North Carolina Pharmacist Volume 102 Number 4 by North Carolina Association of Pharmacists

North Carolina Pharmacist Volume 102 Number 4 Fall 2021

Advancing Pharmacy. Improving Health.

The long-acting injectable authority went into effect October 1, 2021. Look inside to see what NCAP is doing for you!

Official Journal of the North Carolina Association of Pharmacists ncpharmacists.org

Call for Articles North Carolina Pharmacist (NCP) is currently accepting articles for publication consideration. We accept a diverse scope of articles, including but not limited to: original research, quality improvement, medication safety, case reports/case series, reviews, clinical pearls, unique business models, technology, and opinions. NCP is a peer-reviewed publication intended to inform, educate, and motivate pharmacists, from students to seasoned practitioners, and pharmacy technicians in all areas of pharmacy. Articles written by students, residents, and new practitioners are welcome. Mentors and preceptors – please consider advising your mentees and students to submit their appropriate written work to NCP for publication. Don’t miss this opportunity to share your knowledge and experience with the North Carolina pharmacy community by publishing an article in NCP. Click on Guidelines for Authors for information on formatting and article types accepted for review. For questions, please contact Tina Thornhill, PharmD, FASCP, BCGP, Editor, at tina.h.thornhill@ gmail.com.

North Carolina Pharmacist is the Official Journal of the North Carolina Association of Pharmacists Located at: 1101 Slater Road, Suite 110 Durham, NC 27703 Phone: (984) 439-1646 Fax: (984) 439-1649 www.ncpharmacists.org

Official Journal of the North Carolina Association of Pharmacists 1101 Slater Road, Suite 110 Durham, NC 27703 Phone: (984) 439-1646 Fax: (984) 439-1649

www.ncpharmacists.org

North Carolina Pharmacist Volume 102 Number 4

Fall 2021

EDITOR-IN-CHIEF Tina Thornhill

A Few Things Inside

LAYOUT/DESIGN Rhonda Horner-Davis

• From the Executive Director...................................................................................4

EDITORIAL BOARD MEMBERS Anna Armstrong Jamie Brown Lisa Dinkins Jean Douglas Brock Harris Amy Holmes John Kessler Angela Livingood Bill Taylor

BOARD OF DIRECTORS EXECUTIVE DIRECTOR Penny Shelton PRESIDENT Beth Mills PRESIDENT-ELECT Matthew Kelm PAST PRESIDENT Dave Phillips TREASURER Ryan Mills SECRETARY Paige Brown Kevin Rhash, Chair, SPF Tyler Vest, Chair, NPF Anna Armstrong, Chair, Community Angela Livingood, Chair, Health-System Janine Bailey, Chair, Chronic Care Irene Ulrich, Chair, Ambulatory Ouita Gatton, At-Large Vinay Patel, At-Large Riley Bowers, At-Large North Carolina Pharmacist (ISSN 0528-1725) is the official journal of the North Carolina Association of Pharmacists. An electronic version is published quarterly. The journal is provided to NCAP members through allocation of annual dues. Opinions expressed in North Carolina Pharmacist are not necessarily official positions or policies of the Association. Publication of an advertisement does not represent an endorsement. Nothing in this publication may be reproduced in any manner, either whole or in part, without specific written permission of the publisher.

• From the President.............................................................................................6 • Impact of a Pandemic..............................................................................................8 • Bowl of Hygeia Award Recipients.........................................................................17 • NCAP Election Results........................................................................................19 • Medication Administration Scope Advancement..................................................20 • Call for Posters.....................................................................................................22 • NCAP Advocacy Fund Contributers.....................................................................26 • New Drug Monograph..........................................................................................28 • Pharmacists Call to Action....................................................................................34

