are tapping into this new technology to improve the safety, quality and efficiency of the prescribing process and take advantage of government incentives. We all hear from pharmacists about noticeable errors and challenges they face with e-prescriptions. In fact, recent studies have shown that new e-prescriptions are twice as likely to require a pharmacistâ&#x20AC;&#x2122;s intervention as new written prescriptions. Thanks to a grant provided through the Community Pharmacy Foundation, in October the Alliance for Patient Medication Safety (APMS) re-introduced the Pharmacy and Provider e-Prescribing Experience Reporting (PEER) Portal (originally developed in collaboration with SureScripts). The revised PEER Portal uses an enhanced, streamlined web-based questionnaire that enables pharmacies to easily enter information about e-prescribing challenges and experiences and provide their critical feedback and expertise to improving the e-prescribing process. If you are experiencing challenges with e-prescribing systems, please consider visiting this website: https://www.pqc.net/eprescribe/disclaimer.aspx and report your concern.

MARCH 2011

HELP SUPPORT THE ADOPT-A-STUDENT PROGRAM Florida Pharmacy Association 121st Annual Meeting & Convention June 22-26, 2011 The Fairmont Turnberry Isle Resort & Club – Miami, Florida

Again this year, students from Florida Colleges of Pharmacy will be “Adopted” for the FPA Annual Meeting and Convention. Pharmacy students will benefit from the interaction with practicing pharmacists, learn first hand how FPA actually operates and how they can become involved in their chosen profession. As you remember, college students are on a tight budget and most of them cannot afford to attend convention. Here is how you can help! The cost to register/sponsor one student is $110.00. They also have travel, room and food expenses. Adopted students will receive complimentary registration, hotel accommodations and be able to attend special programs designed for them. If enough money is raised, FPA will also be able to include additional support for meals. Make a contribution yourself! Ask your local unit association or get together with friends to Adopt-AStudent. Remember…..these are the future leaders of pharmacy! Mentor Program. Each of the adopted students will be assigned a pharmacist who will invite them to attend meetings, CE programs, and share their knowledge and pharmacy experience with them. If you plan to attend the convention and would like to be a mentor, please contact the FPA office. Please fill out the form below and fax or mail with your check to: Florida Pharmacy Association 610 North Adams Street Tallahassee, FL 32301 Fax: (850)561-6758 Please make your check payable to the Florida Pharmacy Foundation Sponsor Name:_________________________________________________________________________ Address: ______________________________________________________________________________ City: _______________________________________ State: __________ Zip:_______________________ Phone: ________________________________ Amount of Contribution:___________________________ Charge to the following (please circle):

VISA

MASTERCARD

DISCOVER

AMEX

Account #:_____________________________________Security Code:________ Exp. Date: ____________ Signature: ________________________________________________________________________________  Yes, I would like to serve as a Mentor.  Contact me with more information on Mentoring. Contributions to the Florida Pharmacy Association Foundation are tax deductible as a charitable contribution for federal income tax purposes. Consult your CPA for complete details.

Flor i d a Pharmac y To d aY

MARCH 2011

Flor i d a Pharmac y To d aY

MARCH 2011

FLORIDA PHARMACY FOUNDATION SPONSORS

Come and join your friends at Casino Night, glamorous evening of fun, playing Black Jack, Poker, Craps and the numbers game of Roulette. Big Prizes will be awarded. The proceeds will benefit the goals of the Foundation to further the need of providing student scholarships, Adopt-a-Student program, Hardship Fund, Demonstration Project Grants and Alton Tower Philanthropy Award. When: Where: Time: Cost:

June 23, 2011 Fairmont Turnberry Isle- Aventura, FL 7:00 P.M. - 10:00 P.M. $50 per Person (You must be 21 years or older to attend)

1,000 PLAYING CHIPS (Re-buy available) CASH BAR | LITE HORS dâ&#x20AC;&#x2122;OEUVRES | BIG PRIZES A COPY OF THE OFFICIAL REGISRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE 1-800-435-7352 WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE.

