Summer 2011 Minnesota Pharmacist by MPhA Minnesota Pharmacists Association

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MPhA Board of Directors Executive/Finance Committee: President: Scott Setzepfandt Past-President: Brent Thompson President-Elect: Martin Erickson Secretary-Treasurer: Bill Diers Speaker: Meghan Kelly Executive Vice President: Julie K. Johnson Rural Board Members: Eric Slindee Mark Trumm Metro Board Members: Cheng Lo James Marttila At-Large Board Members: Tiffany Elton Tim Cernohous Amy Sapola Jill Strykowski Jason Varin Student Representation: Duluth MPSA Liaison: Jeremy LeBlanc Minneapolis MPSA Liaison: Kandace Schuft Ex-Officio: Rod Carter, COP Julie K. Johnson, MPhA MSHP Representative Pharmacy Technician Representative:

Spring 2011 Volume 65. Number 2, ISSN 0026-5616

in this issue President’s Desk Things Have Changed, or Have They? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Executive’s Report Everything Progresses, Commitment to Quality Service Stays the Same . . . . . . . . . . 7 Viewpoint A Swede’s Passion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Pharmacy Technicians Seek Means to Share Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Barb Stodola

pharmacy and the law Where Have You Gone, Perry? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

MINNESOTA PHARMACIST

Can I Get Sued for That?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Official publication of the Minnesota Pharmacists Association. MPhA is an affiliate of the American Pharmacists Association, the American Society of Consultant Pharmacists, the Academy of Managed Care Pharmacy, and the National Community Pharmacists Association.

Editor: Julie K. Johnson Managing Editor, Design and Production: Anna Wrisky

Features Are You AWARxE Minnesota? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Exhibit ACO: Carilion Pharmacists Set Example. . . . . . . . . . . . . . . . . . . . . . . . . . . 14 MPhA Annual Meeting Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 2011 Speaker of the House Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Phalen Family Pharmacy: A Long-Awaited Step in Addressing the Unique Needs of Hmong People in their St. Paul Community. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 How to Improve Your Team’s Morale: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

The Minnesota Pharmacist (ISSN # 0026-5616) journal is published quarterly by the Minnesota Pharmacists Association, 1000 Westgate Drive, Suite 252, St. Paul, MN 55114-1469. Phone: 651-697-1771 or 1-800-4518349, 651-290-2266 fax, info@mpha.org. Periodicals postage paid at St. Paul, MN (USPS-352040).

Student Perspective The Pharmacist’s Role in Public Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Postmaster: Send address changes to Minnesota Pharmacists Association, 1000 Westgate Drive, Suite 252, St. Paul, MN 55114-1469.

Students Spend Five Weeks in Germany Learning About Pharmacy, Health Care, and Culture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Article Submission/advertising: For writer’s guidelines, article submission, or advertising opportunities, contact the editor at the above address or email julie@ mpha.org.

Join the Partnership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Bylined articles express the opinion of the contributors and do not necessarily reflect the position of the Minnesota Pharmacists Association. Articles printed in this publication may not be reproduced in any manner, either in whole or in part, without specific written permission of the publisher. Acceptance of advertisement does not indicate endorsement.

Plan Carefully When it’s Time to Make a Career Move . . . . . . . . . . . . . . . . . . . . . 25

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Upcoming Events Visit www.mpha.org for more information and to register

Moved, graduated, or have a name change? Update your profile through your online MPhA Member Portal page.

MPhA Office

September 10, 2011

Fall Clinical Symposium-Immunization Focus, Crowne Plaza, Plymouth September 25, 2011

1000 Westgate Drive Suite 252 St. Paul, MN 55114 phone: 651-697-1771 fax: 651-290-2266 Visit us online at www.mpha.org!

Minnesota Pharmacist Spring 2011 n

Immunization Certification, St. Paul November 11, 2011,

MTM Symposium, Sheraton, Bloomington November 19, 2011,

MTM Certification, Rochester

Things have Changed

Or Have they? by Scott Setzepfandt, R.Ph., MPhA President First, let me express my humble appreciation in selecting me as your president. MPhA is a great organization and it is an honor to be put in a position to represent you. I would also like to thank Julie Johnson, Brent Thompson and all the current and past board members and presidents who have donated their valuable time to help advance this association and the profession it represents to where it is today.

whose business function is solely to provide clinical care such as MTM.

...the focus of pharmacy has always been and continues to be: “How can we provide a better service to improve patient outcomes?”

Over the past year, I have had random thoughts about just what I would like to talk about in my inaugural address. There is a lot going on in health care and so many issues could be addressed. We have federal health care reforms, medical homes, MTM, PMPs, electronic prescriptions, pharmacy audits, the pharmacy board rules, and on and on.

So, as I thought about all these issues I kept thinking …Wow! Things have really changed in the last 30 years since I graduated from pharmacy school! Back then, we had “health insurance” where you filled prescriptions and gave receipts to patients. They sent it in to the insurance company for reimbursement. Back then, few pharmacies had patient profiles and often the profiles they did have were simple cards with address, age, allergies, conditions and a list of drugs they were on. They were nothing like the computerized profiles of today. And speaking of computers — back then they were basically word processors, printing labels and adding to the list on the profile card. Today we carry around tools in our pockets called “smart phones” that have an incredible amount of power to access information to help us care for patients.

So as I thought about all these things and how the profession has evolved, I just thought, wow, things have really changed. Or have they?

If you think about it, the profession really hasn’t changed — just the tools and the environment around it have. And these changes most likely have come about because the focus of pharmacy has always been and continues to be: “How can we provide a better service to improve patient outcomes?” With all these advanced tools, with the advancement of new complex therapies, with the excellent education new pharmacists are receiving, with all the evolving changes in the health care delivery systems, the role of the pharmacists has become even more important. My goal for the coming year, with all of this in mind, will be to work with you and the association board to continue to provide networking opportunities for sharing professional experiences, to provide interesting new educational experiences to advance skills and to provide strong advocacy at the Capitol and the Board of Pharmacy to continue the advancement and inclusion of pharmacists as primary care providers. Thank you.

Scott Setzepfandt, R.Ph. President

Then, most pharmacists identified their primary role as dispensers of prescriptions. Today, it appears even this has changed significantly. As presented by Jon Schommer, PhD, professor and associate department head, Pharmaceutical Care & Health Systems at the University of Minnesota College of Pharmacy, 44 percent of the pharmacists he surveyed did not list “dispensing” as their primary responsibility and 18 percent said “patient care” was their primary role. Executive Director Cody Wiberg, Board of Pharmacy, is pursuing changes that would allow pharmacists to open a “pharmacy” Minnesota Pharmacist Summer 2011 n

executive’s report

Everything Progresses, Commitment to Quality Service Stays the Same by Julie K. Johnson, Pharm.D., MPhA Executive Vice President/CEO

June 2011 marks my tenth year with MPhA. Subjects to write about for this article number too many to count. Our goal is to provide valuable information for our members. Pharmacists practice in many different and diverse practice settings. Picking the specific interest of one group and expounding and offering information of value to share with others provides a basis for many different article opportunities. Over the years, Rita Tonkinson, long time MPhA staff writer, has brought a variety of articles telling the stories of pharmacists practicing in different areas of patient care. Her article in this issue tells the story of a pharmacist’s goal of establishing a service location, a place where he and colleagues can bring much-needed pharmacy services to a community, their community. Cheng Lo and his business partner, pharmacist May Xia Lo, opened Phalen Family Pharmacy earlier this year. This pharmacy is located on the east side of St. Paul, in the Hmong Village Shopping Center. (Independent community pharmacies, I thought they were mythical things of the past?) Cheng and May Xia, like many of the pharmacists we have interviewed for our articles, have dedicated their professional lives to service — service to their community, their families, and their profession. Our articles are intended to hold them up like shining examples of pharmacists serving patients. This is our common thread. The pharmacists in Minnesota all serve patients. They accomplish their patient care goals through many different avenues. Direct patient care at the corner pharmacy of the old days is where it all began, but life, medicine, and the delivery of health care have become much more complicated than they used to be. It is necessary now for pharmacists to oversee appropriate medication use from many different levels, none better or more valuable than the other, all extremely necessary to ensure that patients receive and have access to medications to improve their lives. My husband and I recently moved to Northfield. We were visited by the welcome services of Steele, Dakota and Rice counties (I thought these Welcome Wagon services were mythical things of the past). I did a little research on Welcome Wagon. This business was established in 1928. Welcome Wagon International (as it is now known) was founded by Thomas W. Briggs in Memphis, Tenn. He originally designed his service by employing “hostesses” who simply dropped by new residents’ door steps to welcome them to a community with local business and services information, gifts, and coupons. These home visits continued for more than 50 years until 1998, when then-owner Cendant laid off the “hostesses,” saying that changing demographics meant few homeowners would be at home when representatives called. The firm is now based in Coral Springs, Fla. The company has changed owners and business models over the past several years. The “hostesses” team has been expanded to include people responsible for

mailings, phone calls, and gathering community information to present to the homeowners once a time is identified. These welcoming services continue to be made up of people dedicated to bringing value to their community. Welcome Wagon still markets to new residents through mail, telemarketing calls, and online. My understanding is that home visits are not as common as they once were. Much like the pharmacy services of yesteryear, things have changed. One on one service is difficult, complicated by changes in societal demographics, lifestyles and economics. “Representatives,” as the “hostesses” are now called, make several contacts by phone, painstakingly identifying a time when the new home owners are home together and available to sit down and listen to the valuable information about the community that they will live and likely spend many years. If you don’t know anything about a community that you move into, this service is extremely complete. We received information about everything from pizza delivery to urgent care services, from local government offices to restaurants and local artisans. It seems that one would likely spend a lot more time searching the Internet or driving around town exploring than sitting down to listen to a summary of the total package. Like independent pharmacies who many may think are mythical things of the past, Welcome Wagon is alive and well. The courteous professional representative, who grew up in Northfield, attended Carleton College and returned to her home several years ago, spent almost two hours with us one evening sharing the services in our community, a little of the history, and leaving countless brochures and coupons inviting us to try their services. She provided brief descriptions of the names and services offered by each of the businesses contained in her packet. The welcome representative added her own insights not contained in the colorful brochures. This was the case when she got to the local pharmacy in Northfield. When she got to Northfield Pharmacy, she paused and added, “Rob Anderson, he is the pharmacist here, and he takes care of my 87-year-old mother. I really don’t know what I would do without him.” She completed her visit with a promise to follow up on a couple of our questions and left us feeling like we knew a little something about our new home. The more things change, the more they stay the same.

