March/April 2015 z Volume 96 z Issue 2
The official publication of the Pennsylvania Pharmacists Association
You Have a Voice. You Can Make a Difference. Come Make Your Mark and Impact Pharmacy’s Future! Join Us As We March on the Capitol!
PRSRT STD U.S. POSTAGE PAID HARRISBURG PA PERMIT NO 533
PPA’s 2015 Legislative Day – Monday, April 13
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PPA Board of Directors PPA Officers: President: Eric R. Esterbrook, RPh President-Elect: Donna Hazel, RPh First Vice President: Eric Pusey, RPh, CDE Second Vice President: Nicholas Leon, PharmD, BCPS, BCACP Immediate Past President: J. Scott Miskovsky, RPh
Our Vision
Pennsylvania pharmacists will be recognized, engaged, and fairly compensated as health-care providers.
PPA Office Staff: CEO: Patricia A. Epple, CAE pepple@papharmacists.com Communications Coordinator: Jenna Karge jkarge@papharmacists.com Membership Coordinator: Courtney Box cbox@papharmacists.com Program Manager: Sara Powers spowers@papharmacists.com Government Relations Manager: Donald L. Smith, III dsmith@papharmacists.com PPCN Coordinator: Brandon Antinopolous, PharmD ppcn@papharmacists.com
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Pennsylvania Pharmacists Association (PPA) 508 North Third Street, Harrisburg, PA 17101 (717) 234-6151 Fax: (717) 236-1618 www.papharmacists.com ppa@papharmacists.com www.facebook.com/PAPharmacy www.twitter.com/papharmacists Pennsylvania Pharmacist (ISSN 0031-4633) is the official publication of the Pennsylvania Pharmaceutical Association d/b/a Pennsylvania Pharmacists Association and is published every other month, six times per year. Annual subscription is $100 for nonmembers; for members it is included in the annual dues. Editorial information should be addressed to the PPA address listed above. Peer reviewed articles accepted according to the stated guidelines available from PPA. Editorial Board: Hershey S. Bell, M.D., M.S., FAAFP Kim C. Coley, PharmD, FCCP Stephanie Smith Cooney, PharmDPP Bernard Graham, PhD Brian S. Plager, RPh, MBA Associate Editor: Jenna Karge Editor/Manager: Pat Epple Designed and Published by: Graphtech Sarah DiCello, Publications Manager (717) 238-5751 x118, sarah@thinkgraphtech.com
The Pennsylvania Pharmacists Association, as the leading voice of pharmacy, promotes the profession through advocacy, education, and communication to enhance patient care and public health.
Pennsylvania
Regional Directors: Central: Ellen Nastase, BS Pharmacy, MS Pharmacy Northeast: Thomas Franko, PharmD, BCACP Northwest: Elliott Cook, PharmD Southeast: Mark Lawson, PharmD, MBA Southwest: Lauren Simko, PharmD Academy Directors: Academy of Alternative Pharmacy Practice: Jamie McConaha, PharmD, CGP, BCACP Academy of Chain Pharmacists: Vacant Academy of Community Pharmacists: Martin J. Kendra, RPh Academy of Health System Pharmacists: Richard Demers, RPh, MS, FASHP Academy of Long Term Care and Consultant Pharmacists: Brant Gahr, RPh Academy of Pharmacy Industry Associates: Todd Eury Academy of Pharmacy Technicians: Vacant Academy of Student Pharmacists: Benjamin Andrick
Our Mission
MAGAZINE
Departments President’s Message................................................................................... 3 Calendar of Events..................................................................................... 5 Campus Checkup.................................................................................... 26 Pharmacy Time Capsules......................................................................... 28 Member News.......................................................................................... 38 New Members.......................................................................................... 44
Features PPA Foundation Grant Report.................................................................... 6 Member Profile: Richard Smiga, RPh........................................................ 17 Pharmacy Spotlight: Shankel’s Pharmacy................................................. 24 Script Your Future..................................................................................... 29 Profiles in Pharmacy Innovation: Juliana Nowak RPh, CGP, FASCP.......... 30 The Time to Prepare a Disaster Recovery Plan is Now.............................. 40
Association News At the Corner of Third and State Street..................................................... 14 PPA Pharmacy Legislative Day................................................................. 16 2014 PharmPAC Report........................................................................... 20 Nominations Being Accepted for PPA Officers and Members of the Board of Directors................................................ 22 PPA Educational Foundation 2014 Annual Report.................................... 33
Industry News The Expanding Role of Pharmacists in a Transformed Health Care System...................................................... 23
For Advertising Information: Alexis Kierce, Account Manager (717) 238-5751 x119, alexis@thinkgraphtech.com Pharmacist State Board of Pharmacy Members: Gayle A. Cotchen, PharmD, MBA – Institutional” Janet Hart, RPh – Community Chain Robert Frankil, RPh – Community Independent Theresa M. Talbott, RPh – Community Chain Mark J. Zilner, RPh – Community Independent Board of Pharmacy Meeting Dates: March 17, 2015 April 21, 2015 May 12, 2015 June 16, 2015 July 21, 2015 August 18, 2015 On the Cover: Photographs are from our 2014 Legislative Day
Advertisers Index American Pharmacy Services Corporation 13 AmerisourceBergen 7 Buy-Sellapharmacy.com 37 Cardinal Health 31 and 39 Hayslip & Zost 43 Independent Pharmacy Buying Group Inside Back Cover The Jefferson School of Pharmacy Back Cover
The Keystone Pharmacy Purchasing Alliance 18 Pharmacists Mutual Insurance Company 2 PRS Pharmacy Services Inside Front Cover R.J. Hedges & Associates 41 Rochester Drug Company 4 S&L Solutions LLC 25 Value Drug Company 32
Disclaimer — The opinions of the authors reflected in this publication do not necessarily reflect PPA’s official position on an issue.
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Departments
Eric Esterbrook, RPh PPA President 2014–2015
Message from the President P
PPA Legislative day is Monday April 13 2015. PPA’s your elected official, meet new legislators who were Board of Directors approved the following issues recently sworn in or visit with the ones you have as legislative priorities for 2015: known for years. Do not allow fear to keep you from • PBM Registration/MAC Transparency attending. PPA does most of the work for you. All • PBM Transparency you have to do is make an appointment with your • Fair Pharmacy Audits legislator and show up at the Capital. When you arrive • Expanding Immunization Opportunities - 7 at the capital PPA staff with give you talking points years and up for flu only and adding interns to discuss with your legislator. If time away from Substitution of Interchangeable Biologic Products pharmacy is an issue make your appointments close - introducing our version of a better solution. This to each other in the morning and it is possible to only is the vision of our Board of Directors. miss a half day of work. Why do I attend legislative day? First I feel very The action necessary for change does take more strongly that “Vision without action is merely a dream. than one day’s efforts. There are numerous ways Action without vision just passes the time. Vision we can be a part of the solution and take action. with action can change the Responding to “a call to “Vision without action is merely a dream. action” and making a phone world.”- Joel Barker If I want to see change Action without vision just passes the time. call, sending email or a I must be a part of the Vision with action can change the world.” letter. Another way to take solution, not the problem. - Joel Barker action is to contribute to Early in my career I did a our PharmPAC. The reality lot of complaining about things I felt were unfair to is money talks. In 2014, we exceeded our goal of the pharmacy profession. It takes a lot of energy to $60,000. PharmPAC stands for Pharmacy Political complain and it is unproductive. I found if I channeled Action Committee. It is money spent supporting that same energy into something productive such as politicians who are sympathetic to our issues. Also, responding to “a call to action” or finding coverage if you are a student please consider participating for my work schedule so I can attend legislative day in GRASP which stands for Government Relations that I started to make a difference. I took something Advocacy for Student Pharmacists. GRASP is a special negative and draining (complaining) and turned it into program that provides training for students; the something positive. program is temporarily in hiatus as we revamp it but Attending Legislative Day is the action necessary to watch for its return in the fall of 2015! Now is the time to get involved and help create make a change in our profession. It is an opportunity the future of pharmacy in Pennsylvania. for decision makers in our government to hear the challenges we face. Another quote comes to mind “if we can’t hear you, we can’t help you” This is Eric Esterbrook, RPh also an opportunity to establish a relationship with PPA President 2014–2015 z
Pennsylvania Pharmacist I March/April 2015 I 3
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CALL RDC AT 800.333.0538 TO LEARN MORE ABOUT ENROLLING IN THIS EXCITING NEW PROGRAM. Exclusively for RDC’s Independent Quality Care Pharmacy network. Call your RDC sales representative today for more information on how to enroll in our Specialty Pharmacy Program.
Departments Thank You to Our Corporate Partners These companies support PPA activities throughout the year.
DIAMOND LEVEL
PLATINUM LEVEL
Calendar of Events March
27–30
28
APhA Annual Meeting — San Diego, CA Pennsylvania Reception at APhA
April
7–10
AMCP Annual Meeting — San Diego, CA
10–14
ACCP Updates in Therapeutics — Rosemont, IL
25–28
NACDS Annual Meeting — Palm Beach, FL
May
GOLD LEVEL
SILVER LEVEL
BRONZE LEVEL
3–6
NCPDP Annual Conference — Scottsdale, AZ
7
PPA Educational Foundation Board of Directors
14
PPA Board of Directors
16–19
NABP Annual Meeting — New Orleans, LA
June
6–10
ASHP Summer Meeting and Expo — Denver, CO
July
PPA Board of Directors
11–15
AACP Annual Meeting — National Harbor, MD
August
PPA Board of Directors
22–25
NACDS Store Expo — Denver, CO
For additional events including webinars, CE opportunities, and PPA committee meetings, be sure to see our Calendar of Events on the PPA website!
PPA and Your Profession Need You! Committees and Work Groups Many of PPA's projects, programs, and policies are a result of committee work. From Finance to Public Relations to Pharmacists Advocacy—you’re bound to find a committee that interests you! Most committees conduct much of their work via conference calls hosted by PPA.
CE Presenters and Moderators
PPA is always looking for qualified, dynamic speakers to present continuing pharmacy education programs at our Annual and Mid-Year Conferences and through online webinars. Moderators for the CE programs hosted during the conferences are needed also.
Conference Assistance
Help PPA collect tickets and greet your peers and fellow members! Ticket collection shifts are usually 15 minutes and each shift has 2 individuals. Also, with the hustle and bustle of our conferences, PPA needs smiling faces to help out at our registration table. This is a great opportunity to volunteer and to meet your fellow members.
Bloggers and Reviewers
Our new blog provides you with an opportunity to write or review posts. Since this is an ongoing initiative, we are always in need of bloggers (blog authors) and reviewers.
Consider Becoming a Volunteer Today: http://www.papharmacists.com/?page=Volunteer
Pennsylvania Pharmacist I March/April 2015 I 5
Features
PPA Foundation Grant Report Each year, the PPA Educational Foundation awards several grants to explore innovation in pharmacy practice. All awardees are required to submit a report of their work. Below is the report from one of the 2014 awardees, Jamie McConaha. Reports are also retained on the website under the Educational Foundation section.
Evaluation of Student Pharmacist and Pharmacist Impact on Disease State Management and Patient Satisfaction in Adult Patients with Asthma Jamie L. McConaha, PharmD, CPG, TTS, BCACP; Brooke M. Jackson, PharmD Candidate 2014; Sean T. Lasota, PharmD
Introduction Asthma is a chronic disease state involving inflammation of the airways in the lungs and affects over 18.9 million adults and 7.1 million children living in the United States today.1 This condition involves reversible obstruction of respiratory airways, restricting airflow to the lungs, which can result in episodes of coughing, wheezing, chest tightness and shortness of breath. These episodes are commonly referred to as “asthma attacks.� Episodes such as these can be brought on by various triggers, for instance, dust, cold air, pollen, and respiratory infections. While there is no cure for asthma, the ultimate goal of treatment is to gain and maintain control of symptoms in order to improve the patient’s quality of life. Being that asthma is a chronic disease state that affects millions of people nationwide, finding medications that can adequately control the symptoms of the condition is very important. Among the many medication classes currently used to treat asthma in both children and 6 I Pennsylvania Pharmacist I March/April 2015
adults are long and short-acting beta-2 adrenergic agonists, inhaled corticosteroids, and leukotriene inhibitors, in addition to a variety of combination products. In many asthma cases, patients must utilize a combination of multiple inhalers, nebulizer devices, and sometimes even the addition of oral medications to adequately control their disease state; however, the mainstay for treatment in all stages of asthma is inhaled medications. In further exploring the treatment and selfmanagement of asthma, many studies have supported that the two most common reasons for inadequate control of the condition are non-compliance with medication regimens and poor technique with utilizing inhaled medications.2 There is a possibility that patients who do not use their inhalers correctly, and thus do not obtain complete control of their symptoms, may as a result have poor medication compliance. This study sought to investigate this potential correlation and the impact that student pharmacist and pharmacist intervention can have.