Payment Information Check enclosed for Please charge my: q Visa

Casino Night: $50 per person made payable to the Florida Pharmacy Foundation

tickets, in the amount of $ q MasterCard

for

tickets, in the amount of $

Card number

Expiration date

Signature Signature Printed Name Address City

State

Work Phone

Home Phone

Zip

PayPal available at www.flpharmfound.org Florida Pharmacy Foundation | 610 N. Adams St, Tallahassee, FL 32301 | (850) 222-2400 | Fax (850) 561-6758

FPA Officer and Director Nominations Although we have just finished the election for a president-elect and directors for the odd numbered regions to be installed at the 2011 annual meeting, it is time to start thinking about nominees for the 2012 election since the nomination deadline is September 1 of this year (9/1/11). As the form below indicates, this year we will need candidates for president-elect, treasurer, and directors for the even numbered regions. Please note that you may nominate yourself. CALL FOR FPA OFFICER AND DIRECTOR NOMINATIONS for 2012 Elections The FPA By-Laws specify that any subdivision or any member in good standing may nominate one person for the office of President-Elect and one person for the office of Treasurer. A President-Elect shall be elected every year and shall assume the duties of the President on the last day of the annual meeting of the year following election as President-Elect. The treasurer shall serve a two year term and may succeed to one consecutive term of office in that capacity. Nominees must be Florida registered pharmacists in good standing with the Florida Pharmacy Association and the Florida Board of Pharmacy. Nominees for president-elect should have a good understanding of how the Association functions and should be current on the issues impacting pharmacy. Nominees for treasurer should have good analytical skills and experience and ability in financial management and budget preparation. There are nine regional Board Directors who shall serve two year terms. Nominees must be a Florida registered pharmacist in good standing with the Florida Pharmacy Association and the Florida Board of Pharmacy. Additionally, Board Directors must be a member of at least one the FPA Unit Associations within their region. Board Directors terms are staggered such that even numbered regions shall be elected in even numbered years and odd numbered regions shall be elected in odd numbered years. All newly elected Board of Directors Regional Directors shall take office on the last day of the annual meeting, and shall continue in office until the last day of annual meeting of the second ensuing year.

FPA CANDIDATE NOMINATION FORM I AM PLEASED TO SUBMIT THE FOLLOWING NOMINATION: NAME: ADDRESS:

FOR THE FOLLOWING OFFICE:

(Nomination Deadline September 1, 2011)

q q q

President-Elect Treasurer Board Director Region 2 Region 4 Region 6 Region 8

NOMINATED BY: NAME: DATE SUBMITTED: SIGNATURE:

MAIL NOMINATIONS TO: Election Nominations, Florida Pharmacy Association, 610 N. Adams St., Tallahassee, FL 32301 (850) 222-2400 FAX (850) 561-6758 DEADLINE FOR NOMINATIONS IS SEPTEMBER 1, 2011

MARCH 2011

CALL FOR ABSTRACTS FOR POSTER PRESENTATIONS For Florida Pharmacy Students

FLORIDA PHARMACY ASSOCIATION 121st ANNUAL MEETING AND CONVENTION

June 22 - 26, 2011 The Fairmont Turnberry Isle Resort & Club ♦ Aventura, Florida Poster Session: Friday, June 24, 2011, 11:00AM-1:00PM

The FPA Poster Presentations are open to PHARMACY STUDENTS ONLY. Complete and submit this COVERSHEET for each abstract submission. Submissions must be received no later than Monday, May 2, 2011. Abstracts will NOT be accepted after this date. Mail or E-mail this application along with the abstract submission to: Tian Merren Owens, MS, PharmD, Director of Continuing Education Florida Pharmacy Association 610 N. Adams Street Tallahassee, FL 32301 tmerren@pharmview.com

PLEASE TYPE

Contact Information: Presenter's Name (MUST BE A STUDENT):________________________________________________________________

□ Entry Level Pharm.D. □ Post B.S. Pharm.D. Address: ________________________________________________________________________________________

