IPA Journal Jul/Aug/Sep 2022

8515 Douglas Avenue, Suite 16, Des Moines, IA 50322

Phone: 515.270.0713 Fax: 515.270.2979

Email: ipa@iarx.org | www.iarx.org

PUBLICATION STAFF

Allison Hale, Managing Editor

Kate Gainer, PharmD

Emmeline Paintsil, PharmD, MSLD, BCPS

Elizabeth Orput, PharmD

Kellie Staiert, MPA

Laura Miller

OFFICERS

CHAIRMAN

Diane Reist, PharmD, RPh – Cedar Rapids

PRESIDENT

Christopher Clayton, PharmD, MBA – Manchester

PRESIDENT-ELECT

Cheri Schmit, RPh – Ames

TREASURER

CoraLynn Trewet, PharmD – Ankeny

SPEAKER OF THE HOUSE

Deanna McDanel, PharmD, BCPS, BCACP – Coralville

VICE SPEAKER OF THE HOUSE

Heather Ourth, PharmD, BCPS, BCGP – Ackworth

TRUSTEES

REGION #1

Wes Pilkington, PharmD – Waterloo

REGION #2

Pamela

Candace

Grant

Emily

Nancy

Jackie

Angie

Sharon

The Journal of the Iowa Pharmacy Association is a peer reviewed publication. Authors are encouraged to submit manuscripts to be considered for publication in the Journal. For author guidelines, see www.iarx.org/journal.

“The Journal of the Iowa Pharmacy Association” (ISSN 1525-7894) publishes 4 issues per year: January/February/March issue; April/ May/June issue; July/August/September issue; and October/No vember/December issue by the Iowa Pharmacy Association, 8515 Douglas Avenue, Suite 16, Des Moines, Iowa 50322. Periodicals postage paid at Des Moines, Iowa and additional mailing offices.

POSTMASTER: Send address changes to: The Journal of the Iowa Pharmacy Association, 8515 Douglas Ave., Suite 16, Des Moines, IA 50322. Published quarterly, The Journal is distributed to mem bers as a regular membership service paid for through allocation of membership dues. Subscription rates are $100 per year, single copies are $30. Printed by Mittera; Graphic design done by the Iowa Pharmacy Association.

TABLE

COVER STORY

FEATURES

Mission Statement

ANNUAL MEETING

September 22-23, 2022 Cedar Rapids, IA

DoubleTree by Hilton Convention Complex

TUESDAY, SEPTEMBER 13

6:00 PM House of Delegates – Session I (Virtual)

THURSDAY, SEPTEMBER 22

8:00 AM Coffee Hour & Open Networking

8:45 AM Welcome

9:00 AM House of Delegates – Session II

KEYNOTE: Self-Deception & Objectification: Implications for Providing Care

12:15 PM Leadership Lunch – IPA President & Board Installation

1:30 PM Exhibit Hall & Poster Presentations

1:30 PM Open Networking/Roundtable Discussions

3:30 PM Residency Showcase + Meet the Residents

6:00 PM President’s Reception & Annual Awards Banquet

9:00 PM IPA Foundation Silent Auction

FRIDAY, SEPTEMBER 23

6:30 AM FUN Run

7:30 AM Industry Symposium Breakfast

8:30 AM Keynote & House of Delegates – Session III

KEYNOTE: Pharmacy’s Important Role in Health Equity: National Pharmacy Association Panel (ASHP, APhA and NCPA)

11:30 AM IPPAC Pie-in-the-Face

11:45 AM Lunch & Industry Symposium

1:00 PM Boosting Confidence in Communication

THANK YOU TO THE IOWA PHARMACY FAMILY

AsI reflect on the last year as president of the Iowa Pharmacy Association, the first thing that comes to mind is a sense of pride. Here’s why…

During the pandemic, I witnessed so many amazing actions by our profession with members stepping up to help our patients and communities. I observed evidence of this through our educational support for patients during the changing environment, adaptation of ser vices to add testing at many sites, numerous additional staff that became certified for vaccine administration to meet the community needs, or assisting the rest of the medical community as the therapeutic landscape seemed to change every week. Across the state, your efforts, actions and willingness to persevere through this pandemic has been incredible to witness, and for that, I feel proud to be part of the Iowa Pharmacy family.

I can’t help but think we are on the verge of additional wins on this topic. It was fantastic to witness the IPA membership rally and demonstrate strong grassroots support when IPA staff called for it from the capitol. Although we didn’t get everything we wanted this session, we did get a bill across the finish line that has laid the groundwork for meaningful regulation, future discussions and negotiations. We will maintain our good working relationship with the Iowa Insurance Division to make sure our voice is heard through a more formal mechanism of oversight.

As pandemic restrictions continue to ease and we are able to meet in person again, it becomes evident just how special the Iowa Pharmacy family is. While Zoom meetings kept us going during a tough time and allowed us to stay connected, seeing people in person is truly a different level of engagement and brings us a defined sense of purpose. As a member of IPA and the pharma cy profession, you continue to make a difference every day – for fellow IPA members, for your patients, for the communities you serve.

The past year, I have had the pleasure of working with an awesome team of people at IPA, members of the IPA Board, and all of you. Some of my most memorable days as IPA President surround the 2022 Legislative Session, including visiting the Iowa State Capitol to attend a sub committee meeting and assisting with activities around the proposed PBM legislation. What a challenging yet exciting time to be representing and fighting for fair and transparent payment practices!

Today, there is still great activity and energy around PBM reform, both in Iowa and across the country.

The saying, “What is right for the patient is right for the profession,” rings so true here in Iowa, and I couldn’t feel more proud to say that I am a part of that. I am so grateful for all of the relationships I have developed with pharmacy professionals across the state during my time as president. I thank each of you for all that you do! ■

Christopher Clayton, PharmD, MBA Director of Pharmacy & Population Health, Buchanan County Health Center

IPA President

“Some of my most memorable days as IPA President surround the 2022 Legislative Session.”

“Seeing people in person is truly a different level of engagement and brings us a defined sense of purpose.”

UNDERSTANDING DISPARITIES TO IMPROVE HEALTH EQUITY

AUTHOR: Emmeline Paintsil, PharmD, MSLD, BCPS, Director of Professional Affairs, Iowa Pharmacy Association (IPA)

Health equity, inequity, disparities and social determinants of health – You may have heard the buzz of these terms at work in department meetings, while glossing through your inbox, and even scrolling on social media. Much like the conversations around diversity, equity, in clusion and justice, there are many misconceptions around what these terms mean. Public health crises, such as the HIV/AIDS pandemic, opioid epidemic, and recent COVID-19 pandemic, have continued to highlight inequities of the health care system that have unfortunately resulted in disparities in health outcomes for underserved and vulner able patient populations. As healthcare providers, we often neglect to understand how health disparities impact the care we provide to our patients and their ability to be fully present and engaged at the center of that care.

Health equity has been defined as “the attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.” Many types of disparities exist in this world, including economic and social dispar ities. In the context of health and healthcare, the Office of Disease Prevention and Health Promotion’s Healthy People 2020 defines health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”

To better understand the context of disparities, it is important to understand more about Iowa’s population. An estimated 1.35 million people live in rural areas (43% of the population), while roughly 1.8 million people live in urban areas. (Nationwide, 14% of the total U.S. population lives in a rural area.) In Iowa, approximately 15.5% belong to a racial or ethnic minority population (approximately 33%, or more than 100 million people in the U.S., identify themselves as belonging to a racial or ethnic minority population).

Approximately 50% of Iowa’s population is women, which is similar to the U.S. population.

Approximately 8% of Iowans under the age of 65 have a disability (26% of adults in the U.S. have some type of disability).

While these demographic elements are not thought to be related to health, research has found a complex relationship that exists between health and factors such as socioeconomic status, environmental and psychological safety, access to health care services, and legislative policies. These factors, which influence an individual’s or population’s health, are known as determinants of health.

Social determinants of health are non-medical factors that impact health and wellbeing. They are commonly grouped into five domains: economic stability; education access and quality; neighborhood and built environment; social and community context; health care access and quality. The U.S. Department of Health and Human Services de fines social determinants of health as “the conditions in the environ ments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life out comes and risks.” Social determinants of health, such as unequal access to health care, contribute to wide health disparities and inequities and impede opportunities for individuals to achieve optimal health.

To put this into context, about one in ten people in the United States do not have health insurance. People without insurance are less likely to have a primary care provider, and they may not be able to afford the health care services and medications they need. Strategies to improve insurance coverage are critical for making sure more people get important health care services, like preventive care and treatment for chronic illnesses.

Health insurance is not the only barrier to care. We often see geography impacting health due to patients living too far away from health care providers that offer the services they need. According to the recent U.S. Census, Iowa’s population is approximately 40% rural and approxi mately 606,000 residents live in a primary care shortage area. In rural Iowa, pharmacies are the backbone of the health care system. Without a local pharmacy, services such as dentistry, family medicine, and general medicine struggle to maintain viability. Since 1996, the number of pharmacies supporting rural Iowa communities has decreased drastically. Currently, 69.7% of Iowa’s 99 counties have two or less pharmacies. Rural health disparities across the state continue to impact patient care. The further a patient must travel to receive the care and medications they need increases the risk of disease state complications and hospital admissions, placing an increased burden on our health care system.

The pharmacy profession has and continues to help bridge the gap for patients needing pre ventative care and acute and chronic treatment through point-of-care testing, medication ther apy management, and

other supportive services. Collaborative practice has enabled pharma cists to meet the needs of patients in collaboration with other health care providers. Throughout the COVID-19 pandemic, we have seen our profession step up to serve our patients and provide PPE, vaccines, and hope. As a profession, we are intimately aware of how essential our services are to our patients.

Rural communities face higher rates of chronic conditions and poor health outcomes due to systemic health and social inequalities and lack of access to care, which have further worsened due to COVID-19 health disparities. Four in ten U.S. adults have reported avoiding medical care because of COVID-19-related concerns. The ramifica tions of postponed care include an increase in morbidity and mortality associated with acute and chronic health conditions. Public health crises, such as the COVID-19 pandemic, amplify the inequities of the health care system for underserved and vulnerable patient populations. Pharmacists and pharmacy technicians continue to help address the needs of patients who have foregone health visits and delayed care by providing education, increasing access to disease state management

services, and going above and beyond to connect patients to commu nity services addressing their needs. As healthcare providers, we each have a responsibility to bring awareness to health disparities and ineq uities in our health care system. Being informed and educated about the impact disparities have on the communities we serve is essential, and advocating for our patients and profession to maintain the viability of our services is crucial to promoting greater health equity.

References:

1. https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities

2. https://www.census.gov/quickfacts/fact/table/IA/DIS010220#DIS010220

3. https://www.ers.usda.gov/webdocs/publications/102576/eib-230.pdf?v=4409#:~:tex t=The%2046%20million%20U.S.%20residents,23%2C000%20people%20compared%20 with%20245%2C000

4. https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-ac cess-and-quality

5. Abrams EM, Szefler SJ. COVID-19 and the impact of social determinants of health. Lan cet Respir Med. 2020;8(7):659-661. doi:10.1016/S2213-2600(20)30234-4

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7234789/

https://www.ajmc.com/view/underscoring-disparities-in-rural-health-challenges-solu tions-for-a-long-standing-and-growing-national-issue

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2783242

https://www.cdc.gov/mmwr/volumes/69/wr/mm6936a4.htm

https://www.cdc.gov/nchhstp/socialdeterminants/

AMA DENIES PHARMACIST SCOPE OF PRACTICE, APhA RESPONDS

The COVID-19 pandemic has highlighted many of the ways phar macists are integral health care providers. In recognition of this, the Biden Administration proposed a COVID-19 test-to-treat plan earlier this year allowing pharmacists to prescribe Paxlovid or Molnupiravir immediately following a positive COVID-19 test result. Research has shown that quick diagnosis and subsequent prescribing is critical in the administration of Paxlovid. It is 88 percent effective in preventing the progression of a symptomatic COVID infection to hospitalization or death if administered within the first 3 to 5 days of infection.2 In a world where it is not always easy to schedule an appointment with a physician, this proposal was meant to expand access to health care and improve treatment.

In response, the American Medical Association (AMA) released a policy statement slamming the proposal and insulting pharmacist education. The statement says, in part, “The pharmacy-based clinic component of the test-to-treat plan flaunts patient safety and risks significant health outcomes. This approach, though well intentioned in that it attempted to increase access to care for patients without a pri mary care physician, oversimplifies challenging prescribing decisions by omitting knowledge of a patient’s medical history, the complexity of drug interactions, and managing possible negative reactions…Leav ing prescribing decisions this complex in the hands of people without knowledge of a patient’s medical history is dangerous in practice and precedent…COVID-19 is not strep throat—it is a complicated disease that has killed nearly 1 million people in the United States…we must marshal our resources smartly and effectively, which means under the guidance and supervision of physicians with expertise to deal with complex medications.” While the full statement provides more details, the above sentences provide a summary of the AMA’s position.3

In one of its strongest statements to date, the American Pharmacists Association (APhA) quickly drafted a responding policy statement during its annual House of Delegates meeting this March in San Antonio, TX:

1. APhA opposes policies and practices by the American Medical Association (AMA) and other professional organizations that inhibit interprofessional care, patient access to pharmacist-provided care, and health equity.

2. APhA calls on the American Medical Association (AMA) to rescind its policies opposing expanded scopes of practice for pharmacists.

3. APhA adamantly supports the continuation and expansion of collaborative patient care models among pharmacists, physicians, and other health care professionals to improve patient access to care, health equity, and health outcomes.4

The AMA has traditionally resisted the expansion of other health care provider’s scope of practice. Given the wide disparities in health care access and prevalence of underserved health care deserts, pharma cists not only assist physicians as part of an interdisciplinary team but provide access to healthcare that otherwise would be unmet in many instances. As arguably the most accessible healthcare provider, pharma cists are in a unique position to assist patients who otherwise would not receive the care they need. Moreover, this expansion would provide the most benefit for time-sensitive disease states such as COVID-19, where day-to-day clinical progression evolves quickly, and therapeutics work best the faster they are administered. Pharmacists and physicians should be working together to provide safe and effective health care to all Americans.

References:

1. Office of the Assistant Secretary for Preparedness & Response. Fact Sheet: COVID-19 Test to Treat. 2022 Mar 29. https://aspr.hhs.gov/TestToTreat/Documents/Fact-Sheet.pdf (accessed 2022 July 18).

2. Hammond J, Leister-Tebbe H, Gardner A, et al. Oral Nirmatrelvir for High-Risk, Non hospitalized Adults with Covid-19. N Engl J Med. 2022;386(15):1397-1408. doi:10.1056/ NEJMoa2118542.

3. Harmon GE. AMA Statement on Administration’s Test-to-Treat COVID-19 Plan. Amer ican Medical Association. 2022 Mar 4. https://www.ama-assn.org/press-center/press-re leases/ama-statement-administration-s-test-treat-covid-19-plan (accessed 2022 July 18).

4. American Pharmacists Association House of Delegates. Addressing American Medical Association’s Policy Related to Pharmacists Scope of Practice. J Am Pharm Assoc. 2022; 62(2022):941-943. DOI 10.1016/j.japh.2022.05.007

DOES HEALTHCARE HAVE A BROKEN HEART?

Kate Gainer, PharmD

IPA Executive Vice President & CEO

I’m

a believer in silver linings and an optimist through and through. I enjoy hearing stories of silver linings from the COVID-19 pandemic. Some of the more common ones: extra family time with teenagers; slowing down; pausing organized kid activities and replacing with game nights and movie nights; new pets; and discovering parks and exploring nature in their own community or state. For me personally: learning to work remotely; embracing online school; spending extra time with family in Wisconsin; and road-tripping to five national parks. But for every silver lining, there are true hardships and real trauma that many have faced across the country and state of Iowa.

Trauma.

The CDC defines trauma as a physical, cognitive, and emotional response caused by a traumatic event, series of events, or set of circumstances that is experienced as harmful or life-threatening. Usually associated with violence, accidents, ACEs (adverse childhood events) or war, trauma is not a word that I used often or heard much of until the past year. With year two of the COVID-19 pandemic, the word trauma started to enter my inbox, my zoom calls, face to face meetings, and personal conversations on a daily basis.