Inhalers used in the treatment of asthma can be both complicated and difficult to use, providing an opportunity for community student pharmacists and pharmacists to intervene and assist patients in utilizing the proper inhalation techniques to receive the most benefit from their inhaled medication. Through an exhaustive literature review on asthma control and adherence, it was found that the vast majority of studies conducted have focused on the effects of pharmacist intervention on the self-management of asthma. The studies ultimately showed that when comparing a group of patients that were counseled by pharmacists on their asthma medications and devices to a group of patients treated with usual care, the pharmacistcounseled group would have better control of their condition and better adherence to their medications. A review of twenty five published studies on pharmacist involvement in asthma treatment showed substantial benefits of including a pharmacist in the care of asthma, with half of
the studies showing improvements in asthma severity upon pharmacist intervention and seventy five percent of the studies finding improvements in healthcare utilization.3 While a positive correlation has been shown between pharmacist education and proper inhalation technique, there have been no longitudinal studies that evaluate the pharmacist’s impact on disease state control and patient satisfaction. While it is assumed that student pharmacists can play a similar role in improving patient outcomes in those with asthma through education about the disease and counseling on appropriate inhaler usage, no studies to date specifically measure the effect of student pharmacistprovided education on a patient’s asthma control. This study evaluated the utilization of student pharmacists in this area of practice and how they can contribute to research and community-based clinical services. The purpose of this study is to evaluate the impact that student pharmacists, under pharmacist supervision, can have on patient satisfaction and disease state control in adult patients diagnosed with asthma.
Methods Patient Recruitment The patient population for this study consisted of adults between the ages of 18-65 years who had been prescribed any type of prescription inhaler medication (rescue or maintenance) for asthma treatment. Patients were excluded from the study if they fell outside the required age range, had a diagnosis of exercise-induced asthma or other respiratory disorder such as chronic obstructive pulmonary disease, or were diagnosed with asthma but only prescribed an oral tablet medication. This study exclusively dealt with asthmatic patients since the validated instruments used were specifically designed to address asthma control and severity. It was a necessity for all patients enrolled in the study to have at least one inhaled medication for asthma since inhaler usage technique was measured throughout the study. The study was conducted using a six-month rolling enrollment of participants as they were identified, met the appropriate inclusion criteria, and were interested in participating. Multiple recruitment sites and strategies were employed to gain patient interest in the study as described in the next sections. Site Selection Participants of this study were recruited from five locations encompassing three separate entities: three locations of a regional chain grocery store pharmacy, one location of an independent chain pharmacy, and
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Continued on page 8
Continued on page 8
Pennsylvania Pharmacist I March/April 2015 I 7
Features on the primary researcher’s university campus. The community pharmacy locations, both chain and independent, were selected for study inclusion for several reasons. First, the participating pharmacies had the availability of a clinical, non-dispensing pharmacist present to supervise the students in data collection. Second, these stores were chosen due to the consistency of student pharmacists available at these locations. The pharmacy sites were also selected due to their proximity in geographic location, their similarities in patient demographics of patients with private health insurance, and their general interest in participation. As a way to help increase enrollment, recruitment also occurred on the primary researcher’s college campus to allow for faculty, staff, and student participation. Study Recruitment At the pharmacy locations, a table was set up next to the pharmacy with a sign offering free spirometry screenings to any potential participant who met study inclusion criteria. Flyers were placed at both the drop-off and pick-up counter as a way to advertise the study. These same flyers were utilized as “bag stuffers” placed in prescription bags at the pharmacy locations. For recruitment at the university level, flyers were placed in lecture halls, student unions, parking garages, and campus athletic facilities in an attempt to gain additional interest from university personnel and students. Interested patients from any location could call the
8 I Pennsylvania Pharmacist I March/April 2015
clinical, non-dispensing pharmacist to schedule an appointment to determine their eligibility for study enrollment. As a way to incentivize patients to participate in the study, an Apple® iPad Mini was raffled off to those enrollees completing the study in its entirety. Instruments This study incorporated many different types of interventions so as to gauge each patient’s inhaler technique and disease state control. The following sections describe the instruments utilized in this study. Asthma Control Test The Asthma Control Test (ACT), a validated, five-question survey for patients 12 years of age and older, was used to determine control of each patient’s asthma. The ACT is recognized by the National Institutes of Health in its 2007 asthma guidelines, Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (EPR-3 2007).4 The survey was completed by the patient with assistance from the student pharmacist if needed. Following completion, the student pharmacist discussed results of the survey with the patient. Scores less than or equal to 19 out of a possible 25 points indicated uncontrolled asthma. Asthma Control Satisfaction Surveys Pre and post-study asthma control satisfaction surveys were designed by the study investigators as a way to determine the patient’s satisfaction with their level of asthma control, a factor not captured in the ACT. The
same survey, given at both the first and last intervention, used a seven point scale to assess the patient’s agreement with several statements regarding their inhaler use and asthma control. The prestudy asthma control satisfaction survey was completed by the patient during the first face-toface encounter with the student pharmacist and pharmacist. Information for the post-study asthma control satisfaction survey was collected by a phone call from a student pharmacist at the completion of the study. A sample of this survey can be seen in Figure 1. Inhaler Technique Checklists Inhaler technique checklists made by the researchers specific to each prescription inhaler type were utilized during patient demonstration of inhaler usage in order to assess and “score” the patient’s inhaler utilization technique prior to education from the student pharmacist and pharmacist. Proper inhaler technique is crucial to ensure that medication reaches the lungs and is effective. With improper technique, fully prescribed doses may not be received, and thus, asthma not controlled. In order to understand the patient’s current inhaler technique, the student pharmacist observed and documented the patient’s demonstrated use of their inhaler. Once assigning the patient a score of their inhaler technique using the checklist, the student pharmacist then demonstrated the appropriate technique specific to the patient’s inhaler type. This same checklist
Table 1: Results from Student Pharmacist and Pharmacist Intervention
Table 1 illustrates the enrolled patient’s score on the ACT, inhaler technique, and overall satisfaction pre- and post-intervention. Inhaler Type
ACT Score Intervention 1
Intervention 2
Inhaler Checklist Score (score out of 15 points) Intervention 1
Patient Satisfaction (score out of 126 points)
Intervention 2
Pre
Post
Patient 1
MDI
23
23
12 (80%)
14 (93.3%)
96
116
Patient 2
MDI
15
20
13 (86.7%)
14 (93.3%)
71
122
Patient 3
MDI
21
21
13 (86.7%)
15 (100%)
100
112
Patient 4
MDI
21
22
12 (80%)
15 (100%)
92
113
Patient 5
MDI
16
24
10 (66.7%)
12 (80%)
95
96
Patient 6
MDI
23
23
10 (66.7%)
15 (100%)
100
102
was used at two face-to-face interventions to assess patient baseline inhaler technique (first intervention), and then to assess patient recollection of student pharmacist inhaler technique education one month later (second intervention). See Figure 2 for a sample inhaler technique checklist utilized in this study. Spirometry Screening Spirometry is a test employed in those with asthma to measure pulmonary function. It measures how much and how quickly air can be moved out of the lungs. This test measures FEV1, FVC, and FEV1/FVC, which are referred to as the pulmonary function tests (PFTs). FEV1, or forced expiratory volume at one second, is a measurement of the maximal amount of air that can be exhaled with force in one second. FVC, or forced vital capacity, is a measurement of the amount of air that can be exhaled with force after a full and deep inhalation. These measurements are based upon the patient’s age, height, ethnicity, and gender. They are expressed as a percentage of the patient’s expected value.
Values less than 80% of that particular patient’s predicted value are considered abnormal. In asthmatics, FEV1 and FEV1/FVC are typically lower than the predicted value and FVC is typically normal or lower than the predicted value. This study was designed to capture two spirometry readings for each enrolled patient in order for the student pharmacist and pharmacist to gauge lung function and disease state severity. Potential improvements seen in spirometry results may impact inhaler adherence and patient satisfaction with disease control as patients notice an objective improvement as a result of using their inhaler correctly. Student pharmacists, overseen by a pharmacist, were responsible for screening study patients. The spirometer used in this study was an OHD KoKo Spirometer® available through the university’s school of pharmacy. Interventions Study enrollment and initial intervention appointments took place at each pharmacy location for three hours in the afternoon one day per week for six months. Appointments were scheduled at
the university location as needed. A total of three interventions occurred throughout this study: two face-to-face interventions and one telephonic follow-up. Figure 3 illustrates the steps that occurred at each intervention, which are described in detail below. The initial intervention consisted of a face-to-face interaction between the patient and the student pharmacist and supervising pharmacist. At this appointment, asthma inhaler technique was assessed using the aforementioned inhaler technique checklist, followed by counseling on appropriate inhaler use and technique demonstration by the student pharmacist. The ACT and pre-study asthma control satisfaction survey was provided to the patient to complete during the visit. The student pharmacist then discussed the results of both surveys with the patient, addressing any questions or concerns they had. Spirometry testing was completed next, followed by documentation of specific lung function measurements obtained from Continued on page 10
Pennsylvania Pharmacist I March/April 2015 I 9
Features spirometry such as FVC, FEV1, and FEV1/FVC. At the conclusion of the initial intervention appointment, the patient was scheduled for a face-to-face follow-up appointment in one month at either the university or one of the four participating pharmacy locations. Follow-up appointments were conducted for each patient one month after their initial baseline appointment. At this face-to-face visit, asthma inhaler technique was re-evaluated using the inhaler technique checklist, spirometry testing was again completed, and patient counseling and education on asthma, inhaler technique, and proper inhaler usage was completed as needed. Final follow-up interventions were conducted by the student pharmacists via telephone six months from the date of the first intervention. Through this phone call, the ACT was administered by the student pharmacist and results were discussed with the patient. The student pharmacist also addressed any remaining questions that the patient may have had. Lastly, the post-study
asthma control satisfaction survey was administered by the student pharmacist. Student Involvement Student pharmacists on advanced pharmacy practice experience (APPE) rotations were involved in performing the data collection and counseling aspects of this study which included: assisting the patients in completing all intake forms and surveys, performing the spirometry testing, scoring patients on inhaler technique using the provided checklist, conducting post-survey follow-up phone calls, and counseling patients on their survey, technique, and spirometry results under pharmacist supervision. Additionally, students aided in patient recruitment by identifying patients through their normal interactions at the pharmacy sites and hanging flyers at the study locations. These students were trained by a school of pharmacy faculty member through a half-day training session at the university prior to their APPE rotation at one of the study locations. The training session consisted of
Table 2: Spirometry Results Pre- and Post-Intervention
Table 2 illustrates a tending improvement in patient’s spirometry results pre- and post-student pharmacist intervention. Spirometry Results Pre FVC
Post
FEV1
Ratio
FVC
FEV1
Patient 1
3.53
3.13
0.89
3.61
3.42
Patient 2
1.58
1.52
0.96
1.68
1.54
Patient 3
4.71
4.06
0.86
5.54
4.47
Patient 4
4.53
4.23
0.93
4.65
4.01
Patient 5
4.07
2.33
0.57
3.48
2.03
Patient 6
3.13
2.72
0.87
3.15
2.84
10 I Pennsylvania Pharmacist I March/April 2015
an asthma disease state review, inhaler technique review for all inhaler types, spirometry training with the OHD KoKo SpirometerŽ, and training on all forms and documentation utilized in the study (ACT, patient satisfaction survey, informed consent). This study was conducted in compliance with the university’s Institutional Review Board committee requirements and an informed consent was obtained from each participant prior to any intervention.