Julie K. Johnson, Pharm.D. MPhA Executive Vice President/CEO Minnesota Pharmacist Summer 2011 n

viewpoint

A Swede’s Passion by Lowell J. Anderson, D.Sc., FAPhA

I freely admit to a life-long passion for community pharmacy. I have worked in hospital and chain pharmacy, and I learned from each of these experiences. I recognize the value of each. I also understand how important it is for all these practices to be interdependent in providing for the total care of patients.

Tom Thumb to the people at the nursing home. (One elderly resident, to show her gratitude for our service, gave us a self-portrait of herself – in the nude!)

But I chose community practice because it met my career goals and played to my values of community involvement, interaction with consumers, personal responsibility and the opportunity to see directly the results of the application of my professional and business skills. The recognition by customers and patients of my contribution to their wellbeing clinched the deal for me.

Like all community pharmacies, we supported many community activities. We bought ads in the high school yearbooks and in the many church bulletins, gave door prizes to more clubs than I knew existed, and gave the Little Sisters of the Poor free gift wrap at Christmas. Why did we do these things? I don’t believe it provided many new customers. We did it because as a community pharmacy we didn’t just work in the community, we saw ourselves as a part of the community.

I first experienced community pharmacy as high school senior in a “corner drug store” in Elizabethton, Tenn. Much like community practice jobs today, it was multi-tasking. I worked the fountain, the cosmetic department, the OTC department, swept the floors, made deliveries and, at times, helped fill the occasional prescription. My hourly wage was about the same as the $1.25 that many of the current health plans pay for filling a prescription.

As the owner of the pharmacy, these decisions were mine to make. There was no higher authority that I needed to check with. Like many decisions that a small business owner must make, the “higher authority” is the reality of whether or not they achieved the goal. Quality service. Good will. Community acceptance. And, ultimately, did the sum of all the decisions – large and small – result in a profit?

My chain experience came while a pharmacy student at the University of Minnesota. I worked at the Walgreens on 9th and Nicollet in Minneapolis. (They gave me a tuition scholarship that paid my $85 a quarter tuition, in exchange for a commitment of 1000 hours after graduation.)

Like life, the success or failure of a small business is less a matter of the BIG decisions than the sum of the many small decisions.

I learned a lot about community pharmacy while at Walgreens because all the employees saw themselves as part of the downtown community – 9th and Nicollet was a virtual small town. We were acquainted with the people in our community who worked up and down the street – their comings and goings, their promotions and transfers, the births and deaths. All the elements of community. With this familiarity came a feeling of personal responsibility for their wellbeing. I also worked at Northwestern Hospital before joining the Army. The hospital was a community too – a corporate community. Each employee depended on the others to do our job. It taught me that engaged employees are critical to achieving the mission and each is important no matter their standing in the hierarchy. This was a learning experience that gave me skills that served a professional lifetime. We bought our own community pharmacy in 1966. It was a typical drug store of the 1960s: soda fountain, cosmetics, greeting cards, tobacco, and all the rest. We delivered prescriptions to people who had two cars in the driveway, and groceries from the local 8

Minnesota Pharmacist Summer 2011 n

In 1984 we had an epiphany. At the prescription counter we worked to provide a level of service that would improve our patrons’ health, while in the front of the pharmacy we sold tobacco products that we knew diminished their health. We made the decision to no longer sell these products because we felt they made a mockery of our goals as professionals. It was a slow day in the newspapers, so we got a front-page abovethe-fold color picture of us taking cigarettes off the display rack. One of the tobacco reps came in and threw all her inventory on the floor and stormed out. We got national coverage! To this day, people remember the pharmacy as the one that stopped selling tobacco. Some of our customers said they took our action as an opportunity to stop smoking. Others stopped by to say thanks for taking a stand on something that was good for the community but had a cost to us in lost sales. It was good for business! Why is this important? Because, in an independently owned community pharmacy the timeline from idea to action is short. By this simple act, we addressed a public health issue and got people’s attention. We acted on principle and were able to make a difference. A Swede’s Passion continued on page 9

A Swede’s Passion continued from page 8 Obviously at the center of any pharmacy must be the services that the pharmacists provide. In community practice the relationships are such that you know families, not just the patient. Because of these direct and ongoing relationships the pharmacist is able to truly serve as a supplier, primary care provider, health resource and ombudsman for patients, customers and the community. One has to try really hard to not be involved when in community practice. And, if you are successful at not being involved, you will not be successful! As a small business we relied heavily on people from the community for our staff: second workers in households, retirees and students. The students in particular were a joy. We would hire at age 16. Many of these hires stayed with us through high school and college. I think that we underestimate the value of community pharmacies, and other small businesses, in providing first jobs and in training our workforce for rewarding work lives. In the history of Minnesota, I wonder how many people got their first work experience in a pharmacy. As the first employer for many students, we had an opportunity to positively affect the work ethic of these people for their entire careers. If they learned that work had purpose and that it could be also be fun, we were a success. We had fun doing it and we have watched those students establish careers, families and reputations. Community practitioners everywhere feel this same pride when their “graduates” return to bring them up to date on their lives’ progress. My career in community practice also gave me the ability and the opportunities to be involved beyond the community in which I practiced. To the extent that my community knew of my outside activities they reciprocated my feelings of pride in my community by expressing their pride in “their” pharmacist. We often hear, and some of us even believe, that the independently owned community pharmacy is a business of our country’s past. To be certain, there are fewer independents. Those who remain do so, however, because they are good professionals and innovative managers and have established their value to their communities. The independently owned practices of pharmacy in our communities will survive. They will survive as long as they provide value. Surely, practice and business will continue to evolve as creative practitioners and managers adapt to changing environment, take advantage of new opportunities and continue as important parts of the community – not just someone who owns a building or works in the community.

Lowell J. Anderson, D.Sc., FAPhA, practiced in community pharmacy for most of his career. He is a former president of MPhA, MN Board of Pharmacy and APhA. In addition he has held positions in the Accrediting Council on Pharmacy Education, National Association of Board of Pharmacy and the United States Pharmacopeia. Currently he is co-director of the Center for Leading Healthcare Change, University of Minnesota and co-editor of the International Pharmacy Journal. He is a Remington Medalist.

Pharmacy Technicians Seek Means to Share Information At the 2009 annual meeting of the Minnesota Pharmacists Association (MPhA), the House of Delegates approved a petition signed by individuals (technicians and pharmacists) asking for the formation of an academy for Minnesota pharmacy technicians. Work began in earnest in early June 2009 with the formation of a Pharmacy Technician Task Force. On June 27, 2009 the MPhA Board of Directors voted unanimously in favor of the Pharmacy Technician Academy. A number of technicians and pharmacists worked to make this a reality. However, the driving force behind the movement to form an academy was Barbara Stodola, who has been involved in the very beginnings of this effort since 2008. She served as the academy’s first chair. Stodola is a certified pharmacy technician (CPhT), and is completing a term of secretary of the newly formed academy. Stodola has worked as an auditing and compliance manager, a pharmacy PBM auditor, in customer compliance for McKesson medication management, Brooklyn Park, Minn., and Express Scripts, Inc./ValueRx, Bloomington, Minn. She completed an Associate in Applied Science in Pharmacy Technology along with an Associate in Arts from Century College in 2001. Stodola has also been active on the MPhA pharmacy technician conference planning committee. The annual summer conference continues to have a strong attendance. This indicates technicians’ interest in providing a forum for technician issues, for event notification and for individual stories regarding various practice settings. The newly formed MPhA Editorial Advisory Board is encouraging a section set aside each issue in the Minnesota Pharmacists journal for technician news. News for this section will be provided by members of the academy or by pharmacy technicians throughout the state. Stodola has agreed to be the central point person for technician news. She is also a member of the Editorial Advisory Board and will coordinate the information submitted to this section of the journal and facilitate the completion of this section. The first pharmacy technician section in the journal will be printed in the Fall 2011 issue. The title of this section is yet to be determined by academy members. Please work through the Pharmacy Technician Academy to the attention of Stodola, who handles communications for the academy, to submit ideas, news and event information. Contact information is: stodolab@aol.com. She can be reached by phone at 763-424-6799.

Minnesota Pharmacist Summer 2011 n

4 Fraud and Abu se Training 4 Pseudoephed rine Log 4 OSHA Requ irements 4 HIPAA Priva

Policies an cy and Security d Procedur es Quality As Program surance (QA)

Is a QA Program Missing From Your Checklist? Pharmacy Quality Commitment™ (PQC™) is what you need! Reduction of medication errors and implementation of a QA program are no longer options. A growing number of pharmacy network contracts require a process in place and no matter what it is called, QA, CQI, safe medication practices, or medication error identification and reduction program – PQC™ is the answer.

• • • • • •

The PQC™ Program: Legally protects reported data through a federally listed Patient Safety Organization (PSO) Helps increase efficiency and improve patient safety through a continuous quality improvement (CQI) process Provides easy-to-use tools to collect and analyze medication near miss and error data Presents a turnkey program to help you meet obligations for QA and CQI requirements Includes simple method to verify compliance Offers excellent training, customer service and ongoing support

Not all programs are the same, make sure your pharmacy and your data is protected. Pharmacies that license PQC™ and report patient safety events are provided federal legal protection to information that is reported through the Alliance for Patient Medication Safety (APMS) – a federally listed PSO. To learn more about PSOs, visit www.pso.ahrq-gov/psos/fastfacts.htm.

Call toll free (866) 365-7472 or go to www.pqc.net for more information. PQC is brought to you by your state pharmacy association.