North Carolina Pharmacist is supported in part by: • Alliance for Patient Medication Safety (APMS)....................................5 • The Partnership for SAFEMEDICINES ................................................7 • NCAP Career Center ................................................................13 and 32 • Pharmacy Quality Commitment ...............................................18 and 27 • Edupharmtech ......................................................................................18 . • EPIC Pharmacies Inc ...........................................................................18 • Athenex, Inc..........................................................................................24 • Pharmacy Technician Certification Board (PTCB) .............................36 • VUCA Health ...........................................................................38 and 40 • Pharmacists Mutual Companies ..........................................................39 • Your Community Health Plan ..............................................................42 CORRECTIONS AND ADVERTISING For rates and deadline information, please contact Rhonda Horner-Davis at rhonda@ncpharmacists.org

•From the Executive Director• Penny Shelton, PharmD, BCGP, FASCP

The Association’s Assiduity

Okay, if the title caught your eye, well then step one has been achieved. Please read on! My column this issue is about NCAP’s ‘careful and unremitting attention’ to all the ongoing work behind the scenes to enact the different provisions, granted to pharmacists, in the passage of H.196, and H.96/S.575. These new laws expand scope for our profession, by allowing pharmacists to administer long-acting, and other injectable medications, pursuant to a prescription; and by allowing pharmacists to furnish certain medications, pursuant to statewide standing orders or protocols. The long-acting injectable authority went into effect October 1, 2021; and if all goes well, the other provisions will become effective, as early as, February 1, 2022. Soon, North Carolinians will be able to obtain nicotine replacement therapies, post-exposure prophylaxis for HIV, glucagon products, prenatal vitamins, oral and transdermal hormonal contraceptives, from their pharmacists, without a prescription. NCAP has spent numerous hours and resources advocating for these new authorities; howev-

er, our work, for the profession, did not stop with the passage of these bills. Instead, our efforts have shifted to three very important roles: • • Conversing with stakeholders, NC Medicaid and other payers regarding payment for services related to these new authorities; • • Coordinating teams to help with the drafting of statewide standing orders; and • • Creating training content and resource toolkits to equip pharmacists with what they need to legally, safely and efficiently provide these services for patients.

Conversing: North Carolina Medicaid has listened and worked diligently to create a means for pharmacists to bill an administration fee, when they give a long-acting injectable. We have also talked with them about how the 2022 statewide standing orders will have protocols that require screening, assessment, expanded patient education beyond just the medication counseling points, and time involved in required documentation and communication. If they want pharmacists to help address public health needs in our state, like unintentional pregnancies, smoking, and HIV, then the state needs to pay pharmacists for the patient care, as well as for the product. To date, our discussions have been very positive; and we are having similar discussions Page 4

with other health plans.

Coordinating: We are blessed to have amazing members and pharmacy practitioners in our state. NCAP moved quickly to organize small teams of individuals to help us draft standing orders. Why did we do this? In conversation with our Board of Pharmacy, we believed that our profession needed to be proactive; and that this was an opportunity to forge an even stronger relationship between NCAP and the Division of Public Health at NC DHHS. If we were to help on the frontend with the work that goes into issuing a standing order, let alone five different ones, we believed it would be more likely to reach stakeholder consensus in a timely manner. We knew that February 2022 would come around quickly, and this was our Association’s way to help Dr. Tilson and her staff. Currently, drafts have been written, reviewed by a Board of Pharmacy Committee, revised and submitted to NC DHHS, reviewed by their teams, and feedback provided to us on four of the five drafts. NCAP is currently working on incorporating DHHS feedback, and we are also awaiting input from the NC Medical Society. Next steps include recirculating the drafts to the Board of Pharmacy, DHHS, and including the NC Medical Board. Creating: The long-acting inject-