Over two years have passed since the World Health Organization (WHO) declared COVID-19 a global pan demic. Though not the only current public health and healthcare crisis, it has been the most significant in af fecting the way we live, work and provide care. Through out the pandemic, healthcare workers have experienced trauma that appears on brain scans to match the trauma soldiers face during combat. From experiencing death at rates higher than any other condition, to worrying about keeping their staff and teams healthy, to continually adapting to “new normals” and updated guidelines, each individual’s response to these events varies – and the level of trauma experienced varies as well.

As pharmacists, acknowledging that patients have expe rienced trauma and will have an individual response is critical to providing trauma-informed care As phar macists, acknowledging that the healthcare workforce and our pharmacy teams have experienced trauma and will also respond uniquely is called trauma-informed leadership

The IPA Board of Trustees has discussed how the As sociation can provide support, resources and education for pharmacists and technicians to best care for patients, and one another, through a trauma-informed lens. At

a recent Board meeting, a presentation was shared by Helen Sairany, CEO of the Florida Pharmacists Asso ciation, an author, and trauma-informed pharmacist. Helen shared:

“As a trauma-informed pharmacist who has personally served at the frontline in combat zones, I believe the comparison between healthcare workers in the pandemic and soldiers in combat is accurate. The human brain is not designed for uncertainty. It is designed for survival. In times of extreme distress and uncertainty, the neocortex, where higher level thinking takes place, is overtaken by the part of the brain that governs emotion and survival, the amygdala, also known as the body’s alarm system. We become more self-centered and less collaborative, giving and empathetic. It’s a self-defense mechanism that can negatively impact our work and our relationships.”

As pharmacists and healthcare leaders, we can incor porate trauma-informed care and leadership into our practices through normalizing conversations, centering patient interactions around safety and mental health, and adopting policies and procedures to support trauma-informed care. These are not always easy conversations. Whether we call it professional burnout, trauma or healthcare’s broken heart, at IPA, we are here to support our members personally and professionally, just as our members support one another personally and professionally to heal, learn and grow. ■

Helen Sairany presenting to the IPA Board of Trustees in June

RE-ENGAGING PHARMACIES: HIV/HCV TESTING PROJECT

Since 2019, IPA has been managing a multi-year project implementing HIV screenings in community pharmacies in collaboration with the Iowa Department of Public Health’s Bureau of HIV, STD and Hepatitis. There are cur rently twelve pharmacies offering free HIV screenings for their communities, and three of those are also offering free Hepatitis C (HCV) screenings.

In efforts to re-engage pharmacies in this point-of-care testing project, IPA has been hosting virtual project meet ings to provide a platform for pharmacies to share best practices and learn from each other. IPA also provides resources for participating pharmacies on our website. Reducing stigma and counseling patients on their test results are just a couple topics pharmacies are educated on.

IDPH and IPA did additional marketing and promotion during the months of May, National Hepatitis Aware ness Month, and June, National HIV Testing Day on the 27th. Patients were incentivized with a free gift card for completing an HIV or HCV test.

Increasing access to testing has been a priority for IDPH in fighting the HIV epidemic. IPA is looking to gain more interest in the following counties: Palo Alto, Pocahontas, Calhoun, Webster, Humboldt, Kossuth, Clarke, Decatur, Lucas, Monroe, Wapello. These are areas of the state IDPH considers focus areas based on their epidemiology reporting.

To participate in the project or to learn more, please contact Kellie Staiert, IPA’s Lead Project & Partner Manager, at kstaiert@iarx.org.

To learn more about Stop HIV Iowa, visit www.stophiviowa.org.

COUNTIES NEEDED:

Palo Alto

Pocahontas

Calhoun Webster Humboldt Kossuth

SCREENING TOOL TO DETERMINE OVERALL WELL-BEING

Clarke Decatur Lucas Monroe Wapello

Research has been surfacing for many years now that the overall well-being of a pharmacist is directly correlated to pharmacy productivity, creativ ity and perseverance. A recent webinar held by APhA discussed a well-being index for pharmacy personnel. The average consensus from pharmacy personnel showed that pharmacists are at high-risk of distress.

Why does this matter? Pharmacy personnel who identify as high-risk of distress are 3 times more likely to have a low quality of life, have an 8-fold increased risk of burnout, and are 2.5 times more likely to be fatigued or have intent to leave their current job. Possibly most concerning, pharmacy personnel at high-risk of distress are twice as likely to make a medication error.

Since June, there has been a .18% increase in distress by pharmacy personnel. Although this may not seem high, if we consider all medications dispensed in our own pharmacies per month and then multiply that by the 850 pharmacies in Iowa…that is a lot of prescriptions. If pharmacists at high-risk of distress are twice as likely to make medication errors, this scenario has the potential to cause great patient harm.

Scan to take survey

About three years ago, APhA launched an online screening tool, which was created by Mayo Clinic, to allow pharmacy professionals to determine their levels of fatigue, depression, burnout, anxiety, stress, and overall well-being. This tool has shown positive results in helping pharmacy personnel recognize when they are experiencing levels of high-stress and allow themselves the space to rejuvenate.

The pillars of our profession are founded on the protection and care that we provide to our patients. To uphold our oath, we need to care for ourselves and decrease our levels of distress before we’re able to care for others.

THE UNIVERSITY OF IOWA

The UI College of Pharmacy proudly hosted an in-person commencement cere mony–the first in-person ceremony since 2019–in front of hundreds of families, friends, faculty, alumni, and practitioners at Hancher Auditorium on Thursday, May 12.

The celebratory week started with a special recognition event for the graduating students. On Wednesday, May 11, graduates and their families were treated to a reception and program in the new College of Pharmacy building. Susan Vos, Associate Dean, announced individuals receiving dual degrees, certificates and recognition cords, and Dean Donald Letendre introduced the invited commence ment speaker, Nancy Alvarez, from the University of Arizona. IPA Executive Vice President and CEO, Kate Gainer, welcomed the graduates to the profession.

Doctor of Pharmacy commencement exercises began with a welcome from Dean Letendre, followed by graduating senior Trey Van Hemert, Class of 2022 President, and guest speaker, Nancy Alvarez, PharmD, Associate Dean and As sociate Professor at the University of Arizona R. Ken Coit College of Pharmacy. UI President Barbara J. Wilson and Abigail (Abby) Crow of the Board of Regents presided over the ceremony.

Alvarez noted Iowa Pharmacy as the ‘Center of the Pharmacy Universe’ and suggested five ways to deepen professional engagement, including advocacy, realizing themselves as a pharmacist first, demonstrating care, participating in professional activities, and picking out a fabulous, comfortable pair of shoes.

“The titans of your state have worn big shoes as they shaped the Iowa Pharmacy Universe. You don’t need to fill their shoes – instead, you can think about select ing your own shoes in a style that suits you and set them down next to those Iowa pharmacy leaders,” said Alvarez.

This year’s 88 graduates had many accolades and achievements including Julia Christ, Alexis Clouse, Kalyca Nardy, and Ashley Perlwitz, Academic Excellence Awards; Lauren Reist, United States Public Health Service Award; and Chi Nesah, Center for Inclusive Academic Excellence

Dean’s Achievement Award.

PHARMD CLASS OF 2022

Salma Abdelrahman

Fatima Atfif

David Bainbridge

Caelee Batterson

Allen Baugh

Urvi Bhakta

Joshua Brase

James Bullard

Julia Christ

Sarah Cinquepalmi

Alexis Clouse

Steven Cui Alexandra Curran

Kyla Dickey

Michelle Dobrzynski

Austin Dollmeyer

Ashley Duda

Sara El-Hattab

Jacob FitzPatrick

Ben Fox

Hao Fu

Marisol Garcia Alexander Goss

Annie Halfman

Alexander Hall

Hasna Harrabi

Caroline Hartman

Micah Hiner

Sonny Hoang Alaina Hofmann

Analisa Iole

Guissella Munoz

Emma Johnson

Jacob Johnson

Fatima Kamara

Beatrice Kariuki

Tessa Kauffman

Kathryn Kenney

Grace Kim Morgan Kimball

Megan Lake

Kassidy Lawler

Tiffany Le Peizhi Li Damien Lihs

Dylan Lloyd

Jessica McCants

Colton McConnell

Delaney McKone

Raegan Menke

Riley Mohr

Spencer Munroe

Ann Mwangi

Ali Naraghi Kalyca Nardy

Sara Nashed

Chi Nesah

Sara Nezirevic

Chelsea Nguyen

Vy Nguyen Sydney Novak Reid Peloquin Ashley Perlwitz Ellen Peters

Kyla Peters Emma Piehl

Shannon Powers Kaitlyn Quinn Sara Ramirez Shelby Reid Lauren Reist

Jenna Ringsdorf Mason Roberts Marissa Rupalo Amir Saba

Samuel Schauer

Brendan Schryver Erika Schupp Nicholas Shepard Marissa Stewart

Dalton Swift

Trey Van Hemert

Jake Van Oort Hoa Vuong Walt Wang

Tyler Wempen Kayla Wilson Liangping Yu

DRAKE UNIVERSITY CPHS

PHARMD CLASS OF 2022

Anis Abdullahi

Nicholas Andert

Daniel Armstrong

Edina Begic

Beau Blake

Isabella Blankenship

Angelica Castro

Samuel Cataldo MacKenzie Challoner

Derek Cloyd

Barret Collard

Rachel Comito

Noah Cresco

Darshika Desai

Sukhnoor Dhillon

Nicholas Driscoll

Andrew Dunham

Tarah Fisher

Hope Fraise

Michaela Friedeck

Kole Gallick

Caroline Gander

Holly Gardner

Abby Disterhoft

Joshua Hart

Elizabeth Harvey

Latham Hendrickson

Thao Hoang

Jacob Horstman

Caroline Jones

Collin Jones Christopher Karch

Zoe Kedrowski

Ellisa Kim

Sydney Kleven

Courtney Krall

Stephanie Krois

Humam Lafta

Natalie Lee

Britain Lehrer

Richard Levites

Tabitha Liechty

Jacob Lucht

Stephanie Martin

Landon McKee

Haley Miller

Breanna Moore

Hebah Musharafa

Bailey Nagel

Kim Nguyen

Ryan Nulty

Megan Ochs

Joel Parado

Prachi Patel

Elizabeth Petersen

Jordan Pierce

Carissa Popp

Tyler Prokuski

Ann Radtke

Reagan Rathe

Jonathan Resch

Siri Roberts

Andrea Saar

Edie Schwickerath

McKenna Simpson

Emma Smith

Isabel Stanger

Shawna Stricker

Gabriella Tagliapietra

Courtney Temple

Isabelle Tharp

Marc Thieme

Jacquelyn Thomsen

Tatum Torode Mariah Trapp

Brittani Weichman

Kaitlyn Wellens

Tyler Wypych

Verent Yee

Beara Zachariah

Lauren Zimmerman

The College of Pharmacy and Health Sciences (CPHS) held the annual Hooding and Commencement Ceremony for professional program students on Saturday, May 14. The 36 Bachelor of Science in Health Sciences undergraduate students participated in the Undergraduate Commencement Ceremony held on Sunday, May 15.

Receiving their degrees and doctoral hoods during the CPHS Hooding and Commencement Ceremony were:

• 41 Occupational Therapy Doctoral (OTD) students

• 81 Doctor of Pharmacy (PharmD) students

• 5 Master of Athletic Training (MAT) graduates

• 7 graduates from the inaugural Master of Health Informatics and Analytics (MS HIA) class.

In addition to the doctoral and master’s degrees, many of the graduating students also received additional degrees or designations.

The Hooding and Commencement Ceremony included reflections from three of the graduating class student government representatives. Bridget Davidson (MAT), Rylee Steinke (OTD), and MacKenzie Challoner (PharmD) reflected on their experiences from the time they stepped foot on Drake’s campus to gradua tion and provided words of encouragement for the graduates as they start their careers.

IPA’s Director of Professional Affairs, Emmeline Paintsil, PH’18, led the PharmD graduates in the Oath of a Pharmacist. CoraLynn Trewet, PH’03, Senior Medical Science Liaison with Bristol Meyer Squibb and chair of the College’s National Ad visory Council, welcomed the graduates into the Drake CPHS alumni network.

“We congratulate all of our 2021-2022 graduates and are confident that they will have many accomplishments during their careers,” said Renae Chesnut, Dean and Professor. “They are proof that we are fulfilling our mission to prepare today’s learners to be tomorrow’s health care leaders.”

Y o u N e e d a C Q I P r o g r a m

Mistakes

APMS Patient Safety

how,

can

Pharmacy

confidential, highly

and

workflow occurs

A web-based reporting portal to collect patient safety events

chart, graph, and analyze data

advice, tips, and safe practices

help you meet accreditation and quality improvement requirements

build a just culture of safety

Education and training opportunities

A P M S P S O

Patient Safety Organizations (PSOs)

a safe space for members to conduct patient safety work. When you partner with our PSO for your Quality Improvement activities, the collection of quality assurance data and patient safety work is in a protected environment.

We

community pharmacy and are

passionate about medication safety

walk you through the entire process.

customer service team has years

experience

pharmacy

excited to help.

USE YOUR VOICE : A STUDENT PHARMACIST PERSPECTIVE

Throughoutmy time with IPA, my views and understanding of advocacy for the profession have developed through unique avenues.

Serving as a student member of the IPA Board of Trustees has heightened my knowledge and skills as a student pharmacist. Having the opportunity to discuss the newest advancements and concerns within the profession with prominent Iowa pharmacy leaders has been an invaluable experience. This position provides students with the opportunity to step out of the class room and into the larger world of pharmacy practice, long before many other professionals have the ability to do so.

My interest in IPA grew during my second year in phar macy school when I was selected to attend the Bill Burke Student Pharmacist Leadership Conference alongside many peers from Drake University and the University of Iowa. Upon attending this conference and speaking with fellow student pharmacists, I discovered my passion for advocacy and the important part IPA plays in advancing the profession. During quarterly meetings and annual events, my role on the Board has allowed me to take information back to Drake University and vice versa.

Apart from the Board of Trustees, I have had the opportunity to hold several key leadership positions through the college of pharmacy. This includes serving as the International Pharmaceutical Students Federa tion (IPSF) Chairperson for the American Pharmacists Association – Academy of Student Pharmacists (APhAASP). Within this role, I have been able to address and advocate for global health concerns, organize fundrais ers, and arrange free health screenings and resources

for local ESL (English as a Second Language) students. In addition to this role, I have also served as a CPHS Student Governance Association Delegate, a Diversity, Equity, and Inclusion (DEI) Committee Advisor, and on the Academic Affairs Committee for the college. These positions and my professional involvement allowed me the opportunity to be inducted into Phi Lambda Sigma Pharmacy Leadership Society.

I came into the pharmacy profession with a desire to contribute to healthcare equity, and that is where I have chosen to focus my personal and professional devel opment throughout the past few years. My focus on health advocacy for diverse populations and adequate public health resources brought me to pursuing an MBA through Drake’s dual degree program.

IPA has given me a platform to advocate for policy change and organizational growth, as well as influence other leaders within the profession to highlight these ar eas. Iowa has always been a leader in pharmacy, and stu dents within the state need to use their voice to continue to advance the profession. I wish more student pharma cists could have this opportunity, and I hope that more and more of them continue to find their voice! ■

MEMBER TIP: Share Your Comments with IPA!

IPA serves to capture the needs, thoughts and concerns of its members. In instances of request for comments

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Drake University CPHS

Mahi Patel Student Pharmacist, IPA Board of Trustees

Emmeline

Seth Brown, JD Director of Public Affairs sbrown@iarx.org

“Students within the state need to use their voice to continue to advance the profession.”