Minnesota Pharmacist Summer 2011 n

AWARxE

Are You AWARxE Minnesota? By Julie K. Johnson, Pharm.D., MPhA Executive Vice President/CEO AWARxE was founded by the Minnesota Pharmacists Foundation (MPF) in 2009. MPF strongly believes that pharmacists have a critical role in providing medication safety information and helping raise awareness of the dangers of abusing and misusing medications. MPF is providing specific AWARxE information on safe drug use in the state of Minnesota. St. Cloud, Minn., was the home of Justin Pearson, the young man whose death was the inspiration for AWARxE. Due to Justin’s story <http://www.awarerx.org/about. php>, Minnesota has committed to an elevated responsibility in educating the public on the vital public safety and public health issue of prescription drug abuse and misuse. The Minnesota focused initiatives include AWARxE school and corporate presentations, which directly align with the following goals: • Inform parents and children of prescription drug abuse and misuse dangers. • Inform people of safe and proper medication disposal options. • Alert parents and children to the danger of online pharmacies. Let people know there is a chance they could be getting counterfeit medications. • Help people understand the importance of their relationship with their pharmacist in obtaining their prescription drugs. • Address the public perception gap – medicine is more than a commodity and individuals must take personal responsibility for their health care. Progress to date includes:

AWARxE provides a wide variety of educational tools and programs for youth. During the 2010-2011 school year, student pharmacists delivered 100 presentations about prescription drug use and abuse to middle school students in the Twin Cities and Duluth, impacting 2,582 students. Middle school students are targeted because 12- and 13-year-olds are the most common abusers of prescription drugs. These educational presentations provide vital information and a mentoring opportunity for college and middle school students. The goal for the 2011-2012 school year is to deliver a minimum of 150 presentations, primarily in the Twin Cities metro area. AWARxE billboards can be found on major highways across Minnesota, and the campaign’s commercials and radio spots are

broadcast on major stations. Educational brochures are distributed to students during presentations. AWARxE has created a guide for the safe disposal of medication that can be used at “take back” events across the country. Keeping old prescriptions may lead to misuse, and disposing of the drugs by flushing them down the toilet can be harmful to the environment. At “take back” events, police officers collect prescription drugs and dispose of them in a health-conscious, environmentally friendly manner. Community organizations desiring to hold a “take back” event can contact the AWARxE campaign administrator for the safe disposal guide and planning materials. AWARxE volunteers are available to help with these events. AWARxE personnel provided coordination for sites across Minnesota for the DEA’s National Prescription Drug Take Back Event on April 30, 2011. Nationwide, this effort resulted in the collection of 376,593 pounds (181 tons) of prescription medication for proper disposal. AWARxE has created a comprehensive curriculum for prescription drug safety that is available for nationwide use. South Dakota and Arizona have replicated Minnesota’s AWARxE campaign with the help of this curriculum. The Minnesota Pharmacists Foundation leads the Minnesota AWARxE effort with the full support and commitment of local and national partner organizations, including the Minnesota Pharmacists Association, Justin V. Pearson Memorial Fund, Genentech Pharmaceuticals and National Association of Boards of Pharmacy. Minnesota Pharmacists are urged to join us in changing and saving lives through education about prescription drug use and abuse by donating to the Minnesota Pharmacists Foundation (MPF). You may send checks to MPF at 1000 Westgate Drive, Suite 252, St. Paul, Minn. 55114. Your donation is tax deductible.

Officers of the Minnesota Pharmacists Foundation President: Marilyn Eelkema, and Board of Trustees: Howard Juni, Debbie Anderson, Dave McLean, Todd Sorenson, Linnea Forsell, Justin Anderson, Leslie Helou, Chuck Cooper, and Steve Simenson The AWARxE consumer protection program is brought to you by the NABP Foundation®.

Minnesota Pharmacist Summer 2011 n

PHARMACY MARKETING GROUP, INC. • PHARMACY and the law

Where have you Gone, Perry? By Kenneth R. Baker, B.S.Pharm., J.D.

Do you remember Perry Mason? How about Matlock? OK then, Denny Crane? Depending on your age, you should be familiar with at least one of these famous TV attorneys and their courtroom performances. This makes for entertaining TV, but in real life, the story is a little bit different. In most jurisdictions, the number of civil cases filed has been steady or increasing, but the number of trials has been decreasing. Why is this so? The first reason is the discovery process. Discovery is the phase of the litigation process where the opponents share or exchange information and evidence. This includes documents, oral testimony (depositions), and written questions & answers (interrogatories). This exchange is mandated by court rules. When discovery is complete, both parties should have all of the information that they need to evaluate the case and evaluate their chances of prevailing at trial. This typically makes at least one party reluctant to take the case to trial because they know what their chances are. No more surprise piece of evidence or last-minute, surprise witness. These Perry Mason staples are virtually unheard of today. There are still some surprises at trial, but they tend to be smaller issues rather than earth-shattering ones. The second reason is alternative dispute resolution (ADR). This ADR is different from the acronym that pharmacists are familiar with. ADR in the legal sense is a process of resolving cases without a trial. The most common forms are arbitration and mediation. In arbitration, the issues are presented to a neutral arbitrator who issues a ruling on the case. The process is greatly streamlined from that of a trial. For instance, in most cases, arbitration will not have live-witness testimony. It is quicker and less expensive than a trial. The ruling can be binding or non-binding. In the non-binding situation, the parties can evaluate the ruling and compare it to their own predictions, but are not forced to accept it. Binding arbitration is considered a final ruling. Mediation has no third-party decisionmaker. A neutral mediator works to get both sides to agree to a mutually acceptable settlement of the case. The mediator does that by moving between the 12

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parties, sharing information where necessary, and listening to the strengths and weaknesses of each side. If no agreement is reached, the parties move on in the litigation process. Nothing that is said or offered at a mediation is admissible at trial, so parties are motivated to be as open and honest as possible with the mediator. In many jurisdictions, at least one round of ADR is required before any case can go to trial. It is not uncommon for a judge to order the parties to a second, or even a third, mediation. In today’s legal environment, the possibility, or desirability, of trial is quite different from TV lawyers. They try a case almost every week. Non-TV lawyers might have as few as two or three civil trials per year. Some commentators have actually expressed concern that we don’t have enough trials. Case law is built on appellate decisions — and with fewer trials, there are fewer appeals. But with all our cards on the table and court rules that favor ADR, we shouldn’t be surprised that there are more settlements and fewer trials. Maybe that is a good thing, because it puts the parties in control of the ultimate resolution of their case and reduces the emotional toll on the parties. It won’t be as entertaining to watch Matlock take more depositions.

© Don McGuire, R.Ph., J.D., is General Counsel at Pharmacists Mutual Insurance Company. This article discusses general principles of law and risk management. It is not intended as legal advice. Pharmacists should consult their own attorneys and insurance companies for specific advice. Pharmacists should be familiar with the policies and procedures of their employers and insurance companies, and act accordingly. This series, Pharmacy and the Law, is presented by Pharmacists Mutual Insurance Company and your State Pharmacy Association through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy community.

PHARMACY MARKETING GROUP, INC. • PHARMACY and the law

CAN I GET SUED FOR THAT? By Don. R. McGuire Jr., R.Ph., J.D.

One of the questions that I get asked a lot is, “Can I get sued for that?” Unfortunately in today’s world, I have to answer yes; almost anyone can sue for almost any reason. While there are rules against filing frivolous lawsuits, the filing has to be pretty egregious to be considered frivolous. There are two better questions that get to the heart of what pharmacists really want to know. Do I have exposure for that activity? Do I have coverage for it? Since the bar is pretty low for the filing of a lawsuit, it is almost a given that you can be sued for any activity. However, that doesn’t reflect your exposure in that case. Filing a suit is quite different from winning a suit. The plaintiff will still have to prove the four elements of negligence in order to win their case. Let’s use pharmacist-administered vaccinations as our example. An analysis and evaluation of the pharmacist’s duties and possible breaches of those duties is the first step. Was the protocol followed, was the patient a proper recipient under the protocol, was the proper vaccine given, was it given properly, was the patient given proper information about the risks and benefits of the vaccine? If the answer to all of these questions is yes, then the pharmacist’s exposure is low. If not, then additional analysis is needed to see if the breach (or breaches) was the direct cause of the patient’s injury. For example, the patient was allergic to eggs, but received the vaccine and suffered an allergic reaction. If this were true, then the pharmacist’s exposure is higher. For any new service, the pharmacist should consider what duties are required for them to provide the service, the possible ways that those duties could be breached, and the possible injuries that could result from that breach. In this way, the pharmacist can evaluate their exposure for providing any new service. As you can see, this is more in depth than merely asking if you can be sued if you administer vaccines.

only $950,000 of a $1 million limit is left to pay a loss. This becomes very important in a case that is long and expensive to defend. In the other version, the defense coverage is separate from the loss coverage and doesn’t erode the loss limits. In either case, if the loss is covered, the defense coverage provides for the defense of the suit, no matter how frivolous or low the exposure might be. Because of the high cost of legal services, the defense coverage can be an important asset for any pharmacist to have. Even defending a frivolous suit could cost thousands of dollars. Can a pharmacist be sued for a given activity? The answer is almost certainly — yes. But that should not stop a pharmacist from providing inventive, progressive patient care. A more indepth analysis of the true exposure is required along with verification of insurance coverage for that exposure. There may be activities that are determined to be too risky, but that shouldn’t stop pharmacists from continually striving to provide the best possible care for their patients.