able authority requires pharmacists, who want to administer these medications, to be a certified immunizing pharmacist, and to have completed long-acting injectable training. In October, and coinciding with the effective date for this new authority, NCAP made available an all-virtual, 24/7 training program. In addition, we created a long-acting injectable resource toolkit. In this issue of North Carolina Pharmacist, you will find a brief article on our LAI program. We have also been working on an educational training and resource toolkit for hormonal contraception, post-exposure prophylaxis for HIV, and tobacco cessation. These should be ready in January 2022. We also plan to develop a resource page on our website for the new glucagon and prenatal vitamin authorities. Your assiduous Board of Directors and staff will be meeting on December 15th, and the agenda will include both the approval of revisions to our strategic plan, and an updated advocacy strategic plan. We will be posting these documents in the coming days for our members. Also, in the new year, members will begin to see more activity in our online communities, and our staff will be unveiling a new electronic news format. We’ve been working on changes that should provide even more timely delivery of news, announcements and alerts. As the year winds down, I hope this column provides you with a snapshot of some of the important work that the Association has been conducting. On behalf of the NCAP Board of Directors and staff, we hope that you have a wonderful and joyous holiday season. Pharmacy Proud, Penny

Page 5

•From the President• Dr. Beth Mills, PharmD, CPP, BCACP, CDE

Dear members,

It’s hard to believe 2021 is coming to an end and we will soon ring in 2022! This is the time of year we reflect on the successes and difficulties of the past year and set goals for the next. It has been an honor to serve as President of NCAP this year and I am proud of all we have accomplished together. While this past year presented many challenges, not the least of which was COVID-19, NCAP has proven once again we are a strong, viable association.

NCAP has achieved many triumphs this year. Most notably, we had one of the most successful legislative sessions to date with the passage of three out of five bills. After a long fight, we were able to get a revised version of the PBM bill passed. NCAP will be meeting with the Commissioner of Insurance to work on the logistics of the bill to reign in PBM abuses and ensure pharmacists have a system in place for complaints and grievances. Two of the three successful bills, Medication Administration and Public Health, were combined into one bill. This bill expands immunizing pharmacists’ scope of practice

to include prescribing hormonal contraception, tobacco cessation, HIV post exposure prophylaxis, and administering long-acting injectable medications. Check our website for new and upcoming training programs to get you ready for these new authorizations.

The annual convention looked a little different this year. All academy conventions were combined into a virtual 3 day event with a variety of content for all practice areas. The convention was a huge success and we are looking forward to an even better conference in June, 2022 as we begin planning for an in-person event back at the Benton Convention Center in Winston Salem. Education is always a top focus for NCAP and this year was no different. We continued the Sunday CE series, held multiple

live webinars, held trainings and certifications, and created timely resources such as the Diabetes Prevention and Long-Acting Injectable Administration Toolkits. It has been a busy year! This is just a brief look into all that was accomplished. Be on the lookout for the 2021 Annual Report which highlights all of our achievements for the year! Thank you to our Executive Director, Penny Shelton, the NCAP staff, Executive Committee and Board of Directors for their hard work and dedication. A huge thank you goes out to our NCAP membership and the many volunteers as well! Without you, we would not have been able to accomplish all that we did. Have a wonderful and blessed Holiday Season! Beth Mills

Please note the NCAP office will be closed December 23rd through December 31st. If you need immediate assistance during this time, please contact Rhonda Horner-Davis at: rhonda@ncpharmacists.org We hope you have a safe and happy holiday! NCAP Staff & Board Members Page 6

Page 7

Impact of a Pandemic on Resilience Levels within a Health-System Pharmacy By: Dr. Kristen Augustina Korankyi Dr. Shannon Nicole Kraus Dr. Docia Okai

via descriptive statistics.

