2 0 1 1 2 FALL 2012 PUBLISHING SEMIANNUALLY VOLUME 2, ISSUE 1
MAKE YOUR HOLIDAYS STRESS-FREE INSIDE NEW ADVANCEMENT IN HIV PREVENTION & TESTING ROSEMAN UNIVERSITY WINS RESEARCH AWARDS Fall/2012 1
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Contents FALL 2012
FEATURES
14
FDA's New Paradigm
Opportunities and Challenges for Pharmacists BY: (Dr. Ron Ziance)
16
Marketing Yourself to "SELL" In a Recession
17
New Advancements in Prevention and Testing for HIV
BY: (Dr. Okeleke Nzeogwu)
BY: (Dr.William Kuykend)
SPECIAL REPORT: HEALTH CARE ACCESS The Impact of Mid-Level Care Providers
21
BY: (Tracy Hernandez)
22
New Health Care Models
Increasing Access, Decreasing Costs, and the Direction of Primary Care BY: (Caroline Heyrend)
23
Important Questions for Your Pharmacist
Reduce Your Health Care Costs by Asking the Right Questions BY: (Dr. Andrew Draper)
27
Dr. Ron Fiscus and Roseman University Win Research Awards
BY: (Jason Roth)
ON THE COVER: A map from the Association of American Medical Colleges on the physician workforce distribution illustrates the shortage of physicians (all specialties) across the country. The shortage is particularly critical in the Intermountain West region, including Nevada and Utah, which rank 45th and 46th in the number of physicians per 100,000 residents. Read the Special Report on Health Care Access for more information about the physician shortage and its impact on our community.
COVER STORY
19
Expanding Access to Care
The State of Primary Care Access and Solutions for Expanding it. BY: (Tracy Hernandez)
DEPARTMENTS EDITORIAL/LETTERS TO THE EDITOR CALENDAR OF EVENTS ARTS & CULTURE: BROADWAY IN THE DESERT THE SOURCE: INFORMATION RESOURCES HEALTH ON THE NET ONLINE SUPPORT FOR BREAST CANCER INTERNET RUMORS DO YOU KNOW WHO? HEALTHY LIVING BAD TREAT, GOOD TREAT? VACCINES AND YOU MAKE YOUR HOLIDAYS STRESS-FREE AlUMNI NEWS IN HONOR OF MARTIN DR. SCOTT STOLTE ALUMNI Q & A WITH DEVIN MEIER ROSEMAN PEOPLE
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Fall/2012 3
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FALL 2012. Vol. 2, No.1
Assistant Editor Jason Roth
LETTER FROM
Copy Editor Rachael Wadley Editorial Board/Contributors Kitti Canepi Brenda Griego Eileen Hug Laura Jarrett Dr. Okeleke Nzeogwu Kristi Singer Dr. Elizabeth Unni Barbara Wood Dr. Ron Ziance
One of the hottest topics today is healthcare: what is going on with our current system, what are we doing that is working well, where do we need to make improvements, and what does the future landscape look like for patients, care providers, and insurance companies?
Guest Contributors Andrew Draper Caroline Heyrend Dr. William Kuykendall Anh Lam Nena Schvaneveldt Photographers Kris Carson Francia Garcia Cameron Haymond Designer Billy George
remEDy
is published semi-annually by the Office of Marketing, Roseman University of Health Sciences 11 Sunset Way Henderson, NV 89014
As a health sciences university, Roseman’s faculty, staff, and students are also interested in these topics. The healthcare debate is one that has become politically charged, with strong feelings on both sides, but from our perspective, the politics are less important than how the ultimate outcomes affect patient care and professionals in the field. In this issue of remEDy, our special report on Healthcare in America examines what the changing landscape of health care looks like, and how private care providers and government regulations alike are creating new opportunities and trying to address some of the challenges that we face. Some of our faculty, staff, students, and graduates provided their recommendations on ways to save money on your monthly prescription costs, while others helped identify new models of healthcare that are working to fill some of the gaps in access to, and quality of, health care. Healthcare in America is certainly complex, and one issue of this magazine cannot address all the intricacies of the current system and recommendations for the future. However, we hope that by taking a closer look at how policies affect us, and our friends, family, and neighbors, we will have a better understanding of the challenges and opportunities that exist, and can work to create a system that continues to provide some of the best care in the world, while addressing the underserved communities who need better access to that care. Sincerely,
We welcome any comments, questions and submissions. remedymag@roseman.edu 702-968-1633 • 801-878-1035 College of Dental Medicine 702-968-5222 Nevada 801-878-1400 Utah College of Pharmacy 702-968-2007 Nevada 801-878-1053 Utah MBA Program 702-968-2015 Nevada 801-878-1111 Utah College of Nursing 702-968-2075 Nevada 801-878-1062 Utah
4 Fall/2012
© 2012 Roseman University of Health Sciences
EDITOR
THE
Editor Tracy Hernandez
Tracy Hernandez, Editor
R O S E M A N
U N I V E R S I T Y
O F
H E A L T H
S C I E N C E S
2012 EVENTS College of Dental Medicine Oral Health Outreach Salt Lake City Police Department Halloween Trick or Treat Party Wednesday, October 31, 2012 1 - 5 PM Public Safety Building 315 East 200 South, Salt Lake City, Utah Utah Annual Therapeutics CE November 3, 2012, 8 a.m. to 12:30 p.m. 4 Hours CE Credit Roseman University, South Jordan Utah Campus Roseman University's 13th Annual Liberty Mutual Invitational Golf Tournament Benefiting Student Scholarships November 12, 2012 Cascata Golf Club, Boulder City, Nevada College of Pharmacy ASHP Midyear Reception December 3, 2012, 5:30 to 7:30 p.m. For Alumni, Students, Faculty/Staff and Friends Luxor, Las Vegas
Roseman University 13th Annual Scholarship Gala Saturday, May 11, 2012 Location to be determined
Roseman University Mother – Daughter Tea Saturday, March 2, 2013 2:30 p.m. Ravella at Lake Las Vegas, Nevada
For more information about these and other Roseman University events, visit the University’s website at www.roseman.edu.
Fall/2012 5
Arts & Culture FALL 2012
Broadway in the
Desert
By Rachael Wadley Are you in search of fun, family-friendly entertainment that lets you enjoy the outside scenery of Southern Utah while experiencing musical productions? Tuacahn Center for the Arts may just be the place for you. According to surveys, Tuacahn is second only to Zion National Park as a primary reason visitors go to Southern Utah. “Tuacahn is becoming a destination place, “ said Scott Anderson, Artistic Director for Tuacahn. Tuacahn is nestled beautifully in Padre Canyon against the magnificent red rocks on the outskirts of St. George, Utah. It’s a wonderful day trip for those who need a quick vacation and want to experience Broadway without having to fly to New York City. Anderson describes Tuacahn as “a unique way to see live theatre in a beautiful outdoor amphitheater.” Doug Stewart, a Utah playwright who created the musical Saturday’s Warrior founded Tuacahn in the spring of 1995, after a two-year search for an outdoor amphitheater location. “I was brought to tears when I first stood there, and after taking it in for some time – envisioning an amphitheater and a stage with an awesome backdrop of 1,500-foot red rock cliffs, and hearing the sounds of music echoing from the canyon walls – I literally flew back to town and straight to the county recorder’s office to see who the land belonged to,” said Stewart. The land was originally purchased by Orval Hafen and his wife with hopes that its beauty would one day
“inspire folks.” Hafen’s dream came true with the help of Stewart.
with the Live Nativity runs four nights a week starting the day after Thanksgiving, ending December 23rd.
The 70-acre piece of land was transformed into a 42,000 square foot facility and includes the 330 seat indoor Orval and Ruth Hafen theater, a dance studio, a black-box theater, a recital hall, a costume shop and scene shop, studios and classrooms, a gift shop, and a 1,920-seat outdoor amphitheater, which is known as the “jewel of Tuacahn.”
To add to the family-friendly atmosphere, Tuacahn offers ShowCare, a childcare center for kids under seven whose parents are attending a show. ShowCare opens an hour before the show starts and closes 30 minutes after it ends, and parents can check on children anytime during the performances to make sure they are having fun. Anyone planning to bring children to ShowCare must register in advance.
“What we try to do is great quality theater with professionals, but we try to give you a little different twist on how to present the show that you might have seen in an indoor proscenium stage,” explained Anderson. Tuacahn has had many popular productions over the years including Disney’s The Little Mermaid and Grease in 2011, Disney’s Tarzan, Cats, and Crazy for You in 2010, and Annie and Footloose in 2009. Tuacahn entertainment is not just available during the summer months, you can expand your knowledge in performing arts year-round. Concerts have been added for the spring and fall. Upcoming shows at the Tuacahn outdoor amphitheater include Thriller, which will be showing October 24-31. In 2013, Tuacahn is bringing two popular productions, Disney’s Mary Poppins, kicking off in May and Camelot, starting in June. The Hafen Theatre at Tuacahn has performances by Jon Schmidt, Steven Sharp Nelson, and Kurt Bestor scheduled in December. In addition to the December concerts, the annual Christmas in the Canyon
DIRECTIONS
If seeing one of Tuacahn’s many “Broadway in the Desert” productions isn’t enough, you can take a backstage tour to discover the magnificent amphitheater. The 30-minute tours run year-round, and advance reservations are required. Make sure to bring your walking shoes and get ready to learn what it takes to put a Broadway production together. “[Tuacahn is] a really big economic juggernaut for the local economy and it’s a source for employment for some great actors from all over the country and designers as well,” said Anderson. “It impacts our local economy to the tune of about $55 million.” In 2011 over 240,000 people attended either a concert or theatrical production at Tuacahn (and 20,000 more were turned away due to lack of availability). Purchase tickets online at www.tuacahn.org or call the box office at 800-746-9882 when you’re ready to experience Broadway-style entertainment right here in the West.
Tuachan Ampitheatre − 1100 Tuacahn Drive, Ivins, UT 84738
South Jordan to Tuacahn: 4 hours 41 minutes • I-15 S • Exit 8 for St. George Blvd toward State Hwy 18/Santa Clara • Turn right onto E St. George Blvd/St. George Boulevard West • Turn right onto North Bluff Street • Turn left onto Snow Canyon Pkwy • At the traffic circle, continue straight to stay on Snow Canyon Pkwy • Turn right onto Snow Canyon Dr. • Take 1st left onto Tuacahn Dr.
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Henderson to Tuacahn: 2 hours 24 minutes • I-515 N/US-93 N/US-95 N • Take exit 76B to merge onto I-15 N/US-93 N toward Salt Lake City • Continue to follow I-15 N passing through Arizona and entering Utah • Take exit 6 for UT-18 N toward Bluff St/I-15 • Turn left onto UT-18 N • Turn left onto Snow Canyon Pkwy • At the traffic circle, continue straight to stay on Snow Canyon Pkwy • Turn right onto Snow Canyon Dr. • Take 1st left onto Tuacahn Dr.