The second important question is whether there is insurance coverage for the activity in question. Insurance policies typically provide two types of coverage; loss coverage and defense coverage. Loss coverage is the portion of the policy that covers the damages exposure that we have already discussed. This is obviously very important to have for any activity that a pharmacist performs. Equally important is the defense coverage. This is the portion of the policy that pays for defense attorneys, expert witnesses, court reporter fees, etc. Defense coverage is available in two forms. In one version, the defense costs are included in the loss coverage limit. In this version, if $50,000 is spent on defense costs, then Minnesota Pharmacist Summer 2011 n

hubonpolicyandadvocacy

Exhibit ACO: Carilion pharmacists set example Reprinted with permission from the Hub on Health Care Reform column in the July 2011 issue of Pharmacy Today (www.pharmacytoday. org). For more information about the Affordable Care Act and pharmacy’s role in shaping the outcomes of this law, access the Government Affairs section of APhA’s Web site, www.pharmacist.com. Copyright © 2011, American Pharmacists Association. All rights reserved. Regulatory scorecard: What is happening NOW! Proposed regulations receiving public comments:  HHS: Comments due by August 1 on a proposed rule that would amend the Health Insurance Portability and Accountability Act of 1996 to provide individuals with the right to receive a report detailing who has accessed their protected health information  CMS: Comments due by August 1 on a proposed rule that would implement section 10332 of the Affordable Care Act, which directs the HHS secretary to make available to qualified entities data for the evaluation of the performance of providers of services and suppliers Requests for information for which comment periods have closed:  FDA: Public workshop, “Determination of System Attributes for the Tracking and Tracing of Prescription Drugs”  AHRQ: Request to the Office of Management and Budget to approve a survey to measure community/retail pharmacy staff perceptions about organizational priorities and patient safety attitudes/ behaviors Etc:  DEA: More than 188 tons of unused medications were turned in during the second National Prescription Drug Take-Back Event on April 30, 2011.  For a complete list of all the issues and regulations being monitored and acted on by APhA, access the Government Affairs section of pharmacist.com. Also, print readers of the Hub should know that hyperlinks to pharmacist.com, Federal Register notices, and other useful Web sites can be accessed in the online version of the Hub, located at www.pharmacytoday.org.

Promoting the success of his accountable care organization (ACO) is part of this pharmacist’s job.

his goods. But “in an ACO, I have to think beyond those boundaries,” he explained. “I have to get outside of that silo.”

“This is kind of like being pregnant or not. Either we are going to be successful at this or we will fail,” said L. David Harlow III, BSPharm, Director of Pharmacy Operations at the Carilion Clinic’s New River Valley Medical Center in Christiansburg, Va., and Tazewell Community Hospital in Tazewell, Va. He expects to earn his PharmD in 2012.

For instance, take dabigatran (Pradaxa® — Boehringer Ingelheim). “Brand-new product,” Harlow said. “The beauty of this blood thinner is it doesn’t require much lab monitoring. And it’s oral.” Older options include warfarin, an oral version that requires heavy monitoring, or an injectable product that’s expensive and that patients don’t like.

Carilion Clinic is the largest of the participants in the Brookings/Dartmouth ACO Project, which is working with private insurers and federal agencies such as CMS to secure similar payment methods. The 3-year pilot starts at the beginning of 2012, when the first ACOs under a proposed rule CMS issued on April 7 are also supposed to roll out. (See the September 2010 Pharmacy Today for an initial article on Carilion.)

Pradaxa® costs $4 to $5 a tablet. Warfarin costs 5 cents. But maybe the patient who comes to Harlow’s facility is from the hills of western Virginia, with no real ability to get labs drawn except through home health.

Harlow stopped by APhA headquarters on May 25 to give a talk on the topic of pharmacy’s place in an ACO. “An accountable care organization is really a type of payment and delivery reform model that ties provider reimbursement and quality metrics to the total cost of care for some population of patients,” Harlow said. “The payments are going to be directly linked to quality improvements that reduce overall costs.” So the clinical business model will change and evolve, he said. “Can I stand here today and tell you exactly what that looks like? No. Can I guarantee you that it’s going to change drastically? Yeah, pretty much. We’re going to be faced with difficult decisions.” Thinking differently

Pharmacists in an ACO have to think outside of their department. Harlow said that he could impress his chief financial officer by decreasing the cost of

Minnesota Pharmacist Summer 2011 n

“We’re building in cost of care,” Harlow said. “I can make my spreadsheet look really good by saying Pradaxa® is not on my formulary. But if I look beyond the scope of that in an ACO structure,” given that ACOs eventually “get nailed for readmission” with penalties for hospital readmission rates, “I look at my formulary and say this extra cost is worth it in this product because the outcomes are better for the patient and for the ACO.” Patient care

Patients with chronic conditions represented 78 percent of health care spending in 2000, Harlow said. Pharmacists can make an impact on chronic diseases, and therefore on the entire conversation of health care reform. “There is no better place for a good clinical pharmacist than a chronic disease whose primary means of treatment is a drug: diabetes, COPD [chronic obstructive pulmonary disease], CHF [congestive heart failure],” he said. “So if I combine this with the ACO mentality and start talking to the C-suite about it, then pharmacy has the potential to impact these chronic diseases across the continuum of care.” Exhibit ACO continued on page 15

hubonpolicyandadvocacy Exhibit ACO continued from page 14 “In a rapidly changing health care environment, the reimbursement landscape and the relevant success of pharmacy will largely depend on our ability to move into direct patient care roles that are easily tied to monetary benefit and increased positive qualitative and quantitative measures that support scorecard metrics in an accountable care organization,” Harlow said. “It’s a brand-new world, at least where I live. … It is a little scary, though, to be honest with you, because the road map is not completely written out.”

Pharmacy to CMS: Explicitly include pharmacists in ACOs

In June, six joint comments to CMS on the April 7 proposed rule on accountable care organizations (ACOs), the Health Care Reform Pharmacy Stakeholders recommended that CMS clarify in the final rule that pharmacists are among the health professionals eligible to serve as full members in ACOs. “Pharmacists can help patients better manage their medications and chronic conditions, thereby reducing hospitalizations and rehospitalizations,” the group wrote. “Pharmacists’ participation in ACOs will help ACOs reach CMSdetermined clinical and financial performance targets that will show improved patient results and lower health costs.” The proposed rule implemented section 3022 of the Affordable Care Act (ACA), which established the Medicare Shared Savings Program that is intended to encourage the creation of ACOs. (See page 19 in the May Pharmacy Today.) The Health Care Reform Pharmacy Stakeholders group comprises 14 pharmacy organizations, including APhA. The group supported CMS in the development of ACOs and commended the aims of the proposed rule. Other recommendations were that CMS reconsider the extensive administrative requirements that may limit formation of ACOs, include pharmacists in data sharing through ensured access to electronic health information, and consider gradually

Harlow also said that in the future, there will be less reimbursement for institutions, so that all providers, including pharmacists, will have to work with fewer resources; and that pharmacists have to see themselves as providers. “We have to sell it,” he said. “Nobody’s going to believe that pharmacy is a direct patient care provider unless we believe it ourselves.” Emerging structure

In an e-mail to Today after his talk, Harlow described pharmacy-related pilot initiatives that Carilion has adopted in the process of phasing in the proposed quality provisions. The administrative requirements—which were intended to counter fraud, waste, and abuse—may present too much of a burden for potential ACOs, according to the stakeholder group. “We understand from national dialogue that the current proposal presents challenges that may prevent organizations from participating,” the joint comments said. “Much of the success of ACA implementation is based on the uptake of the ACO concept and the willingness to take on risk.” In the national dialogue on ACOs, the proposed rule has not been well received. The American Hospital Association (AHA) released on May 13 a study estimating that the start-up investment required to establish and sustain an ACO was $11.6 million to $26.1 million, instead of the $1.8 million suggested by CMS in the proposed rule for start-up and 1 year of operation. Seven Republican senators signed a May 24 letter asking CMS to withdraw the proposed rule and “craft a new rule that fulfills the promise of ACOs.” According to the letter, which cited the AHA study, nationally known integrated health providers “have expressed serious concerns with the details of the proposed rule.” On May 17, as the national reaction to the proposed rule was gathering steam, CMS announced three new initiatives related to ACOs.

ramping up to become an ACO. In one initiative, pharmacists are embedded in selected primary care clinics and patientcentered medical homes, focusing on chronic diseases and polypharmacy patients. In another initiative, the information technology department has begun creating the capability for virtual consults for other clinics that don’t have a pharmacist physically on site but that would benefit from a pharmacist’s work in a patient’s chart. Exhibit ACO continued on page 23

The Pioneer ACO Model is intended to provide a faster path for mature ACOs that have already begun coordinating care on a track consistent with, but separate from, the Medicare Shared Savings Program. Also, an Advance Payment Initiative was proposed to authorize specified ACOs to access a portion of their shared savings up front to help with infrastructure and staff investments. Third, a series of free Accelerated Development Learning Sessions for executive leadership teams from existing or emerging ACO entities kicked off with a June 20–22 session in Minneapolis. What will be the fate of the ACO proposed rule? “I think the rule will be changed to remove some of the administrative burdens in the final rule,” Brian Gallagher, BSPharm, JD, APhA Senior Vice President of Government Affairs, told Today. “The big question is whether it’s going to go far enough so ACOs will form, because people are saying they can’t make it work” under the proposed rule. Pharmacists interested in participating in ACOs should still be talking to people thinking about forming ACOs. “If the rule changes, then they’ll be in a position to partner with them to save money,” Gallagher said. “Pharmacists are in a great position in terms of being able to contract with an ACO and avoid the administrative burdens. What pharmacists need to be able to do is show how they can help the people forming the ACOs save money by appropriately managing people’s medications.” Minnesota Pharmacist Summer 2011 n

MPhA Annual Meeting Highlights The weather was great at Madden’s Resort during the 127th annual meeting in June. We thank our numerous sponsors and exhibitors who continue to help us present this annual weekend away. June 10-12, 2011, was filled with educational programming and networking opportunities, as well as fun events for pharmacists, technicians, and students. Educational sessions this year included outstanding programming in diabetes care and up-tothe-minute health care reform news from Washington, DC. Brent Thompson concluded his year as president and helped to swear in Scott Setzepfandt as the new leader. Newly elected members of the board include President-Elect Martin Erickson, Tim Cernohous, Amy Sapola, Jeremy LeBlanc and Kandace Schuft. Additionally, current board member Jill Strykowski will be on the next ballot as a presidential candidate. Students, numbering more than 50, played a large role in the meeting and festivities. MPhA continues to support the attendance of these future leaders — encouraging participation and assistance with the meeting’s activities. The students also represented a good showing at the House of Delegates session on Sunday. A review of policy passed by the House of Delegates is on page 19. Rod Carter received the Harold R. Popp Award for outstanding service to the profession of pharmacy. The Bowl of Hygeia Award, recognizing pharmacists who possess outstanding records of civic leadership in their communities, was given to John Hoeschen, while the Excellence in Innovation Award went to Camille Kundel. The recipient of the Distinguished Pharmacist of the Year was Sarah Leslie, New Ulm Medical Center. George Konstantinides received the Patient Education Award while Justin

Anderson and Elizabeth Dow were recognized for their leadership in the Minnesota Pharmacy Student Alliance with the President’s Awards. Brent Thompson commended the work of the Board of Directors during his service and presented many of the awards both during the President’s Banquet on Saturday night and during the Sunday Honor Brunch. “The tradition of recognizing pharmacists who contribute their time and expertise to their profession is one that is near and dear to what MPhA is about,” noted Thompson. The following outgoing board members were recognized: Bruce Thompson, Ted Beatty, Randy Seifert, Brittany Alms, and Alicia Mattson. Incoming and returning board members were announced and sworn in: Martin Erickson, Tim Cernohous, Jill Strykowski, Cheng Lo, Eric Slindee, Jason Varin, Kandace Schuft, and Jeremy LeBlanc.