Key Points: • COVID-19 increased responsibilities of healthcare workers and this study examines its psychological effect on pharmacy staff in a large academic medical center. • There was a slight increase in feelings of depression experienced by the pharmacy team based on a 3.2 point average change on the Patient Health Questionnaire 9 (PHQ-9). • Programs to promote resilience such as an online app/website with resilience training tips may help to prevent burnout in pharmacy team members with future studies examining their success. Abstract Purpose: Determine the impact of a pandemic on levels of resilience, burnout, and overall well-being among staff members at a health-system pharmacy. Methods: Participants were emailed a REDCap® IRB approved survey comprised of the validated General Well-Being Index (WBI),

Patient Health Questionnaire 9 (PHQ-9), COVID-19 related questions adapted from the Copenhagen Burnout Inventory and supplemental demographic questions. During the three-week survey collection period, email reminders were sent weekly. Additional supplemental questions solicited current perspectives on resilience and ways to promote employee well-being. Results were analyzed Page 8

Results: 142 staff members responded (with 14 partial responses) resulting in a 90.1% completion rate and a 21.7% survey response rate. The median score for WBI was 2, which is similar to the median score in a national sample of US workers. A WBI score of ≥2 indicates greater risk of adverse outcomes including 2.9-fold higher risk of burnout and 1.8-fold higher risk of severe fatigue. There was no difference in the overall PHQ-9 score based on position within the pharmacy, however, technicians did experience a slightly significant change (~4.4-unit increase) compared to pharmacists (p<0.0401). There were no statistically significant demographic differences reported on WBI. Conclusion: Reported burnout levels among a pharmacy department during a pandemic are similar to US workers surveyed prior to the

pandemic. There does not appear to be an influence of demographic variables related to PHQ-9 or WBI scores. Nonetheless, there is an opportunity to prioritize resilience training in order to cultivate well-being within the pharmacy department. Keywords: professional burnout, resilience, health-system pharmacists, technicians, pandemic, COVID-19 Introduction Burnout is a continual stress reaction characterized by emotional exhaustion, depersonalization, and lack of personal accomplishment.1 During the earlier months of 2019, the coronavirus (COVID-19) pandemic hit the world and ultimately shook the core of healthcare. As infection rates increased, mortality rates did as well.2 This perpetuated an increase in demand for healthcare workers with a parallel decrease in medical supplies and equipment. Shifts in demand translated into long working hours and strenuous working environments. Apart from the increased work burden, fear of contracting the virus and infecting loved ones were major contributors to stress. Previous literature evaluated the impact of the pandemic on emergency healthcare workers, by comparing individuals who worked in that department before the pandemic to those who were transferred there as a result of the pandemic.3 The Copenhagen Burnout Inventory was used and showed that all health care workers were experiencing moderate to severe burnout during the pandemic and nurses had higher burnout rates compared to physicians.3 A

majority of the survey participants agreed that ways to cope with burnout should include the use of technological media such as watching TV or videos on the internet, spending time with loved ones and acts of gratitude from peers or from the work department.3 Additionally, a multicenter cohort survey was conducted in 2018 to measure the levels of and risk factors of burnout among health-system pharmacists.4 The Maslach Burnout Inventory Human Services Survey (MBI-HSS) was used to measure the degree of burnout. The survey study examined three MBI-HSS subscales of emotional exhaustion, depersonalization and reduced personal accomplishment with each scored individually. The results of the study showed that the survey participants were at a moderate risk of burnout with the highest percent of burnout in administration and the intensive care unit.4

Hospitals within the system range in size from 50 to 900 beds. Patient acuity and specialty services at each hospital vary, but overall include oncology, emergency medicine, pediatrics, trauma, transplant, and general medicine. Participants were identified by an all pharmacy staff distribution list using Microsoft Outlook (Microsoft Corporation, Redmond, WA). During the 3-week survey collection period, email reminders were sent weekly. Study variables and outcomes of interest