Results
After six months of active recruitment, a total of 12 patients met study criteria and enrolled in the study. Seven of the 12 patients were recruited from the pharmacy chain locations, one from the independent pharmacy study location, and four from the university campus. Of these 12 patients, six completed the study in its entirety by participating in all three interventions (50%). All metrics, measurements, and survey questions were evaluated using a repeat-measures ANOVA test in SPSS v. 16.0. A baseline level was measured against clinical findings to assess a difference postintervention. An alpha of 0.05 was used to determine statistical significance. It Ratio was determined that 20 0.95 patients were needed to 0.92 treat to reach a power 0.81 of 80%. This number 0.86 was determined a priori using GPower v. 3.0.10. 0.58 An intention to treat 0.90
methodology was used since the study was a pilot; a true difference between baseline and postintervention was desired. As mentioned previously, an OHD KoKo Spirometer® was used to assess each patient’s FEV1, FVC, and FEV1/FVC. An average FEV1/FVC of 0.85 was seen at baseline compared to 0.84 postintervention. An average ACT score of 19.8 (out of 25; average 79.2% controlled) was noted at baseline, with 22.2 (average 88.8% controlled) post-intervention. In composite, all metrics seen in the ACT and satisfaction surveys saw an increase in terms of patient confidence and satisfaction with asthma control. Please refer to tables 1 and 2 which depict these results.
Figure 1: Study Asthma ControlAsthma Satisfaction Survey Figure 1: Study Control Satisfaction
Patient Name/ID___________ Date_________
Pre-Program 1. I have talked to my pharmacist/pharmacy intern about my inhaler(s) before. 2. My pharmacist/pharmacy intern has showed me the right way to use my inhaler(s).
Strongly Disagree Strongly Agree 1…….…..2..……….3..………4..……….5..……….6..……….7 Strongly Disagree Strongly Agree 1…….…..2..……….3..………4..……….5..……….6..……….7
Survey 1. I understand how to use my inhaler(s). 2. I feel that my asthma is well controlled. 3. I feel confident in using my inhaler(s). 4. I find that using more than one inhaler is confusing. 5. I always know which inhaler to use. 6. I take my inhaler(s) with me when I leave home. 7. I always have the right inhaler with me when I need it. 8. I do not like to use my inhaler(s) in public. 9. I feel that I inhale the right amount of medicine from my inhaler(s). 10. I always use my inhaler(s) when I am supposed to. 11. I am confident that my inhaler(s) will control my asthma. 12. My inhaler(s) leaves a bad taste in my mouth. 13. My throat feels dry after using my inhaler(s).
Discussion
14. My inhaler(s) costs too much.
This study showed important findings in terms of the efficacy of student pharmacists in patient disease state intervention in an ambulatory setting. While not enough patients completed the study to show true statistical significance, improvements in all measured areas were noted. These included improved patient satisfaction with disease state control, improved ACT scores, and improved pulmonary function tests. Students were able to adequately educate patients on the disease state of asthma which led to these improvements. Previous study findings have shown that when patients better understand their asthma and how to use their inhaled medications, adherence and disease state management will
15. Using my inhaler(s) does not interfere with my everyday life. 16. I am happy with my current asthma inhaler(s). 17. I am comfortable talking to my pharmacist/pharmacy students. 18. The pharmacy cares about me and my asthma.
improve.5 Another important finding was the improvement in patient asthma inhaler technique. While studies have previously shown improvement in patient inhaler technique following pharmacist education, the counseling in this study was provided by student pharmacists with pharmacist oversight. This is an important finding since student pharmacists that practice in the community setting can assist pharmacists in expanding the various types of clinical services offered to patients. If the study were to be
Survey
Strongly Disagree Strongly Agree 1…….…..2..……….3..………4..……….5..……….6..……….7 Strongly Disagree Strongly Agree 1…….…..2..……….3..………4..……….5..……….6..……….7 Strongly Disagree Strongly Agree 1…….…..2..……….3..………4..……….5..……….6..……….7 Strongly Disagree Strongly Agree 1…….…..2..……….3..………4..……….5..……….6..……….7 Strongly Disagree Strongly Agree 1…….…..2..……….3..………4..……….5..……….6..……….7 Strongly Disagree Strongly Agree 1…….…..2..……….3..………4..……….5..……….6..……….7 Strongly Disagree Strongly Agree 1…….…..2..……….3..………4..……….5..……….6..……….7 Strongly Disagree Strongly Agree 1…….…..2..……….3..………4..……….5..……….6..……….7 Strongly Disagree Strongly Agree 1…….…..2..……….3..………4..……….5..……….6..……….7 Strongly Disagree Strongly Agree 1…….…..2..……….3..………4..……….5..……….6..……….7 Strongly Disagree Strongly Agree 1…….…..2..……….3..………4..……….5..……….6..……….7 Strongly Disagree Strongly Agree 1…….…..2..……….3..………4..……….5..……….6..……….7 Strongly Disagree Strongly Agree 1…….…..2..……….3..………4..……….5..……….6..……….7 Strongly Disagree Strongly Agree 1…….…..2..……….3..………4..……….5..……….6..……….7 Strongly Disagree Strongly Agree 1…….…..2..……….3..………4..……….5..……….6..……….7 Strongly Disagree Strongly Agree 1…….…..2..……….3..………4..……….5..……….6..……….7 Strongly Disagree Strongly Agree 1…….…..2..……….3..………4..……….5..……….6..……….7 Strongly Disagree Strongly Agree 1…….…..2..……….3..………4..……….5..……….6..……….7
conducted over a greater period of time, it can be assumed that patients would show statistically significant improvements in inhaler technique. Spirometry results would also reflect this change in proper inhaler technique. It is difficult to note dramatic changes in FEV1, FVC, and FEV1/FVC over a short period of time. Similar to proper inhaler technique, if the patient were to be re-assessed at six months and one year, improvement in lung function could be seen. Overall, the results did not show statistical Continued on page 12
Pennsylvania Pharmacist I March/April 2015 I 11
Features Figure 2: Asthma Inhaler Technique Checklist
Figure 2: Asthma Inhaler Technique Checklist Technique Checklist Metered Dose Inhaler (MDI)
Participant name/ID: ________________________________ Name of inhaler: ____________________ Please check the following steps that each participant completes correctly. Each question is worth 1 point.
Removes all packaging from inhaler including foil (if applicable) Inserts metal canister into plastic holding device Removes cap Checks for foreign objects in mouthpiece (if no cap used) Shakes inhaler for 10-30 seconds Primes inhaler (if needed) according to package insert Takes deep breath in Exhales fully before next breath Uses either two finger method or holds inhaler in mouth o Two finger method: holds inhaler two fingers length away from mouth Inhales and presses canister to release medication at the same time (coordinated) Holds breath for 10 seconds after inhalation Lets breath out Rinses mouth out with water or mentions rinsing (if applicable) Removes metal canister to clean holding device
Other important techniques to question patient with: How long to wait before inhaling a second puff (if applicable)? o Answer: one minute in between puffs
Total score: _________________ Figure 3: Intervention Schedule Figure
Technique evaluated by: _____________________
3: Intervention Schedule
Initial Intervention (Face-to-Face) • • • • •
•
Completed after enrollment into program at one of the four pharmacy locations or university Inhaler technique assessed using checklist o Counseling on proper technique and demonstration by the student pharmacist under pharmacist supervision Asthma Control Test and pre-study asthma control satisfaction survey given o Results of both surveys are discussed Technique reassessed using “teach-back” method and checklist o Counseling on proper technique as needed Spirometry screening performed Patient follow-up appointment scheduled
First Follow-up (Face-to-Face) • • •
Completed one month after initial intervention at either one of the four pharmacy locations or the university Inhaler technique reassessed with checklist o Counseling on proper technique and demonstration by the student pharmacist under pharmacist supervision Spirometry screening performed
Second Follow-up (Telephonic) • • •
Completed six months after first follow-up Asthma Control Test reassessed o Results discussed with patient Post-study asthma control satisfaction survey given
12 I Pennsylvania Pharmacist I March/April 2015
significance in all parameters of the study, but positive trends in all aspects prove clinical significance.
Limitations The most significant study barriers were patient enrollment and study completion. It was difficult to find patients who met the enrollment criteria and were willing to participate, and even more difficult to not lose enrolled patients to follow-up. Due to the funding source of this study, recruitment was stopped at six months which contributed to the inability to obtain more than 12 patients. The time commitment associated with multiple interventions caused some patients to drop out of the study prematurely. This patient fatigue led to a smaller sample size which could have impacted the analysis of results obtained from the study. As noted in the results section, this number was insufficient to show statistical significance; however, the study was still conducted as the researchers felt that this intervention was important in the treatment of adult patients with asthma. Furthermore, this served as a valuable learning experience for APPE students in recruiting and conducting pharmacy clinical services in the community setting.
Conclusion and Next Steps Pharmacists are accessible healthcare professionals who are able to provide clinical preventive services. Whether it be measuring a patient’s blood pressure or checking cholesterol levels, pharmacists are attempting to play a larger role in assisting patients
and other practitioners with patient preventive health. Spirometry testing for measuring pulmonary function is just one of the many screenings that can be offered by pharmacists in the community and ambulatory settings. Pharmacists also provide many other services to patients including immunization administration, blood pressure measurement, cholesterol screening, and medication therapy management services. Spirometry is an easy to use ambulatory test pharmacists can utilize to help patients understand how well their asthma is controlled. This service, coupled with medication counseling, would be highly beneficial in regards to patient adherence and disease state control.
This study showed the ease with which student pharmacists on APPE rotations can be utilized to help implement these types of preventive services. Future studies should further investigate the impact of student pharmacists on patient health outcomes. Larger studies that incorporate a control and intervention group should be conducted to further validate the findings of this pilot project.
Acknowledgements The authors wish to acknowledge the following students at the time that the study was conducted for their help in study design and data collection: Ashley Kearney, Amanda Liszewski, Courtney Lynch, Lanette Sipple, and Alexis Spina. The authors also wish to acknowledge
the Pennsylvania Pharmacists Association Educational Foundation whose grant funded this study. z References 1. FastStats, Morbidity and Mortality Data for Asthma. Centers for Disease Control and Prevention. Updated May 30, 3013. 2. Roy A, Battle K, Lurslurchachai L, Halm E, Wisnivesky J. Inhaler device, administration technique, and adherence to inhaled corticosteroids in patients with asthma. Prim Care Respir J. 2011; 20(2): 148-154. 3. Benavides S, Rodriquez J, Maniscalco-Feichtl M. Pharmacist involvement in improving asthma outcomes in various healthcare settings: 1997 to present. Ann Pharmacother. 2009; 43(1): 85-97. 4. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. National Institutes of Health, National Heart, Lung, and Blood Institute. 2007. 5. Franks T, Burton D, Simpson M. Patient medication knowledge and adherence to asthma pharmacotherapy: a pilot study in rural Australia. Ther Clin Risk Manag. 2005; 1(1): 33-38.
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Pennsylvania Pharmacist I March/April 2015 I 13
Association News
At the Corner of Third and State Street By Cassandra Mislyan Philadelphia College of Pharmacy PharmD Candidate 2015 I stare nervously down at my watch, its 8:19 a.m., I have been waiting five minutes and still no one has answered the door. The wind is blowing; consequently messing up what once was my perfectly combed hair. How am I going to make a good impression now with my hair all over the place? I sigh and decide to ring the bell again. People on the street are beginning to stare at me, standing here outside of the building holding all my stuff
14 I Pennsylvania Pharmacist I March/April 2015
while the wind whips around my hair; I must look like an idiot. I breathe in deeply, trying to slow down my racing heart. I glance around, in an attempt to look normal, and notice a man walking in my direction from around the corner of State Street. It’s now 8:22 a.m. and I couldn’t be any more nervous for my first day. I decide to face the door and just wait for the man to either walk by or stop and open the door; heck for all I know he could be going into the
same building I was. Luckily for me, the man was Don Smith, the Government Relations Manager at PPA. I was in; but, somehow not as relieved as I had hoped to be. Could I really be this nervous meeting new people, starting this new rotation? I just have to get through these five weeks. My five week journey was nothing I could have ever imagined. To better understand where I am coming from, it is important to know the reasoning behind my selection of this rotation. First, I had no experience with legislative issues, second, it was close to home, third, I am always open to learning new things and fourth, why the heck not try something new. Life can become dull if you just constantly do the same things over and over again. I consider this rotation my “stepping outside of the box” rotation. Throughout my short time at Pennsylvania Pharmacists Association (PPA), I was given new
opportunities to learn. The most exciting and stressful learning experience came from Senate Bill 405. To step inside my shoes imagine this: you know nothing about legislative issue (a bill, what’s that exactly, you mean the house and senate both have to vote, why can’t they use logic to solve these discrepancies, and can’t everyone just get along?), you are thrown into a meeting with no prior knowledge of the topic, you are unable to follow the conversation because you have no idea what is really being said, you look around the room and have no clue what these people are thinking or what their intentions are, and to top it all off you only met these people a few minutes ago; talk about uncomfortable situations. But through and through with some hard work and dedication, I was able to get up to speed and understand the issues at hand. I had a front row ticket to learning and I was not going to let the opportunity pass me by. I put in countless hours of understanding how bills are lobbied for and the effort pharmacy lobbyists go through to advocate for pharmacist.