The Source: Information Resources FALL 2012
BE A SAVVY
SEARCHER: Check that Health Site with HON By Kitti Canepi
You want to get information online about a specific disease or symptom, but how do you know you can trust the source? Anyone can create a website, and while you know that a .gov is a safer bet than a .com, does that mean all .coms are unreliable? Confused? Concerned? HON to the rescue. HON is the Health On the Net Foundation, a non-governmental organization created in 1995 “to encourage the dissemination of quality health information for patients and professionals and the general public” by creating a certification program for websites offering health information. HON is based in Switzerland, and co-operates closely with the University Hospitals of Geneva and the Swiss Institute of Bioinformatics. Council members and the web team hail from the United States and several European countries. As stated on their website, “The HONcode is a code of ethics that guides site managers in setting up a minimum set of mechanisms to provide quality, objective, and transparent medical information tailored to the needs of the audience.” Possession of the HONcode seal means the organization has met certain ethical requirements and pledged its intent to provide quality medical information. To check if the website you have found meets these standards, go to http://www.healthonnet.org/ or http://www.hon.ch/ and select the tab that corresponds to your status as a Patient/Individual, Medical
Professional, or Web Publisher. Under HONsearch, click on Trustworthy Medical Information and enter the name or URL of a site you want to check, or the health-related term you want information on, in the search box. HON will return a list of all the certified websites that match your search. You can filter the results by gender, age group and whether the site is aimed at patients or health professionals. From this search page you can also select the News link to find recent announcements on 300 medical topics and themes or select the Images link to see images related to your search topic collected from various HON-certified sites. Of particular interest for medical professionals is the searchable international conference schedule and HONselect, an integrated database of not only websites but also MeSH® terms, authoritative scientific articles, healthcare news, and multimedia. HON does warn web searchers to “NEVER regard information found on the internet, in a book or anywhere else as medical advice,” since that can only be given by a medical professional. A savvy searcher is a safer searcher and checking with HON can help you stay in the know.
Fall/2012 7
The Source: Information Resources FALL 2012
O N LI N E S U PPO RT for Breast Cancer Patients and Those who Love Them
October is Breast Cancer Awareness Month, and if you or a loved one has been newly diagnosed with breast cancer, the amount of information, number of options, and decisions needing to be made can be overwhelming. Health care providers try to be there to help you sort through it all, but can’t always give you the amount of one-on-one time you need. Once you leave the doctor’s office, you may feel vulnerable and alone, but fortunately there are a number of support organizations and resources you can connect to online. According to Mayo Clinic, some of the most important things you can do are to learn more about your cancer and your options, talk with breast cancer survivors, keep your friends and family close, maintain intimacy with your partner, and make your own well-being a priority during treatment (www.mayoclinic.com/ health/breast-cancer). The American Cancer Society is a great place to become informed about any type of cancer. At www. cancer.org/Cancer/BreastCancer, you can learn about the different types of breast cancer, the various therapies and important questions to ask your doctor, and what to expect after the initial treatment (quality of life, emotional aspects, body image and sexuality, lifestyle changes, and more). They also provide worksheets to help keep track of medications and side effects. The American Cancer Society offers online communities for current patients as well as cancer survivors. You can search for support programs and services in your area, request rides to treatment, and find out about available “I Can Cope” classes. One of the most comforting services offered is the opportunity to speak with a specially trained “Reach to Recovery” volunteer. As breast cancer survivors themselves, these volun8 Fall/2012
teers offer patients and family members “an opportunity to express feelings, talk about fears and concerns, and ask questions of someone who is knowledgeable and level-headed.” Breastcancer.org is a nonprofit organization started in 1999 by Dr. Marisa Weiss, a nationally renowned breast oncologist. On the community site at www. breastcancer.org/community you can join an online support group with discussion forums, topics, and posts. Members write about their experiences, how to deal with side effects, and where to get support. You can also chat with others in real time, which is comforting when you need support. The site includes healthy living tips, inspirational stories, online conferences with experts, helpful links and recommended readings. You can also get information about symptoms, types of breast cancer, your diagnosis, treatments and side effects, how to manage your daily life, and how to lower risk. Among About.com’s interesting breast cancer articles is one that helps a spouse figure out what he should do. According to Pam Stephan’s “Top 10 Ways to Support a Spouse with Breast Cancer” (breastcancer. about.com/od/supportineveryway/tp/ten_support_tips.htm) the best things you can do are to be there, advocate on her behalf for getting the care she needs, help keep track of all the paperwork, encourage her, keep to your normal routines to the extent possible (keeping in mind her changing needs, of course), be honest, stay with her even through the tough stuff, ask friends and family for help, expect that some people will have weird reactions to the situation and let it go, and when applicable don’t neglect the spiritual side as you will both need a lot of resources to get through this together. HealthyWomen, a nonprofit organization founded in
By Kitti Canepi Director of Library
1988 at the National Women's Health Resource Center, also provides helpful articles at www.healthywomen.org. An article on “Supporting a Friend Who Has Breast Cancer,” by Sheryl Kraft, offers tips for the patient’s friends and loved ones. First of all, don’t avoid your friend because you don’t know what to say. Instead, tell her that you don’t know what to say and then offer to listen. Sometimes that is the most important thing a supporter can do. Unless you are a cancer survivor, don’t tell your friend you know how she feels, because honestly, you don’t. Treat her as normally as possible and talk about the things that bring her joy in life. Acknowledge that this is a scary thing she is dealing with, but don’t jump in and start talking about the cancer unless you have checked that she wants to talk about it. You can stay in touch by sending notes or cards, letting her know you are there even if she doesn’t feel up to replying. And if you want to do something for your friend, ask her what she needs from you (even if she says leave her alone) then do it. While it is rare (only about one percent of all breast cancers) men can also be diagnosed with breast cancer. The American Cancer Society and Breastcancer.org both have pages dedicated to male breast cancer. MedicineNet.com, WebMD’s online healthcare media publishing company, offers more information at www.medicinenet.com/male_breast_cancer/article.htm. And all those tips about supporting women with breast cancer apply to men, too. The key to dealing with a diagnosis of breast cancer seems to hinge on understanding: understanding what is going on inside you and your options, and receiving understanding from other people for what you are going through. These online sites, along with many others, can help with both.
The Source: Information Resources FALL 2012
By Nena Schvaneveldt Library Assistant, South Jordan, Utah
Internet Rumors: Resources to Check the Facts
Do you know WHO?
It has happened to nearly everyone: a Facebook post or forwarded email warning us of the dangers of something, incredible facts, or tricks to save money or our lives. It’s easy to pass them on as truth; after all, they often come with realistic-looking credentials. Some stories are so inspirational that we share them without thinking of how true they are. Still others are partly true, but have been changed along the way. Passing along a story that turns out to be false can be embarrassing, but ignoring a potential virus threat could be damaging to your computer. How can you tell fact from fiction? Fortunately, there are websites that can help you determine if something is worth passing on or not. Websites like TruthOrFiction.com and Snopes.com employ researches to thoroughly fact-check stories. Some of these incredible stories are absolutely true, but others are not. TruthOrFiction, www.truthorfiction.com, is run by a former journalist and has a staff of researchers working on what it calls eRumors. It contains a searchable database of stories on everything from political outrages to virus warnings. You can also search or browse by subject. Some events, like Hurricane Katrina, spawned so many rumors that there is an entire category for them. TruthOrFiction presents the story and how true it is. Instead of just reporting a story as Truth!, Fiction! or Unproven!, a rumor can be Reported to be Truth, or Reported to be Fiction which means that there are few sources supporting the rumor’s truth or fiction and that the sources aren’t reliable; Previously Truth! Now Ended! means that an urgent call to action was true, but has now been resolved; Truth! & Fiction! which means that elements of the rumor are true, but others are not; or Disputed! which means that there is good evidence both for the story’s truth and its fiction. At the end of articles on the rumors, the authors disclose their sources whenever possible. This helps readers determine the credibility of these sources on their own. They also have a page linking to McAfee to explore the validity of virus warnings. Snopes, www.snopes.com, is another website that evaluates online rumors for their validity, and similar to TruthOrFiction, employs researchers. They have somewhat of a folklore bent, so they discuss urban legends more than TruthOrFiction does. They have also disclosed their neutrality on political matters, making them a reliable source. Stories on Snopes are either classified as true, false, multiple truth values, undetermined, or unclassifiable veracity, making it a rating system similar to that used by TruthOrFiction. Unlike TruthOrFiction, though, Snopes has a community where questions about specific rumors are often researched and debated.
By Kitti Canepi
WHO is the World Health Organization, a specialized agency within the United Nations system. Established on April 7, 1948, WHO has a mission to provide leadership on global health matters. As stated on their website, http://www.who.int/en/, they are responsible for “shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.” Part of WHO's responsibility for monitoring and assessing health trends involves collecting statistics and publishing reports. The collected and reported statistics include such diverse areas as worldwide life expectancy rates, the availability and price of essential medicines, the state of the health workforce, road safety, and substance use. Among the publications available online is a recent assessment of pharmaceuticals in the drinking water of the United States, Australia and United Kingdom; a report co-authored with Alzheimer’s Disease International to raise awareness of dementia as a public health priority; a report on health risks and precautions for international travelers (including vaccination requirements); and an international pharmacopoeia.
Occasionally, a story will surface that claims it has already been checked. It may be worth going to TruthOrFiction or Snopes to see if that is the case. And just to be on the safe side, remember to keep your anti-virus and anti-malware program updated and never click on links or open attachments from unknown senders when you are checking your email or browsing social media sites.
The WHO website is a great resource for general information about a number of health topics from radiation accidents to nutrition to specific diseases such as yellow fever. As you might expect, WHO also tracks disease outbreaks and emergencies and disasters, as well as providing public health-related responses to these events. You can search for information about specific countries or learn more about the numerous WHO programs, partnerships and projects.
Before you pass on that next juicy story you see online, check it out to see if it’s true. It’s amazing the stories that are!
So now the next time someone asks if you know WHO, you can say, “yes, I do!” Fall/2012 9
Healthy Living FALL 2012
Bad Treat, Good Treat? Orthodontists caution patients to eat only bracesfriendly sweets during Halloween season
Halloween is a time for holiday parties, costumes, delicious treats, and trick-or-treating. Whether it’s children roaming the neighborhoods knocking on doors in search of scrumptious candy, or parents and adults attending Halloween parties, everyone is consuming massive amounts of sugar, sweets, and candy. For those without braces, this sugar-filled holiday is exciting (though perhaps not very good for your dental or overall health), but individuals with braces are presented with a challenge. Most of the candy that will be available is on the dreaded “do not eat” list because certain candies can damage braces. Among the inedible candies are caramel, nuts, licorice, lollipops, candy corn (a Halloween staple), popcorn and chewy candy. Each orthodontist may have a slighty different list, but the general rule is to avoid candy that is sticky, hard, chewy, or crunchy. Dr. Jaleh Pourhamidi, dean of College of Dental Medicine at Roseman University of Health Sciences, ad-
vises those with braces “to be picky about candy [because] the most common orthodontic damages done during the Halloween season are brackets falling off, wires pulled out of brackets, and tooth decay later on due to candy that gets stuck behind the brackets.”
American Association of Orthodontists (AAO) recommends age 7 because many orthodontic problems are easier to correct if treated prior to the completion of growth (which can prevent the need for more complex treatments, such as extraction of permanent teeth).
Although the Halloween season may seem a little depressing for those who wear braces, it doesn’t have to be. There are plenty of sweets that can be enjoyed without causing damage to orthodontic appliances. Some sweets that are orthodontic-approved include soft chocolates with no nuts or crispy add-ins, peanut butter cups, ice cream, and cupcakes.
October is also a great time for your orthodontist to remind you to eat only braces-friendly sweets.
However, all sweets, including those that are soft and easy to chew, can cause problems if the teeth are not cleaned well after enjoying them. Everyone should make an extra effort to brush and floss during the Halloween season, right after consuming sugary treats, but this is especially true for orthodontic patients. If you’re not at home, carry floss with you so that you don’t damage your braces. Without proper care, you may have to keep your braces on for longer than expected, which is something most orthodontic patients would prefer to avoid at all costs.