The primary outcome of this institutional review board approved study included results from the General Well-Being Index (WBI), a validated tool used to screen for dimensions of distress including fatigue, burnout, depression, anxiety/stress, mental/physical quality of life.5 Additionally, COVID-19 related questions were adapted Overall, current research on pharfrom the Copenhagen Burnout macist burnout especially in light Inventory and the Patient Health of a pandemic seems to be non-ex- Questionnaire (PHQ-9) to screen istent. Therefore, the goal of this for depression6,7. Secondary outquality improvement (QI) project is comes included demographics (age, ethnicity, gender, marital status), to determine the impact of a pandemic on levels of resilience, burn- work characteristics (work location, position [technician, resident, out, and overall well-being among pharmacists, pharmacy technicians, pharmacist, manager/ supervisor/ director, other], years of service), pharmacy residents, pharmacy and open-ended survey questions leaders and pharmacy staff memto elicit information on current bers at a health-system pharmacy. perspectives on resilience and ways Methods that a health-system pharmacy department could promote employee Study Population well-being. Results from the survey were used to determine the state The survey population included 591 of resilience among the pharmacy Wake Forest Baptist Health emdepartment before and during the ployees including residents, techni- COVID-19 pandemic and how to cians, pharmacists, administration, best build resilience among the and support staff at five hospitals pharmacy team. who were involved in inpatient and outpatient services (Figure 1). Study design Page 9

Study data were collected and managed via anonymous survey collection using REDCap® (Research Electronic Data Capture) tools hosted at Wake Forest Baptist Health. REDCap® is a secure, web-based application designed to support data capture for research studies. Only the study staff had access to the REDCap® database and electronic survey created solely for use in the project. The survey assessed current state of resilience, burnout and overall well-being among health-system pharmacy department employees

and the influence of key demographic characteristics (Appendix 1). All participants who met the inclusion criteria of being a Wake Forest Baptist Health pharmacy employee were sent an electronic survey with the validated WBI, PHQ-9 and supplemental demographic questions. The general WBI is a brief assessment designed to identify healthcare workers in severe distress and most likely in need of an individualized intervention. The WBI has been completed by > 35,000 individuals and evidence indicates that the tool also identifies healthcare workers whose degree of distress places them at Page 10

risk for serious adverse consequences (i.e. medical error, turnover, and/or suicidal ideation).5 The WBI also includes questions about satisfaction with work-life integration and meaning in work. Scores on the WBI correlate with meaning in work, high/low quality of life, fatigue, burnout, and recent suicidal ideation.5 The PHQ-9, or Patient Health Questionnaire is a validated instrument that consists of 9 criteria upon which the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) depressive disorders are based. It is adapted from the full PHQ.6 The Copenhagen Burnout Inven-

tory measures personal burnout, work-related burnout, and client-related burnout.7

(83.6%) and were between the ages of 25-34 years old (44.5%). Also, many respondents were married or in a domestic partnership (61.3%) Data analysis and white (84.7%). In terms of outcomes related to depression, about Descriptive statistics comprised 47% of participants had a PHQ-9 the bulk of the statistical analysis. score of 2 which indicates minimal The statistical analysis included depression. The average change in frequencies and percentages for PHQ-9 score comparing feelings analyzing the baseline characterisbefore and during the pandemic tics and change in PHQ-9 and WBI was 3.2 points, which represents a scores. ANOVA along with Wilslight increase in feelings of decoxon Rank Sums test and Kruspression during the COVID-19 kal-Wallis test were used in order to pandemic. There was no difference adjust for covariates with a p-value in the overall PHQ-9 score based of less than 0.05. on position in the pharmacy (technician, pharmacist, resident, or The WBI includes 9 questions, 7 supervisor/director; p= 0.1048), are in the form of “yes” and “no” however, technicians did experiquestions and the last 2 questions ence a slightly significant change are answered using a Likert scale. (an average 4.4 unit increase in One point is assigned for each yes PHQ-9 score) compared to pharto the 7 questions. For Likert type macists, with an average 2.6-unit questions, response of a 1 or 2 on increase (p< 0.0401). In terms of the 7-point scale is given 1 point.5 the WBI, the median score was For the PHQ-9, major depression 2 (56.1% of participants), which is diagnosed if 5 or more of the 9 correlates with national averages depressive symptom criteria have and represents an increased risk of been present at least “more than burnout and severe fatigue. There half of the days” in the past 2 weeks, were no statistically significant and 1 of the symptoms is depressed differences reported on the WBI mood or anhedonia.6,8 Other related to demographic variables depression is diagnosed if 2, 3,or (p= 0.6266). 4 depressive symptoms have been present at least “more than half the In addition to completing the days” in the past 2 weeks, and 1 of survey, participants were asked the symptoms is depressed mood to report what program format or anhedonia. The PHQ-9 is scored would be preferred in order to on a scale of 0 to 27 with ratings help promote resilience learning of minimal depression to severe for the pharmacy team (Figure 2). depression.6,8 A majority of participants (52%) stated an online app/website with Results resilience training tips of advice would be helpful. Other formats Overall, 142 staff members rewere ranked from highest to lowest sponded to the survey with 14 percentages in the following order: partial responses, resulting in a half-day group workshop with a 90.1% completion rate and a 21.7% blend of in person and online comsurvey response rate. A majority ponents (25%), individual coaching of the respondents were female sessions (16%), and 7% reported Page 11