1815 UPDATE

IPA recently completed the 2021-2022 grant cycle for the 1815 project in collaboration with the Iowa Department of Public Health (IDPH). The 1815 project primarily focuses on patients with diabetes but also looks at expanding care and addressing the needs of patients with hy pertension and dyslipidemia. Thank you to the following members who participated this past year:

DSMES Program Development

Pharmacy on 8th, LLC – Wellman, IA Main Street Drug – Charles City, IA

DSMES Program Referrals

Hartig Drug Company – Preston, IA

Diabetes Prevention Program (DPP) Referrals

Drilling Pharmacy – Sioux City, IA

Collaborative Practice Implementation and MTM

UnityPoint Health – Des Moines Medication Management Department

UnityPoint Health – Waterloo Medication Management Department

Medication Therapy Management

BCHC Oelwein Pharmacy – Oelwein, IA Brehme Drug – Manchester, IA Daniel Pharmacy – Fort Dodge, IA Wells Hometown Pharmacy – Bloomfield, IA

IPA is now seeking participants for the 2022-2023 grant cycle which starts in September. Initiatives this year include implementing pro cesses for increasing referrals to and enrollment in statewide accred ited/recognized DSMES programs in Iowa; supporting pharmacies interested in establishing a new DSMES program; providing technical assistance to pharmacists/pharmacies offering MTM services for diabetes management, high blood pressure, and/or hyperlipidemia and providing technical assistance to pharmacists/pharmacies interested in implementing or enhancing collaborative practice agreements to support patients with diabetes, hypertension and hyperlipidemia. If you or your pharmacy are interested in starting or continuing to work with IPA on these initiatives, please contact IPA’s Director of Professional Affairs, Emmeline Paintsil, at epaintsil@iarx.org.

VACCINE EQUITY GRANT

IPA continues to partner with IDPH on increasing COVID-19 vaccine confidence, engaging trusted messengers, and addressing vaccine hesitancy for populations that have been disproportionately affected by COVID-19. In addition to providing timely updates and highlighting our #MembersInTheMedia, IPA hit the road this past spring for the first half of 2022 IPA Goes Local events with North Iowa Pharmacists Inc. in Mason City, Quad Cities Area Pharmacy Association in Daven port, and Southwest Iowa Pharmacists Association in Council Bluffs.

Speakers Deborah Thompson, MPA, and Matthew Witry, PharmD, PhD, developed the content for IPA Goes Local programming which is accredited for pharmacist and pharmacy technician CE. Their session is entitled, “Rethinking Vaccine Communication – The Elephant in the Room,” and focuses on moral foundations and values in vaccine beliefs and using motivational interviewing skills to have productive vaccine discussions with individuals who are vaccine-hesitant. This fall, the IPA team will bring the same programming to the Black Hawk/Bremer County Pharmacy Association in Waterloo (August 18), Dubuque Area Pharmacy Association in Dubuque (September 6), Johnson County

Pharmacy Association in Iowa City (October 6), Central Iowa Phar macy Association in Des Moines (October 20), and Northwest Iowa Pharmacy Association in Sioux City (November 10).

Additionally, IPA is working with Wixted and Company, an external communications and media training firm, to develop workshops to train trusted messengers on communicating evidence-based informa tion and building trust and confidence in vaccines. The next workshop will be held at IPA’s Annual Meeting on September 23rd in Cedar Rapids. For more information, please contact Emmeline Paintsil.

HEALTH DISPARITIES GRANT

IPA continues to partner with IDPH to address social determinants of health needs to reduce COVID-19-related health disparities through partnerships with organizations such as the Iowa Medical Society, Iowa Public Health Association, Iowa Hospital Association, Iowa Rural Health Association, CFY Wisewoman, and Iowa Immunizes. IPA’s ini tiatives include promoting education on chronic disease management, expanding access to screening and testing services, supporting pharma cy technician advancement, promoting mental-health and wellbeing, and developing educational resources for pharmacy professionals on the socio-economic and long-lasting health impacts of COVID-19 for underserved and disproportionately affected communities. To learn more about this project, please contact Emmeline Paintsil.

INCREASING EQUITABLE ACCESS TO COVID-19 VACCINES GUIDE

In partnership with the University of Iowa’s Prevention Research Center for Rural Health, Iowa Immunizes, and the Iowa Public Health Association, the Pharmacists’ Guide to Increasing Equitable Access to COVID-19 Vaccines is a new toolkit that focuses on issues relevant to micropolitan and rural communities in Iowa and strategies to address barriers. The free toolkit contains: an in-depth document highlighting topics such as required documents for COVID-19 vaccination, vaccine administration considerations, health equity concerns, and strategies to eliminate barriers; one-page handouts of important information that can be printed for pharmacy/clinic/office space; a 6-part video series summarizing the document; and supplemental resources that discuss essential information for vaccine providers. While the toolkit was developed with pharmacists in mind, the resources can be used by any vaccine provider, administrative staff, public health department, or anyone else supporting the effort for vaccine equity.

PHARMACY TECHNICIAN WORKFORCE

In May, IPA submitted a grant proposal aimed at supporting the growth of the talent pipeline for the pharmacy technician workforce through the establishment of a Registered Apprenticeship (RA) program. RA programs are a nationally recognized and valuable model to recruit and develop well-trained workers. Currently, the healthcare sector makes up only 1.7% of active RA programs. IPA is determined to address the workforce shortage and reduce barriers to entry for pharmacy technicians through the development of a statewide RA program to establish and increase the presence of pharmacy technician apprentices as part of the healthcare sector in Iowa. The ability of pharmacies to implement and expand services is hindered by the current shortage of pharmacy technicians. With 69.7% of Iowa counties containing two or less pharmacies, the pharmacy technician workforce is more important now than ever. To learn more, please contact Emmeline Paintsil.

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REFRESH. REFOCUS. RECONNECT.

At PharmaCE Expo 2022, pharmacy professionals from across the state of Iowa and Midwest came together for learning, networking and rejuvenation. Taking place May 17-18 in Des Moines, this event served as IPA’s first large in-person meeting since 2019. Attendees and staff alike were thrilled to be back to refresh, refocus and reconnect to each other and the profession.

PharmaCE Expo began Tuesday morning with keynote and wellness coach Cynthia Knapp Dlugosz, BS Pharm, NBCHWC, who engaged attendees by demonstrating ways to active ly practice mindfulness and resilience. Following the keynote, attendees divided between two tracks, Getting Back on Track (accredited for pharmacists and technicians) and Advancing the Profession (accredited for pharmacists). This year’s event featured sessions on informatics, diabetes management, advanced technician roles, pharmacy innovation, COVID-19, managing depression, heart failure therapy, and much more.

On Wednesday, keynote Brandon Jennings, PharmD, BCACP, President and CEO of Abilyn Consulting, LLC, presented on the 5 Voices of Leadership, encouraging all attendees to em brace their strengths and weaknesses to become better leaders and communicators. New this year, IPA welcomed over twenty Iowa pharmacy residents to present their research projects. Presentations were divided by topic among four rooms: Infec tious Disease, Cardiovascular & Critical Care, Disease State Management & Outcomes, and Community & Ambulatory Care. A hands-on course for specimen collection and pointof-care testing was also offered to 2022 PharmaCE Expo attendees.

In total, over 15 hours of continuing pharmacy education (CPE) was available during this year’s PharmaCE Expo. Thank you to all who attended – We hope to see you next year!

INCIDENCE OF NEW SYMPTOMATIC VENOUS THROMBOEMBOLISM & MAJOR BLEEDING IN PATIENTS WITH COVID-19

AUTHORS

McKenzie Magee, PharmD, PGY-1 Pharmacy Residency Program, MercyONE Des Moines Medical Center

Morgan Ridout, PharmD, MercyONE Des Moines Medical Center

Lynn Kassel, PharmD, BCPS, MercyONE West Des Moines Medical Center; Drake University College of Pharmacy & Health Sciences

Zaheer Akhtar, D.O., Internal Medicine Residency, Department of Medicine, Iowa Methodist Medical Center

Fauzia Ullah, M.D., Internal Medicine Residency, Department of Medicine, Iowa Methodist Medical Center

Julian Robles, M.D., Internal Medicine Residency, Department of Medicine, Iowa Methodist Medical Center

Lisa Pham, D.O., Internal Medicine Residency, Department of Medicine, Iowa Methodist Medical Center

Jon Hurdelbrink, PhD, Drake University College of Pharmacy & Health Sciences

Geoffrey Wall, PharmD, FCCP, BCPS, Drake University College of Pharmacy & Health Sciences; Internal Medicine Clinical Pharmacy, Department of Pharmacy, Iowa Methodist Medical Center

CORRESPONDING AUTHOR: Lynn Kassel, PharmD, BCPS

The authors have declared no potential conflicts of interest. This study was investigator-initiated and did not receive grant funding.

Methods, but no findings, of this study were presented at the American Society of Health-Systems Pharmacists, held online, in December 2020.

ABSTRACT

Background: Novel coronavirus (COVID-19) disease is known to cause respiratory failure and complications, such as venous thrombo embolism (VTE). The purpose of this study was to examine incidence of symptomatic VTE and major bleeding in patients with COVID-19.

Methods: This is a retrospective, cohort study of patients admitted to three hospitals within two health systems in one Midwestern metro politan area for treatment of COVID-19 between March 1, 2020 to July 31, 2020. Each institutional review board approved the study. The co-primary objectives analyzed incidence of new -symptomatic VTE and incidence of major bleeding according to the International Society of Thrombosis and Heamostasis (ISTH) criteria. Secondary outcomes were also analyzed.

Results: Data was collected from 697 patients with COVID-19 ad mitted to any of the study hospitals during the study time frame. The overall incidence of VTE was 2.58%, whereas the incidence of major bleed was 3.87%. Patients with major bleed were more likely to require

ICU care, p<0.0001; however, there was no difference in level of acuity for patients with symptomatic VTE, p=0.0922.

Conclusions: Compared to previous publications, overall incidence of VTE was reduced, while major bleeding was similar. Patients with complications were likely to require a higher level of care in the ICU. Patients receiving heparin were more likely to experience VTE, a major bleed, and require admission to the ICU.

Key Words: COVID-19, critical illness, hemorrhage, risk factors, venous thromboembolism

INTRODUCTION

The worldwide COVID-19 pandemic began in late 2019, with infections due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreading quickly. Diagnosis and treatment of ‘cytokine storm’1, fever, respiratory compromise, and thrombus formation have been key components of COVID-19 treatment since. Therapies for patients diagnosed with COVID-19 rapidly changed during the initial months2-11, and continued to evolve until recently with monoclonal antibodies and antiviral treatments being used.

The SARS-CoV-2 virus is known to activate intrinsic and extrinsic clot ting cascade pathways, which may result in arterial or venous thrombi formation.12 Previous studies have documented elevated incidence of venous thromboembolism (VTE) in COVID-19 positive patients ad mitted to the hospital and even higher rates of patients in the ICU.13,14 Mortality was higher among patients with thrombotic events also.14

The purpose of this study was to quantify the incidence of symptomatic VTE and major bleeding in hospitalized patients with COVID-19 and determine risk factors for these outcomes.

MATERIALS & METHODS

Setting and Study Population

In this retrospective cohort study, 697 patients (510 patients admitted to one health system and 187 patients admitted to a second health sys tem) with a diagnosis of COVID-19 were identified for data collection. As the study included patients admitted for COVID-19 at the start of the pandemic, COVID-19 infection was determined through either PCR or rapid testing, given the scarcity of available testing options. Patients with a positive COVID-19 test at or during admission (e.g., in patient, observation, outpatient in a bed) who were > 18 years old were included in the study. Exclusion criteria included any visit not resulting in hospital admission (e.g., seen in emergency department and dis charged home) or any patient who did not have a positive COVID-19 test at any point. The study was approved by the institutional review boards at MercyONE Des Moines, UnityPoint Health, and Drake Uni versity, which included a waiver for informed consent and HIPAA.

Data Collection

Patients were identified using ICD-10 or ICD-9 codes cross-referenced with admissions for COVID-19. Demographic, laboratory, and clinical data were then collected utilizing a unique survey, including: symp tomatic VTE, major bleeding, as defined by the International Society of Thrombosis and Heamostasis (ISTH) bleeding scale, arterial emboli (i.e., myocardial infarction, ischemic stroke, thrombus to an organ, such as the kidneys, liver), incidence of 30-day pulmonary embolism (PE), 30-day deep vein thrombosis (DVT), 30-day bleed, and 30-days readmission, as well as mortality during the index visit. The survey was used to standardize data collection and limit variation. Medication use was also collected, focused specifically on anticoagulation and dose (prophylaxis or therapeutic), and any of the agents utilized in the early treatment of COVID-19. Laboratory data included: d-dimer and pregnancy status. Additional comorbid conditions and demographics included: incidence of atrial fibrillation (Afib) and CHA2DS2VASc score, admission of highest acuity (such as intensive care unit (ICU) or non-ICU), highest level of respiratory support, age, BMI, weight (kg), race/ethnicity, gender, smoking history, VTE history, and cancer history.

Outcomes

The two co-primary outcomes of this study were to analyze the inci dence of a) new symptomatic VTE and b) major bleeding according to the ISTH criteria in COVID-19 positive patients. Secondary outcomes aimed to analyze VTE prophylaxis and therapeutic anticoagulation used, evaluate incidence of arterial embolism and use of extended pro phylaxis after discharge, examine the incidence of 30-day VTE, bleed, readmission, and mortality, as well as d-dimer levels. Other demo graphic risk factors were assessed for the co-primary outcomes.

Statistical Analysis

Patients with missing data were included in the overall population but were excluded where appropriate from reported data below. Categorical data for numerous outcome and characteristic data was used for the population using counts and percentages. Mean data was reported for continuous data points that was associated with age, body mass index (BMI), weight, and CHA2DS2VASc scores. Paired sample t-tests were used to identify any statistically significant differences in patient char acteristics between institutions; these tests used an alpha value of 0.05 and are presented as p-values in the tables below. Microsoft Excel, SAS version 9.4, and Stat SE version 15.1 were used.

RESULTS

Data was collected from 697 patients admitted to any of the study hospitals with a positive COVID-19 test between March 1, 2020 and July 31, 2020. Demographic data can be found in Table 1. The mean age of patients was 62 years old with most of the patients identifying as White. Only a smoking history (30.98% vs. 4.81%, p=0.0001), a history of VTE (8% vs. 4.3%, p=0.05), and a history of cancer (5.3% vs. 12.3%, p=0.01) differed between the institution populations.

TABLE 1. Patient Demographics

Demographic

White: 466 (66.9%)

LatinX: 90 (12.9%)

Black: 65 (9.3%)

Race/Ethnicity

Asian: 39 (5.6%)

Unknown: 31 (4.5%)

Multiracial: 3 (0.4%)

AI: 1 (0.14%)

Male: 352 (50.5%)

Gender

Female: 343 (49.2%)

Transgender Female: 2 (0.29%)

Pregnancy 32 (4.6%)

Smoking history 167 (23.96%)

VTE history 49 (7%)

DVT history 34 (4.9%)

PE history 21 (3%)

Cancer 75 (10.8%)

History of 50 (7.2%)

Active 23 (3.3%)

Afib history 104 (14.9%)

CHA2DS2 VASc 4.28

Afib = atrial fibrillation; AI = American Indian; BMI = body mass index; CHA2DS2 VASc = risk stratifi cation score for annual stroke risk in patients with atrial fibrillation; DVT = deep vein thrombosis; PE = pulmonary embolism; VTE = venous thromboembolism

Data presented as mean with standard deviation and range or as incidence/count and percentage.

The overall incidence of symptomatic VTE among the total population (n=697) was 2.6% (n=18), whereas the incidence of major bleed was 3.9% (n=27). Further details for the primary outcomes can be found in Table 2.

TABLE 2. Venous Thromboembolism and Bleeding Incidence

Outcome All (n=697) Health System 1 (n=510) Health System 2 (n=187)

Symptomatic VTE 18 (2.58%) 14 (2.75%) 4 (2.14%)

Major Bleeding 27 (3.87%) 19 (3.73%) 8 (4.28%)

Data presented as incidence and percentage of population.

Interestingly, there were more arterial embolisms observed than VTE or major bleeds. Arterial embolism, most commonly stroke or myocar dial infarction, was also seen in combination with one of the co-prima ry outcomes. Three patients from each institution were found to have at least one of the primary outcomes with an arterial embolism.

While there was a low incidence (less than 2% each) of 30-day DVT, PE, or bleed, there was a 9.6% incidence of readmission within 30 days and an 8.5% incidence of death in patients who had COVID-19. The incidence of each of the secondary endpoints can be found in Table 3.