If you’re not sure about whether you can eat a certain kind of treat, or you just cannot resist some of your favorites, talk to your orthodontist about ways you may be able to make the treat a little safer for your braces. For example, instead of biting into a caramel apple, try peeling and cutting a plain apple in thin slices, then dipping it in caramel flavored sauce or melted chocolate.
“In October and November the Orthodontic Clinic at Roseman University sees roughly five to 10 patients a day due to damages done by treats consumed,” said Pourhamidi.
Perhaps coincidentally, October—a month of extremely high treat consumption—also happens to be National Orthodontic Health Awareness Month.
The AAO has put together some braces-friendly treats for Halloween. On their website www.mylifemysmile. org, you can find dozens of recipes for the Halloween season, with the assurance that “it’s no trick – these treat recipes are fun to make, fun to eat – and they won’t put a dent in your smile.”
The main focus of this month, according to Pourhamidi, is to remind parents that “children need to be examined for orthodontic needs by age 7, but that does not mean that all children need braces.“ The
Chef Phillip Soriano and Pastry Chef Christy Horner from Ravella Resort at Lake Las Vegas have also put together this braces-friendly recipe to enjoy for Halloween and the fall season.
Pumpkin Chocolate Chip Cookies 1 cup pumpkin puree (canned) 1 cup granulated sugar 1/2 cup vegetable oil 1 egg 2 teaspoon milk (whole) 1 teaspoon vanilla 2 cup all-purpose flour 2 teaspoon baking powder 2 teaspoon pumpkin pie spice 1/2 teaspoon salt 1 teaspoon baking soda 1 cup chocolate chips (mini) 1. Combine first 6 ingredients, set aside. 2. Combine all dry ingredients, except for chocolate chips, add to wet ingredients, combine well. 3. Stir in chocolate chips. 4. Bake at 350 °F for 10-15 minutes.
10 Fall/2012
Healthy Living FALL 2012
Vaccines and You:
Studies by the CDC show that approximately 42,000 adults and 300 children die from diseases every year that could have been prevented with vaccines. In addition, the administration of the right vaccines at the right time has been reported to prevent 14 million cases of disease, save 33,000 lives, reduce direct healthcare costs by $9.9 billion, and save $33.4 billion in indirect costs, according to CDC studies.
KNOW YOUR VACCINES The United States Department of Health and Human Services implemented a nationwide public health project, Healthy People 2020, and one of its stated goals is to increase immunization rates. Healthcare professionals, including pharmacists, are making huge efforts to increase immunization rates, decrease preventable diseases, and improve overall quality of life, but these goals cannot be achieved without your involvement. A better understanding of vaccines can help you make the right decision about your immunization needs.
*These tables are intended for informational purposes only and are not a substitute for health information. Please consult your pharmacist or physician to discuss which vaccines you need, and identify an appropriate schedule for obtaining all necessary vaccines.
Adult Vaccines
Vaccines are one of the most cost-effective ways to protect yourself and others from contracting certain diseases. Following the immunization schedule recommended by the Centers for Disease Control and Prevention (CDC) can benefit you, your children, and society as a whole.
Child Vaccines
END DISEASE WITH EASE
By Anh Lam PharmD student, Roseman University
*These tables are intended for informational purposes only and are not a substitute for health information. Please consult your pharmacist or physician to discuss which vaccines you need, and identify an appropriate schedule for obtaining all necessary vaccines.
COMMON MYTHS AND FACTS Some people are cautious about getting vaccines for themselves or their children due to misconceptions regarding vaccines causing serious adverse events such as autism, seizures, sudden infant death syndrome, and more. Many studies have been conducted to verify the truth behind these serious incidences, and whether they are associated with the administration of vaccines. The table to the right includes some of the most common myths, compiled by the CDC, along with the facts about each vaccine. More information can be found on the CDC website at www.cdc.gov/vaccines. GIVE YOUR PHARMACIST A SHOT As of 2009, all 50 states have authorized pharmacists to administer vaccines. While you may think pharmacists can only give flu vaccines, they are actually certified to administer any type of vaccines. In many instances, a pharmacy is located within five miles of your residence and no appointments or prescriptions are necessary for obtaining vaccines. According to a 2011 survey by the National Association of Chain Drug Stores, pharmacists are the most accessible and trusted healthcare professional in the United States, and have been for several years. They are highly trained professionals who can help identify appropriate vaccines that will benefit you, keep your immunization schedule on track, and answer your questions. Consult your pharmacist today! Fall/2012 11
Healthy Living FALL 2012
MAKE YOUR HOLIDAYS STRESS-FREE By Barbara Wood
We do it every year—people can’t wait for the holidays to arrive and then, more emphatically, we can’t wait for them to end. Why is this so? In a word, it is stress! This is not just ordinary stress, although it does have a role in the destruction of our happiness and holiday joy. No, this is a much more emotional and powerful stress, whose causes come at us from every angle. In a 2009 article posted on Psychology Today’s website, co-authors Ran Zilca and Dr. Deepak Chopra identify several causes of holiday stress. Problem 1: It’s the holidays, time for parties with everyone— friends, family, neighbors, co-workers, and more. Often we say yes to far too many invitations, then find ourselves out of time, out of money, and out of energy. By the end of the season, our holiday joy is definitely dwindling. Solution: Prioritize which events you really want to attend and learn to graciously say “no” to the rest. While you may be concerned about offending people, you can find ways to let them know in a friendly way that you are sorry, but simply unable to attend. The Mayo Clinic website on stress management and the Dr. Oz website both counsel that learning to say “no” is one of the best ways to prevent stress. Problem 2: In our consumer-driven culture, holidays demand gifts for everyone, and retailers are certainly not going to let you forget that. But can your finances afford the biggest and best gifts for everyone you know? For most people, the answer is no. Putting everything 12 Fall/2012
on a credit card is an unhealthy financial habit of the past. So, what can you do to still show people you care without going broke?
duced prices with gift wrapping, delivery and cards included. You can avoid the crowds of shoppers and save time.
Solution: Set a budget of what you can afford and stick to it. Don’t let emotions sway you and make you feel guilty, forcing you to spend more than you can afford. Don’t compare your gifts with those of other people. If you can’t afford a gift, especially in today’s economy, most people will understand (after all, they are probably feeling some of the same pressure). One solution is to talk to your friends and family, and ask them to forego giving gifts this year and, instead, spend time together doing something fun—especially something that doesn’t cost money, like volunteer work. You may find that person was searching for the right words to ask you the same thing.
Problem 3: Trying to be perfect. You are not Martha Stewart, or Rachel Ray, and while you would like to be able to, you can’t please everyone.
If you have a large group of friends or extended family, consider drawing names and each person will give to just one person. That way everyone saves money and can give gifts with more meaning. If you do have a long list of people to shop for, shop online for re-
Solution: Home-cooked treats are delicious, but baking for days can make you exhausted. Limit the amount of homemade treats you commit to provide, and when you do have to make treat, try to do it all at once to save time, and involve your spouse, kids, friends, or roommates in the process. Instead of baking endless treats to have around the house, skip it to save time and stick within your normal diet plan—this also helps avoid the guilt of overeating. Hand-crafted holiday cards, while adorable, can be extremely time- and fund-consuming with printing, postage and addressing. Instead of sending out 500 cards by mail, consider a quick, easy and inexpen-
Healthy Living FALL 2012 sive e-mail version. Before the holidays start this year, evaluate all your “traditions” to find places where you can change, or stop doing, trivial things that sap your strength and energy. Problem 4: You try to do it all for everyone. Your church needs your help, a local nonprofit also needs you to volunteer, and let’s not forget all you have to do for your family and friends. Before long you are being pulled in a thousand different directions. Something has to go and most likely it will be your health, or your sanity.
recognize that some things are not enjoyable. Instead of begrudgingly participating in everything, or inviting everyone to your events (even those you don’t want around), remember that you only have to do what YOU want to do. Admit what bothers you, acknowledge that it is okay to have these feelings, and discuss it with a therapist or other counselor if it helps. On WebMD. com and Stress-Relief-Choices.com, Dr. Deepak Chopra reaffirms that admitting what bothers you and dealing with it will help in dealing with and preventing future stress.
Problem 5: You keep deep-seated feelings of resentment and stress related to the season buried, allowing them to build up inside.
When it comes to parties, some people are not pleasant to be around, and that list may include your friends and family. If you are hosting a get-together and there is one person who always starts a commotion, it is within your rights as a host to not invite that person. Be understanding, but be strong. Explain to the troublemaker that they will be welcome to come when they can be pleasant with others. If you do invite them and stressful situations come up, talk with the person calmly and use humor, if appropriate, to diffuse the situation, or feel free to politely ask them to leave. Accept that sometimes families just do not get along, and try not to get involved in petty arguments or little spats, as this can make things even more stressful. If you are not sure you can confront the person in advance, try inviting guests outside of the family or the usual circle of friends and acquaintances. Sometimes people are on better behavior when outsiders are present.
Solution: Acknowledge your feelings about the season, and
Problem 6: It is the holidays and you over-indulge.
Solution: Delegate. Delegate. Delegate. You are only one person. Instead of being in charge of the event at church, be part of the committee and give someone else the opportunity to grow their leadership skills. When the local charity needs help, invite your friends and neighbors to participate as well so you can reduce your individual time commitment. The more you let others do, the less pressure you will have on yourself. If you delegate enough, maybe you can even find time to relax and do nothing for a change.
Solution: Save the guilt and regrets for other times, don’t overindulge in food, alcohol, or anything else. Watch your alcohol intake to limit poor decisions and comments to others. Set a limit on how much you will consume and instead drink more water, which helps flush your system and keeps you from becoming dehydrated. Don’t change your diet during the holidays. With all the delectable cuisines available, you may want to devour everything. It’s okay to allow yourself some of the treats, but put a limit on how much and how often. Focus on filling up with fresh fruits and vegetables rather than sweets, friend foods, and brownies. If you’re headed to a party where you know there will be unhealthy foods, eat a healthy snack in advance so you are full and won’t be tempted to eat so much at the party. In addition, try to plan meals in advance so you can avoid eating out too frequently. Problem 7: You are stressed before the holidays even begin. Solution: Realize and accept that you are stressed and seek help if you need it instead of being in denial. Try to identify the things in your life that make you happy, and those that do not. When you look at your list of things that make you unhappy, consider whether you have the power to change it. If you do, then take action and make the change. If not, release it so it will not continue to stress you out!
Learn what helps you relieve stress when your emotions are out of control. Here are just a few things that you can do to relieve your stress—feel free to add your own to this list. Practice gratitude Laugh more Allow yourself to grieve, cry, scream Watch funny movies or punch a pillow if needed Read a humorous book Practice deep breathing techniques Find time for a massage Take some time to be alone Take a bubble bath Take a nap Read Meditate Painting Pray Take a walk Read books about your beliefs Play cards, board games or Sudoku Look for meaning in your faith Get enough rest Be forgiving and compassionate Reduce your caffeine intake Reach out and volunteer at a food bank Take your vitamins Bake something for a lonely neighbor Drink more water Let go of the little stuff Eat a healthy, balanced diet Be flexible More ideas on stress relief activities can be found on About.com/stress management. If you’re tried all these things and are still suffering from symptoms like irritability, lack of resilience, lack sleep or sleep too much, no energy, constant negative feelings, or exhaustion all of the time, you may be suffering from depression. In that case, seek professional help. The key to avoiding stress during the holidays is to stay healthy, take care of yourself first, be realistic, reach out to your friends and the people who really matter to you, fight the urge to spend, take a breather and add humor and fun to all you do. Fall/2012 13
Feature FALL
By Ron Ziance It is well documented that patients postpone or do not seek medical care, due to the expense and time associated with obtaining a diagnosis and treatment by physicians and other health care professionals who prescribe drug products. In an effort to decrease under-treatment of certain diseases or medical conditions, the U.S. Food and Drug Administration (FDA) is currently considering a new paradigm in which certain current prescription drugs would be approved for nonprescription use under conditions of safe use (hereafter in this article referred to as the “New Paradigm”, or the “FDA’s New Paradigm”). Those conditions may include limiting the sale of such drugs to pharmacies, and requiring pharmacist intervention in specific cases.