“other.” Comments left in the “other” field included daily focused attention on well-being during team meetings/interactions with colleagues, half-day group workshop plus an app for maintenance and reinforcement of tips and advice, and flex scheduling for employees to manage childcare/schooling and other personal needs. Discussion Healthcare professionals are relied upon daily to provide quality care for patients in a very fast paced environment. The demands placed upon healthcare workers can lead to feelings of burnout and emotional exhaustion, even without the impact of a global pandemic. In the 2018 study looking at levels and risk factors for professional burnout among health-system pharmacists, 53.2% of participants reported a high degree of burnout on at least one subscale of the MBI-HSS (emotional exhaustion, depersonalization, and reduced personal accomplishment) and 8.5% of respondents had scores indicating burnout on all 3 subscales.4 However, this study did not look at ways resilience could be built into the pharmacy profession or assess the impact of a pandemic on levels of burnout. Therefore, our present study indicates that in terms of depression before and during the pandemic, there was a slight increase in scores (3.2 points) during the pandemic. Additionally, the WBI score was reported as the national median of 2, indicating an increased risk of burnout and severe fatigue. Many respondents, 42.2% (54 people) were not aware of the current resources the institution had to deal with feelings of burnout and out of those who were aware of the current resources, only

Figure 2. If a program was started to help promote resilience learning for our pharmacy team, which format woud be best?

Online app/website with resilience training tips and advice

7.03 15.63

52.34 25

Half-day group workshop (with a blend of in person and online components) Individual coaching sessions Other

Figure 2. Other indicates responses that were descriptive that were not choices provided in the survey. These include: daily focused attention on well-being during team meetings/interactions with colleagues; half-day group workshop plus an app for maintenance and reinforcement of tips and advice; flex scheduling so employees can manage childcare/schooling and other personal needs.

28.1% actually used the resources. This illustrates that the methods available to build resilience before the pandemic need to be refined.

Overall, the results of our study indicate that COVID-19 did not significantly affect the well-being of pharmacy staff within a larger healthcare system. However, the Our study identified methods median WBI score reflects an into deliver resilience training to creased risk of burnout and fatigue, pharmacists. Other studies have which demonstrates that there must examined methods of resilience be continued efforts to increase training for healthcare professionresilience among pharmacy staff als, with the predominant profesmembers. Our study also identified sions being nurses and physicians. a specific subset of pharmacy team These methods included continumembers who are at an increased ing education courses focused on risk of burnout and fatigue. Technimindfulness-based stress reduction, cians experienced a slightly signifyoga/breathing exercises, lifestyle icant change in PHQ-9 score (an advice (diet/exercise), and stress average 4.4 unit increase in PHQ-9 management delivered in a variety score) compared to pharmacists, of ways including a half-day group with an average 2.6-unit increase workshop (in person/online), small (p< 0.0401). Our study also identigroup learning, one-on-one coach- fied methods to increase resilience ing sessions, and the use of an onand include an online app/website line app.9, 10,11,12,13,14,15 In our study, with resilience training tips and many participants stated an online a hybrid online/in person group app/website with resilience training coaching session on resilience. tips of advice would be helpful. These methods were similar to Page 12