TABLE 3. Secondary Outcomes

Outcomes* All (n=697)

Total (n=697)

Age 61.68 ± 18.88 (18-100)

BMI n=689 30.83 ± 9.04 (11.90-85.40)

Weight (kg) n=692 87.28 ± 26.55 (17.30-213.80)

Health System 1 (n=510) Health System 2 (n=187)

Arterial Embolism 26 (3.7%) 16 (3.1%) 10 (5.4%)

Any Clot 45 (6.5%) 31 (6.1%) 14 (7.5%)

Arterial Embolism

+ Major Bleed 3 (0.4%) 1 (0.2%) 2 (1.1%)

Arterial Embolism

+ VTE 3 (0.4%) 2 (0.1%) 1 (0.5%)

30 day PE 9 (1.3%) 5 (1.0%) 4 (2.1%)

30 day DVT 3 (0.4%) 2 (0.4%) 1 (0.5%)

30 day Bleed 9 (1.3%) 5 (1.0%)

(2.1%)

30 day Readmission 67 (9.6%) 53 (10.4%) 14 (7.5%)

Index Visit Mortality 59 (8.5%) 52 (10.2%) 7 (3.7%)

Extended Prophylaxis 60 (8.6%) 45 (8.8%) 15 (8.0%)

Anticoagulants

DOAC 38 (5.5%) 37 (7.3%) 1 (0.5%)

Enoxaparin 318 (45.6%) 210 (41.2%) 108 (57.8%)

Heparin 165 (23.7%) 136 (26.7%) 29 (15.5%)

None 77 (11.1%) 68 (13.3%) 9 (4.8%)

SCDs alone 45 (6.5%) 45 (8.8%) 0

Warfarin 18 (2.6%) 12 (2.4%) 6 (3.2%)

Data presented as incidence and percentage of population.

*No incidence of ‘any VTE+Major Bleed’ or of ‘any VTE+Arterial Embolism+Major Bleed’ DOAC = direct oral anticoagulant; DVT = deep vein thrombosis; PE = pulmonary embolism; SCD = sequential compression device; VTE = venous thromboembolism

The initial d-dimer level and highest recorded d-dimer were collected. When assessing these in patients who had VTE, the highest d-dimer throughout the stay was elevated compared to the total population. Compared with patients with VTE, the mean highest d-dimer for those without VTE was 2.28 ± 1.35 for Health System 1 (p=0.0234) and 2.70 ± 3.69 for Health System 2 (p=0.5670). The mean admission d-dimer for patients with VTE were elevated compared with patients not expe riencing VTE (1.60 ± 1.27, p=0.0275) at Health System 1 and (2.01 ± 3.19, p=0.5141) at Health System 2. Compared with patients without a major bleed, patients at Health System 1 with a major bleed had signifi cantly higher mean d-dimer at admission (1.58 ± 1.27, p<0.0001) and mean highest d-dimer during hospitalization (2.28 ± 1.36, p=0.0003). There was no difference among d-dimer at admission or highest during hospitalization in the Health System 2 group, p=0.6163 and 0.0725, respectively. Table 4 shows all d-dimer data for the population. Of note, the values are not combined for the two institutions as the reference range for the institutions differed, even though the same units, mcg/ mL, were used.

TABLE 4. D-dimer Trends

Overall Population

Health System 1 (n=366) Health System 2 (n=152)

D-dimer at admission 1.64 ± 1.30 (0.27 to ≥ 4.0)

2.11 ± 3.49 (0.27 to ≥ 20.0)

Highest d-dimer during admission 2.32 ± 1.36 (0.27 to ≥ 4.0) 2.79 ± 3.92 (0.27 to ≥ 20.0)

VTE

n=14 n=3

D-dimer at admission in VTE group 2.66 ± 1.59 (0.27 to ≥ 4.0) 7.09 ± 11.18 (0.51 to ≥ 20.0)

Highest d-dimer during admission in VTE group 3.23 ± 1.37 (0.27 to ≥ 4.0) 7.09 ± 11.18 (0.51 to ≥ 20.0)

Major Bleed

The VTE and major bleeding subgroups were evaluated for associated risk factors. In this study, more patients with major bleed utilized ICU care as the highest acuity (20 vs. 7, p<0.0001) compared with non-ICU, whereas there was no difference in acuity of care for patients with symptomatic VTE, p=0.0922. Patients with any clot were more likely to require ICU care, p=0.0088, than non-ICU care. Patients within the ICU were significantly more likely to have a major bleed than to not, p=0.0001, but were not more likely to experience VTE, p=0.0921. Patients with symptomatic VTE required mechanical ventilation (MV) or high-flow nasal canula (HFNC), 28% and 22%, respectively, whereas patients with any clot required room air (RA) or MV, 36% and 27%, respectively. Patients with a major bleed often required MV (52%) and nearly equivalent frequency of use of RA, HFNC, and nasal cannula (NC) for respiratory support.

Heparin was the most frequently used therapeutic anticoagulant. In comparing use of heparin with any other agent, patients receiving heparin were more likely to experience VTE (p=0.0060), a major bleed (p=0.0042), and ICU admission (p<0.0001).

Among patients with Afib, average CHA2DS2VASc scores were lower than the total population and higher than in the total population when looking at the clot group and bleed group, respectively. There was no statistical difference between the CHA2DS2VASc scores for patients with and without VTE (p=0.3015) or in patients with or without major bleed (p=0.2888).

Pregnancy, which occurred infrequently overall, was not a risk factor that contributed to any of the assessed complications. No pregnant patients experienced VTE, any clot, or major bleeding in this study.

Treatments for COVID-19 were collected, though no correlation can be made from this data when analyzing subgroups for specific outcomes such as VTE, clots, or major bleeding. The full results from the sub group analysis can be found in Table 5.

TABLE 5. Risk Factors by Sub-Group

Risk Factors Symptomatic VTE (n=18) All Clots (n=45) Major Bleeding (n=27)

Prophylaxis Used Heparin: 1 None: 1

Therapeutic Anticoagulation

Enoxaparin: 2 Heparin: 9 Apixaban: 3 Rivaroxaban: 2

Combination: 6 Heparin/Rivarox aban: 1

Enoxaparin: 6 Heparin: 8 DOAC: 2 None: 2

Enoxaparin: 8 Heparin: 12 Apixaban: 4 Rivaroxaban: 3

Enoxaparin: 1 Heparin: 6 DOAC: 1 SCD: 1 None: 4

Enoxaparin: 2 Heparin: 8 Warfarin: 1 Apixaban: 1

n=13 n=8

D-dimer at admission in Major Bleed group 3.31 ± 0.77 (1.91 to ≥ 4.0) 2.71 ± 3.34 (0.41 to ≥10.64)

Highest d-dimer during admission in Major Bleed group 3.38 ± 0.79 (0.41 to ≥ 10.64) 5.30 ± 3.52 (1.91 to ≥10.64)

Data presented as incidence and percentage of population. The label of measurement for the d-dimer levels at both institutions used mcg/mL.

Combination Anticoagulation*

Heparin/Heparin: 2 Enoxaparin/Hep arin: 1 Heparin/Apix aban: 1 Warfarin/Heparin: 1

Combination: 13 Enoxaparin/Enoxa parin: 3 Enoxaparin/Rivar oxaban: 1 Enoxaparin/Hep arin: 2 DOAC/Heparin: 1 Heparin/Rivarox aban: 1

Heparin/Heparin: 2 Heparin/Apix aban: 1 Warfarin/Heparin: 1 SCD/Apixaban: 1

Combination: 11 Enoxaparin/Enoxa parin: 2 Warfarin/Warfa rin: 1 Heparin/Argatro ban: 1 Enoxaparin/Hep arin: 1

Warfarin/Heparin: 2 DOAC/Heparin: 1 Heparin/Heparin: 3

COVID Treatments

Angiotensin II: 1

Convalescent Plasma: 3

Dexamethasone: 5

Famotidine: 8

Hydroxychloro quine: 0

Melatonin: 1

Other Parenteral Steroids: 7 Remdesivir: 6 Tocilizumab: 8 None: 7

Angiotensin II: 1

Convalescent Plas ma: 12

Dexamethasone: 10

Famotidine: 13 Hydroxychloro quine: 4 Melatonin: 1

Other Parenteral Steroids: 10 Remdesivir: 15 Tocilizumab: 14 Pentoxifylline: 2 Theophylline: 1 None: 12

Angiotensin II: 0

Convalescent Plas ma: 11

Dexamethasone: 4 Famotidine: 13

Hydroxychloro quine: 2

Melatonin: 1

Other Parenteral Steroids: 11 Remdesivir: 7 Tocilizumab: 8

Pentoxifylline: 2 Theophylline: 2 None: 4

Average CHA2DS2VASc 4.0 4.8

DOAC = direct oral anticoagulant; HFNC = high-flow nasal cannula; ICU = intensive care unit; MV = mechanical ventilation; NC = nasal cannula; RA = room air; SCD = sequential compression devices; VTE = venous thromboembolism

*Therapies

DISCUSSION

In this retrospective, cohort study, incidence of symptomatic VTE was 2.6% while incidence of major bleed was 3.9% in this multi-institution population. The demographics of the patients included in this study were similar to a non-pandemic year and were similar to each other, aside from histories of cancer, smoking, and VTE.

A systematic review of VTE in COVID-19 patients found 11 studies that provided a wide range of VTE risk: 4.4% to 8.2% in all inpatients and up to 53.8% in ICU patients.13 Another study14 showed that 29.4% of ICU patients had a thrombotic event and 11.5% of non-ICU patients had a thrombotic event leading to an overall rate of thrombus of 16% in all hospitalized patients. All-cause mortality occurred in 24.5% of patients but was higher in those who had thrombotic events (43.2% vs 21%).14 This is markedly increased from the pooled symptomatic PE and DVT incidence of 0.4 – 0.8% for hospitalized patients without COVID,15 though other data suggest that this increases to 1%, even with prophylactic anticoagulation.16

The incidence of symptomatic VTE here was 2.6%, suggesting that ei ther these institutions may have a lower risk compared to others, these institutions took additional steps to prevent VTE at or above those of non-COVID patients, the institutions did not appropriately diagnose VTE, or a combination of these. A review compiled risks of VTE and demonstrated a wide range of acceptable VTE prophylaxis regimens for patients with COVID-19.13 In this study, heparin and enoxaparin were used in approximately 70% of all patients. Heparin, at any dose, was used in roughly 50% of individuals who developed a major bleed (n=14/27). Unfortunately, VTE development also occurred in those who received prophylactic anticoagulation, with over half of those having received heparin (n=10/18). Nearly 75% (n=34) of patients developing any clot received either heparin or enoxaparin, at any dose. Instead of a failure of the medications to prevent clot or avoid bleeds, data suggests this may be a trend in COVID-19 patients.17

Two trials demonstrated that use of initial therapeutic dose anticoag ulation (as unfractionated heparin or low-molecular weight heparin) improved organ support-free days in noncritically ill patients with COVID18 but this did not hold true to critically ill patients with COVID.19 Use of therapeutic anticoagulation improved survival to hospital discharge in noncritically ill patients but not those with severe

disease.18-19 It is likely impossible to avoid VTE in all patients with COVID-19, even with prophylactic or treatment dosing of anticoagu lation. Patients in this study who experienced a major bleed were often located within the ICU and were frequently on heparin, corroborating the above study19 that therapeutic anticoagulation did not change out comes of patients in the ICU and may increase harm.

While the reasoning behind major bleeding in COVID-19 patients is not well known and conflicts with the concurrent clotting, it has been observed while caring for these critically ill patients, particularly those who are intubated.17 This study provides insight on the incidence of major bleeding as defined by ISTH criteria as well as patient factors that may be associated with an increased incidence of major bleeding. The incidence of major bleeding was 3.9%, which can be partly ex plained by the severity of illness and requirement of MV. The incidence of major bleed seen here is not different from other trials, that also used the criteria from ISTH, where critically ill patients19 on therapeu tic anticoagulation (3.8%) or prophylactic anticoagulation (2.3%) and of non-critically ill patients18 on therapeutic anticoagulation (1.9%) or prophylactic anticoagulation (0.9%). The patients who experienced major bleeding were more often admitted to the ICU and had d-dimer levels on average > 3 mcg/mL during their stay.

Atrial fibrillation is a known complication of COVID-19 infection, occurring in approximately 20% of cases.20-22 The incidence of previous Afib in this study was lower than this, and new Afib incidence was not recorded. Interestingly, a smaller study reported that many (approxi mately 75%) of older adult patients hospitalized with COVID-19 had a history of Afib prior to admission.22 Patients with Afib were of particu lar interest, as their lack of or use of baseline anticoagulation may influ ence the incidence VTE or major bleeding.23 The mean CHA2DS2VASc scores are reported in Tables 1 and 5. Patients with Afib who experi enced a major bleed had a nonsignificant higher mean CHA2DS2VASc than individuals with Afib who experienced any clot. The clinical relevance between 4.0 and 4.8 may not be enough to protect patients from clot development.

The incidence of arterial embolism was higher in this study than the VTE incidence, and this finding has since been suggested in larger, published, trials. The independent link between COVID-19 and stroke or myocardial infarction was reported by a large, matched-cohort study from Sweden.24 The increased incidence coupled with the risks of new Afib diagnosis and prothrombotic potentials of the COVID-19 disease may partially explain this.

It is unlikely that pregnancy is protective for clot or major bleed devel opment. Pregnancy was not common within this study population, and the study’s retrospective nature limit interpretation of causality. The baseline risk of VTE in any pregnancy coupled with COVID-19 may have pushed prescribers to be more cautious. Another explanation may be that patients presenting for delivery tested positive but did not show symptoms of COVID-19, and admission to the hospital for delivery was the only reason for receipt of the test.

This study has limitations. This study includes two different health systems in a single city which may limit the generalizability to other in stitutions with different populations. Another limitation is the potential for data collection error. There was an attempt to minimize this as data collection procedures were taught to each other within each health sys tem. The use of a standardized intake form likely helped with this lim itation. Thirdly, the data collected and reported here was from patients diagnosed during the initial waves of COVID-19, when vaccinations

were not yet available and before variants emerged. The application of this data to the Delta and Omicron variants and any future variants is largely unknown, particularly if future variants increase illness severity. Fourth, treatment options and algorithms between the two institutions did not follow a standardized protocol followed in this retrospective study. Fifth, the degree of therapeutic anticoagulation (e.g., INR, PTT, or Anti-Xa) was not collected. Sixth, timing in d-dimer levels was not addressed or collected in this study, which could play a small role in differences seen. Of note, researchers from both institutions have confidence in the laboratory practices of their respective institutions. Lastly, it was a retrospective cohort study resulting in correlation, and it is likely that more prospective studies are required to confirm these results. Multiple care teams intervened on care during index visits, thus highlighting differences in treatments received which may not be linked with their complications, such as VTE or bleed.

Strengths of this study include the large sample size. Systematic reviews have been completed to increase patient population, but there have been few studies that were composed of a large sample size itself. Another strength from this study is that the population studied was representative of the population treated at the medical centers, increasing the external validity. Lastly, this study had many endpoints which allowed for exploration of significance associated with patient characteristics and the COVID-19 population.

CONCLUSION

In this retrospective, cohort study of patients with COVID-19 infection early in the pandemic, the overall VTE incidence was less than that reported in prior publications, while incidence of major bleeding was similar. Higher acuity care was required for patients with major bleeding or any clot development. Use of heparin was associated with increased rates of VTE, major bleed, and ICU-level admission. This study provides additional literature to an ever-expanding sector related to COVID-19 morbidity prevention and treatment. As the disease se verity increases with variants, this data can serve as a baseline for how to adjust therapies, while considering further exploration into these same data points.

REFERENCES

1. Henry B, Vikse J, Benoit S, Favaloro EJ, Lippi G. Hyperinflammation and derange ment of renin-angiotensin-aldosterone system in COVID-19: A novel hypothesis for clinically suspected hyper coagulopathy and microvascular immunothrombo sis. Clin Chim Acta. Aug 2020. 507:167-173. doi:10.1016/j.cca.2020.04.027.

2. Brown B and McCullough, J. Treatment for emerging viruses: convalescent plasma and COVID-19. Transfus Apher Sci. June 2020. 59:102790. doi: 10.1016/j. transci.2020.102790.