In this article, a “new paradigm drug” is defined as a prescription drug that is switched by the FDA to a status of a nonprescription drug with conditions for safe use. In order to carry out their important role in the FDA’s New Paradigm where pharmacist intervention is required, pharmacists may: Confirm or disagree with a consumer’s self-diagnosis Diagnose a new medical condition Diagnose the worsening of an ongoing condition Provide consultation When appropriate, refer a customer to a physician or other health care provider When working with new paradigm drugs, pharmacists also may consider a person’s risk factors and, when appropriate, evaluate results of diagnostic tests (for example, serum cholesterol levels) conducted in the pharmacy. A pharmacist could then prescribe, dispense, provide consultation, or refer the customer to ensure 14 Fall/2012
appropriate use of a New Paradigm drug product. In all of these situations, the pharmacist intervention could benefit the patient or potentially cause harm, depending on whether the diagnosis and treatment were correct, which brings up concerns about increased liability and providing effective patient care. Implementation of the New Paradigm drugs may also include innovative technologies such as kiosks located in pharmacies or other retail outlets. Consumers could enter medical history and other relevant information into kiosks that contain drug-specific algorithms (provided by sources yet to be identified), then the kiosk would issue a written recommendation of drug therapy specific to the consumer. In this scenario, a pharmacist may verify the accuracy of information entered and provide consultation regarding a kiosk recommendation. The FDA will conduct public hearings to explore additional types of innovative technologies as they continue through this process. Opportunities for Pharmacists In the event the FDA implements the New Paradigm, pharmacists will have an opportunity to enhance their contributions to improve consumer health. Pharmacists who participate could increase their knowledge of pharmacotherapy for certain diseases and medical conditions, and be more readily recognized by other health care providers for their professional capabilities. Challenges to Pharmacists On the other hand, participation can mean several challenges and associated questions involving increased legal liability, need for additional education, impact on pharmacy practice, and increased expense. Some of the most common issues that come up in this area include: Increased legal liability Will pharmacists become, like physicians, a learned intermediary with a legal duty to warn of important safety issues? What is the risk of agreeing with a consumer’s erroneous self-diagnosis or making a new diagnosis in absence of medical records and other relevant information? How does a pharmacist who practices in a retail establishment obtain medical records and other
essential health information that is not included in a consumer’s database maintained by the pharmacy? Is a typical pharmacist qualified to analyze information that may include treatment by one or more specialists? How is a consultation documented to substantiate that it was provided with an acceptable standard of care? Additional education What additional education is required to detect worsening of a chronic medical condition? In what situations does textbook knowledge not apply to best medical practice? Will pharmacist continuing education (CE) programs be the most effective means to enable pharmacist participation in the New Paradigm? Will the FDA approve a specific New Paradigm drug product prior to the availability of CE programs involving use of the drug in treatment of targeted medical conditions? That is, will there be a time gap of available relevant information? Must pharmacists be certified to participate in the New Paradigm? What professional organization(s) will determine any certification requirements? Impact on pharmacy practice What is the impact of increased consultation on normal workflow and efficiency? In lieu of a shared database, how will pharmacists inform the consumer’s prescribing physician(s) of the new data regarding diagnosis, lab test results, and identity of pharmacist-prescribed New Paradigm drugs? Are revised procedures needed to meet HIPAA requirements to protect the privacy of consumer health information within the pharmacy? Expense associated with participation What is the cost to purchase, maintain and use lab equipment? What is the cost and feasibility to provide a suitable area with adequate privacy for consultation? What is the cost to complete CE or other targeted education programs?
Feature FALL 2012 New Paradigm drug products The FDA will evaluate drugs to identify ones that have certain desirable characteristics, demonstrated by results from clinical trials, efficacy and safety, and other factors. A drug may be desirable as a New Paradigm drug if: The clinical trial and marketing experience as a prescription drug has enabled detection of significant adverse reactions, drug interactions, precautions, and contraindications. Efficacy and safety is evident in doses approved for New Paradigm use. It can treat a disease symptom or condition that is readily detected or diagnosed by the patient, pharmacist, or health care provider. A pharmacist is able to perform any required laboratory or other medical monitoring. Although the initial New Paradigm drugs are yet to be determined, a partial list of drug products proposed by several pharmacists (which have not been evaluated by the FDA) are presented in the following table. Implementing the New Paradigm Pharmacist Algorithms It is well documented that pharmacist participation in collaborative medication therapy management (MTM) agreements has made significant positive contributions to treatment of chronic conditions such as asthma, coagulation disorders, diabetes, heart failure, hypertension, and lipid disorders. Under the auspices of a MTM agreement, pharmacists work with one or more physicians within the context of a defined protocol for the disease or medical condition to be treated. Pharmacists who participate in MTM typically obtain additional training, conduct patient assessments, counsel and educate patients, order and perform laboratory tests, and select, initiate, monitor and adjust drug regimens. Pharmacists who participate in
FDA’s New Paradigm would assume similar professional responsibilities but without the benefit of a MTM agreement. Given the positive outcomes of MTM agreements on patient health, some feel the success of the New Paradigm may require a pharmacist’s independent use of standard consensus-based algorithms, developed for specific New Paradigm drugs and their associated diseases and medical conditions. Possible algorithm developers have not yet been identified.
delay a needed revision and cause patient harm. For example, is a pharmacist able to identify asthma patients who require addition of corticosteroid inhalation therapy rather than an increased reliance on rescue therapy for asthma control? It is not apparent how collaborative MTM agreements are relevant in the New Paradigm Reduced coverage of New Paradigm drugs may increase drug cost to Medicare recipients.
Pilot Programs Another option is to participate in properly designed pilot programs that could identify logistics and procedures to be implemented or avoided.
Conclusions Under-treatment of certain diseases and medical conditions can be a problem for patients, and the FDA has targeted pharmacists as professional conduits who may be able to help address this problem. However, this opportunity for pharmacists is accompanied by several challenges that require an in-depth, objective examination by pharmacy professionals and the medical community, and provision of sufficient information to allow individual pharmacists to decide whether to participate.
Decision to participate A pharmacist’s decision to participate will likely involve responses to the following questions: Is participation feasible in absence of a reimbursement fee for provision of cognitive services? Will possible increased liability and other challenges noted above decrease participation? Is the value of the New Paradigm to pharmacists readily apparent? What are the roles of the National Association of Boards of Pharmacy, state boards of pharmacy, and pharmacy professional organizations to support the pharmacist role in the New Paradigm? The American Medical Association (AMA) believes the range of diseases or medical conditions eventually included in the New Paradigm could be quite limited. AMA concerns include: Safe and effective drug use requires a practitioner who is adequately trained to evaluate, diagnose, and treat a medical condition, licensed to prescribe drugs, and be responsible for supervising use of that drug. Treatment of chronic diseases and medical conditions may worsen over time and require a revised treatment plan. Less physician involvement may
PROPOSED NEW PARADIGM DRUGS Specific Drugs Albuterol® inhalant Inhaled corticosteroids Chantix® Flexeril® Epipen injection® Nalaxone® Rozerem® Tamiflu® Tretinoin topical® Drug Classes Triptans Statins Antihistamine eye drops Corticosteroid nasal spray Hydrochlorothiazide Certain antibiotics without evidence of resistance
Indications for Use Acute worsening of asthma Chronic asthma Smoking cessation Muscle relaxant Allergic reaction (bee sting, others) Narcotic overdose Insomnia Influenza Acne Migraine attack Hypercholesterolemia Allergy Sinus inflammation Hypertension Infection
Support for the New Paradigm The following professional organizations have indicated support:
National Association of Boards of Pharmacy National Alliance of State Pharmacy Associations National Association of Chain Drug Stores National Community Pharmacists Association Consumer Health Care Products American Pharmacists Association Patient Safety Clinical Pharmacy Services Collaborative Foundation for Health Smart Consumers Reproductive Health Technologies Project In addition, the 2011 Report to the U.S. Surgeon General titled “Improving Patient and Health System Outcomes through Advanced Pharmacy Practice” concluded that existing pharmacy practice models can rapidly relieve some of the projected burden of access to health care and improve overall health care delivery.
Opposition to the New Paradigm The following organizations currently do not support the New Paradigm:
American Society for Reproductive Medicine American College of Obstetrics and Gynecology Food Allergy & Anaphylaxis Network Food Marketing Institute Public Citizen
Other candidates include drug products for treatment of osteoporosis and diabetes. Fall/2012 15
Feature FALL 2012 By Dr. Okeleke Nzeogwu MBA Program Director ation is a one-way power relationship with all the cards in favor of the employer. In every market economy, including a job market, job seekers and employers alike are playing simultaneous roles of buyer and seller. On one hand, the applicant (seller) is marketing and selling his or her credentials and services to a potential employer (buyer), while simultaneously, the potential employer (seller) is pitching his or her company as a desirable place of employment to the applicant (buyer). A transaction only occurs when the applicant wants what the employer has to offer, and the employer also wants what the applicant offers. In business, useful information is often costly to acquire, and employers are hungry for “free” information. Applicants who provide valuable information at no cost to potential employers when advertising their talents, skills, and services are often viewed as more useful in a crowded job market. No matter what industry a job seeker is currently in or want to be in, I recommend using a “push and pull” strategy to provide useful information, and maintain buzz with a potential employer.
Skillful politicians are unabashed in their application of the principles of Marketing 101: first, grab public attention, then use every opportunity to generate interest and desire among consumers (voters, in this case), and finally, motivate voters to take action. Similarly, in the soft job market of the recessionary economy a prospective job applicant must skillfully repackage his or her education, experience and expertise to grab the attention of potential employers, then employ personal selling strategies to generate interest and desire among employers, with the hope that at least one employer will take action. Like successful politicians, today’s job seeker must become adept in self-repackaging, promotion, marketing and distribution (the last two of the classic 4Ps of Marketing—Product, Price, Place and Promotion). In the early 1990s recession I ran into a group of college graduates—business students—during one campus homecoming week. They were bemoaning the economic recession, their overdue college loans and their jobless plights. One graduate in particular caught everyone’s attention when he declared emphatically that there were no jobs out there, except flipping hamburgers, for graduates to payoff student loans. His story and the underlying pessimism caught on until someone asked him how many applications he sends out per month and his self-promotion, marketing and distribution plans. His response evaporated the sympathies around because he had done little.
−The “pull” strategy is what you envision in a traditional jobs search an applicant advertises his or her skills and talents to potential employers by sending a resume or other letter of interest; developing email and Twitter campaigns to grab employers’ attention; establishing and advertising a web presence; responding to job announcements; following up with phone calls, emails and thank-you notes; signing up with recruiting agencies; attending career/job fairs; coldcalling and engaging employers through informational interviews; networking, and participating in other self-promotion activities. −The “push” strategy emphasizes internships, volunteering, and providing your skills and services for free (on a temporary basis) to demonstrate your capabilities. I have a colleague who once worked as an engineer, but was unfulfilled and wanted to do something different. Without any prior experience in the financial world, he repackaged his experience and skills, and ended up on Wall Street. Repackaging and re-marketing yourself to create a new product (you) does not necessarily mean more education, experience, or a new specialty or expertise. It could simply mean re-pitching your education and skills by adjusting your resume, and marketing yourself the right way to an employer in another field.