“I pledge to uphold the articles and bylaws of the Minnesota Pharmacists Association and contribute my professional expertise to the work of the board in its guidance of association initiatives and goals.”

Please join us next year at Arrowwood Resort in Alexandria, June 22 to 24, 2012

MPhA student attendees with Rod Carter, 2011 Harold R. Popp award recipient (front, left of center holding award)

Minnesota Pharmacist Summer 2011 n

Rod Carter received the Harold R. Popp Award, sponsored by MPhA. The award was established in 1969 in honor of the late Senator Harold R. Popp, who was known to support the profession tremendously during his lifetime. This award recognizes one pharmacist annually for outstanding service to the profession of pharmacy and is the highest honor bestowed by MPhA. Carterâ&#x20AC;&#x2122;s most notable contribution to pharmacy was his role to provide the leadership for the expansion of the College of Pharmacy campus at Duluth.

Brent Thompson presented the Excellence in Innovation Award to Camille Kundel. The national award is coordinated by the National Alliance of State Pharmacy Associations, and generously sponsored by Upsher-Smith Laboratories, Inc., to recognize and honor a qualified pharmacist who has demonstrated significant innovation in their respective practice, method or service, directly or indirectly resulting in improved patient care and/or advancement of the profession of pharmacy.

Melissa Middaugh, McKesson, made a special presentation to incoming MPhA President Scott Setzepfandt.

Distinguished Pharmacist of the Year was Sarah Leslie, New Ulm Medical Center.

Martin Erickson gives the Pharmacistâ&#x20AC;&#x2122;s Mate Award, sponsored by Gallipot, to Colleen Dokken for her support of Brent Thompson during his presidency. Minnesota Pharmacist Summer 2011 n

MPhA Annual Meeting Highlights, continued

The Distinguished Young Pharmacist award is sponsored by Pharmacists Elizabeth Dow and Justin Anderson were presented the Presidentâ&#x20AC;&#x2122;s Award Mutual Companies, and recognizes a young pharmacist who has distinDuluth and Twin Cities by Brent Thompson for leadership of their guished himself/herself in the field of pharmacy (left to right, Reid Horning, respective groups. Sarah Leslie, Brent Thompson). This award has been presented since 1987 and was presented by Leeann Wheeler with Pharmacists Mutual.

The Bowl of Hygeia Award for an outstanding record of community serBruce Thompson receives the MPhA traditional green jacket for dedivice was presented to John V. Hoeschen. The Bowl of Hygeia is the most cation and time devoted to the work of the Minnesota Pharmacists widely recognized international symbol of pharmacy and derives from Greek Association over the past three years. mythology. Hygeia was the daughter and assistant of Es-Kah-Lay-Pi-Ous, the God of Medicine and Healing. Her classical symbol was a bowl containing a medicinal potion, with the serpent of wisdom (or guardianship) partaking of it. This is the same serpent of wisdom that appears on the caduceus, which is the symbol of medicine.

Minnesota Pharmacist Summer 2011 n

2011 Speaker of the House Report by Meghan Kelly, Speaker I would like to begin by thanking all those who attended the 2011 Annual Meeting, with special thanks to those who served as delegates. Your presence and active involvement helps guide MPhA’s actions and focuses our efforts throughout the year.

RESOLUTION 11-002

In an effort to keep the resolutions passed at this year’s meeting from becoming simply a memory, the Speaker’s Report is now provided at the beginning of the MPhA organizational year so the incoming Board of Directors can use your input to help guide their strategic plan for the year. The report contains the policies presented and the actions taken by the House of Delegates at the 2011 Annual Meeting. All official House documents are located on MPhA’s Web site — including MPhA articles and bylaws, policy flow chart, and delegate news.

Submitted by: MPhA Professional Affairs Committee

Policy Resolutions from 2011:

Resolutions were presented for consideration by the House and action taken as follows: RESOLUTION 11-001 Subject: Pharmacy Practice Model Presented by: Dan Kennedy, Committee chair Submitted by: MPhA Professional Affairs Committee

Subject: Pharmacy Internet Access Presented by: Dan Kennedy, Committee chair

House Action: Adopted MPhA supports employer provided worksite access to the Internet to optimize patient safety, medication therapy management and clinical outcomes and to ensure compliance with state and federal law. MPhA’s policies are created and enacted by you, our members. I encourage you to act on these policies and make them relevant to your practice. They are here to support and encourage you as you work to serve your patients. I also encourage you to bring forth issues that may not be addressed by our policies, so we may continue to advance our profession. Thanks again for your continued support and active involvement; I look forward to seeing all of you throughout the year.

Meghan Kelly Speaker, House of Delegates, MPhA

House Action: Adopted Consistent with the vision for pharmacy practice as expressed by the Joint Commission of Pharmacy Practitioners’ “Future Vision of Pharmacy Practice 2015”; MPhA will seek and establish relationships with various professional organizations to create a collaborative environment to bring the vision to reality.

Join Us for the MPhA 2011 Annual Fall Clinical Symposium.

Fall Clinical

symposium

Immunizations AND Infectious Disease

September 10, 2011 Crowne Plaza Minneapolis West Plymouth, MN

Our focus this year is on immunization and infectious disease. We are excited to have Minnesota Department of Health epidemiologist Dr. Ruth Lynfield providing an infectious disease update, and North Carolina Association of Pharmacists Director Fred Eckel discussing a future pharmacy practice model for implementing the JCCP Vision 2015. This meeting indeed provides a day of rich educational content as well as networking time for pharmacists. Please join us! Scott Setzepfandt, R.Ph. MPhA President Minnesota Pharmacist Summer 2011 n

feature

Phalen Family Pharmacy: A Long-Awaited Step in Addressing the Unique Needs of the Hmong People in their St. Paul Community by Rita Tonkinson Dr. Chengseng Lo stands at the pharmacy counter in the newly opened Phalen Family Pharmacy.

Perhaps watching non-English speaking people struggle with understanding Western medicine or simply trying to pick out a suitable over-the-counter medication, Chengseng (Cheng) Lo, Pharm.D., began moving beyond the pharmacy counter and reaching out to individuals who were obviously in need of counseling, or perhaps, just someone to help make the right selection. It was then, while working at Setzer Pharmacy on Rice Street in St. Paul, that he formed the idea of outreach and education in the community to help foreign-born patients begin to trust Western medicine. The Setzer Pharmacy community is diverse. People of many cultural backgrounds visit the pharmacy. It was apparent to pharmacist/owner Gary Raines that there was an unmet need in the neighborhood for education on pharmacy services. While in the outreach role at Setzer’s, Dr. Cheng’s desire to help bridge the gap for his people began to emerge. At Setzer Pharmacy, the culture of taking time with patients, helping them understand how, when and why to take medications, was and is how that pharmacy operates. When he moved to a CVS pharmacy at Arcade and Maryland, Dr. Cheng became acutely aware that his people, the Hmong families of that neighborhood, were not getting the help they needed; they were not getting basic counseling because of the language and cultural barriers. On Sunday, May 15, 2011, Dr. Cheng’s dream of providing the best possible pharmacy services to his people became reality. On that day, Phalen Family Pharmacy in the Hmong Village Shopping Center at 1001 Johnson Parkway, St. Paul opened for business. Dr. May Xia Lo, Pharm.D., BCPS, and Dr. Cheng were about to realize their long-planned goal – to team up as pharmacy owners, providing their community a pharmacy environment of safety, caring, learning, understanding, and ease of communication. From the outside of the shopping center, a single banner on the front of the building announces the pharmacy inside. While looking for B23, the pharmacy’s numbered location, a stroll through the aisles of this sprawling building is an introduction to the sights, sounds and aromas of the Hmong people. In a corner near the main entrance, next to the fresh produce, is the glass front to the pharmacy. Just feet away, children were playing with a ball on the concrete floor and shoppers were haggling over prices of fruits and vegetables. But as Dr. Cheng pointed out, “This is a perfect place 20

Minnesota Pharmacist Summer 2011 n

for a pharmacy. There is plenty of foot traffic – we just have to get acquainted with our community.” “We do, of course, reach out to the greater community,” Dr. Cheng said. “The goal is to provide pharmacy services to everyone in the community.” Because there is not a pharmacy entrance from the parking lot, he said, many people may not realize a pharmacy is here. The pharmacy wants more outdoor signage, perhaps a sign near all of the entrances. Phalen Family Pharmacy has segments on the all-Hmong, 24-hour radio station, where three commercials are run daily. The messages are educational but they are also promotional. The goal is to let the neighborhood know this is their pharmacy – this is the place to come with their medication needs and health questions. “In addition to counseling, follow-up is particularly important. Many of the Hmong people are shy and unaware about calling the pharmacist for recommendations. So we ask the questions, we look at all of their medications, we sort the medications with regard to disease states and then explain what the medication will do if taken as directed,” said Dr. Cheng. “Our challenge here is greater than a large busy pharmacy can provide, simply because of their business model. We are hoping to make a difference, one patient at a time. May Xia and I are devoting our energies and our expertise to improve the lives of our patients beyond what they have experienced to date. That is our driving force. “My people generally have a distrust of Western medicine. Many, particularly the elderly, still cling to the ‘old ways’ of self-medication with herbal remedies. Our customer base here is about 99 percent Hmong. And within that population, diabetes and related heart disease states are common. In addition, patients are overwhelmed by co-pays and insurance restrictions they don’t comprehend; we try to help them understand their insurance as well.” Of the patient population, about 30 percent are medical assistance (MA) and of those, 80 to 90 percent are medication therapy management (MTM) eligible. Dr. Cheng said their hope is to incorporate a strong MTM program in the near future as they build their practice. Phalen Family Pharmacy continued on page 21

feature Phalen Family Pharmacy continued from page 20

Women would likely not ask health related questions in a crowded, busy pharmacy – there is a need to build trust in a comfortable setting. Her clinical background and her training have prepared her to provide help to women with sensitive health issues through asking the right questions. The pharmacy has a comfortable conference room for closed-door consultations. When transportation to a clinic is not available, Hmong women may allow health conditions to deteriorate. In having this health education service available in a non-threatening environment, Hmong women can have their questions answered regarding the need to seek further medical treatment. Outside of patient time, the pharmacist/owners are experiencing long days. “There is so much accounting involved. We are learning more about the business aspect every day. I guess we didn’t anticipate the long hours; when our business is stronger, we will hire an accountant. Until then,” Dr. Cheng said, “it’s what we have to do.”