Imagine my surprise when I realized not a single pharmacy lobbyist I interacted with was a pharmacist. I know what you are thinking, they are getting paid to do that, but it really is so much more than that. These nonpharmacist lobbyists have such a great passion for pharmacy and making sure the pharmacists are treated fairly; despite not being pharmacist themselves. As a future pharmacist, I am truly grateful for all of the lobbyists’ hard work and passion because at the end of the day it comes down to their dedication to the issue, not just the money. Furthermore, SB 405 granted me the opportunity to network by completing a call to action plan. During this time my whole goal was to get as many pharmacist, pharmacy students, and patients as I could to contact their state representative and oppose SB 405 in its current form. The current form part is very important because that excludes potential proposed amendments that might get added. See I learned and applied something! This involved a lot of networking and reaching out to people I have never interacted with before. I
was fortunate enough to talk to some pharmacists I already knew and asked them to spread the word and contact their state representative and oppose the bill. In the end thankfully, SB 405 was not voted on in the house and Pennsylvania’s legislative session came to an end; our call to action was a success. Many representatives stated the voting was abstained from because they were contacted by their local pharmacies and pharmacists. The sense of accomplishment I gained was worth all of my hard work. Needless to say my five weeks came and went and I can’t believe my time is up. It feels like I just got here, was it really five weeks already? There are still so many more things to learn, do and experience, but, sadly my time at the corner of Third and State Street has come to an end. As I walk out of the building I will forever be reminded of the knowledge, experiences and friendships I have encountered. My time at PPA will not be stored away in my brain and forgotten, but instead tucked behind my ear where I can quickly access it every time I come across pharmacy legislation. z
Student members: Did you know you have the opportunity to win $50? For every new student pharmacist that you recruit to become a PPA member (make sure your name is on the application) you will be entered for a chance to win $50. A winner will be drawn at random and announced at PPA's 2015 Annual Conference. You do not need to be present to win. The competition ends August 31, 2015!
Invite your friends to join PPA today!
Student members: Did you know you have the opportunity to win $50? Pennsylvania Pharmacist March/April For every new student pharmacist that you recruit to become a PPA member (make sure your I name is on 2015 the I 15 application) you will be entered for a chance to win $50. A winner will be drawn at random and announced at PPA's
Schedule of Activities 8:00 a.m.
Registration begins— East Wing Rotunda, Capitol Building
8:30 - 10:00 a.m.
Continental breakfast for attendees, invited legislators and staffers—East Wing Rotunda
10:00 - 11:00 a.m. Pharmacy Rally— Main Rotunda
8:30 a.m. - 2:00 p.m.
Screenings and informational displays presented by schools of pharmacy—East Wing Rotunda
8:30 a.m. - 2:00 p.m.
Legislative appointments as scheduled with legislators or staffers
We need you to be here and speak out for the future of pharmacy and for your patients!
PPA will provide you with issue briefings, background papers and leave-behind packets for the major legislative issues affecting pharmacy.
Are You... Frustrated about a level playing field for pharmacy? Experiencing or experienced an unfair pharmacy audit? Interested in expanding immunization opportunities? Passionate about advancing pharmacy practice? If the answer is “yes”—then we need you to join us in
Advance briefings:
Conference calls to help you prepare for the issues will be held: Pharmacists: Tuesday, April 7 at 2:00 p.m.* Students: Wednesday, April 8 – 7:00 p.m.* *Calls will be recorded for those unable to participate.
Harrisburg on April 13!
“I come to Legislative Day because I want to represent community pharmacists throughout the entire state that share the same concerns as I do. We need to let the legislators know that we will not stand by and let PBM's control our future anymore. I feel that being in Harrisburg face-to-face with our Representatives and Senators carries more weight then an email or phone call. They know I really care!” - Dave Cunningham, Independent Pharmacy Owner
Please contact Don Smith at dsmith@papharmacists.com with any questions and be sure to visit PPA’s Legislative Issues webpage to view PPA’s legislative priorities and other issues being monitored.
16 I Pennsylvania Pharmacist I March/April 2015
Features
Member Profile Richard Smiga, RPh By Cassandra Mislyan Philadelphia College of Pharmacy PharmD Candidate, 2015 Richard Smiga RPh, graduated from Duquesne University with a dual degree of a BS in Biology, 1981, and BS in Pharmacy, 1984. He currently works at Care Capital Management, a pharmacy entity that focuses on retail, long term care and institutionalized pharmacy. Rich chose the pharmacy profession
because he wanted to play a role in helping patients with their health care needs. How did your experiences shape your career? While completing his pharmacy school internship, Rich realized that his calling was to provide for patients; he realized he truly could make a difference in people’s lives. Getting involved in the health care arena made Rich more aware of the needs of the public. Seeing the aged population living longer and
having healthier lives made him realize that pharmacy can offer so many different avenues that would be impactful in so many ways. Rich says, “As a Pharmacist and being in a health profession one can get involved in the different aspects of the sciences and touch the patient directly.” What was the most memorable experience of your career? Rich’s most memorable experiences include being Continued on page 19
Announcing PREP Start your residency off on the right track! Out shine your competition! Designed specifically to assist individuals entering a pharmacy residency program July 1, 2015, this program will give you tips, direction, ideas, and review your skills so that you can be better prepared to jump-start your residency year. Set yourself on course to be as successful as possible! The PREP Series consists of 13 recorded webinars covering 17 hours focusing on how to be a resident, pharmacy practice, and skill review.
All 13 modules are available on-demand, so you can watch them a time that’s convenient for you! All are designed with optional readings, presentations, and the opportunity for you to ask questions and participate in discussions. Modules will be 60 to 120 minutes in length and released on the PPA website in May.
PA state law as it affects clinical practice, documentation requirements/best practices, professional development, ID bug/drug review, pharmacokinetic drug dosing, evaluating literature, comprehensive medication management, an introduction to the residency process, expectations, navigating your residency site, emotional intelligence, communication basics, professionalism, self-reflection/ evaluation, research projects, information management, pearls for teaching and more! More information will be available soon, including fees, registration, specific dates and times. To get on our mailing list and be among the first to register— email PPA at cbox@papharmacists.com or visit our website www.papharmacists.com
Presented by the Pennsylvania Pharmacists Association
Pennsylvania Pharmacist I March/April 2015 I 17
Over $8.5 Million disbursed to participating members in 2013
appointed to the Pennsylvania State Board of Pharmacy and receiving the Bowl of Hygeia Award in 2012. What made you decide to join PPA? Rich believes, “being a PPA member offers an opportunity for all areas in the profession to have one common meeting point regardless of your specific professional career path and expertise. PPA promotes the ‘Profession’ while offering everyone a chance to be heard and listened too. Its advocacy and involvement with the students at the schools of pharmacy is going to shape the future of the profession.” How has being a PPA member helped you professionally? “PPA has helped me professionally because they keep abreast of the most recent regulations and pending legislative proposals. They offer suggestions and are valuable stakeholders
in past and present regulations and changes that impact pharmacy. Being the conduit for the profession, PPA can see a pending issue from all angles and offer viable options and thought provoking questions.” Where would you like to see the profession go in 10 years? “Pharmacists need and should be considered part of the entire health care of patients in all aspects. The medical professional groups need to embrace the Pharmacist as a ‘true partner’ in all instances, just as they do with the rest of their staff and team. Although, it has gotten much better in recent years there is still much more room for improvement. Having a Pharmacist within the practice setting and being a closer part of the patient medication review and determination will ultimately lead to better patient outcomes. Also, seeing Technicians playing a larger role in the scope of the profession
will enable the Pharmacist to get more involved with true patient collaboration and health care. This coupled with advancement in technology and support will allow all the resources available to make the best decisions possible in treating and serving the patient.” Additional Remarks: Many folks are unaware that Rich is very passionate about fly fishing and back in the day he had a collection of old bottles. When he is not working he can be found spending quality time with his family. He is unable to just pick one individual that he has learned the most from; “he has been blessed to have many mentors along the way, who he is deeply indebted to.” Lastly, Rich reminds pharmacists to always remember to give back to the profession. “Embrace the profession; while being a person who is more of a ‘giver’ than a ‘taker’.” z
Help Us Spread the Word! Share the link to PPA's new blog with your patients, family, and friends!
www.pharmacistscare.net Pharmacists Care was a blog created for the public in order to promote the value of pharmacists, the services they provide, and their role on the healthcare team.
Pennsylvania Pharmacist I March/April 2015 I 19
2014 Report A special thank you is in order to all 2014 PharmPAC donors…
This marked another historic and successful year for PharmPAC! PharmPAC reached its 2014 goal of $60,000 – by raising $60,846.70! This is the most PharmPAC has raised – EVER! And the impact was felt! With a stronger PAC, we were also able to deliver real and meaningful results! Carrying this momentum forward, we are aiming for $63,000 in 2015 – and it’s a goal we NEED to reach. Please consider making your contribution today; or donate monthly via our regular credit card charge program.