Many job applicants who have exceptional skills are unsuccessful because of poor packaging, marketing and promotion. As a job seeker, your “packaging” includes your resume, interview skills, and follow-up communications. Your “promotion” encompasses your distribution plan (how to get your resume in the right hands), market presence (are you visible in the marketplace?), and competition (finding ways to stand out from other job seekers). In some industries, product packaging, distribution, advertising and promotion are so essential to market success and survival that it costs more to sell the product than to make it (toothpaste is an excellent example). Ignoring the importance of promotion would likely doom a toothpaste brand, and the same is true for job seekers. “It’s a buying and selling game,” says an A.T. Kearney Executive Search consultant. This practical assessment debunks the notion that the pre-employment situ16 Fall/2012
The idea of taking an existing product with a specific application or use, making adjustments, and marketing it to a new target audience in a different industry, or for a different function is not unique. In Marketing 101 it’s called product adaptation and extension. When you are able to successfully adopt this strategy in your own job search, it’s called a fulfilling career.
Innovations FALL 2012
NEW Advancements in Prevention and Testing for HIV By William Kuykendall, Pharm.D. Assistant Professor of Pharmacy Practice
In the rapidly evolving world of Human Immunodeficiency Virus (HIV), advancements in testing and a new strategy to prevent transmission have emerged for this disease.
New Testing Breakthroughs
A new FDA-approved device allows patients to test and receive results privately and comfortably in their own homes. Before the introduction of the newly approved OraQuick In-Home HIV Test, testing required going to a testing center or sending out test samples in the mail and waiting days for results to come back.
prophylaxis (PrEP) in combination with safer sex practices to reduce the risk of sexually acquired HIV infection. Truvada’s new indication for PrEP received FDA approval on July 16, 2012. It is to be used for adults who are at high risk of acquiring HIV infection: men who have sex with men and/or HIV discordant couples, defined as HIV-negative individuals with a regular HIV-positive partner.
The OraQuick In-Home HIV Test will be available in October in most retail pharmacies and is similar to the HIV tests used in primary care centers. Orasure, the manufacturer of the testing device, hasn’t determined a sales price but expects the consumer version to be less than $60. The product tests for the presence of HIV antibodies and delivers results in 20-40 minutes. This test does not require blood samples; instead patients using the device obtain a swab of oral fluid from the upper and lower gums and place this swab in a vial of solution. The device either displays one line indicating a negative result or two lines signifying a positive result. The Oraquick In-Home HIV Test is highly reliable, particularly in identifying when someone does not have the virus (99.98 percent accurate, or one false positive out of every 5000 tests). It is still reliable, although less accurate, in detecting when someone does have HIV (92 percent accurate, or one false negative expected out of every 12 test results in HIV positive individuals).
Truvada’s FDA warning will be altered to include that Truvada for PrEP is only to be used in individuals who are confirmed to be HIV-negative prior to it being prescribed and must be tested for HIV at least every three months during use. Two clinical trials used for the new FDA approval reported the most common side effects being diarrhea, nausea, abdominal pain, headache, and weight loss. Serious adverse events, including those related to kidney and/or bone toxicity, were uncommon. One major concern clinicians are raising about the use of Truvada in PrEP is acquisition of drug resistance. Gilead, the manufacturer of Truvada, is required to collect viral isolates from individuals who develop HIV while taking Truvada for PrEP to address this concern. Medicare Part D and most private insurance companies have Truvada on their formulary but it remains uncertain whether they will cover Truvada for PrEP. The out-of-pocket cost for a month’s supply is high, at approximately $1,200.
Prevention Options
These advancements within the HIV community instill great optimism toward progress in HIV testing, preventive measures, and the impact of how these new FDA approvals will affect HIV infection rates in today’s society.
Further progression in the fight against HIV has transpired using Truvada (emtricitabine/tenofovir disoproxil fumarate), a once-daily medication currently used in the treatment of HIV. The new indication is for pre-exposure
Fall/2012 17
18 Fall/2012
Healthcare Access in America FALL 2012
EXPANDING ACCESS TO CARE The state of primary care access and solutions for expanding it
Health care is a hot topic in the U.S. these days, whether it’s related to discussions on provider shortages, or the impacts of the Patient Protection and Affordable Care Act (PPACA). Regardless of your political feelings about the new health care law, it’s important to understand how the current health care climate—and changes brought about by a changing consumer market as well as legislative mandates—will impact the future of care in our country.
Where Did all the Primary Care Physicians Go?
In the past 50 years the landscape for primary care has changed drastically. In the 1960s and 1970s, most physicians were “general practitioners”, meaning they provided patients with both general medicine and surgical care if needed, caring for patients in the hospital and also maintaining an office practice to visit with and treat patients who did not require hospitalization or surgery. This model of care provided a comprehensive approach. Since the same physician often coordinated most or all of the patient’s care, the doctor could take an all-inclusive approach to managing diseases with that patient. Advancing Primary Care, a report by the Council of Graduate Medical Education (COGME) in 2010 identifies the 1980s as the point where things started to shift. As surgical procedures became more complex, many physicians began to specialize in surgery and had to abandon general practice. Additionally, the model for insurance and Medicare reimbursements also changed. New reimbursement models focused more on paying for specific procedures, and less on paying for consultation, or what are often called the “cognitive” services—such as managing diseases, coordinating care, and counseling patients. The change in reimbursement model meant that income for physicians who chose a specialty instead of primary or general care grew at a much faster rate, and today specialists can make double, or even triple, what a primary care physician makes. Combine that with the rising cost of medical school, and it makes sense why so many students choose specialty care over primary care. The result of these changes, along with changes in consumer health care needs, is a shrinking pool of primary care physicians. Dozens of studies have been done on a state and national level, and all show a current shortage in many areas (which will likely get worse in coming years), as well as the likelihood of a shortage in the near future for areas not yet experiencing it.
By Tracy Hernandez
A Compounding Problem
In the COGME 2010 study Advancing Primary Care, a number of factors are identified that have contributed to the long-term decline in primary care physicians in the U.S. One of the first, as was briefly mentioned previously, is the compensation model. Nationally the average compensation for a primary care physician is less than 55 percent of the average for someone practicing in a specialty field. While reimbursement rates remain low for the services that a general practitioner provides, overhead costs continue to rise and proper patient management becomes more and more difficult because of the increasingly complex healthcare needs of most individuals. Most medical students are exposed to primary care practices during clinical training, so they see firsthand the difficulties that primary care physicians face. When you combine that exposure with the prospect of making less money, it often leads students to avoid primary care and choose another specialty. The COGME report also identifies the fact that medical schools are often rewarded for having large medical research components. As they develop better research facilities, they often attract patients with highly complex cases, and therefore must have a high volume of specialists in the system to address these difficult cases. A perhaps unintended consequence of this is that students are inadvertently exposed to more specialists and fewer primary care physicians during their clinical training.
Primary Care in the Intermountain Region
The Intermountain Region, like many other areas in the U.S. is suffering from a shortage of primary care providers. Several studies between 2005 and today show states like Arizona, Idaho, Nevada, New Mexico, Texas, and Utah already have physician shortages, and Oregon is likely to be there soon. Between 1980 and 2011, the states of Utah and Nevada have gone from being ranked 21st and 36th (respectively) in terms of total physicians per 100,000 population, to being ranked 46th and 45th. Utah and Nevada are two of five Intermountain and Western states ranked in the bottom 10—in addition to Idaho, Wyoming, and Texas, according to 2011 study by the Association of American Medical Colleges on physician workforce. A 2010 survey of primary care physicians in Utah showed that only 36 percent of all physicians practice in a generalist field—which includes family medicine, general internal medicine, pediatrics, and obstetrics and gynecology. Of those physicians, 50 percent reported a full or nearly full practice in 2010, meaning they cannot currently accept new patients or will not be able to in the near future.
The Impact of Primary Care
Having a healthy, thriving supply of primary care physicians can have a significant economic impact on individual communities, particularly those in rural or underserved areas. An analysis by the American Academy of Family Physicians identified the economic impact of family physicians in Utah to be $716,449 per physician, per year, for a total economic impact of $376 million. In Nevada, the numbers are even higher, where each family physician has an economic impact of $959,118, for a total of nearly $402 milliion per year. In addition to providing health care services, primary care physicians also contribute greatly to local economies by providing jobs, income, and development within the community.
continued on page 18 Fall/2012 19
Healthcare Access in America FALL 2012 Is There a Solution?
There is no easy solution to this issue. Currently, recommendations on ways that we can increase the volume of primary care providers include a mix of increasing incentives, expanding workforce development programs, examining curriculum at medical schools to enhance exposure to primary care, and retaining primary care physicians by increasing their earning potential. Of particular interest in states where shortages currently exist or are imminent, is the opportunity to develop the pipeline for potential future primary care providers, and increase the incentive to practice in HPSAs. Many studies have shown that students recruited from rural or underserved areas are far more likely to return to those areas to practice once they obtain their medical education. Pipeline development programs that recruit students from these areas can have a big impact. Both state government programs and medical schools are developing programs for medical schools to do outreach to students at a very early age. This outreach can help build a more constant stream of interested students from a wider variety of backgrounds, both ethnically and geographically. In the Intermountain Region, Area Health Education Centers are critical in this process.
How the Affordable Care Act Changes Things
Regardless of your political leanings and your personal feelings about the Patient Protection and Affordable Care Act (which goes by many names, including PPACA, and more informally, “Obamacare”), it has already changed the landscape for healthcare coverage in America, and if it is upheld in future years, it will continue to have a big impact. One of the largest impacts it will have is on the number of people who are covered by insurance. As of 2010, CNN reports that about 50 million Americans are uninsured, or about 16 percent of the population. A lack of insurance is particularly prevalent among young adults (ages 24 to 35) and low-income families (those making less than $25,000 per year), where 28 percent and 27 percent are uninsured, respectively.
Another piece of the puzzle is reducing the amount of debt that students take on in order to become physicians. Students who graduate with extremely high debt volume naturally select the area of the profession where they have higher earning potential, and thus can more readily reduce their student loan burden. Some states have loan reimbursement programs that offer students the opportunity to reduce or eliminate expensive medical school loans in exchange for working for a specified amount of time in an HPSA. However, with tighter budgets and a slower economy, much of this funding has been cut or eliminated, so other alternatives are needed.
After the Supreme Court ruling in late June that upheld the individual mandate as constitutional, projections by the non-partisan research group RAND show that as many as 27 million people could be added to insurance roles as a result of the PPACA, including millions added through increases in employer-sponsored coverage, the availability of low-cost state health insurance exchanges, and changes to Medicaid eligibility. Generally speaking, someone without insurance usually doesn’t go to a primary care physician for things like regular check-ups, and will only utilize health care facilities in the event of an emergency (which usually means they go to the emergency room). With millions more people on the insurance roles, the number of individuals who visit primary care physicians is expected to increase, which will further exacerbate current and projected provider shortages. The shortage is expected to hit designated Health Professional Shortage Areas (HPSAs) particularly hard. These areas include many rural and low-income communities, where the highest volume of newly insured under the PPACA are expected to come from. In Utah, all but two counties are designated as either full or partial HPSAs for primary medical care, according to the U.S. Department of Health and Human Services’ Health Resources and Services Administration (www.hpsafind.hrsa.gov). In Nevada as well, the number of physicians per capita is far lower in rural versus urban counties. When the number of patients needing care exceeds the availability of primary care physicians, the result is often overwhelming patient loads for existing physicians, extensive waiting periods, and a higher-than-normal volume of emergency department usage, even for routine treatment. Without an increase in the number of available primary care physicians, this will likely only get worse in HPSAs under the new health care law.