those employed in previous studies for nurses and physicians, which demonstrated improvements in resilience. Therefore, future studies may examine the impact of these training strategies on levels of burnout among health-system pharmacy team members. Strengths of this study includes the use of Copenhagen Burnout Inventory and the PHQ-9, which assessed the physiological and psychological well-being of the participants. Additionally, this was a multi-centered study in a health-system pharmacy which adds to the body of literature on healthcare professional burnout. Limitations include a small sample size. Additionally, the time period in which the study was conducted may be a confounding variable seeing as it was at the end of the first wave of COVID-19. Future research on resilience in pharmacy staff members would possibly require a larger population of pharmacy team members in a variety of healthcare institutions, including smaller hospitals in addition to large academic medical centers. Diversifying the study population would help to examine trends in healthcare environments that increase risk of burnout (such as having larger volumes of prescriptions for multiple complex patients or increased patient care activities) and different perspectives on ways to promote resilience. Conclusion Results of this study demonstrated there was not a statistically significant difference in the well-being of the pharmacy staff at Wake Forest Baptist Health before and during the pandemic. However, the median WBI score reflects an increased

risk of burnout and severe fatigue. Half of survey respondents stated that an app or website with training would help promote resilience in the workplace. While timing of the survey may have impacted the results, it is nonetheless imperative to have resources to promote employee well-being during events such as COVID-19. Authors: Kristen Augustina Korankyi, PharmD (Corresponding Author), High Point University Fred Wilson School of Pharmacy, High Point, NC and Wake Forest Baptist Health, Winston-Salem, NC. Kristen.Korankyi@cuw. edu. Shannon Nicole Kraus, PharmD, MS, BCPS, Wake Forest Baptist Health, Winston-Salem, NC. Docia Okai, PharmD, Wingate University School of Pharmacy, Wingate, NC and Wake Forest Baptist Health, Winston-Salem, NC. Disclosures The authors of this manuscript have nothing to disclose concerning possible financial or personal relationships with commercial entities that may have a direct or indirect interest in the subject matter.

doi:10.2146/ajhp170818 5. Dyrbye LN, et al. “Ability of a 9-item Well-Being Index to Identify Distress and Stratify Quality of Life in US Workers.” J Occup Environ Med. 2016; 58(8):810-7. Kroenke K, Spitzer R, Williams J. The PHQ9. J Gen Intern Med. 2001;16(9):606-613. doi:10.1046/j.1525-1497.2001.016009606.x 6. Talaee N, Varahram M, Jamaati H et al. Stress and burnout in health care workers during COVID-19 pandemic: validation of a questionnaire. Journal of Public Health. 2020. doi:10.1007/s10389-020-01313-z 7. Patient Health Questionnaire (PHQ-9). Med.stanford.edu. http://med.stanford.edu/ fastlab/research/imapp/msrs/_jcr_content/ main/accordion/accordion_content3/download_256324296/file.res/PHQ9%20id%20 date%2008.03.pd. Published 2020. Accessed September 7, 2020. 8. Goodman M, Schorling J. A Mindfulness Course Decreases Burnout and Improves Well-Being among Healthcare Providers. The International Journal of Psychiatry in Medicine. 2012;43(2):119-128. doi:10.2190/ pm.43.2.b 9. Matheson C, Robertson H, Elliott A, Iversen L, Murchie P. Resilience of primary healthcare professionals working in challenging environ-