Congressional Club ($1,000+)
Thomas Bradley* Brockway Drug Co. (Ronald Matson)* J. Richard Brown* Burman’s Media Pharmacy LLC (Steve Burman) Burman’s Pharmacy, Inc. (Steve Burman) Burman’s Specialty Pharmacy (Steve Burman)
Laurence Doud Greg Drew F.B. Thomas Drug Store, Inc. (Andrew Thomas) Robert Frankil* John F. Hinkle, Jr.* Mark Lawson Millersburg Pharmacy (George & Dorathy McAlanis*) John A. Pavis*
Primary Care Pharmacy Services (Anthony Bertola)* Quik-Stop Pharmacy (Robert Steele) Salem Crossroads Apothecary (Theodore Stoklosa) Darrin & Debra Silbaugh* Mat Slakoper* Mark & Sandy Szilagyi
Bechtel’s Pharmacy, Inc. (Ed Bechtel) Anthony Bertola Joseph Bettinger* Dave Cippel* Contract Pharmacy Services (Wayne Shafer) Dave Cunningham* Patricia Epple* Erie APhA-ASP/SPPA Chapter Donna Hazel* D. Sco cott Himler*
Nicholas Karalis Nicholas Katra Coleen Kayden* Robert Kayden* Marty Kendra* Patrick Lavella* Charles Lebegern* Medicine Shoppe #1468 (Michael Fapore) MedVisors (PJ Ortmann)* Bethany Miller* r* J. Scott Miskovsky*
Shawn Nairn* Ellen Nastase* Norwin Pharmacy (Marvin Sheffler)* Richard Ost John J. Pavis* Eric Pusey* David Smith* Stephanie Smith Cooney* William Thompson
Mary Grisnik-Kaup* Janet Hart* Nicholas Kernich* Bob Killoran* Charles Kohlerman III* Melissa Krause* Nick Leon* Fred Lombardo Robert Maher, Sr. Dorathy McAlanis McElroy Pharmacy, Inc. (Jeffrey Eshelman)
Professional Pharmacy (John McCullough) Robert Schreiber Wayne Shafer Jared Shayka William Sherman Thomas Silvonek Theresa Talbott Greg Teitel The Medicine Shoppe (Susan Schropp) Adam & Kim Welch* Wilkes University
Amy Baloh Frederick Bonchosky Boswell Pharmacy (Jacqueline Martella) Mel Brodsky* James & Marybeth Dillon Joseph DiMatteo Eaglescripts Apothecary (Robert Kasisky) Ellis Pharmacy (Walter Cwietniewicz) Eric Esterbrook* Ferri Pharmacy (William Ferri)* Brandon Antinopoulos* James Beatty
20 I Pennsylvania Pharmacist I March/April 2015
Keystone Club ($500+)
Capitol Club ($250+)
Patriot’s Club ($100+) Edward Bechtel Joseph Bechtel
Ross Bevevino Robert J, Bimeal
Harold Brog Richard Bronstein Michael Brown Choice Apothecary, Inc. (Andrew J. Altobelli) Choice Critical Care, Inc. (Andrew J. Altobelli) Choice Family Pharmacy, Inc. (Andrew J. Altobelli) Walter Cwietniewicz Russ Daniels East Berlin Pharmacy, Inc. (Andrew J. Altobelli) Michael Fapore* Jon & Kim Ference* Gary Fields Michael Fino Anthony Gallucci John Gans
Rosemarie Halt Robert Hinkle Barry Jacobs Gary Karwaski Kristin Katra John Kearns Jackie Klootwyk* Charles Kohlerman III Kohlerman’s Pharmacy (Charles Kohlerman) Judith Kristeller Holly Lang Sherri Lee* John McClellan Enid McClung* Cheryl Meek Michelle Mikus* Karla Moschella Joseph Mosso
Michelle Musheno John Price III Andrea Pugh Ethan Schwarz David Shappell Bruce Sigman Joseph Sobolowski Thomas F. Stonesifer Melissa Sweigert The Medicine Shoppe (Dan Swain) True Care Pharmacy, Inc. (George Botros) Vogenberg Family LTD PTNS (Allen Vogenberg) Gerard Volgraf Megan Weigand Jeanette Young
Sustaining Members ($50+)
Joseph Albert Douglas Allen Charles D’Ardenne Tracey Frawley George Haynes Paul J. Hiller Robert Howell Dan Hussar
Tamre Joyce Patricia Kroboth Ramon Levin James Loyer Sinoe Naji Dennis J. O’Brien Maria Osborne Mary Ray
Clinton H. Roderick III Maureen Scheuerman Jude Vavala Dawn Wagoner Fred Weissberger Eric Wright
Contributors ($25+)
Galen Bear Chalfont Immunization (James Vickery) Stacy Costa
Gary Garrett Robert Hartzell, Jr. Amanda Jaber Anthony Mortelliti
Thomas & Jean Olcese Julie Olenak John Paone Lauren Simko
Donors ($10+)
Ben Andrick John C. Barrett Howell’s Medicine Center
Knight’s Road Pharmacy, LLC (Regina Williams) Thomas Lindeman
1878 Society Members (Student-Only)
Duquesne Ben Andrick Hannah Cawoski Mariah Corso Jordan Moore Rachael Richter
Jefferson Kenneth O’Donnell LECOM Jennifer Addo Mohammed Amer Alex Covey
Please note: Donations under $10 not listed *Designates regular monthly or quarterly donors
Alex Gragg Chris Sedgwick Paulina Trzcinka PCP Kevin Farrow Terry Pak
Pittsburgh Trey Draude Keito Hoshitsuki Amanda Jaber Anthony Kostka
Temple Seth Aaron Michael Bellano Tonisha Thompson Wilkes Sara Bellanco Sarah Elias Alysha Lopez Sheena Patel Jennifer Smith Trey Tietz
Pennsylvania Pharmacist I March/April 2015 I 21
Association News
Nominations Being Accepted for PPA Officers and Members of the Board of Directors The following positions are available: President Elect and Vice President Regional Directors – Northwest and Southeast Practice Network Directors – Academia, Associates, Community-Independent/LTC, HealthSystem/Institutional, Managed Care/Government, and Student Pharmacists
Help lead your profession and pharmacy forward! For more information, contact PPA – ppa@papharmacists.com
Are you prepared to be among our next generation of leaders? No matter where your hang your pharmacy license or how you use it in practice—pharmacy needs leaders and advocates for the profession!
LEAD is presented through the PPA Educational Foundation
Be one of our first leadership program graduates! LEAD is a year-round experience starting in August 2015 through June 2016, building your leadership skills, fostering connections, and building your professional network. A small and select group of participants will participate in thought-provoking discussions, idea sharing, and learning sessions all designed to help you become a strong LEADer in your workplace, community, and for pharmacy! Applicants for LEAD must be pharmacy graduates within the last 3 and 10 years interested in building their experience, skills, and leadership abilities. Modules of learning include workplace culture, communicating as a leader, strategic planning and thinking, time management, organizational and non-profit leadership, business leadership, pharmacy advocacy, and more! Throughout the program you will interact with established leaders in Pennsylvania pharmacy and assess how you will make your mark! More information, including an application, will be coming soon on the PPA website at http://www.papharmacists.com/?page=LEAD
22 I Pennsylvania Pharmacist I March/April 2015
Industry News
The Expanding Role of Pharmacists in a Transformed Health Care System Excerpts from A National Governor’s Association (NGA) Paper Pharmacists’ roles are evolving beyond dispensing medication to providing direct care to patients as part of an integrated team of health care providers, according to a new paper released by the National Governors Association. “The Expanding Role of Pharmacists in a Transformed Health Care System” paper explores ways states can better integrate pharmacists into the health care delivery system, including amending existing laws and regulations to allow them to practice to the full scope of their profession. “As the health care system undergoes a major transformation in both finance and the delivery of services, states are focusing on improved quality and health outcomes,” said NGA Executive Director Dan Crippen. “Integrating pharmacists, who represent the third largest health profession, into the health care delivery system is one way to meet those goals.” An executive summary of the paper is below. To read the full paper, please visit: http://www.nga.org/files/live/sites/NGA/files/ pdf/2015/1501TheExpandingRoleOfPharmacists.pdf. Pharmacists practice in a variety of health care settings. Although they are most often associated with dispensing medications in retail pharmacies, their role is evolving to include providing direct care to patients as members of integrated health care provider teams.1 The critical role that medication management plays in treating chronic diseases suggests that the integration of pharmacists into chronic-care delivery
teams has the potential to improve health outcomes. Studies of pharmacists providing medication therapy management (MTM) services to improve therapeutic outcomes indicate that services can improve outcomes and reduce costs. Pharmacists typically provide those services in interdisciplinary teams through collaborative practice agreements (CPAs). Such agreements with other health care providers allow a licensed provider to refer patients to a pharmacist and delegate the delivery of clinical services under supervision. Several key challenges and barriers, however, prevent the full integration of pharmacists into health care delivery teams: restrictive laws and regulations governing CPAs, lack of provider recognition in federal and state law governing compensation of pharmacists who provide direct patient-care services, and limitations on pharmacists’ ability to access health information systems. States seeking to integrate pharmacists more fully into the health care delivery system can examine state laws and regulations governing the profession to address the challenges to pharmacists practicing to the full scope of their professional training. z 1: According to the U.S. Bureau of Labor Statistics, in 2012, 43 percent of pharmacists were employed in pharmacies and drug stores, 23 percent in hospitals (state, local, and private), 8 percent in grocery stores, and 10 percent in other retail locations (see http://www.bls.gov/ooh/healthcare/ pharmacists.htm#tab-3). This paper does not address questions related to compounding pharmacies that create and mix drugs customized to specific patient needs based on a prescription written by a physician or compounding pharmacies that distribute a high volume of compounded drugs without prescriptions.
Pennsylvania Pharmacist I March/April 2015 I 23
Features
Pharmacy Spotlight It’s All About Patient Rights at Shankel’s Pharmacy By Alysha N. Lopez, PharmD, Candidate 2015 Wilkes University In the heart of downtown DuBois, PA, surrounded by other well-known, locally owned businesses, you’ll find Shankel’s Pharmacy owned by Tom and Cindy Bowser. The Bowser’s have been in possession of the pharmacy since 1987, and have definitely added essential amplifications to the establishment since. Tom and Cindy both attended and met at the University of Pittsburgh, graduating in 1980. Before purchasing the pharmacy, Tom worked as a hospital pharmacist and served as a Director of Pharmacy at the DuBois Hospital in the mid-80’s. The drive to own and operate an independent came from Tom’s strong belief that patients have the right to choose their own healthcare. “I believe a patient has a fundamental right to choose a pharmacy that best meets their needs, just like they have the right to choose their physician.” One way PPA helps its members is through advocacy of legislative issues, which commonly intrigues pharmacy owners because it unites their voices against big business. Tom has been a strong member of PPA since 1991, not
24 I Pennsylvania Pharmacist I March/April 2015
just for the purpose of protecting his occupation, but more so for the rights of the patient. He truly feels that healthcare in our nation could overcome many downfalls if all providers would remember the most important item, the patient. One can definitely find this great sense of patient appreciation and loyalty at Shankel’s Pharmacy. All the staff at Shankel’s treats each patient with individual care, from the greeting to the goodbye. In a busy work day of filling, faxing and PBM issues, Tom states that his favorite part of the day is when someone pulls him aside for a question. “Many patients begin the conversation with ‘I’m sorry Tom, I know you are so busy,’ but I tell them this is the best part of my day! This is why I chose this career, to help you.” Speaking of choices, Shankel’s is now offering a type of DNA testing to their patients that can be done right at the pharmacy. Recently, research has emerged showing that a whopping 30% of people thought to be protected by Plavix (clopidogrel) are surprisingly not. The test shows which patients actually change clopidogrel to its active form and which do not possess the proper enzyme. This
simple test that Shankel’s makes available to patients absolutely impacts their care substantially; it saves lives and money! Those who are not protected can be switched to something like Effient or Brilinta, which some insurance companies do not include in their list of “preferred brands.” The DNA test gives proof that the nonpreferred brand is essential to the patient’s health and therefore can be covered. Another item that helps the Shankel’s staff lend their hand in patient care is their computer and filling system. All of their patients can be on auto-refill which opens up many opportunities for improvement in care. First off, it gives them the ability to synchronize the patients’ medications to allow them to come to the pharmacy once or twice a month instead of eight. The system also prompts the pharmacist when it’s time to refill a prescription. Shankel’s staff even bring up the queue 10-12 days early to make sure all the prescriptions still have refills; if not, the patient doesn’t even have to worry because Shankel’s will call the doctor to get a new prescription for them. Finally,
the staff will call the patient to let them know the prescription will be ready, which leads to the common patient reply of, “but I have lots of medicine left.” This is the perfect opportunity for the pharmacist to ask the patient questions about how they are taking their medication; if they are having trouble remembering or do not understand when to take which ones, Shankel’s will offer a variety of solutions and work with the patient to decide what would be best for them. You can find Tom Bowser frequently at his state officials’
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offices, having lively conversations and educating them on healthcare topics. Always keeping in mind his patients, Tom fights for fair legislation so he can continue to serve them. There once was a day when pharmacists couldn’t substitute generics or administer vaccinations, and now look how far pharmacy has come because we kept advocating for our patients. Tom mentioned that even the legislative items that seem to only deal with business and money effect our patients too. Independent pharmacies need to stay alive because the patient
needs to continue to have the right to choose their pharmacy; as is with any industry, monopolies need to be avoided. Along with being a full service pharmacy, Shankel’s sells common goods and gift items located at the front of the store. They also offer free delivery for in-town residents. Tom and Cindy are also in the preliminary stages of renovating the store so it can include a private area for counselling and vaccinations. If you are in the DuBois area, stop into the unique and historic “Shankel’s Pharmacy, caring for you is what we do.” z
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Pennsylvania Pharmacist I March/April 2015 I 25
Departments
Campus Checkup Jefferson School of Pharmacy The APhA/ PPA chapter of Jefferson School of Pharmacy has kept busy over the last few months by engaging in service, professional, and social events across Philadelphia. Some highlights include participation in the American Diabetes Association Walk and the Heart Walk, organized by the Patient Care Committees. The walks engaged many Jefferson students and served as both educational and outreach events. The Jefferson chapter also held an on campus OTC competition to determine a winner that would represent Jefferson School of Pharmacy at the MidYear Conference this February. The competition was tight, with representatives from all professional years of the student body working to represent Jefferson.