City, State, Zip: ___________________________________________________________________________________ Telephone No: _____________________E-Mail Address: _________________________________________________ Abstract Title: ____________________________________________________________________________________ Poster Type:

□Clinical Research □Basic Science Research □Translational Research (Basic Science and Clinical Research)

Primary Author: __________________________________________________________________________________ (Students must be listed first to be considered for the Award. Presenter will be notified by mail of acceptance). Co-Author(s): _________________________________________________________ Student

□YES □NO

Awards:

Posters will be eligible for 1st, 2nd, and 3rd place prizes to be presented at Convention. (Only one prize is given for each winning poster)

Free Registration:

Three entry level students from each Florida College of Pharmacy will be eligible for a complimentary Florida Pharmacy Association Convention Student registration. (Student Registration does not include CE or hotel accommodations) I am interested in being considered for this registration:

College:

□YES

□NO

_____________________________________________________________________________

ABSTRACT FORMAT The abstract form submitted should be the equivalent of one page. The abstract should include: Title (Include authors’ names and name of College of Pharmacy), Purpose, Methods, Results, and Conclusions. Abstracts will not be accepted if it is not in this format. Do not include figures or graphs.

Please direct all questions and concerns to:

Tian Merren Owens ♦ (850) 222-2400 ext. 120 ♦ tmerren@pharmview.com DEADLINE DATE: MONDAY, MAY 2, 2011 22

Flor i d a Pharmac y To d aY

Buyer’s Guide florida PHARMACY TODAY

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PHARMACY RESOURCES

PHarmaceutical WHOLESALER

PPSC Retail Pharmacy Purchasing Program (888) 778-9909

McKesson Drug Company Jim Springer (800) 804-4590 FAX: (863) 616-2953

PHARMACY CONSULTANTS HCC Pharmacy Business Solutions Dean Pedalino (800) 642-1652 Mobile: (727) 460-1855

TEMPORARY PHARMACISTs – STAFFING

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Medical Staffing Network (800) 359-1234

Meadowbrook Workers Comp Insurance Endorsed by FPA (800) 825-9489

HealthCare Consultants Pharmacy Staffing Bob Miller (800) 642-1652

Rx Relief (800) RXRELIEF

LEGAL ASSISTANCE Kahan ◆ Shir, P.L. Brian A. Kahan, R.Ph., and Attorney at Law (561) 999-5999

FREQUENTLY CALLED NUMBERS AHCA MEDICAID PHARMACY SERVICES 2727 Mahan Drive Tallahassee, FL 32308 (850) 487-4441 www.fdhc.state.fl.us/medicaid/ pharmacy AMERICAN PHARMACISTS ASSOCIATION (APhA) Washington, D.C. (800) 237-2742 www.pharmacist.com AMERICAN SOCIETY OF HEALTH SYSTEM PHARMACISTS Bethesda, MD (301) 657-3000 www.ashp.com/main.htm Drug Information Center Palm Beach Atlantic University (561) 803-2728 druginfocenter@pba.edu FLORIDA BOARD OF PHARMACY 4052 Bald Cypress Way Bin #C04 Tallahassee, FL 32399-3254 (850) 245-4292 www.doh.state.fl.us/mqa FLORIDA POISON INFORMATION CENTER NETWORK (800) 222-1222 www.fpicn.org National Community Pharmacists Association 100 Daingerfield Road Alexandria, VA 22314 703.683.8200 703.683.3619 fax info@ncpanet.org Recovering Pharmacists Network of Florida (407) 257-6606 “Pharmacists Helping Pharmacists”

Advertising in Florida Pharmacy Today Display Advertising: please call (850) 264-5111 for a media kit and rate sheet. Buyers’ Guide: A signed insertion of at least 3X per year, 1/3 page or larger display ad, earns a placement in the Buyers’ Guide. A screened ad is furnished at additional cost to the advertiser. Professional Referral Ads: FPA Members: $50 per 50 words; Non‑members: $100 per 50 words; No discounts for advertising agencies. All Professional Referral ads must be paid in advance, at the time of ad receipt. MARCH 2011

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