3. Lee K, Yoon S, Jeong GH, et al. Efficacy of corticosteroids in patients with SARS, MERS, and COVID-19: A systematic review and meta-analysis. J Clin Med. July 2020. 9:2392. doi:10.3390/jcm9082392.

4. RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with COVID-19 – preliminary report. N Engl J Med. 2021;384:693-704. doi:10.1056/ NEJMoa2021436

5. The WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group. Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis. JAMA 2020;324:1330-41. doi:10.1001/jama.2020.17023.

6. Freedberg D, Gonigliaro J, Wang TC, Tracey KJ, Callahan MV, Abrams JA, Famotidine Research Group. Famotidine use is associated with improved clinical outcomes in hospitalized COVID-19 patients: a propensity score matched retrospective cohort study. Gastroenterology 2020;159:1129-31.e3. doi: 10.1053/j. gastro.2020.05.053.

7. Zou L, Dai L, Zhang X, Zhang Z, Zhang Z. Hydroxychloroquine and chloroquine: a potential and controversial treatment for COVID-19. Arch Pharm Res. Aug 2020;43:765-72. doi: 10.1007/s12272-020-01258-7.

8. Shukla A, Archibald LK, Shukla AW, Mehta HJ, Cherabuddi K. Chloroquine and hydroxychloroquine in the context of COVID-19. Drugs Context. April 2020;9:2020-4-5. doi: 10.7573/dic.2020-4-5.

9. Reiter R, Sharma R, Ma Q, Dominquez-Rodriquez A, Marik PE, Abreu-Gonzalez P. Melatonin inhibits COVID-19-induced cytokine strom storm by reversing aerobic glycolysis in immune cells: a mechanistic analysis. Med Drug Discov 2020. 6:100044. doi: 10.1016/j.medidd.2020.100044.

10. Wang Y, Zhang D, Du G, et al. Remdesivir in adults with severe COVID-19: a ran domised, double-blind, placebo controlled, multicentre trial. Lancet. May 2020. 395:1569-1578. doi:10.1016/S0140-6736(20)31022-9

11. Barlow A, Landolf KM, Barlow B, et al. Review of emerging pharmacotherapy for the treatment of coronavirus disease 2019. Pharmacotherapy. May 2020. 40:416437. doi: 10.1002/phar.2398.

12. Dobesh PP, Trujillo TC. Coagulopathy, venous thromboembolism, and antico agulation in patients with COVID-19. Pharmacotherapy 2020;40:1130-51. doi: 10.1002/phar.2465

13. Fontana P, Casini A, Robert-Ebadi H, Glauser F, Righini M, Blondon M. Venous thromboembolism in COVID-19: systematic review of reported risks and current guidelines. Swiss Med Wkly. June 2020. 150:w20301. doi:10.4414/smw.2020.20301.

14. Bilaloglu S, Aphinyanaphongs Y, Jones S, Iturrate E, Hochman J, Berger JS. Thrombosis in hospitalized patients with COVID-19 in a New York health system. JAMA. 2020;324:799-801 doi: 10.1001/jama.2020.13372.

15. Kahn SR, Lim W, Dunn AS, et al. Prevention of VTE in non-surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2012 Feb; 141(2Suppl):e195S-e226S

16. NIH. COVID Treatment Guidelines: Antithrombotic therapy in patients with COVID-19. Feb 2021

17. Paranjpe I. Fuster V, Lalal A, et al. Association of treatment dose anticoagulation with in-hospital survival among hospitalized patients with COVID-19. JACC 2020;76:122-9. doi: 10.1016/j.jacc.2020.05.001

18. ATTACC, ACTIV-4a, REMAP-CAP Investigators (a). Therapeutic anticoagulation with heparin in noncritically ill patients with COVID-19. N Engl J Med 2021; Aug 4. doi: 10.1056/NEJMoa2105911

19. ATTACC, ACTIV-4a, REMAP-CAP Investigators (b). Therapeutic anticoagula tion with heparin in critically ill patients with COVID-19. N Engl J Med 2021; Aug 4. doi: 10.1056/NEJMoa2103417

20. Manolis AS, Manolis AA, Manolis TA, Apostolopoulous EJ, Papatheou D, Melita H. COVID-19 infection and cardiac arrhythmias. Trends in Cardiovascular Medi cine 2020;(30):451-60. doi: 10.1016/j.tcm.2020.08.002

21. Hu YF, Cheng WH, Hung Y, et al. Management of atrial fibrillation in COVID-19 pandemic. Circ J 2020;84:1679-85. Doi: 10.1253/circj.CJ-20-0566

22. Gawalko M, Kaplon-Cieslicka A, Hohl M, Dobrev D, Linz D. COVID-19 asso ciated atrial fibrillation: incidence, putative mechanisms and potential clinical implications. IJC Heart and Vasculature 2020;30. Doi: 10.1016/j.ijcha.2020.100631

23. Lip GYH , Banerjee A, Boriani G, et al. Antithrombotic Therapy for Atrial Fibril lation: CHEST Guideline and Expert Panel Report. Chest. 2018 Nov;154(5):11211201. doi: 10.1016/j.chest.2018.07.040.

24. Katsoularis I, Fonseca-Rodriguez O, Farrington P, Lindmark K, Fors Connol ly AM. Risk of acute myocardial infarction and ischaemic stroke following COVID-19 in Sweden: a self-controlled case series and matched cohort study. Lancet 2021; online. doi:10.1016/S0140-6736(21)01071-0

EMBARKING ON THE JOURNEY OF A LIFETIME

always been a very future-oriented thinker. I dream big and work my hardest to reach the goals I set for myself. The path to IPA’s Executive Fellow ship in Association Management was no different. I had dreamed of joining the IPA team for years, and in July of 2021, that dream came true.

Ihave

As a young pharmacy student, I knew I was interested in non-traditional areas of pharmacy – management, entrepreneurship, practice transformation. What I didn’t know was I would find all of that and more while at IPA. From my first day at the Association, I knew the journey I was embarking on was special and would shape me into the pharmacy leader I had always envisioned becoming.

With new opportunity comes change, and change is something I had to learn to embrace and lean into over the last year. From my first month to my last, there were many changes that challenged me to grow both professionally and personally, learn something new, take on a new role, and ultimately, strengthen my confidence as a pharmacist.

During my year as the IPA Executive Fellow, I experi enced all areas of association management. I worked with pharmacists, residents, students, and technicians alike. I shared and expanded my passion for mental health, discovered a new passion for the legislative pro cess, managed projects big and small, planned events, and worked with healthcare organizations across the state. I learned about the importance of advocacy, a uni fied voice for our profession, and building relationships with state and national legislators. While all of these experiences pushed me to the next level in my training, the most important thing I learned was how vital it is to grow and maintain your professional network.

In one short year, my professional network has doubled, if not tripled, in size. Attending state and national meet ings allowed me to build connections I never would have imagined. It was an incredible feeling to attend virtual calls and meetings with people from across the country who I later had the opportunity to connect with in person! Through these connections, I was able to share ideas, learn about the passions of both state and national leaders, create friendships, and keep up with pharmacy practice across the country.

Throughout my fellowship year, words of wisdom shared by IPA President Chris Clayton kept me motivat ed. “Just keep moving.” Association work was nothing like I had ever experienced before. It was exciting, fun, challenging, fast-paced, and passion filled. Some days, I was overjoyed with the work I was doing for the profession. Some days, I felt unsure of the importance of my role. Some days, I worked throughout the night to ensure the work was getting done. Every day, I learned something new. Every day, I made a new connection. Every day, I made a difference for the profession of pharmacy. “Just keep moving.”

Embarking on this journey of a lifetime was everything I had hoped for and more. To IPA, the pharmacists, technicians, and students who made my fellowship experience one I will never forget, thank you. ■

IPA is excited to announce Elizabeth will be continuing on as the Iowa Pharmacy Association’s PGY2 Executive Fellow in Association Management!

Elizabeth Orput, PharmD

COVID-19 VACCINE CONFIDENCE AT A PRIVATE UNIVERSITY

A 2021 Survey and Student Pharmacist Comparison

AUTHORS

Molly Nelson, PharmD Candidate, Drake University CPHS

Ashlie Bunten, PharmD Candidate, Drake University CPHS

Lindsey Rowatt, PharmD Candidate, Drake University CPHS

Jerime Gendron, PharmD Candidate, Drake University CPHS

CORRESPONDING AUTHOR: Andrew R. Miesner, PharmD, BCPS, Professor of Pharmacy Practice; Drake University CPHS

The authors declare no relevant conflicts of interest or financial rela tionships. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

ABSTRACT

Background: Limited research is available regarding vaccine attitudes among students in higher education. Identifying problems of vaccine confidence among the entire university population may be import ant to public health on a campus, particularly during the COVID-19 pandemic. Additionally, while student pharmacists play a vital role in vaccine administration, little is known about their own attitudes toward vaccination. The primary objective of this study was to charac terize vaccine confidence regarding COVID-19 vaccines in a university population using the Vaccine Confidence Scale (VCS) and secondarily to compare VCS between pharmacy and other students.

Methods: An electronic survey regarding vaccine confidence was available to all students, faculty, and staff at a private university from January to February 2021 (Phase 1a/1b of vaccine availability). The survey consisted of 26 questions related to demographics, vaccination intent, perceived vaccine barriers and benefits, the VCS questionnaire, and COVID-19 experiences. The VCS is a validated scoring system, ranging 0-10 to quantify general confidence, including subscales for harms, benefits, and trust related to vaccination. VCS and subscales were tabulated and survey responses were compared using chi-square, ANOVA, or t-tests where appropriate.

Results: Of 1184 completed surveys, 139 (11.8%) were student phar macists. Among respondents, 16.3% had already received at least one dose of a COVID-19 vaccine, 71% planned to receive a COVID-19 vaccine, 7.1% planned not to, and 5.6% were unsure. Mean VCS scores were higher among those that had received or planned to receive a vaccine, than those that were unsure, or would not receive a vaccine (8.88 vs 7.30 vs 5.55, P<0.001). Student pharmacists were more likely than other students to have received or plan to receive a vaccine (96.4% vs 85.2%, P=0.002). VCS was higher among student pharmacists than other students (8.71 vs 8.52, P=0.05). Harm and trust subscores were not different, but benefits subscores were higher among student phar macists (9.17 vs 8.79, P<0.001).

Conclusions: Vaccine confidence was high at private university early in COVID-19 vaccine rollout. Student pharmacists’ VCS was slightly higher than other students with higher impact from vaccine benefits.

BACKGROUND

Limited research is available regarding vaccine confidence among students in higher education. This is of particular concern during the COVID-19 pandemic, where students in higher education may be at risk for transmission due to classroom crowding and shared housing. Prior to the pandemic, available studies in the literature have mea sured attitudes on other vaccines such as the human papillomavirus and influenza vaccines on college campuses.1 Prior studies have found that the biggest barrier to influenza vaccination in this age group is lack of knowledge and understanding as to why young, healthy individuals would need it.1 An increasing number of surveys regarding COVID-19 vaccines are being published, highlighting the importance of vaccine confidence in this pandemic. A previous survey of students at the University of Washington in November 2020 demonstrated 91.6% intended to be vaccinated for SARS-CoV-2 when the vaccine was available.2 Another survey among college students in New Jersey showed a lower proportion intending to be vaccinated but greater odds of positive attitudes among students who were also healthcare workers.3 While student pharmacists are frequently involved in administration of vaccines, little is known about their personal views on vaccines despite extensive training in this area. Recently vaccine distrust has been de scribed among students of health professions.4

The Vaccine Confidence Scale (VCS) is an 8-item validated scoring system, ranging 0 to 10 to quantify general confidence, including sub scales for harms, benefits, and trust related to vaccination with higher numbers indicating greater impact.5 While prior VSC studies have been used to measure parents’ vaccine attitudes, vaccination confidence has been negatively associated with vaccine refusal and positively associat ed with vaccinated status in a national sample of parents of teenagers.6 The unique, rapid development and subsequent emergency use autho rization of the COVID-19 vaccines may have undermined confidence among the general public in these agents at the time of their release. Given the previously known low uptake of influenza vaccinations among students in higher education and the transmission risks asso ciated with shared living and educational spaces, universities need to assess possible barriers to vaccine use in order to protect the health of students, faculty, staff, and administrators. Use of a brief questionnaire such as the VCS to assess vaccine confidence may be useful to identify barriers, allow the university to provide targeted education, and to address potential misconceptions about the COVID-19 vaccine on campus. This study was meant to determine vaccine confidence and intention of receiving the COVID-19 vaccine in a university popula tion shortly after emergency use authorization. This study also seeks to identify barriers to this population receiving a COVID-19 vaccine.

The secondary outcome is to determine if vaccine confidence differs between PharmD students and other students in higher education. Ar eas in which confidence differs between student pharmacists and other students may provide clues to the direction of interventions to improve the confidence of those without a healthcare background.

METHODS

Study Design

Drake University is a private university in Des Moines, Iowa. It is home to approximately 5,000 undergraduate and graduate students and 140 full-time faculty. The demographics of the school can be broken down into 77% white students and 23% ethnic minority students and 62% female students and 38% male students. The University also has a phar macy program with approximately 450 professional and pre-pharmacy students at the time of the study. A survey was conducted to determine vaccine confidence among the students, faculty, and staff at Drake Uni versity. Inclusion criteria included students, staff, and faculty members at Drake University who have access to campus-wide email announce ments and consent to participating in the survey. Individuals could participate regardless of if they have previously received a COVID-19 vaccine. Exclusion criteria included students and faculty members who did not consent to participating in the survey as well as any individual under the age of 18. Results of partial responses were excluded if a VCS score could not be obtained from the submission. This study was reviewed by the institutional review board (IRB) at Drake University and determined to be exempt from full IRB review.

Data Collection

The survey study was available online through the QualtricsXM platform (Qualtrics; Provo, UT). The survey was open for four weeks in January and February 2021. During this time period, US vaccine rollout was in phases 1a and 1b. During phase 1a, healthcare workers and residents of long term health facilities were available to receive the vaccine. Phase 1b expanded those terms to people 75 and older, as well as vulnerable populations. The survey consisted of a maximum of 26 questions based on participant response. The questions consisted of 9 questions on demographics, 8 regarding the VCS, and 9 on the partici pants own experience regarding COVID-19. Wording from the original VCS questionnaire was slightly altered to remove references to “teen agers.”5 The electronic survey was piloted, questions were reviewed for face validity by a group of approximately 19 student pharmacists in a professional organization, and adjustments were made prior to release. Participants were recruited by using campus-wide email announce ments by emails sent from the University’s Dean of Students. Addition al recruitment of student pharmacists was obtained using bi-weekly email announcements sent specifically to the College of Pharmacy and Health Sciences, as this was a subgroup of interest.

Statistical Analysis

The VCS subscales were tabulated to find the mean VCS score, the mean benefits score, the mean harms score, and the mean trust score on 0-10 scale as previously described.5 Comparisons were conducted in SPSS v25 (IBM; Armonk, NY). ANOVA, t-tests, and chi-square tests were used where appropriate. The mean VCS scores were also deter mined for participants enrolled in the pharmacy program to determine if there was a significant difference in vaccine confidence.

RESULTS

Of the approximately 5000 eligible participants, 1323 surveys were returned; however, 1184 participants completed the survey (~26% response rate) to meet inclusion in the sample. See TABLE 1 for de

mographics of the surveyed population. Of the 1184 participants, 139 identified as student pharmacists (31% response rate among student pharmacists; approximately 19% response rate for non-pharmacy students). The survey demonstrated that 16.3% of participants had already received at least one dose of the COVID-19 vaccine, 71% of these participants were planning on receiving the COVID-19 vaccine when eligible, 7.1% of participants were not planning to receive the vaccine, and 5.6% of participants were unsure if they were planning to receive the vaccine. The top rationales for wanting to receive the vaccine among those that had received the vaccine or planned to receive the vaccine were “To protect the health of others” (97.4%) and “To help end the COVID-19 pandemic” (95.8%). The top rationales for those who were unwilling or unsure about receiving the vaccine were “I’d rather see more people receive it before I decide” (64.7%) and “How fast the vaccine was developed or studied” (62.7%). The students, faculty, and staff involved with the pharmacy program were more likely to have already received or plan to receive a COVID-19 vaccine than other individuals on campus (96.4% vs 85.2%, P=0.002).