20 Fall/2012
Many health professionals working to address these issues identify the crucial development period for primary care physicians during medical school. Both the COGME report and professionals at the state level in Utah and Nevada recommend increasing medical students’ exposure to primary care, particularly in rural or underserved areas. This exposure will give them the opportunity to see the benefits of primary care and be more likely to choose that as a viable option for their future practice. Finally, the topic of reimbursement should be addressed. In Utah, primary care physicians make 34 percent less than their specialist counterparts. Nationwide, the average primary care physician earns about half as much as a specialist. In order to attract more students to the field, earning potential must increase. While there are differing opinions on the best way to implement this increase, there is no doubt that increased earning potential could attract more students to go into primary care. All of the data indicate that our current supply of primary care providers is inadequate to meet the needs of an ever-expanding pool of patients, and this need is likely to get higher if or when the Patient Protection and Affordable Care Act is fully implemented. The health care community must begin planning now for ways to address the shortage and increase providers before it is too late.
Healthcare Access in America FALL 2012
The Impact of Mid-Level Care Providers By Tracy Hernandez obtain access to care; second, it’s a cost-effective way to expand that access for millions of patients. The potential impact these providers can have will only expand if the Patient Protection and Affordable Care Act (PPACA) is upheld in future years. If it remains in place, analysts expect about 27 million new patients to be added to insurance roles within a couple of years. The expectation is that once these individuals have insurance coverage, they will utilize primary and preventive care at a much higher rate than when they did not have insurance.
Defining Their Roles
One of the biggest challenges with mid-level care providers is defining the scope of practice—laws vary from state to state with regard to what these providers are legally allowed to do.
When we look at the health care landscape, study after study today shows that the number of primary care providers is on the decline. While there are many efforts underway to address the issue—by attracting more students to the field of primary care, addressing issues with significant medical school debt and the ability to make more money in specialty fields—there is also another quiet change happening that’s not showing up on the studies. That is the shift toward mid-level providers to fill in the gaps where primary care is not available.
Who are Mid-Level Providers?
The term “mid-level provider” is generally used to refer to physicians assistants (PA) and nurse practitioners (NP). While they still make up a relatively small percentage of the total primary care workforce, the number is growing. A 2011 report by the Robert Wood Johnson Foundation, Primary Care Health Workforce in the United States, showed that nurse practitioners make up about 19 percent of the primary care workforce, and physician assistants comprise about 7 percent. There are more than 84,000 certified PAs in the U.S., up from 74,000 just four years ago, according to the American Academy of Physician Assistants. The American Academy of Nurse Practitioners reports that there are 155,000 NPs practicing in the U.S., and close to 70 percent practice in at least one primary care site (a significantly higher number than graduates of medical school, where only about 35 percent go into primary care). Physician assistants and nurse practitioners often practice independently, with training similar to the kind a primary care doctor would get—just a little bit less of it. Students entering PA programs can generally finish in about two years. Nurse practitioners are required to obtain either a master’s or doctoral degree with advanced clinical training in acute care, primary care, disease prevention, and health management. Depending on which path a student takes, it could take two years or more after graduating with a bachelor’s degree in nursing (BSN). With the rising cost of attending medical school, PA and NP programs have become increasingly important in attracting students who can then practice in the lower paying field of primary care, because they will not have as much student loan debt upon graduation.
The Impacts of Mid-Level Providers
There are two areas where NPs and PAs can make a significant difference: first, by expanding the volume of primary care providers, making it easier for a patient to
For PAs, most states have abandoned the idea of creating a specific checklist of items that the provider can and cannot do; instead the laws allow supervising physicians to determine exactly what duties a PA will perform. However, the physician is ultimately responsible for coordinating and ensuring quality patient care, and must be available to work with the PA whenever it is needed. The scope of practice for nurse practitioners, on the other hand, is specifically dictated by the laws in each state. In some states, no medical doctor (MD) involvement is required, while in others, the NP must be supervised by an MD. Depending on the state laws, NPs may be able to diagnose, order tests, prescribe medication (including controlled substances), and refer patients to specialists with or without MD involvement.
Providing Benefit to the Community
When more providers are available, physicians offices and clinics can expand services to meet the needs of the community. Many effective new models for healthcare delivery include a patient-centered “team” approach. Rather than having the physician try to do everything, he or she can hand off lessspecialized tasks to another member of the team, which frees up more of the physician’s time to dedicate to the tasks that do require a higher level of training. For example, a PA or NP can work with patients who require specialized attention for a chronic condition or other health issue. By having every person in the medical office or clinic practicing at the top of their license, the practice can run more efficiently, see more patients, and reduce costs. Studies have also shown that nurse practitioners are a tremendous benefit to rural and underserved areas. The 2011 Robert Wood Johnson Foundation report points out that one of the greatest barriers in access to care is geographic distribution—rural and frontier areas tend to have less access to an adequate number of primary care providers than urban or suburban areas. In fact, only one of out every five medical school graduates practices in a low-supply area. In order to address that discrepancy, many states have expanded the scope of practice to allow NPs to work autonomously in underserved regions. The supply of physician assistants can help address the needs in rural communities, but to a lesser degree. Since PAs practice in the same offices as physicians, their geographic distribution tends to mirror that of the existing primary care physician workforce, with a lower volume in rural and frontier communities. With the right skills and training, mid-level providers are uniquely positioned to provide care to a growing number of people who need access to qualified medical professionals that can coordinate care and enhance service. Fall/2012 21
Healthcare Access in America FALL 2012
NEW HEALTH CARE MODELS: Increasing Access, Decreasing Costs, and the Direction of Primary Care
By Caroline Heyrend PharmD student, Roseman University
Non-Traditional Clinics
While some changes and innovations related to the law and expanded access are likely to be forthcoming, some of the medical community has already responded to the need. The first CVS MinuteClinic was opened in 2000 in response to the need for quick, convenient, and inexpensive treatment for some of the most common ailments (such as strep throat, influenza, and bladder infections) after regular business hours, when physician’s offices are traditionally closed. Non-physician providers, including nurse practitioners and physician assistants, treat patients in clinics attached to a CVS pharmacy, and appointments are not required. The model has been incredibly successful, with hundreds of clinics across the country open today, and treatment that has expanded to include a wide variety of ailments. Open seven days a week, the clinics accept insured and non-insured patients, and offer an affordable alternative to emergency room treatment. In an article posted on FierceHealthcare.com, Dr. Andrew Sussman, president of MinuteClinic and senior vice president/associate chief medical officer of CVS Caremark, identified models like the one CVS has as being a good fit in the new health reform, since the goal is to provide accessible, affordable care to everyone.
With the affirmation of the Patient Protection and Affordable Care Act (PPACA, or Affordable Care Act) and the aging United States population, health care access and cost are at the forefront of everyone’s mind. If the law achieves its goal of expanding coverage to a greater portion of the population, it makes sense that more people will be seeking medical care and the current shortage of physicians and other health care providers will only get worse. In response to these predictions, the health care community has come up with solutions such as the “MinuteClinic”, cooperative clinics, and new practice models that utilize non-physician health care providers in greater numbers. In this pivotal time, all stakeholders need to be mindful of the balance between decreasing national and state health care costs and increasing quality of care. President Barack Obama signed the PPACA into law March 23, 2010, and the individual mandate, a hotly contested component of the law, was recently upheld as constitutional in a June 2012 Supreme Court ruling. No matter what your political leanings, the law has many implications for the expansion of health care for Americans. The PPACA expands Medicaid coverage and increases the number of people who are eligible. It also requires insurance companies to cover children of those they insure up to age 26, and approximately 2.5 million young adults gained health care coverage as a result, according to a report by the Congressional Research Service (CRS). Patients with pre-existing conditions will also no longer be denied coverage, according to the new law. The same 2011 report by the Congressional Research Service examined physician supply as it relates to the Affordable Care Act. In the report they document data compiled by the Association of American Medical Colleges which found that 33 states are experiencing current physician shortages or anticipating shortages. Much of the PPACA focuses on access to primary care, as decreased access often leads to delays in care, worsening health conditions, and higher costs due to greater hospital and emergency department use. The CRS reports that the PPACA includes provisions that aim to increase access to primary care by (1) increasing the number of physicians trained and (2) increasing physician productivity by growing the number of non-physician providers. 22 Fall/2012
Health Cooperatives
Another emerging health care system is health insurance cooperatives. Although cooperative systems have been around for over 50 years (Group Health), they are making a comeback due to evidence suggesting decreased cost and increased quality of care. The PPACA specifically includes grants and funding for this model, which revolves around a collaborative practice for primary care. Group health cooperatives have physicians who are paid a flat salary with the option of bonuses for high-quality performance. Since they are not reimbursed on a per-patient basis, or for specific treatments provided, doctors are not incentivized to see as many patients as possible in one day, or order unnecessary tests. The cooperative organizations are also the only systems governed by the consumer. Thus, when the co-op’s costs are lower, the members reap the benefit in the form of reduced copays. “There’s a kind of accountability to the patients in our system,” said Scott Armstrong, president of Group Health in Washington.
Healthcare Access in America FALL 2012
Utah will soon get its own health insurance co-op through Aarches Community Health Care. Opening in 2013 as a non-profit insurer, it is designed to create improved care at a lower cost. Aarches plans to target Latinos in the community who tend to have higher uninsured rates and decreased access to primary care, and to have transparent costs and payments based on “episodes of care,” according to a March 2012 article in the Salt Lake Tribune. This means, for example that a patient might pay one inclusive fee for all pregnancy visits related to prenatal care and delivery. Groups like the National Association of Socially Responsible Organizations (NASRO) have options available for health insurance cooperatives in Nevada. Although it is a national organization, it provides some state-specific coverage as well.
“Boutique” Medical Offices
The changing health care climate is also bringing about less inclusive forms of primary care. Often referred to as “boutique” or “concierge” services, patients pay retainers or large annual fees ($1500-$10,000 or more) to have access to the physicians. Doctors provide exclusive care, are sometimes available 24/7, and may perform house calls for their patients. Boutique physicians, who practice outside of the third party paying system, contend their practice means lower waiting times, increased time with a doctor, and inevitably better care. Priority Physicians in Indianapolis has four physicians and sees 620 total patients annually. By contrast, most primary care practices see 2,000 patients per physician, according to a May 2011 article in the Indianapolis Business Journal. Having greater access to a physician, and care focused on solutions rather than quick fixes, is beneficial in the health care system. Boutique or concierge medical offices, however, have been criticized for leaving behind patients who cannot afford better care, and in an interview with the Associated Press in January 2012, Harvard Medical School professor Dr. Stephanie Woolhandler said concierge practices are "absolutely the wrong solution.” Unfortunately in our current system, third-party payers (insurance companies) reimburse physicians on a per-patient basis, which encourages them to see as many patients as possible in the shortest amount of time. In addition, with the shortage of available primary care physicians, offices are often overloaded with patients simply because there are not enough providers to address the demand. Finding a way to address these problems without increasing the cost to the patient is a difficult problem. Many people in the United States know that our current system is not working. Health care costs are skyrocketing unsustainably, while access to care for many Americans is lacking. Fortunately the medical community is working on solutions for what is quickly becoming a health care crisis. Collaborative practice between multiple health care providers is growing, efficient and affordable MinuteClinics and other similar clinics are cropping up across the country, and large health care organizations are mobilizing to create reform. The Affordable Care Act can be expected to drastically increase the number of Americans covered by health insurance, so the work of finding the right solutions is not over. Stakeholders will need to continually assess the nation’s need for both providers of health care and health systems, particularly in rural and underserved areas, while also finding ways to make that care as affordable as possible for patients.