Although it was indeed a close competition, Jefferson School of Pharmacy is proud to support Amanda Gibson, Kyle Massey, and Oludamilola Olugbile. In the next few months the APhA/PPA chapter is looking forward to participating in upcoming PPA events including the Mid-year Conference as well as Legislative Day. The Jefferson School of Pharmacy chapter is also looking forward to events during Heart Health Month including involvement in a Go Red Day, a patient counseling event organized by Operation Heart, and a Mr. Pharmacy event to benefit the American Heart Association organized in collaboration with the Jefferson School of Pharmacy, Student Body Governance. z
Duquesne University Student pharmacists at Duquesne University have been busy with the start of a new semester. PPA members have been actively preparing for Legislative Day in Harrisburg in April by promoting advocacy and awareness among members. PPA meetings have hosted guest speakers and discussions about important legislative issues facing pharmacy such as provider status. Students were really interested to learn the many ways in which provider status would have a huge impact in the profession of pharmacy. In addition, preparation for the second issue of the new PharmDispatch newsletter is in full swing. The PharmDispatch is an informational newsletter written by students to educate other student pharmacists about new legislation and current events within the pharmacy community. Duquesne University students have also been active in many educational outreach projects this 26 I Pennsylvania Pharmacist I March/April 2015
semester. Student pharmacists have been participating in the Katy’s Kids program, teaching students at local elementary schools what medicine is, safe medication use, and the role of a pharmacist. The elementary students also had a blast pretending to be pharmacists by trying on white coats and using stethoscopes to hear their heartbeat. Other student pharmacists have been participating in drugs of abuse presentations to local middle and high schools. The goal of these presentations is to teach these students that prescription medications are not safe to use unless prescribed to you and they can have serious consequences if improperly used or abused. We are very proud of all of the hard work our students have put in and look forward to participating in many more screening and outreach activities as the semester progresses. z
Wilkes University This semester, Wilkes University’s PPA chapter has been busy making plans for Mid-Year Conference, health fairs, Katy’s Kids, Fundraisers, and Legislative Day. The first event we are participating in is a health fair at the Walgreen’s in Kingston, PA on February 17th for Wilkes’ Pharmacy Week. Our members will be educating on smoking cessation. With this and organizing Katy’s Kids at local daycares, we look forward to educating others on medication safety and the role of pharmacists. It is really important for our
chapter to advocate, but to also focus on patient care and improve the lives of our patients. For the Mid-Year Conference students are excited for the student competitions especially the OTC Competition in which Wilkes hopes to win back the title of OTC Champs. Every year Wilkes’ PPA chapter supports PharmPAC and are in the process of coming up with a fundraiser. Finally we have been busy with spreading the word about Legislative Day in April. We are also making plans to have a “How to Meet with your Legislator” session for students. Our chapter hopes that by doing this more students will feel confident and comfortable with talking to their legislators about importance pharmacy bills and issues at Legislative Day. Overall, with the conference, educating patients, fundraising, and Legislative Day, Wilkes University’s PPA chapter has great plans this semester and cannot wait to implement them! z
LECOM The month of January has been very exciting for LECOM as we have begun competing in the National Consumers League Script Your Future challenge for the fourth year in a row. Each organization in our pharmacy school will be hosting an interprofessional event with our medical school to promote medication adherence in the Erie community. On January 28th, Erie County Executive Kathy Dahlkemper presented LECOM with a proclamation in recognition of the College’s commitment to Script Your Future and community health. For our first event, Operation Heart hosted an educational event at a local elderly community where students presented the importance
of medication adherence and ways to improve their overall health. Next month, we will be going back to this same facility to discuss ways to control diabetes. Other events planned for the month of February include answering medication questions and creating medication lists for patients at a local multicultural resource center and a health fair at a local CVS focused on asthma and the importance of pneumonia vaccines. LECOM is also looking forward to PPA’s mid-year meeting in Harrisburg. Our team for the Student Pharmacist Self Care Competition has been preparing and is excited to compete. We are also looking forward to the various presentations and networking opportunities. z Continued on page 28
Pennsylvania Pharmacist I March/April 2015 I 27
Departments
University of Pittsburgh In December our PPA Chapter hosted a toy drive for Matilda Theiss, a hospital based clinic that provides various services to the underserved population in Pittsburgh. We were extremely proud of our students’ donations and had a car full of toys to take to the facility so that many of the families’ children would have toys to open on Christmas morning. This was our first year hosting this event and it was a huge success! The spring semester was very busy for our chapter. In February we hosted our annual pharmacy week event, the OTC Competition. We were very proud of the winning team who went on to compete in the OTC Competition at the PPA Mid-year Conference. The Mid-year Conference was also another big event for us, because we sent over 63 students and many of them presented posters!
We were also able to participate in Katy’s Kids events this semester by partnering with our student SSHP chapter. We integrated a Katy’s Kids station into SSHP’s poison prevention program. This was a very rewarding experience and it was awesome to collaborate with another student organization in pharmacy school to co-host the events. We were also able to finally implement our Dean’s Theme Project that many of our members had worked very hard on in the fall semester to put together. We educated many of our fellow University of Pittsburgh students about various over the counter products utilized for women’s sexual health. We specifically focused our efforts on Plan B, Monistat, Cranberry supplements, pain relievers, Midol, and Violet Iodine. Finally, we dedicated a lot of our planning efforts to the much anticipated Legislative Day. We plan to send our entire second year professional students to the event and hope to make a positive impact for our pharmacy profession! We were honored to have received the Government Relations Award at the PPA Annual Conference last September and we hope to be a strong candidate for the award again this year! z
Pharmacy Time Capsules 2015 (First Quarter) 1990 OBRA 1990 passed. States required to offer prospective and retrospective DUR. Patient counseling mandatory for Medicaid patients.
Society of Infectious Diseases Pharmacists founded.
1964 Title XVIII and XIX (Medicare and Medicaid) passed.
Quaalude (methaqualone Rorer) named to invoke the phrase “quiet interlude” was approved. The drug was discontinued in 1985 because of its addictiveness and recreational use.
1940 Ida M. Fuller became the first person to receive an old-age monthly benefit check under the new Social Security law. 1915 Abraham Flexner refused to do a study of pharmacy similar to his study of medical education. He describes pharmacy as “nonprofessional because it is unintellectual, highly profit motivated, without a technique of its own and without a primary responsibility.” y: Dennis B. Worthen, PhD, Cincinnati, OH B One of a series contributed by the American Institute of the History of Pharmacy, a unique non-profit society dedicated to assuring that the contributions of your profession endure as a part of America’s history. Membership offers the satisfaction of helping continue this work on behalf of pharmacy, and brings five or more historical publications to your door each year. To learn more, check out: www.aihp.org
28 I Pennsylvania Pharmacist I March/April 2015
Features
Script Your Future In the United States, nearly three out of four patients put their health and futures in jeopardy by not taking their medications as directed, resulting in serious health consequences. In an effort to curb this concerning public health issue, the second-year pharmacy students at the University of Pittsburgh School of Pharmacy, in conjunction with the School of Medicine, joined health profession students across the country and took part in the Script Your Future’s Fourth Annual nation-wide Medication Adherence Challenge. It is a two-month long interprofessional competition, and select schools or colleges are nationally recognized for their efforts. Script Your Future focuses around the importance of patients continually taking their medications as prescribed in order to live happier, healthier lives. The campaign specifically focuses on three major health conditions: cardiovascular disorders (high blood pressure and high cholesterol), respiratory illnesses (asthma and COPD), and diabetes. The primary objective of the campaign is for students in the various health professions to promote medication adherence to patients. During the months of January and February, pharmacy and medical students held a series of community outreach activities throughout Pittsburgh. The student pharmacists incorporated Script Your Future into the daily activities conducted at their 77 community-pharmacy rotation sites, as well as twice a week at Falk Pharmacy, UPMC Presbyterian Prescription Shop, and the University Pharmacy. The medical students fostered the campaign in a variety of medical clinics, including the Birmingham
Clinic and the traveling optometry clinic, Guerrilla Eye Service. Each health profession student was responsible for effectively communicating with patients entering the various pharmacies and clinics involved. The student-patient interactions consisted of brief interviews gauging the patients’ baseline devotion and adherence to taking his or her medications, utilizing a 4-question survey. Once the questionnaire had been conducted, the students then distributed a multitude of resources to the patients, including helpful tips and tools to make taking their medications as directed much easier. These resources included a wallet card for medication information, informative fact sheets about the focus disease states of Script Your Future, and a pledge card where patients could share a personal reason why they promised to take their medicines as directed. They were also offered the opportunity to sign up for text message reminders, and could receive a free blood pressure screening, as well as a pillbox. Each year, Script your Future has a dramatic impact on patients across the country. It offers health professional students the opportunity to reach out to people throughout their surrounding communities and better their medication experience by engaging in an informative, and much-needed conversation. Though the students do act as medication adherence coaches, the coaches themselves cannot be successful without the team players – those being the patients. It takes the patients’ own willingness to adhere to their medications as prescribed, to keep their disease states well-controlled, and thus, to script a healthy future of their own. For helpful tips and resources, as well as more information about the campaign, visit ScriptYourFuture.org today! z Pennsylvania Pharmacist I March/April 2015 I 29
Features
Profiles in Pharmacy Innovation Juliana Nowak RPh, CGP, FASCP By Cassandra Mislyan Philadelphia College of Pharmacy PharmD Candidate 2015
Name of Pharmacist: Julie Nowak RPh,CGP, FASCP, Lead Pharmacist, consultant pharmacist, certified geriatric pharmacist at MageeWomens Hospital of UPMC Education: 1977 graduate of Duquesne University. Julie has been continuously furthering her education in the areas of immunizations, MTM, pain management, compounding, outcomes and many other topics. Name of Practice Site and Location: MageeWomens Hospital UPMC in Pittsburgh, PA Site Description: Up until several years ago, MageeWomens hospital of UPMC was focused solely on women’s health. Today, the hospital is classified as a general hospital that covers a variety of area including: NICU care, women’s health, general surgery, bariatric surgery, transitional care, geriatrics, orthopedics and others. Overall the hospital has become a center of excellence in several areas including geriatric care. Innovative and other services provided: To begin with, Julie has
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years of experience in community pharmacy and long term care and now in hospital care. She is a provider for several departments of Magee- Womens Hospital and has the opportunity to follow patients throughout their entire stay at the facility. “I have a unique experience of seeing multiple layers of a patient’s visit in the hospital.” She works closely with The Benedum Geriatric Service, geriatric patients, The Transitional care unit, and post discharge care. She focuses on a holistic approach when treating her patients and
always takes those extra minutes to double check. She attempts to think of everything when it comes to geriatric care, such as, how to reduce her patients’ pill burden, the impact on mobility her patients experience, and the support her patients will receive from family or friends. Utilizing a standard evaluation assessment allows comfort that many areas are discussed and evaluated but still gives the opportunity for
individual patient needs. Since the care taker may be the same age as the patient, ensuring that all post discharge medications are correct, ensuring proper formulations of medications are prescribed is very important. Evaluation of potential medication side effects and linking them to common complaints the patient may state can answer a lot of questions. She puts the patient’s needs first and is sure always answer the rhetorical question “When you are ninety, is it really necessary to take all of those pills”. Julie regularly uses the Beer’s List and other tools when ensuring proper usage or dosage of medications. She wants to remind everyone to look at more than what we see on paper or in a computer record. Listen to your patients. Why Julie chose to advance her practice: Her career path was a natural progression. She has always worked with geriatrics. She is firm believer that, “Every person you interact with has something to teach”. Advice for others: Just to be open to trying new things! z
“Every person you interact with has something to teach.” - Julie Nowak
You are
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© 2013 Cardinal Health. All rights reserved. CARDINAL HEALTH, the Cardinal Health LOGO and ESSENTIAL TO CARE are trademarks or registered trademarks of Cardinal Health. All other marks are the property of their respective owners. Lit. No. 1RI12495 (09/2013)
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January 2015
Mission
To foster research, education, and practice models that advance patient care.
2014 Foundation Board of Directors President—Jon Ference, PharmD, BCPS Vice President—Nish Kasbekar, BS, PharmD, FASHP Secretary/Treasurer—Pat Epple, CAE Immediate Past President— Melissa McGivney, PharmD, FCCP, FAPhA Ed Bechtel, RPh Stephanie Smith Cooney, PharmD Larry Doud George Downs, PharmD Bill Ferri, RPh Julie Gerhart-Rothholz, RPh, MS Melissa Krause, PharmD Sherri Lee, RPh Michele Musheno, RPh, MS Maria Osborne, PharmD, BCACP, CDE PJ Ortmann, RPh, MBA Nick Wytiaz, PharmD
PPA Educational Foundation 2014 Annual Report Pharmacists….Advancing patient care! New Strategic Plan Why don’t more pharmacists support the Foundation? How can we do more good things for the profession? How can we raise awareness? These and many other questions were on the minds of the Foundation Board members as they gathered in May to debate the Foundation’s future direction. In order to tackle these issues, the group broke into several separate groups. Group topics included Fundraising, Communications/PR, Investments, and Program Development and participants eagerly provided a whole cadre of ideas. Ideas which, if all tackled, would take hundreds of thousands of dollars and a full-time Foundation staff! Ambitious as some of the ideas were, the Board was able to sift through them and establish critical direction and key elements and from that approve a strategic plan, leading the organization forward for the next few years. Pharmacists…Advancing patient care Mission: To foster research, education, and the development of practice models that advance patient care Goal #1 – Build a strong program portfolio aimed towards activities that will benefit the community at large and enhance the profile of the services provided by pharmacists Goal #2 – Develop a solid plan to increase total assets and annual contributions significantly Goal #3 – Increase the public awareness, both internally and externally, about the Foundation, its mission, and its successes. Goal #4 – Achieve a total asset amount of $500,000 in five years. To see the plan’s objectives and other specifics, please go to the Foundation portion of PPA’s website. In order to achieve the goals and objectives, committees were formed and specific charges/job descriptions of their duties were developed. See a list of committees and their chairs on page 3. The Foundation Board welcomes involvement by any interested PPA member on any of the committees. Please contact PPA with your interest.