ments: a focus group study. British Journal of General Practice. 2016;66(648):e507-e515. doi:10.3399/bjgp16x685285 10. Cheshire A, Hughes J, Lewith G et al. GPs’ perceptions of resilience training: a qualitative study. British Journal of General Practice. 2017;67(663):e709-e715. doi:10.3399/bjgp17x692561 Maunder R, Lancee W, Mae R et al. Computer-assisted resilience training to prepare healthcare workers for pandemic influenza: a randomized trial of the optimal dose of training. BMC Health Serv Res. 2010;10(1). doi:10.1186/1472-6963-10-72 11. West C, Dyrbye L, Rabatin J et al. Intervention to Promote Physician Well-being, Job Satisfaction, and Professionalism. JAMA Intern Med. 2014;174(4):527. doi:10.1001/jamainternmed.2013.14387 12. Bauer-Wu S, Fontaine D. Prioritizing Clinician Wellbeing: The University of Virginia’s Compassionate Care Initiative. Glob Adv Health Med. 2015;4(5):16-22. doi:10.7453/ gahmj.2015.042 13. Dyrbye L, Shanafelt T, Gill P, Satele D, West C. Effect of a Professional Coaching Intervention on the Well-being and Distress of Physicians. JAMA Intern Med. 2019;179(10):1406. doi:10.1001/jamainternmed.2019.2425

NCAP Career Center Connecting Talent with Opportunity

References: 1. PhysicianBurnout.AHRQ.https://www.ahrq. gov/prevention/clinician/ahrq-works/burnout/ index.html. Accessed November 2, 2020. 2. Burrer, S., de Perio, M., Hughes, M., Kuhar, D., Luckhaupt, S., McDaniel, C., Porter, R., Silk, B., Stuckey, M. and Walters, M., 2020. Characteristics Of Health Care Personnel With COVID-19 — United States, February 12–April 9, 2020. [online] CDC. 3. W.P.D. Chor, W.M. Ng, L. Cheng, et al., Burnout amongst emergency healthcare workers during the COVID-19 pandemic: A multi-center study, American Journal of Emergency Medicine, https://doi.org/10.1016/j. ajem.2020.10.040. 4. Durham M, Bush P, Ball A. Evidence of burnout in health-system pharmacists. American Journal of Health-System Pharmacy. 2018;75(23_Supplement_4):S93-S100.

www.ncpharmacists.org North Carolina Association of Pharmacists Career Center is the perfect location for finding your next career opportunity. This site brings industry leading employers together with local, qualified pharmacists. Here you can upload a resume, search the Resume Bank, post an opportunity, or search jobs! Page 13

Appendix 1. Survey Questions

Well Being Index Questions

Response Options

During the past month have you felt burned out by your work?

Yes No

During the past month have you worried that your work is hardening you emotionally? During the past month have you often been bothered by feeling down, depressed, or hopeless? During the past month have you fallen asleep while sitting inactive in a public place?

Yes No Yes No Yes No

During the past month have you felt that all the things you had to do were piling up so high that Yes you could not overcome them? No During the past month have you been bothered by emotional problems (such as feeling anxious, Yes depressed, or irritable)? No During the past month has your physical health interfered with your ability to do your daily work at home and/or away from home?

Yes No

Please rate how much you agree with the following statement: The work I do is meaningful to me.

Very strongly disagree Strongly disagree Disagree Neutral Agree Strongly agree Very strongly agree

Please rate how much you agree with the following statement: My work schedule leaves me enough time for my personal/family life.

Very strongly disagree Strongly disagree Disagree Neutral Agree Strongly agree Very strongly agree

Questions adopted from the Copenhagen Burnout Inventory and Patient Health Questionnaire-9

Response Options

Since the start of the COVID-19 pandemic, how much do you worry about your family members and friends getting sick as a result of your exposure?

Not at all Mildly Moderately Highly, extremely

Since the start of the COVID-19 pandemic, how much do you worry about getting infected by COVID-19?

Almost never Once or a few times per month Once or twice a week Four or five times a week Almost every day

Since the start of the pandemic until now, how often have you had little interest or pleasure in doing things?