5
Important Questions For Your PHARMACIST Reduce Your Health Care Costs by Asking the Right Questions
By Andrew Draper Coordinator of Introductory Pharmacy Practice Experience
American healthcare and medication use are currently in a state of rapid evolution. These topics are on nearly everyone’s mind as discussions about the Patient Protection and Affordable Care Act (PPACA), new medication therapies, and rapidlyescalating health insurance premiums claim a good deal of the media’s time. More and more people are choosing high-deductible insurance plans, where patients and their families take the driver’s seat to manage their own healthcare and medication costs. Cost-effective use of brand-name, generic, and over-thecounter (OTC) medications is becoming increasingly important to financially-savvy consumers. Health insurances companies often stop paying for medications that become available OTC. In addition, more medications are becoming available as lower-priced generics. For example, the blockbuster brand-name medication Lipitor®, used to treat high cholesterol, has become available generically in the last few months. Over the next two years several more costly, brand-name medications treating common diseases such as asthma, heartburn, and diabetes should also become available as less-expensive generic medications, according to Dr. Michael Bartholow’s analysis of the top 200 drugs in an article published on the Pharmacy Times website in July 2012. A consumer armed with knowledge about insurance medication terminology, such as “generic” and “preferred”, can stretch health care dollars even farther. Medications that have recently gone generic, or are poised to shortly become available generically, promise to save wise consumers money. When you visit your local pharmacy, here are some of questions you can ask your pharmacist to obtain the medications you need as economically as possible: 1. “Is a generic available, or will a generic soon be available?” Generic medications are typically covered by insurance companies at a lower patient copay. Many generic medications can also be purchased at a cash cost of approximately $4 per 30-day supply. 2. “Is there a similar drug that costs less money?” This is often referred to as a “preferred” drug. The pharmacy may be able to recommend a medication that works similarly to the prescribed or recommended OTC medication, but which costs less. 3. “Are there lifestyle modifications I can make to help decrease my need for prescription medication?” Efforts to exercise, eat healthy, and stop smoking may help to decrease the need for prescription or OTC medication. Any exercise, diet, or lifestyle modifications should always be done under the care of a healthcare professional. 4. “Is an OTC medication available to treat my condition?” By using an OTC medication, you could save yourself the time and cost of a provider visit. 5. “Can I save money by purchasing a 90-day supply instead of a 30day supply?” When you take medications long-term, a 90-day supply may be more economical than three 30-day supplies. Americans are living longer and drug therapies are playing an ever-increasing part in our health care treatments. A wise consumer who asks questions about appropriate, cost-effective medication use can not only ease the strain on their pocketbook but also increase their quality of life.
Fall/2012 23
Alumni Relations FALL 2012
In Honor of Martin
THE ROBERT AND MARTIN STOLMAN SCHOLARSHIP:
“He had an easy time in pharmacy school, despite the volumes of information he had to memorize.” Martin was also a brother in the pharmacy fraternity, Rho Pi Phi. As a family, the Stolmans opened Jefferson Drug Store in Peabody, Mass. on Feb. 14, 1962. It was the right place and the right time. Business at the pharmacy in the coming few years went “through the roof” as the community grew and other businesses opened nearby. Jefferson Drug Store – yes, named after the president – became a gathering spot for the community. Young families brought their children in to enjoy the soda fountain as well as to pick up prescriptions and other items. Pleased with the result of their investment, the family sold the store a few years later. Having helped Martin establish to himself professionally, the family then focused on Robert’s business interests. And so on Feb. 14, 1968, they opened their first cinema. It was an exciting time for the movie business, and Robert enjoys discussing the wheeling and dealing – and significant financial investment – that was necessary to book showings of blockbuster movies like “Guess Who’s Coming to Dinner” and “The Godfather.”
“With the current state of the economy, fewer people can af ford higher education. Yet, advanced degrees open doors to higher-paying jobs. Thanks to generous benefactors who establish scholarships, Roseman University can assist students with tuition and help them realize their dream of becoming a health professional.”
Jesse Stasher Roseman's Director of Financial Aid
Las Vegas Bound With all their success in their home state of Massachusetts, you may wonder how this close-knit family ended up in Las Vegas.
Martin Stolman
How the bond of two brothers impacts future pharmacists at Roseman University By Brenda Griego Roseman University is grateful to its benefactors, whose contributions strengthen academic programs, impact community service projects, and enable talented students to gain an education. Behind every gift is an inspiring story of wonderful people who care. Robert Stolman is one such benefactor, and the story of the ‘wonderful people’ encompasses his entire family. In memory of his brother Martin and his lifelong career as a pharmacist, Robert Stolman has established an estate-based endowment that will provide scholarships for pharmacy students. Robert’s brother Martin was born in 1938 to Hyman and Gertrude (“Hy and Gert”) Stolman when the family lived in Revere, Mass. Martin was five years older than his brother, and “he always watched out for me,” notes Robert. “He was truly like a second father.” The family was very close; their parents were dedicated to each other and to their children’s happiness and success. The Pharmacy Connection Their father Hy was in the printing business, so how did Martin decide to become a pharmacist? Martin started working in a local pharmacy when he was just 14 years old, Robert explains. He was very outgoing and enjoyed the interaction with customers as well as with the pharmacist, who became a mentor to him. But before pursuing his pharmacy studies, Martin enlisted in the army. He served at Fort Sam Houston in San Antonio as a medic, and continued to serve in the Reserves for several years. Martin graduated from Massachusetts College of Pharmacy in 1960. “Marty was very smart, and he had almost a photographic memory,” Robert notes, 24 Fall/2012
The family had enjoyed vacationing in the west – they traveled to the brand-new Disneyland theme park, visited the Santa Anita Racetrack, and enjoyed the beauty of Scottsdale, Az. Their first vacation to Las Vegas was in 1968; Robert recalls staying at the glamorous Riviera Hotel and Casino, and he smiles as he remembers “what a little airport McCarran was, and how the gates were outdoor covered corridors, with stairs that were wheeled up to arriving planes.” From their very first vacation to Las Vegas, “We all fell in love with the city,” Robert notes. “There was something special about Las Vegas, and we knew that someday we would like to relocate.” Marty moved to Las Vegas 1979, flying from Boston to arrive in Las Vegas as the first pharmacist hired by Vons Supermarkets in Southern Nevada. He started at the Vons at Maryland Parkway and Twain, in what was then a thriving new shopping center. Marty went on to serve 26 years with the company, endearing himself to several generations of Las Vegans. Robert meanwhile, also moved to Las Vegas and threw himself into business again, this time in the retail arena. After starting as a manager at GNC stores, Robert ascended the corporate chain, including managing a district that spanned Tucson, Az. to Kansas City, Mo. to Salem, Ore. and all parts between. He also later oversaw operations at Marshall Stores, Ross Stores and Burlington Coat Factory. Hy and Gert Stolman soon joined their sons in Las Vegas. They continued to travel and took great pleasure in their new lives in Nevada. Hy and Gert had been married and dedicated to each other for 67 wonderful years before Hy passed away in 2004. Marty culminated his career at Vons at the Owens and J Street store. “He really enjoyed working in that neighborhood and appreciated his customers,” said Robert. Marty was “famous,” Robert notes, for his wall of pictures featuring his customers with their children and pets, and for always having lollipops available for children. He was a warm and wonderful person, and his customers became an important part of his life. Robert reminisces how Marty would get postcards from his customers as they traveled on vacation, whether they were visiting Reno or Rome. Who knows what the future would have held for Marty – continued success in his field, an affiliation with a university, and perhaps even an elected office. But his health
Alumni Relations Fall 2012
DR. SCOTT STOLTE Joins Roseman University as Dean of the College of Pharmacy By Jason Roth
declined suddenly, and deteriorated rapidly. In July of 2009 Robert’s brother, his role model and only sibling, passed away. It was a devastating loss for his family, and for his customers. Losing Marty made Robert understand very deeply just how much his brother had taught him. “I suddenly realized how I had always tried to be just like him,” he said. Compounding a difficult time, Robert’s mother Gert passed away in the following year.
On Aug. 20, Dr. Scott Stolte joined Roseman University as Dean of the College of Pharmacy, succeeding Dr. Renee Coffman who transitioned to her new role as Executive Vice President of Quality Assurance and Intercampus Consistency after serving as Dean for eight years. “I’m very grateful to have the opportunity to serve the students, alumni, faculty and staff of the College of Pharmacy as dean,” says Dr. Stolte. “I was very interested in joining Roseman University because of its model of mastery learning. It’s truly innovative and an appropriate way to teach pharmacy because of its necessity for competency and accuracy.” Dr. Rosenberg expressed delight in welcoming Dr. Stolte to Roseman University. “He is committed to advancing the College of Pharmacy, strengthening its support for students and alumni, and further developing our outstanding faculty. Most important, he is committed to preserving and enriching Roseman University’s educational model and teaching philosophy.”
The Nevada College of Pharmacy As he dealt with his grief, Robert felt compelled to honor his brother’s memory. He recalled Marty mentioning the fact that a college of pharmacy had opened in Nevada, the first and only college of pharmacy in the state. It had piqued his brother’s interest; Martin thought that perhaps one day he would teach at the school, or become a mentor to students.
Dr. Stolte joins Roseman with nearly 15 years of experience in pharmacy education, most recently serving as Associate Dean of Academic Affairs at the Bernard J. Dunn School of Pharmacy at Shenandoah University in Winchester, Va. He has been a member of that School of Pharmacy since 1998, serving in a variety of faculty and administrative roles, including Associate Professor and Department Chair, Acting Dean, Interim Director of Experiential Learning, and Director and Assistant Professor as well as Curriculum Coordinator and Assistant Professor in the Division of Technology in Education. He also currently serves as Adjunct Associate Professor of Healthcare Sciences at the School of Medicine and Health Sciences at The George Washington University.
”I wanted my brother's name to be remembered by future pharmacists and others in the health sciences,” said Robert, explaining his reason for establishing the scholarship.
In addition to his faculty and administrative positions, Dr. Stolte has extensive professional experience and is a nationally recognized speaker on many topics, and a consultant to many pharmacy organizations, including serving as a Site Evaluator for the Accreditation Council for Pharmacy Education (ACPE).
After touring Roseman, Robert came away very impressed. “The tour made me wish Roseman had existed when I was ready to enroll in college – if it had, I might be a pharmacist today.”
According to Dr. Stolte, it was during an ACPE accreditation site evaluation visit at Shenandoah University that he became intrigued about Roseman University.
”I'm sure he would have been excited at how much Roseman University had grown and advanced in these few short years,” Robert added. Roseman University students never knew Martin Stolman as a professor nor were they able to benefit from his vast professional experience. And yet, thanks to his family’s generosity, future generation of students will be able to fulfill their dream of becoming a pharmacist precisely because of the Martin and Robert Stolman Scholarship. Roseman University is grateful to Robert Stolman and his wonderful, caring family. Are you interested in learning more about scholarships and the impact they have on students at Roseman? Please contact Brenda Griego at (702) 968-1619 or BGriego@Roseman.edu.