Dr. May Xia and Dr Chengseng Lo greet family, friends and community at the ribbon-cutting ceremony on May 15, 2011.

Dr. May Xia has experience working collaboratively and successfully with physicians during her clinic work, Dr. Cheng said. “If we can develop more collaboration with physicians, people will experience better outcomes and begin to understand the importance of compliance. It would be great to have Hmong physicians here in the shopping center. Many of our patients do not have transportation.” An ideal scenario, Dr. Cheng said, would be physicians and an urgent care center, along with the pharmacy, in this center where they regularly shop. “I guess you might say we want to build a Setzer-like pharmacy staffed by Hmong speaking pharmacists, technicians and clerks,” Dr. Cheng said. “Our pharmacy technician is fluent in Hmong. Reading and writing Hmong is a must. All of our prescription labels are printed in both Hmong and English. Because everyone on staff is fluent and can respond to a variety of questions, we believe that the comfort level of patients enhances their pharmacy experience. “Both Dr. May Xia and I are preceptors. We have one second-year student who started here July 18. We have three more students lined up after August 8,” Dr. Cheng said. “We hope our students will take away a new understanding of the fears that non-Englishspeaking patients experience with regard to medications. “I want to offer a very unique service – one that has never been done, to my knowledge. Dr. May Xia and I are willing to accompany a patient and his/her family to a clinic or hospital meeting with their medical providers. We would listen, observe and become the medication manager. We could then educate the patient, and perhaps the family, about stroke, heart disease and diabetes in our pharmacy while dispensing their medications,” Dr. Cheng said. “We believe there could be a major change in outcomes.” Educating the whole family, Dr. Cheng said, is the key. Hmong elders make decisions for family members regarding health services. Everyone needs to be informed to make changes in the overall health of the community, he said. Another service that is currently offered at the pharmacy is the caring and insight that Dr. May Xia can offer female Hmong patients.

Dr. Cheng said his father, Yao Lo, has been a strong figure at the Lao Family Community Center in business and in volunteering, working with the state government in locating jobs and helping Hmong people become financially independent. “I want to make change happen in the health care arena, helping to solve the issues of my people in this health care environment,” Dr Cheng said, “As a pharmacist, I am in a unique position to intervene when patients are confused, overwhelmed and fearful. “I followed the advice of Julie K. Johnson, Pharm.D., executive director and CEO of the Minnesota Pharmacists Association and mentor, If you want to see change, then you have to work to ensure that the change you want happens. “At Phalen Family Pharmacy, we all speak the language, share the history and are committed to helping Hmong patients know that this pharmacy is a place where their needs are met.” Dr. Chengseng Lo is a 1998 graduate of the University of Minnesota, College of Pharmacy with a doctorate in pharmacy. He worked at Setzer Pharmacy in St. Paul for several years. Part of his role there was community outreach. He has been a guest speaker in kindergarten to high school and university level classrooms. Dr. Chengseng Lo is a preceptor, training pharmacy students during their community pharmacy rotation. He has been named Preceptor of the Year, and believes the role of pharmacy preceptor is vitally important. While at CVS located at Arcade and Maryland, where the majority of the patients are Hmong, he continued to plan for a pharmacy dedicated to serving the Hmong community. Dr. May Xia Lo, Pharm.D., graduated from the University of North Carolina in 2002 and completed her residency at the University of Minnesota. After working as a clinical specialist at the Community University Health Care Center in Minneapolis, she moved to St. Paul to expand pharmacy services to the East Side Family Clinic. She has served as a preceptor for postgraduate pharmacy residents. She will continue to be a preceptor at the Phalen Family Pharmacy. Rita Tonkinson is a contracted staff writer for the association, who provides insightful looks into the field of pharmacy for our readers. Minnesota Pharmacist Summer 2011 n

Feature

How to improve your team’s morale

Employees need guidance and leadership, not sympathy By Nathan Jamail

Many times in business, much like in life, a person’s perspective determines one’s morale or attitude more so than any actual situation does. Many companies will make statements such as, “the morale of the team is down because of recent company changes, cuts in benefits and employee layoffs.” These issues are real and the impact it has on people is real as well. Let’s not diminish real emotions tied to these issues that cause morale to be low. However, to improve morale is to change the team’s perspective versus looking for a golden answer. An organization can spend all its time focusing on these changes and continue to experience negative emotions, or it can choose to change the perspective of its people. Which do you think is more productive and advantageous? In some situations a company may hire a motivational speaker to speak to its group about a tragedy and as a result, the audience gets motivated and is eager to make the best of their personal situation. Why is that? What happened was a change of perspective. When a leader is faced with low employee morale, his/her job is to hold team members accountable by teaching the team members to be grateful before they can be successful and happy even if they are not necessarily content. workers start to sympathize with each other on the struggles or unfairness of the job. The intent of these leaders is to show comEverybody can be grateful for what they have, but more often than passion and empathy for their team members and therefore hopenot we forget to think about the good. In one room a young couple fully help them turn around their morale, but instead they end up is disappointed when they find out they are having a baby girl confirming why the morale should be bad. To improve morale the instead of a baby boy, where just across the street there is a young leader must change the team member’s perspective. This is not a couple grateful for the six hours they have with their newborn baby cold or insensitive approach, it is an empathetic approach that says before she passes away. In the business world it is no different. In the feelings the person is feeling are real, but may not be necesDallas, a gentleman is upset and feels like he is not treated fairly sary, helpful or have a purpose. The leader’s job is to give the team because due to company financial struggles, they remove company members hope and understanding, not sympathy. cars and increase the current work loads to make up for those that When a team complains about work load increase due to others were laid off. In the same city, a man and woman need to figure out where they are going to live because they just had to close their being laid off or people leaving the company, the leader should discuss how the individual now has the opportunity to step up even small business, file bankruptcy and can’t pay their bills. It is all about perspective. Smart parents around the world tell their children more than before and challenge them to own the job … not in a to be grateful for what they have, because there is someone out there cheesy, “you can do it” cheer, but in a real tone, that says this is what it will take from the team; and each person has to decide if who has it a lot worse (and by the way-those “someone’s” usually they are committed and willing. have a better perspective than others). Difficult times do not cause bad morale the lack of gratefulness It does not do any good to sympathize with employees when they does. Leaders need to take a look at their team and their situaare complaining about workload or removal of benefits and even A person must be grateful before they can be successful

pay cuts. In fact, the bad morale is created when leaders and 22

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Improving Team Morale continued on page 23

Feature

hubonpolicyandadvocacy

Improving Team Morale continued from page 22

Exhibit ACO continued from page 15

tion and know they are the only ones who can change it. Morale is a result of the actions or lack of actions of the leader and the team. By taking this positive attitude on, the individuals win, the company can win again, which will come right back to the individuals in the long run. Every decision is a choice. One can stay and complain and be miserable, one can leave and hope for something better, or one can truly change perspective, be grateful and move forward with a purpose. Stop searching for happiness. It is not a destination: rather it is a state of being

A leader once said that if your goal is to be happy then you will never be happy. People say it all the time, “My goal is to be happy.” What are they really saying? Are they not happy now or is their goal to stay happy? There is the old saying “money can’t buy you happiness” and everybody has heard the ending, “yes, but it can buy the things that make a person happy.” Deep down everybody truly wants to be happy; however, people are not happy because they are successful – they are successful because they are happy.

“Because of the lack of realistic reimbursement models, we are actually subsidizing those positions from our current pharmacy staff, which of course can only be a temporary and limited answer to the issue,” Harlow told Today. “Pharmacy is trying to make certain that all levels of the organization understand how we can impact the big picture and allow opportunities to come forward as the ACO’s real structure begins to emerge.” Although Harlow said that in principle the ACO concept is the future, he cautioned that no organization, including his, would adopt the April 7 ACO proposed rule as written. “The bottom line is the bottom line,” he said. (See sidebar on page 15.) —Diana Yap

A great leader must insist on all team members being happy, and if anybody is not happy they should find a new place to work or hang out. Keep in mind that being happy does not mean being content. Life and business is game of competition with oneself. As people and as business leaders, one must always strive to be better and improve. When people stop trying to improve or learn they become bored and content (and actually unhappy). Contentment is a major contributor to morale. Contentment is like quicksand; anybody can fall in it and it will continue to pull a person down until they are gone or until a leader challenges them and pulls them out. If an organization is having a morale issue, look at the happiness and contentment of the team. Just remember: Contentment is like bad breath; sometimes we can’t smell our own bad breath and we need someone to tell us, so we can change it. Get in a happy state of being and challenge yourself and your team to never be content.

Nathan Jamail, best selling author of “The Playbook Series,” is also a motivational speaker, entrepreneur and corporate coach. As a former executive for Fortune 500 companies, and owner of several small businesses, Nathan travels the country helping individuals and organizations achieve maximum success. A few of his clients include Fidelity, Nationwide Insurance, The Hartford Group, Cisco, Stryker Communications, and Army National Guard. To book Nathan, visit www.NathanJamail.com or contact 972-377-0030.

The Minnesota Pharmacists Foundation works to create a strong future for pharmacy by investing in pharmacists of tomorrow. The Foundation backs this commitment by providing annual scholarships to pharmacy students attending the University of Minnesota campuses in Duluth and Minneapolis. Visit our page on Facebook or the MPhA site to learn more about how you can help us achieve our goals!