New Contribution Tools Inside this issue: Message from the President
2
Meet the New Board Members
2-3
Committee Chairs
3
Contribution Honor Roll
4
Financial Report
4
Help the Foundation raise money by simply doing what you might do anyway - shop online! It’s simple and easy step to set up accounts and then simply shop your favorite sites through these pages, and the Foundation will get money!
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goodsearch: The simple act, combined with those of the millions of other people on
Goodsearch, can make a big difference in the world -- Helping your Foundation can be something you do every day -- not only when you have time to volunteer or extra money to donate. This is what Goodsearch is all about. We give you the ability to turn your everyday actions into simple ways to support and raise funds for your favorite cause. Go to goodsearch.com and set up your account, then search for and select the PPA Educational Foundation.
iGive: iGive is a free service where shopping at any of 1478 stores like Travelocity, Over-
stock, and more can mean a donation to the PPA Educational Foundation. Go to iGive.com and set up your account and search and select the PPA Educational Foundation.
Pennsylvania Pharmacist I March/April 2015 I 33
Page 2
PPA Educational Foundation 2014 Annual Report
Message From the 2014 –15 President
Jonathan Ference, PharmD, BCPS Associate Professor, Wilkes University Nesbitt College of Pharmacy and Nursing; Director of Pharmacotherapy Education, The Wright Center for Graduate Medical Education - Family Medicine Residency Program
It has been an honor to serve as president of the Foundation this past year as we fostered research, education, and the development of practice models that advance patient care across the commonwealth. The Mid-Year meeting provides us with an opportunity to reflect upon our accomplishments with pride and look forward to the future with excitement.
This past summer, the Foundation Board of directors adopted a 4- point strategic plan which will guide our work through 2017. I invite you to learn more about the Foundation, including our strategic plan, by visiting our website. We continue to sponsor high-quality programing including the Mid-Year Conference Substance Abuse and Addiction Program Track, featuring the “No Pain – No Gain” competition, and our student poster presentation focusing on Pharmacists Exploring the Emergence of Patient Care. Both of these programs offer tremendous networking opportunities and even better, CE credits! The Foundation continues to the exploration of innovative and best pharmacy practices, focusing on patientcentered outcomes, through our grant program. We look forward to announcing our 2015 recipients at our Sunnyside Up Breakfast, where we will also hear from our 2014 grant award winners.
As we look forward to the future, the Foundation is excited to kick-off its brand new Leadership Excellence and Advocacy Development (LEAD) program. The LEAD program is a one year annual longitudinal program of self-learning, group sessions, skill development, and networking opportunities with leaders all designed to foster leadership and advocacy for young pharmacists. The LEAD program will begin at our 2015 Annual Meeting in Grantville. Please look for more information in the coming months. In order to continue to serve PPA and our profession through these and other foundation-sponsored programs we rely on contributions from our members. As a charitable foundation, your contributions are tax deductible - please consider making a contribution today. A simple and easy way to donate is through a regular monthly credit card deduction. Giving $10, $15 or $25 a month is almost painless and greatly helps your Foundation. You can also help the Foundation raise money by simply doing what you might do anyway – shop online! Our fundraising and development page provides instructions to set up accounts and shop on some of your favorite sites and the Foundation will receive money. If you are already a contributor, on behalf of the 18 members of the Foundation Board of Directors, we offer our sincere thanks. I would also like to thank all of our Board members, in particular Michele Musheno, George Downs, and Marie Roke-Thomas, who will be stepping off the board to become Foundation Ambassadors. Finally, please help me welcome our new Board members!
Be sure to visit the Foundation online at http://www.papharmacists.com/?page=FoundationInfo Learn more about who we are and what we do to benefit your pharmacy profession!
Meet the New PPA Educational Foundation Board Members Sarah Dombrowski
Sarah Dombrowski, PharmD, BCACP is currently an Assistant Professor of Pharmacy Practice at the Lake Erie College of Osteopathic Medicine (LECOM) School of Pharmacy. She serves as a clinical pharmacist in ambulatory care in an internal medicine practice with Medical Associates of Erie. She is also a community pharmacist for Rite Aid Pharmacy in the Erie Area. Sarah is a graduate of the University of Pittsburgh School of Pharmacy. She completed a PGY1 Community Pharmacy Residency with the University of Pittsburgh School of Pharmacy and Rite Aid Pharmacy. Passionate about interprofessional practice, she then pursued a PGY2 Ambulatory Care Specialty Residency at UPMC St. Margaret in Family Medicine. Sarah serves on the PPA New Practitioner Advisory Board and the Pennsylvania Pharmacists Care Network (PPCN) Research Collaborative. In addition to PPA, she is an active member of the American Pharmacists Association (APhA) and American College of Clinical Pharmacists (ACCP).
34 I Pennsylvania Pharmacist I March/April 2015
Page 3
Amanda Jaber
Amanda grew up with her family in Aliquippa, Pennsylvania where she is currently a CVS Pharmacy intern. She completed her Biology degree from St. Vincent College in Latrobe, PA before going on to the University of Pittsburgh for pharmacy school. She has recently done rotations in Palestine, Washington DC, and the greater Pittsburgh region, and is passionate about outpatient pharmacist care in ambulatory and community settings. Additionally, Amanda tries to remain active in advocacy activities surrounding political issues in pharmacy such as provider status and student immunization by attending NACDS RxImpact Day and PPA’s GRASP training last spring. She will be working as a CVS Pharmacist in the Pittsburgh market after graduation, and is very eager and excited to get to work as a new Board member!
Kyle McCormick
Kyle McCormick is a community pharmacy practice resident with Gatti Pharmacy in Indiana, PA, and the University of Pittsburgh School of Pharmacy. At Gatti Pharmacy he performs clinical services, dispensing services, and research. Kyle’s passion lies at the intersection of pharmacy, technology, and education. Aligning interests with practice, he has taught and presented on mobile health technology and worked with develop an online pharmacy education platform, electronic pharmacist-patient interaction tracking tool, and patient-facing medication app. Kyle is a past member of the Pennsylvania Pharmacists Association (PPA) Board of Directors, as Director of Students. He is also an active member of NCPA and APhA. Kyle is a 2014 graduate of the University of Pittsburgh School of Pharmacy.
Stephanie Smith Cooney
Stephanie Smith Cooney, Pharm.D. is a clinical community pharmacist and owner of Gatti Pharmacy in Indiana, PA. Stephanie received her Doctorate of Pharmacy from Wilkes University (2004). She serves as a primary preceptor with the University of Pittsburgh School of Pharmacy Community Practice Residency Program. She is also a preceptor for students completing introductory and advanced practice experiential education rotations with Duquesne University, LECOM, the University of Pittsburgh, and Wilkes University. She contributes to the state of Pennsylvania with her active involvement in the Pennsylvania Pharmacists Association, serving on the Editorial Review Board, the Educational Foundation Board, and various other committees. Stephanie has earned certificates from the American Pharmacists Association in immunizations and medication therapy management. Working with her pharmacy team, she has implemented a variety of innovative services in her pharmacy, including robust medication synchronization programs, immunization programs, including travel medicine, and medication therapy management programs. She currently serves on the Regional Advisory Board for Value Drug Company and on the Board of Downtown Indiana, Inc. Stephanie maintains active memberships with the National Community Pharmacists Association and the American Pharmacists Association.
Megan Weigand
Megan Weigand, R.Ph. is currently a practicing community pharmacist with 23 years of retail pharmacy experience and 15 years of long term care experience. Outside of the rotations that were required for the completion of her education, her career at Ferri Pharmacy, in Murrysville, PA has been her first pharmacy employment and her desired career choice. She has a strong sense of compassion and loyalty to her customers and to her employer. She is very passionate about customer service and providing her patients with the best in pharmacy care. She is looking forward to being a part of the Education Foundation Board and helping pharmacy students to cultivate and implement new ideas in patient care and growing the profession of pharmacy for the future.
Foundation Committee Chairs Fundraising and Development – Julie Gerhart-Rothholtz Grant Review – Nish Kasbekar Investment – PJ Ortmann LEAD Curriculum Development – Jon Ference
Pain Competition – Coleen Kayden Poster Competition – Maria Osborne PR/Communications – Missy Krause Program Development – George Downs If you are interested in serving on a committee, please contact a Board member or the PPA office.
Pennsylvania Pharmacist I March/April 2015 I 35
2014 Contribution Honor Roll Almost $20,100 Raised in 2014. Help us exceed $25,000 in 2015! Mortar and Pestle Club ($1,000 +) George Downs (Gen Rx Award Match) Greg Drew Julie Gerhart-Rothholz (Merck Match) Rochester Drug Cooperative* Rx Club ($500—$999) Pat Epple* Donna Hazel* D. Scott Himler* Coleen Kayden* Robert Kayden* Scott Miskovsky* Stephanie Smith Cooney Cornerstone Club ($250—$499)
Dave Cunningham* William Ferri Rob Frankil* Michele/Jerome Musheno* Eric Pusey* Missy Sherer Krause* Darrin/Debra Silbaugh* Adam/Kim Welch*
Century Club ($100—$249)
Sharon Abayasekara* Jenny Bacci* Edward Bechtel Joe Bechtel Cassandra Bellamy James Dillon Sarah Dombrowski Ida Mae Englehart* Jon/Kim Ference* John Gans Nishaminy Kasbekar Martin Kendra Sherri Lee* Nick Leon*Melissa McGivney* Karleen Melody* Andrea Pugh Lauren Simko* Theresa Talbott Oksana Terlecki (Endo Match) Eric Wright Benjamin Beidel*
Patron of Pharmacy ($50—$99)
Samantha Decker* Eric Esterbook* Colleen Herman Jamie McConaha Maria Osborne*
Andrew Irons
Donors
Teresa Breslin Kimberly Carter Thomas Franko Stanton Jonas Jacqueline Klootwyk* Margaret LaBuz Patricia Nixon Roshni Patel Bojana Stevich Patricia Traubert-Baum Nicholas Wytiaz* *-Monthly Contributor Please consider becoming a monthly contributor!
Foundation Financial Report for 2014 Balance Sheet—December 31, 2014 ASSETS Current Assets 120,931.77 TOTAL
S 120,931.77
LIABILITIES & EQUITY
Profit and Loss
Opening Bal Equity 5,465.19
Jan. 2014—Dec. 2014
Unrestrict (retained earnings) 115,659.70 Income Net Income -193.12
Contributions 24,218.92
TOTAL LIABILITIES & EQUITY $ 120,931.77
Interest Earned 116.82 Total Income $ 24,335.74
Expense Fundraising Expenses 270.75 Grants Awarded 4,342.00 Scholarships Provided 12,000.00 Adminstrative Expense 441.27 Bank Service Fees 0.15 Total Expense 17,054.17
Foundation Fundraising The Foundation relies mostly on contributions and fundraisers, such as our silent auction and golf outing for funding. This past year, during the 2014 Mid-Year Conference, the PPA Educational Foundation hosted a themed dinner party: Pharmargaritaville! Guests enjoyed tropical food and drinks while drifting away into a tropical paradise. They were encouraged to dress for the occasion and many wore their sandals, shorts, and favorite Hawaiian shirt. It made a nice break from the cold of winter! This event featured the Silent Auction and Chinese Raffle along with games and giveaways – all to raise funds for the Foundation so it can continue to support the grants, pain competition and poster presentations.