The mean VCS score for the campus population was 8.55 (SD 1.38). The mean benefits score was 8.85 (SD 1.54), the mean harms score was 2.22 (SD 1.99), and the mean trust score was 8.73 (SD 1.54). Mean VCS scores and all subscale scores varied significantly based on vaccination plans. See TABLE 2. VCS score did not vary based on female or male gender identification (8.65 vs 8.41, P=0.059), nor any of the subscores. The student population had a similar VCS score to faculty, staff, and administrators (P=0.409), but a slightly lower trust subscale score (8.69 vs 8.95, P=0.025); benefits and harms scores were not different. When compared to the non-pharmacy students, faculty, and staff, the stu dents, faculty, and staff involved in the pharmacy program had higher mean VCS scores (8.73 vs 8.53, P=0.025) and a significantly higher benefits score (9.19 vs 8.81, P<0.001). Harms and trust scores were not significantly different between these two groups.

In the secondary outcome analysis, student pharmacists had a sig nificantly higher VCS score (8.71 vs. 8.52, P=0.05) and benefits score compared to the other students (9.17 vs. 8.79, P<0.001). Because student pharmacists were more likely to be eligible for vaccination at the time of the survey because of healthcare employment, a subgroup analysis of unvaccinated students was conducted. Unvaccinated student pharmacists (27.3% of those surveyed) had similar VCS scores as other students, but a significantly higher harms score than other unvaccinat ed students (2.93 vs 2.21, P=0.039). See TABLE 2 for full comparisons.

DISCUSSION

This study demonstrates high vaccine confidence among students, faculty, and staff of a university shortly after the emergency use autho rization of the COVID-19 vaccines. The mean VCS in our population was 8.55 with high impact on the benefits and trust scores and low impact on the harms scores. Gilkey and colleagues have categorized VCS scores of 8 or greater as high.6 In this study, this VCS threshold of less than 8 also appeared to reveal individuals that were unsure about receiving the vaccine (mean = 7.55) and those that would refuse to receive the vaccine (mean = 5.55). This shows the utility of VCS as a quick screening tool for vaccination acceptance among this population.

As COVID-19 vaccines have been distributed, student pharmacists have played a large role in immunizing the public. As such, this study aimed to characterize vaccine confidence in regard to the COVID-19 vaccine in a university population, as well as compare the VCS between pharmacy and other students. This study shows student pharmacists’

VCS was slightly higher than other students with a significantly higher impact from the domain of vaccine benefits. This effect, while modest, may potentially be explained by education on outcomes of vaccination for multiple disease states throughout pharmacy curriculum while non-healthcare students may not recognize the diverse number of disease states prevented by standard immunization practices, not just to the individual, but to their close contacts and community. In fact, the top reason given for those that wanted to receive the COVID-19 vaccine was “To protect the health of others.” Given that student pharmacists have higher benefit scores than other university students, universities may need to develop interventions that explain these addi tional benefits to students that are unsure about receiving vaccines.

As SARS-CoV-2 becomes an endemic and vaccination efforts continue, studies continue to characterize vaccine beliefs in various populations. In the past, vaccine acceptance, especially of the influenza vaccine, has been extremely low in college populations.7-8 With this, it is reasonable to question the COVID-19 vaccine acceptance and attitudes in this population. A study conducted at the University of Washington sought to characterize vaccine intentions in an undergraduate population.2 Similar to this study’s findings, the researchers found that undergrad uate students had high intentions of receiving the COVID-19 vaccine once it became available to them. Another study conducted at the University of Rhode Island also found that intentions to receive the vaccine once it became available were high amongst college students.9 The findings of past studies and this one are crucial in understanding the continuation of COVID-19 vaccine hesitancy and confidence as SARS-CoV-2 becomes an endemic in the population. This study took place during Phase 1a/1b of COVID-19 vaccine availability, during which time the vaccine was still largely unavailable to this study’s popu lation. At the time, over half of the participants planned to receive the vaccine once it became available to them. Based on current national COVID-19 vaccine trends by age, 18-24 year old populations (most consistent with most university students) lag behind older age groups in achieving full vaccination.10 This may indicate that more efforts are needed to instill vaccine confidence in the hopes of vaccine acceptance in this population.

Vaccine hesitancy has surfaced as a major barrier in the pandemic, but an important distinction exists between vaccine hesitancy and vaccine confidence.12 The World Health Organization’s SAGE Group defines vaccine hesitancy as a complex scenario in which a vaccine is delayed in acceptance or is refused despite availability and is influenced by three C’s: complacency, convenience, and confidence.11 Confidence includes trust in effectiveness and safety of vaccines, the health system and health professionals, and motivations of the policy-makers. Be cause confidence is tied to deep-seated beliefs and experiences with the healthcare system, it may have the largest impact on hesitancy.

Vaccine hesitancy has also been heightened in the various profes sions within healthcare. Hesitancy to receive the COVID-19 vaccine has also been reported in medical student populations.13 Previously, pharmacists and student pharmacists have been shown to have positive attitudes in general toward vaccines, and given the increased hesitancy in other healthcare providers with emergency use of the COVID-19 vaccines, characterization of COVID-19 vaccine confidence in student pharmacists is important.14-15 As indicated by the results, student pharmacists demonstrated greater vaccine confidence, especially in terms of benefits, than their student counterparts. Given the large role that student pharmacists have played in the COVID-19 vaccine distribution and the influence they can have on patients' knowledge

and attitudes about vaccines, this study’s findings are valuable.16 Given the overwhelming amount of false information being spread regarding the COVID-19 vaccines, it is important that those immunizing the public, such as student pharmacists, have confidence in the vaccine and are able to communicate the benefits of the vaccine to patients. Interestingly, the unvaccinated student pharmacist subgroup had a higher mean vaccine harms score compared to other unvaccinated students. Because evidence-based medicine is emphasized in the PharmD curriculum, the lack of evidence regarding the long term risks of the COVID-19 vaccines may have contributed to a higher harms score among this subgroup. Given that two of the three COVID-19 vaccines available at the time utilized a novel mechanism, this may have prompted concern. Further studies may be done to compare vaccine hesitancy and confidence between different vaccines indicated for the college-aged population, including different COVID-19 vaccine products.

Limitations

Based on the nature of the study, certain limitations exist and should be carefully considered. The possibility of selection bias exists as those who felt strongly either way about the vaccine might have increased likelihood of participation in the study. Those that were more uncer tain might have been disinterested and therefore underrepresented in our sample. Because of additional promotion of the survey to pharma cy students, there was a greater response rate amongst students in this program (31%), but these made up only 11.8% of the total sample and would have less numerical impact on the mean VCS score.

Since this study was conducted on a single midwestern college campus, the external validity may be limited. The results of this study do not necessarily reflect the attitudes of all regions nationally or of all student pharmacists. Additionally, the response rate of this survey was modest at approximately 26%, but the sample involved was considerably larger than many contemporary studies at universities. Despite this, the de mographics of the respondents reasonably corresponds with that of the university. However, 86.5% of the respondents identified as white. This limitation should be taken into consideration since COVID-19 has disproportionately impacted racial and ethnic minority groups.17 Better targeted research should be conducted to characterize COVID-19 vaccine confidence in minority and historically marginalized commu nities.

Because this study was conducted early in the vaccine rollout, a ma jority of the participants were not yet eligible to receive the COVID-19 vaccine and vaccination reporting of intent had to be reported on this survey. Approximately six months after the completion of this survey after the resumption of the fall semester, employees and students were asked to report vaccination status to the university. Among residential students, 87% reported full vaccination and 85% of employees reported full vaccination status. This was very consistent with the reported intent in our sample earlier in the year (87.3% received or intended to receive), lending validity to the responses recorded at that time. Additionally, because this study was conducted early on in the vaccine emergency use, subsequent approval by the FDA of some products, expanded use to all populations over 6 months, and greater portions of the population receiving the vaccines without significant adverse outcomes would result in more confident attitudes.

CONCLUSION

During Phase 1a/1b of the COVID-19 vaccine distribution, vac cine confidence was high at a private university (87.3% received or

intending to receive) and VCS scores were consistent with vaccination intent in this population. When compared with other students, student pharmacists demonstrated slightly higher confidence with a higher impact on vaccine benefit in regard to the COVID-19 vaccines. This study helps establish the VCS as a useful screening tool for vaccination intent among the higher education population. Universities should consider using the VCS in future vaccination and education efforts on their campuses.

ACKNOWLEDGMENTS

The authors wish to acknowledge the assistance of Braden Weiser, PharmD Candidate, for his contributions in the development of the research protocol and in the analysis phase of this project.

REFERENCES

1. Bednarczyk RA, Chu SL, Sickler H, Shaw J, Nadeau JA, McNutt LA. Low uptake of influenza vaccine among university students: Evaluating predictors beyond cost and safety concerns. Vaccine. 2015;33(14):1659-1663. DOI 10.1016/j.vac cine.2015.02.033

2. Graupensperger S, Adballah DA, Lee CM. Social norms and vaccine uptake: Col lege students’ COVID vaccination intentions, attitudes, and estimated peer norms and comparisons with influenza vaccine. Vaccine. 2021;39(15);2060-2067. DOI 10.1016/j.vaccine.2021.03.018

3. Kecojevic A, Basch CH, Sullivan M, Chen Y, Davi NK. COVID-19 vaccination and intention to vaccinate among a sample of college students in New Jersey. J Com munity Health. 2021;46(6):1059-1068. DOI 10.1007/s10900-021-00992-3

4. Zaidi A, Elmasaad A, Alobaidli H, et al. Attitudes and intentions toward COVID-19 vaccination among health professions students and faculty in Qatar. Vaccines. 2021;9(11):1275. DOI 10.3390/vaccines9111275

5. Gilkey MB, Magnus BE, Reiter PL, McRee AL, Dempsey AF, Brewer NT. The Vaccine Confidence Scale: a brief measure of parents’ vaccination beliefs. Vaccine. 2014;32(47): 6259-6265. DOI 10.1016/j.vaccine.2014.09.007

6. Gilkey MB, Reiter PL, Magnus BE, McRee AL, Dempsey AF, Brewer NT. Valida tion of the Vaccine Confidence Scale: a brief measure to identify parents at risk for refusing adolescent vaccines. Acad Pediatr. 2016;16(1):42-49. DOI 10.1016/j. acap.2015.06.007

7. Ryan KA, Filipp SL, Gurka MJ, Zirulnik A, Thompson LA. Understanding influenza vaccine perspectives and hesitancy in university students to promote in creased vaccine uptake. Heliyon. 2019;5(10):e02604. DOI 10.1016/j.heliyon.2019. e02604

8. Benjamin SM, Bahr KO. Barriers associated with seasonal influenza vaccina tion among college students. Influenza Res Treat. 2016;2016:4248071. DOI 10.1155/2016/4248071

9. Silva J, Bratberg J, Lemay V. COVID-19 and influenza vaccine hesitancy among college students. J Am Pharm Assoc. 2021;61(6);709-714. DOI 10.1016/j. japh.2021.05.009

10. Centers for Disease Control and Prevention. Demographic Trends of People Receiving COVID-19 Vaccinations in the United States. COVID-19 Data Tracker. https://covid.cdc.gov/covid-data-tracker/#vaccination-demographics-trends (accessed 2022 Feb 14).

11. Dror AA, Eisenbach N, Taiber S, et al. Vaccine hesitancy: the next challenge in the fight against COVID-19. Eur J Epidemiol. 2020;35(8):775-779. DOI 10.1007/ s10654-020-00671-y

12. SAGE Working Group. Report of the SAGE working group on vaccine hesitancy. https://www.who.int/immunization/sage/meetings/2014/october/1_Report_ WORKING_GROUP_vaccine_hesitancy_final.pdf (accessed on 2022 Jan 21).

13. Lucia VC, Kelekar A, Afonso NM. COVID-19 vaccine hesitancy among medical students. J Public Health. 2020; 43(3):445-449. DOI 10.1093/pubmed/fdaa230

14. López-Sánchez I, Domínguez A. The perception and attitudes of pharmacists and their users towards vaccination and vaccine hesitancy: a cross sectional study. Vacunas. 2021;22(3):138-149. DOI 10.1016/j.vacun.2021.06.001

15. Kubli K, McBane S, Hirsch JD, Lorentz S. Student pharmacists’ perceptions of immunizations. Curr Pharm Teach Learn. 2017;9(3):479-485. DOI 10.1016/j. cptl.2017.02.005

16. Chou TI, Lash DB, Malcolm B, Quach JY, Dong S, Yu J. Effects of a student pharmacist consultation on patient knowledge and attitudes about vaccines. J Am Pharm Assoc. 2014;54(2):130-137. DOI 10.1331/JAPhA.2014.13114

17. Tai DBG, Shah A, Doubeni CA, Sia IG, Wieland ML. The disproportionate impact of COVID-19 on racial and ethnic minorities in the United States. Clin Infect Dis. 2021;72 (4):703-706. DOI 10.1093/cid/ciaa815

TABLE 1. Demographics

Gender Female: 70.1% (830/1184)

Male: 27% (320/1184)

Non-binary: 1.6% (19/1184)

Other/no response: 1.2% (14/1184)

Ethnicity

White: 86.5% (1024/1184)

Multiple ethnicities or “Other”: 5.2% (62/1184)

Asian/Pacific Islander: 2.5% (30/1184)

Latinx: 2.4% (28/1184)

Black: 1.9% (23/1184)

Native American/Indigenous: 0.1% (1/1184)

Prefer not to say: 1.2% (14/1184)

Age Mean: 25.8 (Range 17-87)

Role Student: 84.8% (1004/1183)

» Student Pharmacist: 11.7% (139/1183)

Staff: 8.8% (104/1183)

Faculty: 5.6% (66/1183)

Administrator: 0.8% (9/1183)

Subjective risk self-assessment

Feel that I am NOT at risk for complications: 78.2% (926/1184)

Feel that I am high risk for complications: 17.1% (202/1184)

Unsure: 4.7% (56/1184)

COVID-19 history Positive: 12.5% (148/1182)

» Mild: 65.5% (97/148)

» Significant symptoms, not hospitalized: 18.9% (28/148)

» Asymptomatic: 12.8% (19/148)

» Hospitalized: 2.7% (4/148)

Negative: 87.5% (1034/1182)

Family member had COVID-19: 79.8% (943/1182)

» Mild: 43.5% (410/943)

» Significant symptoms, not hospitalized: 34.9% (329/943)

» Hospitalized: 12% (113/943)

» Died: 6.9% (65/943)

» Asymptomatic: 2.7% (26/943)

Neither had COVID-19 nor knew anyone who had it: 15.0% (177/1182)

Received a flu vaccine in the past 2 years

Yes: 75.2% (890/1183)

No: 21% (248/1184)

Don’t remember: 3.8% (45/1183)

TABLE 2. Mean Vaccine Confidence Scale Comparisons

Group

VCS Score Benefits Score Harms Score Trust Score

Vaccinated or plans to be vaccinated (n=1034) 8.88 9.20 1.85 8.97

Unsure (n=66) 7.30 7.66 3.62 7.52 Will not be vaccinated (n=84) 5.55 5.63 5.76 6.71

P-value <0.001* <0.001* <0.001* <0.001*

Pharmacy students, faculty and staff (n=150) 8.73 9.19 2.34 8.91

Non-pharmacy students, faculty, and staff (n=1033) 8.53 8.81 2.21 8.71

P-value 0.025* <0.001* 0.444 0.128

PharmD students (n=139) 8.71 9.17 2.39 8.88

Non-PharmD students (n=865) 8.52 8.79 2.18 8.66

P-value 0.05* <0.001* 0.254 0.12

Unvaccinated PharmD students (n=38) 8.27 8.63 2.93 8.76

Unvaccinated Non-PharmD students (n=788) 8.48 8.76 2.21 8.61

P-value 0.404 0.634 0.038* 0.562

IOWA BOARD OF PHARMACY UPDATE

Prescription Monitoring Program

During the June 28 Iowa Board of Pharmacy meeting, the Board discussed budget reviews for Prescription Monitoring Program (PMP) integration. The PMP program was launched on June 15 and provides all pharmacies in Iowa gateway portal access at no additional cost. The integration brings a comprehensive view of the patient, all in one place. Being a part of the PMP integration program allows each pharmacy to save 2-4 minutes per patient encounter.