Minnesota Pharmacist Summer 2011 n

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PLAN CAREFULLY WHEN IT’S TIME TO

MAKE A CAREER MOVE The days when an employee would spend his or her entire career with the same company appear to be all but gone. Nowadays, beyond simply changing jobs over the course of a career, many workers even take on an entirely new career before they finally reach retirement. When you make a job change, one of the biggest challenges you may face could be deciding what to do with the assets you’ve built up in your former employer’s retirement plan. Unfortunately, many people look at these funds as a free gift when they change employers, and they choose to take a cash payment and spend it. Keep in mind one of the most important sources of your retirement income is the payments you receive from company retirement plans. By taking the money out in cash, you eat away at this valuable source of retirement income. Instead of taking the cash, you may want to consider rolling the money from your company-sponsored plan into an IRA. A direct rollover, where the funds from your company plan go directly into an IRA, is a simple way to allow these assets the opportunity to continue to grow tax-deferred, and will help you avoid the temptation to spend these important funds on other things. Moving from job to job may not be the only change you’re considering. IRA rollovers can also prove useful if you decide that instead of just changing jobs, you want to retire. If you’re younger than 59½ and would like to take withdrawals from a retirement account, you may be able to avoid the IRS 10% early withdrawal penalty as long as the withdrawals qualify for certain exceptions. Let’s take a look at an example to help illustrate the options. John is 58 years old, and would like to retire early to join his wife Carol, 57, who retired two years ago. Currently, their modified adjusted gross income (MAGI) is $98,000, but if John retires that figure will drop to $48,000. This should still be enough to cover all their expenses, except their mortgage payments. John has a 401(k) balance of $300,000 and an investment portfolio worth another $125,000, while Carol has an IRA with a current value of $25,000. They are considering taking $100,000 out of their retirement nest egg to pay off their mortgage, but if they’re not careful, doing so could require them to pay both income taxes and the IRS 10% early withdrawal penalty on the amount they withdraw.

at retirement, John would qualify for a special “55 or over” exception, meaning he would not face the early withdrawal penalty. The remainder of his 401(k) balance could still be rolled into an IRA. As another alternative, John could roll the money from his 401(k) into an IRA first. He could then use one of three IRS-approved withdrawal methods to take “substantially equal periodic payments” from the IRA without an IRS penalty, and use that money to make their monthly mortgage payments. While these withdrawals would be taxable, this strategy could still allow for greater tax deferral because the entire 401(k) distribution could be rolled over. As you can see from these examples, it’s important to know what your options are and you may need to consult with financial professionals — including your tax advisor — to sort them all out. Whether it’s your first job change or your last, your retirement nest egg needs to be handled with care. Consider your alternatives so you can make good decisions to keep your savings in line to meet your needs.

Provided by courtesy of Pat Reding, CFPTM of Pro Advantage Services Inc., in Algona, Iowa. For more information, please call Pat Reding at 1-800-288-6669. Registered representative of and securities offered through Berthel Fisher & Company Financial Services, Inc. Member NASD & SIPC. Pro Advantage Services, Inc./Pharmacists Mutual is independent of Berthel Fisher & Company Financial Services Inc. Berthel Fisher & Company Financial Services, Inc. does not provide legal or tax advice. Before taking any action that would have tax consequences, consult with your tax and legal professionals. This article is for informational purposes only. It is not meant to be a recommendation or solicitation of any securities or market strategy. This series, Financial Forum, is presented by Pro Advantage Services, Inc., a subsidiary of Pharmacists Mutual Insurance Company, and your State Pharmacy Association through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy community.

One option that may help would be to take a $100,000 withdrawal from John’s 401(k) to pay off the mortgage. This would result in taxable income, but since he would be older than age 55 Minnesota Pharmacist Summer 2011 n

Student Perspective

The Pharmacist’s Role in

Public Health

By Laura Palombi, Class of 2012, student at the College of Pharmacy in Duluth, MPSA’s Vice-President of Community Outreach

How can you help your patients live longer and healthier lives? Will you be ready when disaster strikes? What are you doing to help eliminate health disparities? How will you respond in the event of a pandemic? These questions and others remind us as pharmacists that our role in the healthcare system goes far beyond preparing and dispensing medications. Pharmacists in Minnesota play a critical role in the health of their communities and in their state, but our profession remains an untapped resource in the larger world of public health.

What is Public Health? Public Health is concerned with protecting the health of entire populations. The goal of public health is to safeguard and improve the health of communities through education and promotion of healthy lifestyles. Public health is also focused on research for disease and injury prevention as well as limiting health disparities and promoting health care equity, quality, and accessibility.

Why is Public Health Important?

Public health professionals try to prevent problems from happening or re-occurring through the implementation of educational programs, the development of policies, the regulation of health systems, the conducting of research and the administering of services.

Public health initiatives help people live longer, healthier lives! During the 20th century, the health and life expectancy of individuals living in the United States improved dramatically. The average lifespan of a person living in the United States has lengthened by more than 30 years – advances in public health were responsible for 25 years of this gain. Public health initiatives also help to eliminate health disparities and prepare communities for disaster.

The field of public health encompasses a variety of academic disciplines but is mainly composed of the following core areas: behavioral science/health education, biostatistics, emergency medical services, environmental health, epidemiology, health service administration/management, international/global health, maternal and child health, nutrition, public health policy and public health practice.

What is the Pharmacist’s Role? The American Public Health Association has recognized that there are many functions of public health that can “benefit from pharmacists’ unique expertise,” such as pharmacotherapy, access to care, prevention services or a combination of these functions. “Apart from dispensing medicine, pharmacists have proven to be an accessible resource for health and medication information. The pharmacist’s centralized placement in the community and clinical expertise are invaluable.” Pharmacists in the community are in an ideal position to educate patients on lifestyle changes that can promote positive health outcomes. Pharmacists are also involved in health screenings for diabetes, cholesterol, osteoporosis and hypertension that may catch these conditions in their early stages when there is more benefit to medical intervention and more opportunity for prevention. Pharmacists provide patient information on self-management for conditions including asthma, hypertension and HIV, and can teach patients how to protect their own health. Pharmacists play a critical role in smoking cessation, family planning, and medication optimization for chronic health conditions. In 1999, the Centers for Disease Control and Prevention named the 10 Greatest Public Health Achievements of the 20th Century. Public Health continued on page 28 26

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Students in the Minnesota Pharmacy Student Alliance (MPSA) in Duluth participate in public health initiatives by educating their community on healthy eating and sugar intake. This poster, which visually depicts the sugar content in various foods, has been used at the UMD Health Fair, Rainbow Center Health Fair, CHUM Center Educational Event and Mariner Mall Health Fair.

Student Perspective

Minnesota Pharmacists and students tell us why they think

Public health is important… “Pharmacists, especially those in rural areas, are in the perfect position for identifying public health problems. This occurs by caring for individual patients and identifying trends. By realizing that these health care trends may be an early signal of a future public health issue, we can be at the forefront for early identification of these problems. Whether it is by unusual high usage of a particular prescription or OTC medication or through hearing multiple patients describe the same unusual health care scenario, we need to be prepared to act. By thinking bigger and broader than the individual patient, we can all serve our communities better.” -Patty Lind, PharmD, MS Patty Lind covers hospital, academic, long-term care and community practice at the First Light Health System in Mora, Minn. “I chose to return to the University of Minnesota to expand my skills in areas of disease prevention, epidemiology, and health care leadership. The MPH program has provided me with a better understanding of how the pharmacy profession can contribute to public health challenges such as care transitions, immunizations, disaster planning, and abuse of prescription drugs. The tools that I have gained from the MPH program complement the skills that I have as a pharmacist, which helps me to provide better care for my patients and my community.” -Laura Odell, PharmD Laura Odell is the Medication Therapy Management Coordinator at Mayo Clinic in Rochester, Minn. She is a graduate of the University of Minnesota College of Pharmacy and will complete a MPH degree from the School of Public Health in August 2011. “I chose to learn more about public health because I am interested in the big picture. I wanted to learn how society is affected by health issues and how I can best make an impact. I am especially interested in public health issues surrounding disadvantaged populations.” -Maggie Kading, student pharmacist Maggie Kading is a fourth-year pharmacy student at the University of Minnesota College of Pharmacy in Duluth and will graduate in May of 2012 with a Leadership Emphasis. Maggie is originally from Park Rapids, Minn.

“Pharmacists can play a key role in the elimination of health disparities, which can be caused by inadequate access to both healthcare providers and hospitals. Pharmacists can bridge that gap by providing assessments, blood pressure readings, diabetic foot examinations in addition to counseling on correct medication use.” -Kelechi Aguwa, student pharmacist Kelechi Aguwa is a fourth-year pharmacy student at the University of Minnesota College of Pharmacy in Duluth and will graduate in May of 2012 with a Leadership Emphasis. Kelechi is originally from Silver Spring, Md. “In pharmacy school we become the “drug experts” and learn a great deal about the various medical conditions that are treated with pharmaceutics. Knowing that many of the most common and most debilitating diseases could be prevented with better education and lifestyle changes, rather than medical intervention, has led me to learn more about how I can make a bigger difference in improving the health of an entire population and in eliminating health disparities.” -Laura Palombi, student pharmacist Laura Palombi is a fourth-year pharmacy student at the University of Minnesota College of Pharmacy in Duluth and will graduate in May of 2012 with a Leadership Emphasis. Laura is originally from Ely, Minn. As pharmacists, we underestimate our impact on public health. Medication safety, disease prevention, antibiotic stewardship, and drug formularies are simple examples of medication-related public health issues where pharmacists have a key role. We need to use these opportunities to assert ourselves as members of the public health team. Our expertise ensures safe and effective medication use for individual patients, but we need to start thinking and acting on a population basis. --Shannon Reidt, PharmD, MPH Shannon Reidt is an assistant professor at the main campus of the University of Minnesota College of Pharmacy and works for the Minnesota Visiting Nurse Agency.