36 I Pennsylvania Pharmacist I March/April 2015
Educational Foundation Advancing Patient Care
My Profession...My Practice...My Philanthropy “Pharmacy is a wonderful profession and I love that what we do can make such a difference in the lives of our patients. The efforts of the PPA Educational Foundation are helping to advance the practice of pharmacy, creating further opportunities for us to take care of our patients. To me, it's a "no brainer" to contribute to the Foundation. I hope you'll join me! The monthly credit card deduction is a simple, convenient way to support our professional future. For the cost of one lunch or dinner out, a contribution is added to our monthly tab. At the end of the year, we get a charitable contribution statement for our total contribution for use in preparing our tax returns. It’s so easy but it accomplishes a lot. Through the Foundation, we are supporting grants, student programs, and fostering the future of our profession. This is OUR way of making a difference—join us and support your profession and your philanthropy– the PPA Educational Foundation.” Stephanie Smith Cooney, PharmD, Clinical Community Pharmacist and Pharmacy Owner, Gatti Pharmacy, Indiana, PA For more information on how you can make a difference, www.papharmacists.com/foundation. BuySell_ads15_Layout 1 11/28/14 4:34 PM Page 7
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Departments
Member News Brian D. Simpkins, PharmD, Assistant Professor of Pharmacy Practice at Lake Eric College of Osteopathic Medicine (LECOM) School of Pharmacy, was awarded certification as a Pharmacotherapy Specialist from the Board of Pharmacy Specialties (BPS). Pharmacotherapy specialists are responsible for ensuring the safe, appropriate, and economical use of drugs in patient care and frequently serve as the primary source of drug information for other healthcare professionals. Sarah Krahe Dombrowski, PharmD, Assistant Professor of Pharmacy Practice at Lake Eric College of Osteopathic Medicine (LECOM) School of Pharmacy, was awarded certification as an Ambulatory Care Specialist from the Board of Pharmacy Specialties (BPS). Ambulatory Care Pharmacy is the provision of integrated, accessible health care services for patients in the community by pharmacists who are accountable for addressing medication needs and working closely with patients. Albert Wertheimer recently authored a book titled Your Drugs and Sex: How Prescription and Non-Prescription Drugs Can Affect Your Sex Life. More than 400 drugs are in this book, are yours? It’s estimated that one third of adult males have a health problem affecting their sex performance, sometimes as an adverse effect of the medicine they are taking to treat their health problem. Some commonly used drugs with known sexual performance side effects include cholesterol lowering drugs, blood pressure drugs, antidepressants, anti-anxiety and antipsychotic drugs, anti-fungals, anti-ulcer and antiepileptic drugs, oral contraceptives, and cancer drugs. ISBN 978-1478738404; Publisher Outskirts Press. 180 pg paper back. Available from Amazon $14.91; Kindle early February for $9.99. Also book stores can order for you. The Lancaster County Pharmacists Association (LCPA) recently installed their new officers and board for 2015. Their annual installation dinner was held on Saturday, January 17 at the Stockyard Inn, Lancaster. Coleen Kayden, a past LCPA and PPA president served as emcee for the event and Pat Epple, PPA CEO installed the Board. Additionally, LCPA honored four longtime members with a Lifetime Membership Award, all presented by Skip Rhoades, LCPA’s historian extraordinaire; Paul Obetz, Jim Longenecker, Dan Hussar, and Stan Buch, who all regaled the audience with stories of how they got involved in pharmacy and the “good old days!” There were plenty of chuckles as each shared some very interesting stories. z Honorary Lifetime Members: Paul Obetz (Pictured) Jim Longenecker (Pictured) Dan Hussar (Pictured) Stan Buch (not pictured) Incoming Officers: President: Victoria Hart Vice President: Kelly White Secretary: Erika Martin (not pictured) Treasurer: Jay Rhodes Immediate Past President and Chair of Executive Committee: Erika Morgan New Board Members: Scott Hershey Denise Alexander 38 I Pennsylvania Pharmacist I March/April 2015
Features
The Time to Prepare a Disaster Recovery Plan is Now By: R. Jeffrey Hedges, CDME, President & CEO, R.J. Hedges & Associates When you hear the term, Disaster Recovery Plan or Contingency Plan, what does it mean to you? Have you or someone you know lost their pharmacy through some kind of disaster? Before a disaster strikes is the time to prepare your Disaster Recovery Plan. You may also know this as a Contingency Plan. Did you know that a Disaster Recovery Plan is required under the HIPAA Security Rule and the Centers for Medicare and Medicaid Services’ DMEPOS Quality Standards? Both regulations require the healthcare
provider to plan for a disaster, safeguard Protected Health Information (PHI), mitigate risks and threats to the health care operations and have a recovery or reconstitution business plan for electronic media, patient care and continuation of healthcare operations in the event of a disaster. There is a roadmap available to you on how to create a Disaster Recovery Plan. The National Institute of Standards and Technology (NIST) has published a guide that enables any health care provider to develop a fully
functional Disaster Recovery Plan. This NIST Guide identifies where to start planning and where to begin after disaster strikes. Once the plan is created, it needs to be tested to verify the accuracy of the information and annually reviewed to maintain its accuracy. There are five sections for constructing a Disaster Recovery Plan: 1. Scope and Applicability of the Plan 2. Concepts of Operations 3. Notification and Activation Phase 4. Recovery Operations 5. R eturn to Normal Operations Scope and Applicability of the Plan establishes how broad the plan is, when the plan is applicable, how the plan is developed and establishes requirements needed. An example is storm water drainage that frequently floods the building with four to six inches of water. The Continued on page 43
40 I Pennsylvania Pharmacist I March/April 2015
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2014 Recipients of the “Bowl of Hygeia” Award
Mike Mikell Alabama
Scott Watts Alaska
Crane Davis Arizona
Eric Shoffner Arkansas
Walter Cathey California
Wendy Anderson Colorado
Philip Bunick Connecticut
Donald Holst Delaware
Norman Tomaka Florida
Robert Bowles Georgia
Jeani Jow Hawaii
Susan Cornell Illinois
Sean McAlister Indiana
Craig Clark Iowa
Richard Bieber Kansas
Jerrold White Kentucky
Robert Hollier Louisiana
Mark Polli Maine
Donald Taylor Maryland
Erasmo Mitrano Massachusetts
Joseph Leonard Michigan
Brent Thompson Minnesota
Carter Haines Mississippi
Kenneth Michel Missouri
Mark Donaldson Montana
Christopher Shea Nevada
Lawrence Routhier New Hampshire
Maria Leibfried New Jersey
Stephen Burgess New Mexico
Karl Fiebelkorn New York
Ronald Maddox North Carolina
Charles Peterson North Dakota
James Liebetrau Ohio
Henry Roberts Oklahoma
Larry Cartier Oregon
Julie Gerhart-Rothholz Pennsylvania
Blanca Delgado-Rodriguez Puerto Rico
Katherine Kelly Orr Rhode Island
Gene Reeder South Carolina
Earl Hinricher South Dakota
Robert Shutt Tennessee
May Jean Woo Texas
Brent Olsen Utah
Cynthia Warriner Virginia
Patricia Slagle Washington
Wallene Bullard Washington D.C.
Arlie Winters West Virginia*
Nicole McNamee West Virginia
Terry Maves Wisconsin
Ardis Meier Wyoming
The “Bowl of Hygeia”
The Bowl of Hygeia award program was originally developed by the A. H. Robins Company to recognize pharmacists across the nation for outstanding service to their communities. Selected through their respective professional pharmacy associations, each of these dedicated individuals has made uniquely personal contributions to a strong, healthy community. We offer our congratulations and thanks for their high example. The American Pharmacists Association Foundation, the National Alliance of State Pharmacy Associations and the state pharmacy associations have assumed responsibility for continuing this prestigious recognition program. All former recipients are encouraged to maintain their linkage to the Bowl of Hygeia by emailing current contact information to awards@naspa.us. The Bowl of Hygeia is on display in the APhA Awards Gallery located in Washington, DC. Boehringer Ingelheim is proud to be the Premier Supporter of the Bowl of Hygeia program.
* 2013 recipient not previously pictured.
plan will require enough prefilled sandbags and a roll of plastic to be kept in an accessible area. These will be placed in front of the doors as water rises to prevent it from coming into the building. Concepts of Operations are identifying key computer systems, internet access, phones and backup procedures. This means understanding what the key components of the operation are and how to protect them. In addition, the designation of a Disaster Recovery Team is established to react prior to, during and after a disaster. The Notification and Activation Phase sets the parameters of who is notified during an event. Once the plan is activated, a “Damage Assessment� is completed to determine the scope and size of the disaster and what is effected. The Recovery Operation begins when the initial disaster is over. The initial disaster is the main event, however, the aftermath of a disaster can be more devastating than the actual disaster. As a health care provider, your ability to continue to provide health care services is critical. Each county or parish has an Emergency Management Coordinator to contact. Each state has one or multiple state disaster response centers. The federal government has the Federal Emergency Management Agency or FEMA. Depending on the scope and size of the disaster, one or all of these agencies may be involved. The plan must have contact information for these agencies. In
the event of a major disaster, the county Emergency Management Coordinator manages the resources coming to aid. The state disaster response agency coordinates state assets, including the National Guard to deliver critical assets to health care providers. The last section is Returning to Normal Operations. This sounds simple, but there may be a small period of time where the temporary facility and a permanent location are both operating. Coordination between these locales is crucial. When an earthquake, fire, flood, hurricane or other natural or man-made disaster strikes your facility, the Compliance Officer, the Disaster Recovery Team and HIPAA Security Officer
Tony Hayslip, ABR/AREP 713-829-7570 Tony@RxBrokerage.com
must be able to act, to recover and re-establish the entire operations. Now is the perfect time to review your Disaster Recovery Plan. Properly written, this plan will be the guide for re-establishing your business with or without you being present. It enables your staff to take recovery actions even if you are unavailable. The Disaster Recovery Plan must be accessible to the entire staff. It is wise to keep an additional copy off-site in the event the business is destroyed. The Disaster Recovery Plan is your most valuable asset when a disaster strikes and is the best and cheapest insurance policy you can obtain. z
Ernie Zost, RPH 727-415-3659 Ernie@RxBrokerage.com
Pennsylvania Pharmacist I March/April 2015 I 43
Departments
Welcome! New Members PPA welcomes the following New Members who joined the association – December 6, 2014–January 29, 2015. Please make these new members feel welcome and part of Pennsylvania pharmacy! ASSOCIATES Christopher Lyman 1847 Financial Bensalem
New Practitioner 1 Elliot Marino CVS Health Harrisburg
New Practitioner 2 Amanda Fidler American Pharmacists Association Sinking Spring Kelly White Sloan’s Pharmacy, Inc. Columbia
Part-Time Pharmacist Yoshimi Clark Hershey
Active Pharmacist Mark Caplan Ramon Pharmacy Amy Cong Americare 1 Pharmacy Michael Crain Myers Medical Supply Eric Donley Alert Pharmacy Services, Inc. Carlisle Erin Fitzgerald CVS Pharmacy Nazareth John Grabenstein Merck Vaccines Collegeville
44 I Pennsylvania Pharmacist I March/April 2015
Sharon Parsons Philkana Ram Modnur Pharmacy James Reed Walgreens Macingie Robert Reiver Medicine Shoppe - Rockledge Brent Ronan Thompson Pharmacy Altoona Morton Rosenberg Samuel J. Robinson Pharmacy Michael Selassie Haverford Pharmacy Diane Senn Morton Thomas Smith Anderson Pharmacy Lititz Hilary Szczypioski Pharmblue LLC
Resident Rebecca Clarke
Student Duquesne University Brent Hindman Nicole Modany Jefferson School of Pharmacy Jamie Baccaro Toan Pham LECOM School of Pharmacy Joel Keckler
Temple University School of Pharmacy Caitlin Berrier Ugo Eke-Okoro Hye Een Kim Elease Lee Kristen Metzler Khanh Nguyen Hiroyuki Ono Ami Patel Jasica Truong Matthew Wolfe University of Pittsburgh School of Pharmacy Marissa Badzik Brandon Barry Nayanika Basu Danielle Bellan Meredith Bollinger Mackenzie Boring Yun-Hsin Chi Benjamin Colosmo Julie DiBridge Nicolette Diehl Brenda Fuh Katlyn Grossman Danielle Mayer Ingrid Pan Karen Quach Stephanie Tchen Carolyn Ubinger
Pharmacy Technician Angie Butrej Courtney Conaway Duncansville Pharmacy Altoona Robert Foster Bethlehem
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