Security Rules

During the May 3 meeting, the Iowa Board of Pharmacy adopted and filed Chapter 6, “General Pharmacy Practice,” Chapter 8, “Universal Practice Standards,” and Chapter 10, “Controlled Substances,” under Iowa Administrative Code. These rules allow Iowa pharmacies to utilize minimum security and monitoring systems, preventing and detecting unauthorized access to prescription drugs and records. They require an exact count of all schedules of controlled substances for a controlled substance inventory count and a program to be established to monitor controlled substance accountability. Additionally, pharma cies will be required to develop and execute a corrective action plan following the report of the theft or loss of controlled substances and require a controlled substances inventory to be taken with each change in pharmacist-in-charge.

In addition, the Iowa Board of Pharmacy was awarded the National Association of Boards of Pharmacy’s (NABP) 2022 Fred T. Mahaffey Award for its rulemaking regarding wholesale drug distributors, tech nology-assisted TPV programs, and telepharmacy practice. Congratu lations to the Board!

FEDERAL UPDATE

On May 24, Senator Chuck Grassley introduced the bipartisan Phar macy Benefit Manager Transparency Act. This legislation would ban unfair pricing, prohibit arbitrary claw backs of payments made to phar macies, and mandate PBMs to be transparent about how much money they make through spreading pricing and pharmacy fees.

Senator Grassley has been pushing the Federal Trade Commission (FTC) to take a closer look into PBMs and their payment models. CVS/Caremark, OptumRx and Express Scripts are three of the largest PBMs, controlling about 75% of the market. IPA has been working with Senator Grassley to help ensure pharmacy viability. In addition, IPA is working to ensure that effective regulations of PBMs are in place and enforced to protect consumers and patient access.

The bipartisan proposal has been supported by over 200 organizations, including the National Community Pharmacists Association (NCPA), Community Oncology Alliance (COA), American Pharmacists Association (APhA), Biotechnology Innovation Organization (BIO), American Pharmacy Cooperative (APCI), and Association of Mature American Citizens (AMAC).

MAAC UPDATE

The Medical Assistance Advisory Council (MAAC) assists the Medic aid Director to make decisions about health and medical care services under the medical assistance program. The Council meets each quarter to discuss quarterly reports and updates from the Medicaid Director and Managed Care Organization (MCO). During the most recent quar terly meeting, the MAAC elected the Iowa Pharmacy Association (IPA) as one of the Professional and Business Entity Voting Members. IPA will serve for a three-year term, along with two other organizations. Brett Barker, IPA’s Senior Policy Advisor, represents IPA on the MAAC.

PBM BILL UPDATE

IPA’s PBM bill was the very last piece of business considered by both chambers during the 2022 Legislative Session. In the end, the bill was significantly watered down in the Senate, and IPA decided to regis ter against the bill to continue working on this issue in future years. Positive provisions to the bill include those on transparency, prohibit ing claw backs, and prohibiting steering towards affiliate pharmacies. Currently, IPA is working closely with the Iowa Insurance Division on rule making and is seeking input from those interested. Contact Seth Brown at sbrown@iarx.org to provide input.

Tune in to IPA’s BOP: What, Why & How podcast following each Iowa Board of Pharmacy meeting to recap the Board’s actions and earn Pharmacy Law CE!

Each episode will focus on WHAT actions were taken by the Board of Pharmacy, WHY the BOP took the actions it did, and HOW BOP action will impact practice in Iowa.

2022 INSIGHT TO ADVOCACY PHARMACY LAW SERIES

IPA hosted its second year of the Insight to Advocacy Pharmacy Law Series, offering 1 hour of CPE per session. This year, the series was included with IPA Legislative Day registration for all paid members.

The 2022 series kicked-off on February 25 with Matt Stoller, Director of Research at the American Economic Liberties Project. Author and monopoly expert, Stoller joined IPA staff to discuss the anti-competitive practices of PBMs and recent actions by state and federal government.

On March 18, IPA’s Senior Policy Advisor, Brett Barker, presented alongside IPA lobbyist Matt Eide on the 2022 Iowa Legislative Session, providing an update on IPA priorities and what bills passed the first funnel. Maddy Bradley, Legislative Assistant for Eide & Walton, explained the funnel process and the current makeup of the Iowa Legislature.

On April 15, NCPA’s Anne Cassity, JD, Vice President of Federal & State Government Affairs, and Matt Magner, JD, Director of State Government Affairs, joined IPA’s Brett Barker to describe PBM legislative efforts made at the national level following the Rutledge v PCMA SCOTUS decision. IPA’s PBM bill was also discussed.

As the final session, Senator Chuck Grassley joined IPA on May 16 to share federal legislation affecting pharmacies and pharmacy practice. In addition, the Senator described his co-sponsored bill, the Pharmacy Benefit Manager Transparency Act of 2022 (S.4293), which was introduced in the U.S. Senate the following week.

If you missed any of these sessions, the 2022 I2A Series is available and accredited on-demand. Please contact IPA at ipa@iarx.org to access these recordings.

The Iowa Pharmacy Political Action Committee (IPPAC) is a fund used to strategically strengthen relationships with legislators that are supportive of pharmacy interests. The IPPAC is funded by contributions from individual pharmacists, pharmacy technicians or student pharmacists, as well as member PACs of other organizations. Your contributions to the IPPAC aid in advocating for practice advancement, PBM regulation and other important issues facing our profession.

THE ROLE OF PHARMACY TECHNICIANS IN CMRS

From IPA’s April 2022 Tech Tidbits

Many pharmacy technicians have heard the term ‘comprehensive med ication review’ (CMR) before, but most do not know what it means and haven’t had a part in these services. With the role of the pharmacy technician rapidly expanding throughout the COVID-19 pandemic, CMRs are yet another area where technicians can further develop their skill sets.

What is a CMR?

A CMR is a performance measure of Medication Therapy Manage ment (MTM) services offered to improve patient health. With CMRs, all medications taken by a patient are reviewed (typically once a year), including any supplements and over-the-counter medications. The complete medication list is then used to discover potential drug interactions, adherence issues, adverse drug effects, and more. A pharmacist uses a CMR to identify any potential issues with a patient’s mediations and provides recommendations to the patient’s physician for therapy changes. OutcomesMTM is the most common platform used to complete a CMR.

Why are CMRs important?

Healthcare professionals strive to provide the best patient care, and CMRs are an important way to accomplish this. In addition, most insurance plans will pay for CMR services to be completed. In 2018, $3.87 million was awarded to retail pharmacies for completion of MTM services including CMRs. As more health plans understand the importance of these services, more mon ey will be awarded in the future. Completion of CMRs also boosts Medicare Star Ratings, which impacts a pharmacy’s inclusion in a health plan’s network and potentially lowers direct and indirect remuneration (DIR) fees. Therefore, it is important to complete as many CMRs for patients as possible.

How can pharmacy technicians play a role in CMRs?

Currently, due to increased demands of the pandemic, many pharmacists are too busy to complete CMRs.

Pharmacy technicians can help by assisting with CMRs in the follow ing ways:

• Offer and schedule CMR consultations for patients. Work with your pharmacist to determine availability for appointments.

• Before the patient-pharmacist consultation, collect a complete medication list from the patient, including all prescription med ications, over-the-counter products, and herbals. Note any new medications for the pharmacist’s review.

• Encourage patients to bring copies of recent lab work and immu nization records to the consultation. These will help determine any actions needed to help improve patient care.

Consider diving deeper into your role in the pharmacy profession and start aiding in CMRs to help provide the best possible care for your patients.

References:

1. https://outcomesmtm.com/wp-content/uploads/2021/02/2019-Out comesMTM-Trends-Report.pdf

2. https://www.powerpak.com/course/print/113858

3. https://secure.outcomesmtm.com/secureSite/resources/docs/Out comesMTM-For-Technicians.pdf

PHARMACY BURNOUT

A NEW CONVERSATION

From IPA’s May 2022 Tech Tidbits

When burnout was discussed three years ago, pharmacy professionals were not part of the conversation. At the time, burnout research was being conducted largely on physicians and nurses. A few years later, a global pandemic, highly sought-after tests and vaccines, as well as routine health care services, the burnout conversation among pharmacy professionals could not be any more prevalent.

Burnout is when an individual experiences emotional, physical and mental exhaustion due to stressful work sit uations, financial struggles or any stress inducing factor.1 Burnout has been detrimental to the pharmacy workforce over the course of the past two years with longer shifts, lower pay and great demand for COVID-19-related services, all while managing heightened emotions of both customers and staff. Pharmacy technicians have been at the forefront, often the first face seen in the pharmacy and providing vast knowledge on insurance, changing NDCs, and most importantly, the patient’s needs.

Recognizing the signs of workplace burnout is an im portant first step in getting through mental, physical, and emotional exhaustion. Physical symptoms may include feeling tired, not sleeping, physical aches and pains. Emotional symptoms may include feeling frustrated with yourself and others, lacking motivation, and self-doubt. Behavioral or mental symptoms may include isolation when away from work, feeling helpless, and possessing a more negative outlooks on things. Coming to terms with these feelings is key in making change.

If you are feeling overly stressed or exhausted, consider finding new hobbies that can help you clear your mind after a long day. Dive into those hobbies, and find who you are outside of your role as an outstanding Iowa pharmacy technician. In addition, make sure to reach out to your support system of colleagues, friends, family and licensed professionals when needed. As a technician, you are always providing support to your pharmacy staff, but now it’s your turn!

References:

1. “Burnout Prevention and Treatment.” HelpGuide.org, Nov. 2021, https://www.helpguide.org/articles/stress/burnout-preven tion-and-recovery.htm.

NEWLY CERTIFIED IOWA TECHNICIANS

APRIL 1 – JUNE 30, 2022

Congratulations to the following pharmacy technicians on becoming PTCB-certified!

Kaylie Adams

Jaime Ambrose

Collin Arndt

Ian Ball Emily Banes Kandace Bass

Mercedi Bauer Danielle Bessman Debra Blind Tara Brandon Kara Brinker Kayla Brock Autumn Bryan Christie Burlingame Sarah Canfield Olive Chung Diana Clark

Estefany Narvaez Collado Connor Corbin Erin Cousins

Kayliann Crittenden

Alyssa Cruise Sarah Davis Danielle De La Cruz Jonathan Diaz Erika Elbert Madian Elola Grace Feuerbach Jennifer Frame Hallie Frohn

Evangeline Gallentine Clinton Garlock Paige Gibler Jamie Goodman Christoph Gorman Amber Grabau

Pamela Gulick Rebecca Haase

Ajla Hadziric Erin Mathers-Hansen Malea Harmon Audrey Harris Megan Healy Sydney Hehnke Dawn Heiden Ashlie Heuss Molly Hill Samantha Holden Fitim Hoti Samantha Jackson Jesse Jacob Hope Johnson Nicole Jones Natalie Kaiser Talbot Kinney Sarah Klinkhammer Laura Knoll Sadie Lehmkuhl Daniel Leonetti Stacy Lindsey

Lacie Long Mikayla Long Cj Lozano Kirstin Lunde Cameron Malichky Renee Merrill

Mariah Morris Kayla Nuehring Lisa Oatman Melissa Oberholtzer Laurie Paasch McKenna Parker

Landen Parmelee

Abigail Paul Courtney Pfleeger

Saige Pietig Hope Rasmussen Isabele Raveling Sean Redding Allie Renner

Joseph Riley Elizabeth Rome Jenica Rubner Zach Sandeen Megan Schieffer Jennifer Schmidt Kelley Schroeder Tanya Shepard Dierra Sims

Dagmar Smith Briley Sodergren Kiera Soteco Misty Starkweather Madonna Stuflick Mahsa Tajnesaei Ashley Thiele Melissa Tom Denise Towsley Victor Vavrinek

Cory Vetter Angela Ward Hillary Weir

Robert Wetzler Jennifer Williams Loren Wittmer Macy Wood Ellise Wykert Shuyu Xian

2022 EGGLESTONGRANBERG GOLF CLASSIC

The 2022 Eggleston-Granberg Golf Classic was held on June 9, a beautiful day at Finkbine Golf Course in Iowa City. Thanks to the generosity of 96 golfers, the IPA Foundation raised over $8,000 toward initiatives to support student pharmacists at Drake University and the University of Iowa.

Thank you to all golfers who, in addition to participating, purchased mulligans and string (that they obviously didn’t need) to benefit the Foundation. The Golf Classic is a friendly competition – Congratulations to all winners!

THANK YOU SPONSORS

The IPA Foundation would like to extend a special thank you to the following sponsors. This event would not be possible without their support!

CART SPONSOR – MHCS

BEVERAGE CART SPONSORS – Greenwood Pharmacy and Compounding Center; NuCara Pharmacy

HOLE SPONSORS Drake University College of Pharmacy & Health Sciences; Dubuque Area Pharmacy Association; IPA Foundation; MedWiseRx; North Iowa Pharmacy, Inc.; Osterhaus Pharmacy; Pharmacists Mutual; PharmServ; Quad Cities Area Pharmacy Association; Textile Brewery; The University of Iowa College of Pharmacy; Towncrest Pharmacy; Wells Fargo Advisors/Chris Connolly.

PRIZE SPONSOR – Carl Chalstrom

STUDENT SPONSORS – Bill Baker; Mike Brownlee; Connie Connolly; Kate Gainer; Nic Lehman; Nick Lund; Steven Martens; Jim Miller; North Iowa Pharmacy, Inc.; Lisa and Andy Ploehn; Susan Shields

2021 OUTCOMES GRANT FINAL REPORTS

FREESTYLE LIBRE PRO USE FOR IMPROVED CONTROL OF BLOOD SUGARS IN PATIENTS WITH DIABETES

Author: Wendy Mobley-Bukstein, PharmD, BCACP, CHWC, CDCES, FAPhA, Drake University College of Pharmacy & Health Sciences

Amount: $6,149

Summary: Individuals (n=5) were identified in the clinic by the diabetes care and education specialist or a medical provider as having unmanaged diabetes. The person received informed consent regarding the study. If they agreed, a professional Freestyle Libre CGM device was applied, and the person wore it for 14 days. At the end of the 14 days, the person returned to the clinic for removal of the device and interpretation of the data collected from the device. Therapy changes were made to the person’s diabetes treatment plan. The person adhered to the new plan for 4 weeks and then returned to the clinic to wear a second CGM for 14 days. Data from this CGM wear was recorded.

The average glucose was decreased by approximately 20mg/dL. The glucose variability was decreased by more than 8% and the average GMI was decreased by 1%. Looking at the time-in-range data, recall that the changes in these numbers are occurring over a 6-week time period. In most clinical practices, an A1C would be drawn every 12 weeks. These averages are heavily skewed by individual patients

who had very high glucose at the beginning of the study period, and although improvement in the blood glucose ranges occurred, they remained above the target range. The more impressive improvement was the average low or very low was decreased by 2.7%. This is an area of importance because this decrease in hypoglycemia and severe hypoglycemia has a cost savings of an emergency department visit, hospitalization or death attributed to it. Lastly, you can see that the high touch follow-up that was being performed has been beneficial to these patients, resulting in more interactions and subsequently more frequent adjustments of their insulin dosages.

CGM Data Points First Wear (n=5) Second Wear (n=4)*

Average Glucose 222.6 mg/dL 200 mg/dL

Glucose Variability (%) 43.8% 35.8%

Glucose Management Index 9.05% 8.1%

Time-In-Range (TIR) 36.8% 39.75%

High/Very High Range 59% 58.75%

Low/Very Low Range 4.2% 1.5%

Number of patient interactions 28 56

Number of drug therapy interventions 27 56

*One patient is scheduled to return for second wear in the two weeks.

PATIENT PREFERENCES AND WILLINGNESS-TO-PAY FOR MEDICARE PART D CONSULTATIONS OFFERED IN A COMMUNITY PHARMACY SETTING

Author: Logan Thomas Murry, PharmD, The University of Iowa

Amount: $10,000

Summary: The objectives of this study were to 1) identify patient preferences for Medicare Part D consultation service offerings from the perspective of service-naive and service-experienced patients, and (2) quantify patient stated preferences for service attributes using partworth utilities and willingness-to-pay.