Minnesota Pharmacist Summer 2011 n

Student Perspective Public Health continued from page 26 Pharmacists across the nation have played an active role in many of these accomplishments: • Vaccination • Motor-vehicle safety • Safer workplaces • Control of infectious diseases • Decline in deaths from coronary heart disease and stroke • Safer and healthier foods • Healthier mothers and babies • Family planning • Fluoridation of drinking water • Recognition of tobacco use as a health hazard Despite these achievements, however, pharmacists have traditionally been conspicuously underrepresented in both state and national inter-professional public health associations. What’s Happening with Public Health in Pharmacy Curricula? While pharmacists are engaged in public health activities of all sorts, some argue that pharmacy education “has failed to recognize the potential for pharmacists in public health as well as to acquaint pharmacy students and practitioners with role models in public health.” This has been recognized and addressed by the American Association of Colleges of Pharmacy, which recommends “population-based care” as one of the three functional roles for pharmacists in the curricula of the future. The primary aim of this populationbased care is the prevention of disease. At least a dozen different pharmacy colleges around the nation currently offer the combined PharmD/MPH degree. Although there has been discussion about offering a combined PharmD/MPH degree through the University of Minnesota’s College of Pharmacy and the University’s School of Public Health, no formalized agreement has been made. How Can I Learn More About Public Health? There are plenty of ways to learn more about public health and how you as a pharmacist can make a difference. The School of Public Health at the University of Minnesota, for example, has more than 80 free, online courses available to the general public. All that is required is the creation of an account. Courses include but are not limited to: • What is Public Health? • Community Healthcare Disaster Planning in Minnesota • Culture and Health Literacy: Beyond Access 28

Minnesota Pharmacist Summer 2011 n

Point of care testing, as provided at the Rainbow Center Health Fair (PDII students pictured here), is a valuable public health service for those who cannot afford regular preventative care and screenings.

• Healthcare Response to a Pandemic: Ethical Resource Allocation During a Pandemic • Health Promotion and Adult Education • Legal Implications for Public Health Professionals in Emergencies • Personal and Family Emergency Preparedness The University of Minnesota also offers face-to-face courses and training, online certificate and licensure programs for health professionals and advanced degree program (Master and Doctor of Public Health). More information can be found at the School of Public Health’s Web site: http://www.sph.umn.edu/. Becoming involved in the Minnesota Public Health Association (MPHA) is another way to learn more about the healthcare-related topics that affect our state. MPHA represents a broad range of professionals from various disciplines who have come together as “Minnesota’s Voice for Public Health.” MPHA informs its members of new legislation and policies that focus on public health, examples for the 2011 Legislative session being: • Protecting public health funding and sustaining SHIP (the Statewide Health Improvement Program) • Ensuring healthcare access • Eliminating healthcare disparities • Working in partnership with various coalitions on topics that include reducing childhood obesity, reducing exposure to toxic chemicals and reducing chronic disease in Minnesota Public Health continued on page 29

Student Perspective Public Health continued from page 28 You can learn more about MPHA by visiting its Web site: http:// www.mpha.net/. Why Me? Pharmacists have historically been among the most trusted and the most accessible of healthcare professionals. Although the important role the pharmacist plays within his or her community is easy to recognize, the responsibility of the pharmacist to contribute to the greater good of the population has not been emphasized enough. Increasing the participation of pharmacists in all levels of the public health system is “fundamental to achieving substantial improvement in the health status of our population” as well as to “achieving full preparedness to respond to any type of mass casualty event.” Pharmacists and other health professionals are needed in all phases of disaster planning, including the development of preventative measures. Although pharmacists can be found in most state public health systems, little has been done to try to “maximize the community health status benefits that might accrue from a close, coordinated relationship between the practices of pharmacy and public health.” Pharmacist involvement is needed to help build these relationships, not only to monitor disease states but to optimize communication in the event of a disaster or mass casualty event.

Centers for Disease Control and Prevention. “Ten Greatest Public Health Achievements – United States, 1900-1999.” MMWR Weekly; 48(12): 241243. http://www.cdc.gov/mmwr/preview/mmwrhtml/00056796.htm Bush P, Johnson K. “Where is the public health pharmacist?” Am J Pharm Educ. 43: 249-2S2. Bush P, Johnson K. “Where is the public health pharmacist?” Am J Pharm Educ. 43: 249-2S2. Jungnickel P et al. “AACP Curricular Change Summit Supplement: Addressing Competencies for the Future in the Professional Curriculum.” American Journal of Pharmaceutical Education 2009; 73(8): article 156. The pharmacy programs at the University of Southern California, University of Florida, Kentucky, Ohio State, Virginia Commonwealth, University of Iowa, University of Maryland, University of Arkansas, University at Buffalo, University of Wisconsin-Madison, Touro University, University of Connecticut have established PharmD/MPH programs. There are likely other schools that are in the process of implementing such programs. University of Minnesota School of Public Health. “Online Courses and Trainings.” http://www.sph.umn.edu/ce/trainings/online.asp Accessed July 6, 2011. University of Minnesota School of Public Health. “Degrees and Programs.” http://www.sph.umn.edu/programs/. Accessed July 6, 2011.

Pharmacists play a vital role in maintaining and promoting public health. It is our responsibility to work with other professionals to promote public health practices to keep our communities healthy. This sentiment is echoed by ASHP, which suggests that “healthsystem pharmacists should be involved in public health policy decision-making and in the planning, development, and implementation of public health efforts,” and by APhA, which emphasizes that “pharmacy professionals have a valuable role in the nation’s public health, as one of the most accessible health care providers.”

Minnesota Public Health Association. http://www.mpha.net/ Accessed July 8, 2011.

Please take the time to learn more about how you can make an even greater impact on the health of your community by becoming more active in public health initiatives and organizations.

The American Society of Health-System Pharmacists. “ASHP Statement on the Role of Health-System Pharmacists in Public Health” Am J HealthSys Pharm. 2008; 65: 462-7.

About the author: Laura Palombi is a fourth-year student at the University of Minnesota College of Pharmacy, Duluth, and is a member of the Minnesota Public Health Association.

Capper S, Sands C. “The Vital Relationship Between Public Health and Pharmacy.” The International Journal of Pharmacy Education. 2006: Fall 2006, Issue 2. Capper S, Sands C. “The Vital Relationship Between Public Health and Pharmacy.” The International Journal of Pharmacy Education. 2006: Fall 2006, Issue 2.

The American Pharmacists Association. “Pharmacy Practice.” http://www. pharmacist.com/AM/Template.cfm?Section=Public_Health2&Template=/ TaggedPage/TaggedPageDisplay.cfm&TPLID=87&ContentID=11973 Accessed July 8, 2011. Association of Schools of Public Health. “What is Public Health?” www. whatispublichealth.org Accessed July 6, 2011.

References Bunker JP, Frazier HS, Mosteller F. “Improving health: measuring effects of medical care.” Milbank Quarterly 1994; 72: 225-58. American Public Health Association. “Policy Statement: The Role of the Pharmacist in Public Health.” Policy date 11/8/2006. http://www.apha. org/advocacy/policy/policysearch/default.htm?id=1338 American Public Health Association. “Policy Statement: The Role of the Pharmacist in Public Health.” Policy date 11/8/2006. http://www.apha. org/advocacy/policy/policysearch/default.htm?id=1338 Minnesota Pharmacist Summer 2011 n

Student Perspective

Students Spend Five Weeks in Germany Learning About Pharmacy, Health Care, and Culture Maggie Kading, University of Minnesota College of Pharmacy, Class of 2012 Students gather in front of the Burgerstube, their “Home Away from Home.”

Students at the University of Minnesota College of Pharmacy recently spent five weeks in Germany for an Advanced Pharmacy Practice Experience. From June 6 to July 8, 2011, nine students engaged in conversations about medication therapy management (MTM) pharmacy education, best practices, and health care with German government officials, students, professors, business people, and association leaders. Students also spent time in German pharmacies compounding creams, capsules, and teas, and learned about pharmacy workflow and German pharmacy law. What makes pharmacy in Germany unique?

Herbal medicine plays a more significant role in German pharmacy than in the United States. German pharmacists refer to Commission E monographs for information on herbal remedies. Pharmacy students are trained to be able to identify the contents of herbal teas during school, and are required to pass a tea identification practical exam to become a pharmacist (University of Minnesota students learned how to identify teas while on the rotation!).

building. Dosing calculations are usually done by nurses or doctors, and pharmacists are not usually involved in double-checking doses or drugs. Everyone in Germany has health insurance. Patients go to the pharmacy with their prescription and have a copay of €5 minimum or €10 maximum (at the current exchange rate, approximately $7 and $14 USD, respectively). Some patients are exempt from a copay, and there is a maximum annual copay amount that a patient would have to pay. In addition, as long as a drug is approved for reimbursement by the insurance companies, a patient can never be denied medication due to cost, even if it is extremely expensive.

To learn more, contact Maggie Kading, pharmacy student. She can be reached at kadi0014@d.umn.edu.

The pharmacy curriculum in Germany is based more on chemistry and basic sciences than in the United States. However, pharmacy schools in Germany have recently added a pharmaceutical care/ pharmacotherapy course in the curriculum, and the MTM model, developed by professors Robert Cipolle, Pharm.D., and Linda Strand, Pharm.D., Ph.D. with the University of Minnesota College of Pharmacy, is being taught at the University of Bonn. Germany is at the very start of a transition from the chemistryfocused pharmacist to the patient-focused pharmacist. Currently, pharmacists are required by law to use analytical chemistry to verify that the chemical compound in bulk powders is actually the labeled ingredient. Pharmacists are also required by law to provide “pharmaceutical care” to patients, but this term is not well defined. There is no reimbursement for cognitive services (such as patient counseling or MTM) provided by pharmacists in Germany.

Students and preceptors at a meeting with German VIPs to discuss pharmacy and MTM.

Pharmacy technicians in Germany go through three years of training before being able to work in a pharmacy. They are able to compound, counsel patients on “simple” issues, dispense medications, and identify many drug-drug interactions. Pharmacists counsel patients, verify controlled prescriptions, analyze pharmaceutical powders, and oversee the flow of the pharmacy. There are very few pharmacists in hospitals in Germany. Many hospitals do not have a pharmacist or even a pharmacy in the 30

Minnesota Pharmacist Summer 2011 n

Students celebrate the Fourth of July with a plane ride over the German countryside.

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