The study used a mixed methods design with qualitative interviews of Iowa CPESN patients and a national quantitative discrete choice experiment. Patients at 5 Iowa CPESN community pharmacies were interviewed about their experiences selecting a Medicare Part D plan. Perspectives were collected from 17 patients who both had and had not

used a Medicare Part D consultation service offered by a community pharmacy in the past. After 17 interviews had been completed, qual itative analysis identified themes within the SERVQUAL framework domains of: Technical Quality, Interpersonal Quality, Environmental Quality, and Administrative Quality. Thematic analysis identified five attributes important to Medicare Part D service quality from Iowa CPESN patients: Service Length, Information Provided, Service Loca tion, Service Provider, and Price.

The DCE showed that when considering Medicare Part D consultation services, patients associated the highest value with shorter services (15 minutes), a discussion of Medicare Part D plans and a follow-up phone call, offered in person at the pharmacy, and provided by a pharmacist they knew. While patients had the highest preference for a service offered free of charge, a charge of $25 USD was still associated with positive utility. Community pharmacies currently offering or interested in offering Medicare Part D consultation services may benefit from considering patient preferences for service offerings and the monetary value of these services.

VAXITAXI.COM PROVIDER PILOT

Author: Casey Villhauer, PharmD, Vaxi Taxi

Amount: $15,000

Summary: The goals of the Vaxi Taxi Provider Pilot were restructured from the original presentation to better align with the Board’s recom mendations in anticipation of delivering COVID-19 vaccines to those Iowa communities of greatest need. Revised project goals include: De velop key roles with the intent of expanding Vaxi Taxi services beyond the primary service locations; Streamline training and credentialing of Vaxi Taxi pharmacists with an in-house program to minimize on boarding and “Vaxi Taxi certification” costs; Experience and document the challenges of serving individuals living in areas with high Social Vulnerability Index scores vs. suburban neighborhoods.

The key role was identified as the Director of Pharmacy, fulfilling responsibilities related to Pharmacy Partner Relations (Community Pharmacies), Immunizer Relations, and Patient Relations. In expanding services, Vaxi Taxi established a Pharmacy Partner program, created a dedicated team consisting of a clinical coordinator, eight immunizers and an administrative assistant, and streamlined with Pharmacy Part ner onboarding process. In addition, Vaxi Taxi streamlined its training and credentialing for pharmacists, utilizing state funding to cover these costs. The final goal, experiencing and documenting challenges serving patients in high vulnerability areas, was not achieved due to insufficient data.

NEW FUNDING OPPORTUNITY

The IPA Foundation is looking to support the next generation of innovative pharmacy ideas through the Outcomes Innovative Pharmacy Grant Program. New this year, there are TWO funding pathways available for Iowa pharmacists!

OUTCOMES GRANT

Original Track

• Funding up to $10,000 per project

• Iowa PGY1/PGY2 residents eligible to apply

• Up to five residents funded per year

• Funding up to $2,000 for residents

• Application Deadline: September 1

OUTCOMES GRANT

Entrepreneur Track

• Funding up to $50,000

• Must submit letter of interest to IPA

• Must complete 10/20/30 pitch deck (10 slides, 20 minutes, 30-point font)

• Application Deadline: Rolling

Applicants must be a current Iowa licensed pharmacist and active member of the Iowa Pharmacy Association. To be considered for the original Outcomes Grant, complete the online application by September 1, 2022. Individuals interested in learning more about the Entrepreneur Track may submit a letter of interest to ipa@iarx.org

The IPA Foundation Outcomes Innovative Pharmacy Endowment was established by the original investors of Outcomes Incorporated to support innovative pharmacy initiatives in the state of Iowa. The Outcomes Innovative Pharmacy Grant Program provides financial support for research, education and promotion of innovative pharmacy practice initiatives in the state of Iowa.

Visit www.iarx.org/OutcomesGrant for more information.

PHARMACIST SPOTLIGHT: JOHN L'ESTRANGE, PHARMD

John L’Estrange, PharmD, RPh, BCACP

MTM Manager UnityPoint Health

Like many other pharmacy professionals, Dr. John L’Estrange credits his love of science and passion for helping others as a few reasons he knew early on in life that he wanted to become a pharmacist. He also attributes his interest in pharmacy to his local community pharmacist, Jerry Karbeling, who shed light on the value of a pharmacist and the importance of giving back to one’s community and profession. “I still remember his wisdom and kindness to this day,” said John.

To fulfill his dream of becoming a pharmacist, John attended pharmacy school at Drake University and completed a pharmacy residency at the University of Iowa Hospitals and Clinics upon graduation. After res idency, John accepted his first pharmacist position with the University of Iowa Hospitals and Clinics as a Patient Care Unit-Based Pharmacist with a focus on hematolo gy and oncology.

Looking for a change, John started working at Unity Point Health in Des Moines and is now practicing as the manager of UnityPoint Health’s Medication Therapy Management team. He describes a typical day in his position being divided between direct patient care and leading a team of six pharmacists and one CMA. The cross-regional pharmacist team that he manages is based in ambulatory clinics.

He shares how he is “lucky to get to interact with pa tients, providers, and other care team members on a dai ly basis.” John's team recently piloted pharmacist-driven medication management clinics. His goal for these programs is to “help patients meet their goals faster by working with them inbetween their regular primary care provider (PCP) visits and help minimize medica tion access barriers, such as cost and insurance issues.”

that allows them to have a better quality of life.” He also enjoys leading his team of health care professionals to provide the best care possible to patients.

One of the challenges that John has had to overcome, similar to many pharmacists across the state and coun try, is the COVID-19 pandemic. He has faced this obsta cle by connecting with patients telephonically. He believes pharmacists were particularly important during the pandemic, as patients had fewer opportuni ties to meet with their PCPs. Instead, pharmacists were able to bridge the gap between PCP visits to ensure patient care was still provided.

Another major challenge John faces is medication affordability for patients. He shares how healthcare is moving away from traditional fee-for-service contracts and toward value-based care instead, which empha sizes evidence-based guidelines more than ever. While following guidelines for treatment recommendations is ideal, he says this may be unaffordable for some patients. For example, guidelines are favoring the more expensive SGLT2 inhibitors and GLP-1 agonists that many patients cannot afford. It is difficult when patients are not able to afford the best medications possible to treat their conditions, but there is hope that medication costs for these newer agents will decrease over time.

Regarding the future of pharmacy, John hopes the pro fession will continue to move in the direction of com prehensive medication management with an increased responsibility for pharmacists managing medication related problems. He feels continued collaboration among pharmacists and the rest of the patient care team will “assure [the] best outcomes, minimize side effects, remove adherence barriers, and provide maximal value [to patients].”

Author:

Ternes,

School of

of

John says the most rewarding part of his current posi tion is “getting to work with patients and seeing their excitement as they achieve a medication related goal

Thank you, John, for the care you provide to patients and your ambition to help grow the pharmacy profes sion to its fullest extent! ■

Chad Delzell Brett Lundsten

Chayla Morris Theresa Rowan Constance Atkinson

WELCOME NEW IPA MEMBERS!

APRIL 1, 2022 – JUNE 30, 2022

Lauri Dvorak Katie Hadsall Bryan Hafits Sara Herr

Alatheia King Tyler Knudson

Hope Meier Darryl Nunes Karriann Reising

Andrew Sabers

Caitlin Stephens Matthew Tam Collin Vollmer

Jennifer Williams Jean Dougherty Robyn Stoner Mari White

Victor Bakhoum

Samuel Salib

MEMBER MILESTONES

Best of luck to Brian Seifert, PharmD, MBA, in his new role as Assistant Vice President of Ancillary Services at Broadlawns Medical Center! Seifert has worked for Broadlawns since 2017, previously serv ing as the Director of Pharmacy.

Congratulations to Robert (Bob) Osterhaus, RPh, past IPA and APhA president, for receiving the University of Iowa’s Eight Over 80 Award, honoring Iowa alumni age 80 and over who carry the Hawk eye spirit of achievement and continue to help others. Bob established Osterhaus Pharmacy in Maquoketa in 1965.

Best of luck to Tanya Wilhite, PharmD, MPH, in her new role as Director of Malignant Hematology MSL at Novartis Oncology! Wilhite has been with Novartis for over eighteen years, most recently serving as Regional Director of Population Health Account Management.

Congratulations to Jeffrey Reist, BS, PharmD, BCPS, Clinical Associate Professor at the University of Iowa College of Pharmacy, for being awarded a 2022 Hubbard-Walder Award for Excellence in Teaching by the university’s Council on Teaching! The award recogniz es faculty who have participated in a rich variety of university teaching and have contributed to curriculum or program development.

Best of luck to Matt Hubble, PharmD, BCPS, in his new role as Advisor of Clinical Services at OutcomesMTM! Hubble has been in his new position since April of 2022.

Best of luck to Dawn Grittmann, PharmD, CPHQ, in her new role as Senior Manager of Health Care Initiatives at the National Alliance on Mental Illness (NAMI)! Previously, Grittmann served on the NAMI Iowa Board of Directors after volunteering for the organization for almost ten years.

Best of luck to Sharmi Patel, PharmD, MBA, 2020-2021 IPA Executive Fellow, in her new role as Manager of Regulatory Affairs at Seagen in Bothell, WA! Previously, Patel served as Seagen’s Oncology Regulatory Affairs Fellow.

Congratulations to Kimerly Metcalf, CPhT-Adv, for her appoint ment to the Pharmacy Technician Certification Board’s (PTCB) TPV Pathway 2 Eligibility Review Committee! Metcalf will serve a threeyear term, ending in December of 2024.

Best of luck to Alex Mersch, PharmD, MBA, BCPS, in his expand ed role as Assistant Director for Ambulatory Specialty Programs at UI Health Care! Mersch is excited to join the team at the University of Iowa Hospitals & Clinics (UIHC) and advance health care services for patients.

Congratulations to Stevie Veach, PharmD, BCACP, who was promoted to Clinical Associate Professor of Pharmacy Practice and Science at the University of Iowa College of Pharmacy!

Congratulations to Matthew Witry, PharmD, PhD, who was pro moted to Associate Professor of Pharmacy Practice and Science with Tenure at the University of Iowa College of Pharmacy!

IN MEMORIAM

With a heavy heart, IPA shares the passing of previous Board member, Gary Maly. Maly began his career in pharmacy at Marian Health Center. He later joined the pharma cy team at Soo Thrifty Drug Store in Sioux City and then transitioned to Thompson Dean Drug, where he served as the head pharmacist and owner since 2005. Maly was an active member of the association and will be dearly missed.

IPA is saddened to share the passing of Jordan Cohen, former Dean at the University of Kentucky College of Pharmacy, Dean at the University of Iowa College of Pharmacy, and Vice President of Research and Economic Development at the University of Iowa. Cohen leaves a tremendous impact on the profession of pharmacy, not only in Iowa but nationally. Cohen was residing with his wife, Jana, in Napa, California.

NEW IPA STAFF

Please help us welcome Jill Guetersloh, IPA’s 2022 Max W. Eggleston Executive Intern in Association Management! Guetersloh is from the small town of Nashville, Illi nois and received her bachelor's degree from Murray State University. Currently, Guetersloh is a P2 student at the University of Iowa College of Pharmacy and works as a pharmacy intern at MedWiseRx. Additionally, she serves as President of the Academy of Managed Care Pharmacy chapter, COO & CFO of the Healthcare Business Leadership program, and Worthy Vice Counselor of the Phi Delta Chi Nu chapter.

The newest face at IPA is Director of Public Affairs Seth Brown, JD! Brown earned his undergraduate degree from Baylor Univer sity, a BBA in Supply Chain Management. Here, he also ran on the track and field and cross-country teams. Brown then went on to attend Drake University Law School, where he obtained the Legislative Practice Certificate and worked in the Iowa State Capitol. Outside of his professional roles, Brown enjoys running, camping, photography and cheering for the Baylor Bears.

UPCOMING IPA EVENTS

additional details to these events

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on “Calendar of Events”

IPA GOES LOCAL

IPA has hosted four Goes Local events so far this year, all with great at tendance and engagement! This year’s CPE program, “Rethinking Vaccine Communication – The Elephant in the Room,” dives into moral foundations for vaccine beliefs and provides best practices for productive vaccine con versations. Register today for an upcoming date near you! CPE details are available at www.iarx.org/goeslocal

September 6, 2022, 6:00-8:00 PM

Dubuque Area Pharmacy Association, Dubuque, IA

October 6, 2022, 6:00-8:00 PM

Johnson County Pharmacy Association, Iowa City, IA

October 20, 2022, 6:00-8:00 PM

Central Iowa Pharmacy Association, Des Moines, IA

November 10, 2022, 6:00-8:00 PM

Northwest Iowa Pharmacy Association, Sioux City, IA

IPA MEMBER FORUMS

On June 21, IPA hosted its 2022 Independent & Community Pharmacy Practice Forum, covering topics such as launching test & treat as a cashbased service, selling CBD products in a licensed Iowa pharmacy, and more. Elizabeth Webb, PharmD, shared resources Drilling Pharmacy is utilizing in offering test & treat services. Cory (PharmD) and Michelle Garvin (CPhT), owners of Wester Drug, joined Andrew Funk, PharmD, Executive Director of the Iowa Board of Pharmacy, to discuss selling CBD products. Over 40 IPA members took part in this forum. As a reminder, IPA Member Forums are an exclusive member benefit for ENGAGED Pharmacist, Technician, and Student Pharmacist members. Learn more at www.iarx.org/forums

Local:

2022 NAPLEX-MPJE REVIEW COURSE

On May 10, IPA, Drake University College of Pharmacy & Health Sci ences, and the University of Iowa College of Pharmacy hosted the 2022 NAPLEX-MPJE Review Course virtually, bringing faculty and pharmacy experts together to help graduating student pharmacists prepare for their NAPLEX and MPJE exams.

Over 125 student pharmacists took part in this year’s review course, covering competencies and question structure, federal and state law, USP Chapters 795, 797 and 800, clinical topics, and more. IPA Executive Fellow Elizabeth Orput, PharmD, alongside PGY1 Pharmacy Practice Residents Er ika Bethhauser, PharmD, Francesca Milavetz, PharmD, and Nevin Radechel, PharmD, recorded a session on managing expectations with tips for success from new practitioners. Tim Ulbrich, PharmD, CEO of Your Financial Pharmacist, also recorded a session on financial considerations for a first position.

Issues & Events That Have Shaped Iowa Pharmacy (Or Are Fun to Remember!)

MARCH:

The 81st Annual Convention was held at Hotel Roosevelt in Cedar Rapids. One of the opening discussions was over mail-order prescription schemes and their danger to public health.

Johnson & Johnson launched a new stock room modernization program. The program was designed to eliminate duplication that ties up capital unnecessarily.

The Iowa Pharmacy Association (IPA) organized Congressional District Fair Trade Committees, which worked toward the passage of HR 1253 (Harris Bill) and S. 1083.

Max W. Eggleston was installed as the 75th President of IPA.

MAY:

The first oral contraceptive, Enovid, was approved by the FDA on May 11 after being on the market since 1957 for menstrual disorders.

William Wimer took the place of the late Barney Myers as IPA’s legal counsel.

SEPTEMBER:

Drake University College of Pharmacy changed to a five-year program instead of four. The college’s enrollment increased from 31 in 1956 to 76 in 1960.

Fred L. Wright of Vinton, Iowa was elected as the American Animal Health Pharmaceutical Association’s (AAHPA) President.

OCTOBER:

The Iowa Pharmacy Foundation was established with the purpose of providing loans, grants, and scholarships in order to enhance the stature and prestige of the profession.

HONORS & AWARDS :

• Ivor Griffith was awarded the Remington Medal.

• M.F. Coontz was elected as Honorary President of IPA.

• Otto A. Bjornstad was awarded the Bowel of Hygeia.

• Phil Coontz, IPA President, was elected Vice President of the Midwest Conference.

• Thomas A. Foster was awarded the Harvey A.K. Whitney award.

The Iowa Pharmacy Association Foundation is committed to the preservation of the rich heritage of pharmacy practice in Iowa. By honoring and remembering the past, we are reminded of the strong tradition we have to build upon for a prosperous future for the profession.

G.D. Searle & Co. Pharmacia Corporation Accessed at www.pbs.org