“I had to opportunity to meet Dr. Coffman who served as a site evaluator during an accreditation site visit of the school I was employed by. I was very impressed with what I learned from her about Roseman University, but also with her as an individual. When the dean position became available, I knew it was a tremendous opportunity to be considered to join a leadership team that truly embraces and values teaching. Since meeting Dr. Coffman, she has become an invaluable mentor.” In just a few weeks since joining the College of Pharmacy, Dr. Stolte has been meeting with each faculty member to share his vision for the college. “I want to build upon the amazing foundation established at Roseman. The College of Pharmacy, which graduated its inaugural class 10 years ago this year, is no longer new. It has reached a maturing stage. I want to take it to the next level in establishing it as a destination college of pharmacy. This will enhance our ability to recruit the best faculty and attract the best students from around the region and country.” Fall/2012 25
Alumni Relations FALL 2012 Devin Meier College of Pharmacy Graduate, 2010 South Jordan Campus
The College of Pharmacy is a grueling three-year program that requires students to truly dig deep and find their inner pharmacist. After surviving the program, Devin Meier, who graduated in 2010, recently opened Meier’s Pharmacy in his hometown of Holladay, Utah. Meier knew that pharmacy was his calling, and decided
on Roseman University (at the time it was the University of Southern Nevada) mainly because of the block system. He talked to Alumni Director Brenda Griego and discussed some of his thoughts about his education, as well his journey as a true entrepreneur and the steps he took to get where he is today.
1. How did you decide you wanted to become a pharmacist?
9. What are your plans for the future?
I was originally planning on going to medical school but then I decided that was not going to be the right kind of lifestyle for me. I had already done several classes for pharmacy school so I decided to pursue a career in pharmacy since it was in the same field but didn’t entail a rigorous residency program.
Hopefully to open more stores and grow the business.
2. What made you apply to and then decide to enroll at Roseman/USN? I really loved the idea of the block system. I thought it was very hard at BYU to learn the things that I needed to when I had to jump from subject to subject rather than just focusing on one topic at a time, which is the style that is taught at Roseman. I was very pleased with the block system at Roseman. 3. Why did you start your own business – was that always your plan? I wanted to be able to make my own decisions and to practice pharmacy how I thought pharmacy should be done. I was tired of being an employee and having to do everything according to someone else’s plan whether or not I thought that was the best solution. 4. What is the toughest part of owning your own business? It is definitely how many hours I work. I am putting in at minimum 60 hours per week right now, which is very hard. I work 6 days per week every single week, and I have not had a day off except Sunday since the day we opened. 5. What is the best part? The best part is definitely watching the business grow. Being able to watch the numbers increase and the volume of patients is very exciting. It is also a lot better working atmosphere. 6. What has surprised you about opening your own pharmacy? I am very surprised at how much better patients treat their local pharmacist more than they treat the typical chain pharmacist. If you treat them with respect that attitude is generally always reciprocated. 7. Why do you think your business is thriving? Because we are so fast and friendly to the people. If they come in once we usually never lose customers; we get them coming back each month. 8. What is important to your customers / patients? They love how we treat them and they are very concerned about the cost of their medications. 26 Fall/2012
10. How would you describe your experience as a Roseman student? I loved every minute of it in hindsight. Those were the days—late-night studying until 2:00 in the morning every other Thursday night! 11. Do you feel you received a strong pharmacy education? I feel I am very qualified to do the job that I do because of my education at Roseman. 12. What would you say to a prospective student who is considering enrolling at Roseman? It is worth every dollar I spent on tuition. The block plan is amazing and the extra year you have to work is such an added bonus! 13. What advice do you have for current Roseman students? Learn as much as you can because before you know it you will be out in the real world making those critical decisions for patients. You don’t think that day will come but it will. Be prepared! 14. What advice do you have for future Roseman pharmacy graduates? Don’t get caught in the rut of a job that works for you today, for you never know what tomorrow will bring. Always be thinking of ways that you can advance yourselves and this profession. 15. Which Roseman classmates do you stay in touch with? The ones that I was really good friends with. Most of them did residencies so they all think that they are smarter than me. 16. How did your family factor into your education and your business? My wife has shown me so much support through building up my business. She has let me do whatever I want and is never demanding. I could have never done it without her full-fledged support, which she gives to me each and every day.
Feature Fall 2012
Dr. Ron Fiscus and Roseman University WIN RESEARCH AWARDS By Jason Roth
Roseman University's emphasis on growing its research programs received significant recognition at the 2012 NevBio/Awards for Biotechnology & Health Science Achievement. The event was held Thursday, Sept. 20 at UNLV and presented by the Nevada Biotechnology and Health Sciences Consortium, an organization dedicated to advancing research in Nevada. Dr. Ron Fiscus, Roseman's Director of Research and head of the University's Center for Diabetes and Obesity Research, was awarded Researcher of the Year for the important studies he and his team are conducting to develop better ways of preventing and treating type 1 and type 2 diabetes and the associated pathological complications patients develop, such as cancers, cardiovascular diseases, and Alzheimer's and other neurological complications. The team utilizes two highly sophisticated instruments (NanoPro100 and NanoPro1000) that are the first of their kind in the Nevada and the region. They are used for ultrasensitive and accurate analysis of protein expression and phosphorylation in biological and clinical samples. Roseman University was also awarded the Research Organization of the Year award for its research endeavors, including the creation of a growing, world-class research teams that, in addition to Dr. Fiscus, now includes:
Center for Diabetes and Obesity Research Mary Johlfs Coordinator of Roseman University Research Centers and Associate Scientist Dr. Oscar Goodman, Jr. Adjunct Professor of Pharmaceutical Sciences and Member, Cancer & Diabetes Research Programs Dr. Ranjana Mitra Adjunct Assistant Professor of Pharmaceutical Sciences and Senior Research Scientist Janica Won Research Associate Ben Constatino Post Doctoral Research Associate Olivia Chao Post Doctoral Research Associate
Cancer Research Program Dr. Aurelio Lorico Co-Leader of the Cancer Research Program and Associate Professor of Pharmaceutical Sciences Dr. Germana Rappa Co-Leader of the Cancer Research Program and Associate Professor of Pharmaceutical Sciences Dr. Javier Mercapide Post Doctoral Associate Fabio Anzanello Research Technician
Research Grants Transferred to Roseman University On Sept. 20, an NIH grant for $256,788 for Dr. Germana Rappa’s study of the design of therapeutic strategies specific for breast cancer initiating cells has been transferred to Roseman University of Health Sciences. Also in September, a Department of Defense CDMRP research grant in the amount of $134,770 was transferred to Roseman University of Health Sciences in support of Dr. Oscar Goodman, Jr.’s research.
Research Grants Submitted An NIH RO1 grant proposal was submitted on June 6, 2012 by Dr. Thuc Tim Le of Desert Research Institute and Dr. Ron Fiscus for a research project, “Protein Kinase G Isoforms in the Phenotypic Switch of Adipose Tissue Macrophages,” to be conducted April 2013 through March 2016. The proposal requests total direct costs of $770,979 (split 50:50 between the two institutions) and total indirect costs of $364,061. An NIH R15 AREA Grant (Academic Research Center Enhancement Award) proposal was submitted on June 21, 2012 by Dr. Ron Fiscus for a research project, “Neuroprotective Mechanisms of Protein Kinase G in Preventing Diabetic Neuropathies,” to be conducted April 2013 through March 2016. The proposal requests total direct costs of $250,000 and total indirect costs of $20,000. On July 16, 2012, a proposal for a Juvenile Diabetes Research Foundation (JDRF) Innovative Research Grant was submitted by Dr. Ron Fiscus for a research project, “Protein Kinase G-Iα as Key Mediator of c-Cell Survival
and Proliferation,” to be conducted March 2013 through February 2014. The proposal requests total direct costs of $100,000 and total indirect costs of $10,000.
Recent Research Publication and Contributions In June, a research article, “Imaging Immune and Metabolic Cells of Visceral Adipose Tissues with Multimodal Nonlinear Optical Microscopy,” by Mary Johlfs and Dr. Ron Fiscus, and collaborators Yasuyo Urasaki and Thuc T. Le, was published in PLOS ONE, a peer-reviewed, open access, online journal that features primary research. In September, a research article by Janica Wong and Dr. Ron Fiscus, and collaborator Madhavi Bathina, “Cyclic GMP/protein kinase G type-Iα (PKG-Iα) signaling pathway promotes CREB phosphorylation and maintains higher c-IAP1, livin, survivin, and Mcl-1 expression and the inhibition of PKG-Iα kinase activity synergizes with cisplatin in non-small cell lung cancer cells,” was published online by the Journal of Cellular Biochemistry. It is scheduled for print publication in November. Dr. Ron Fiscus, Janica Wong and Mary Johlfs, and collaborator Dr. Elaine Leung of Macau University of Science & Technology, contributed “Nitric oxide/protein kinase G-I promotes c-Src activation, proliferation and chemoresistence in ovarian cancer” to a chapter in Ovarian Cancer – Basic Science Perspective. The book is edited by Samir A. Farghaly and published by InTech. Dr. Ron Fiscus and Mary Johlfs contributed “Protein kinase G (PKG): involvement in promoting neural cell survival, proliferation, synaptogenesis and synaptic plasticity and the use of new ultrasensitive capillaryelectrophoresis-based methodology for measuring PKG expression and molecular actions” to a chapter of Protein Kinase Technologies, edited by Hideyuki Mukai and published by Springer as part of the Neuromethods series. Janica Wong and Dr. Ron Fiscus contributed “Protein kinase G-Iα hyperactivation and VASP phosphorylation in promoting ovarian cancer cell migration and plantinum resistance” to the book Ovarian Cancer, edited by Dr. Ivan Diaz Padilla and schedule for December publication by InTech.
Fall/2012 27
ROSEMAN PEOPLE May 2012 to Present New Hires & Promotions Dr. Linda Baughan is Director of Endodontics in the preclinical and clinical educational programs at College of Dental Medicine in South Jordan, Utah campus. Sara Bodnar is the Recruitment, Admissions & Enrollment Specialist with the College of Nursing in South Jordan, Utah. Loretta Campbell is Audio Visual Systems Specialist I at the South Jordan, Utah campus. Angela Bigby
Garry L. Church is Assistant Director of Library Services at the South Jordan, Utah campus. Gaye D'Agata has been promoted from Library Assistant to Library Technician. D'Agata started at Roseman University’s Henderson, Nevada campus as a part-time employee in September 2004.
Dr. Prashanti Bollu
Rhonda Dahlberg is Assistant Professor and Coordinator of Adult Health for the College of Nursing's ABSN program at the Henderson, Nevada campus. Linda Doleshal is Clinical Staff at the Orthodontic Clinic of the College of Dental Medicine at the Henderson, Nevada campus.
Dr. Wendell Jones
Dr. Becky Doman is Assistant Professor of Pharmacy Practice with the College of Pharmacy at the South Jordan, Utah campus. Dr. Suzette Farmer is Professor of Nursing for the College of Nursing at the South Jordan, Utah campus.
Barbara Wood
Dr. Oscar Goodman, Jr. is Adjunct Professor of Pharmaceutical Sciences and Member of Roseman University’s Cancer and Diabetes research programs. Dr. Shannon Hillebrand is Administrative Assistant to the MBA program.
28 Fall/2012
Parand Mansouri-Rad is Adjunct Faculty for the MBA program. Adam P. McCormick is Assistant Professor and Director of the Oral and Maxillofacial Surgery in the College of Dental Medicine at the South Jordan, Utah campus. Dr. Joseph McCoy is Assistant Professor of Pharmacy Practice in the College of Pharmacy at the Henderson, Nevada campus. Dr. Brian Oxhorn is Assistant Professor and Skills Laboratory Coordinator for the College of Nursing at the Henderson, Nevada campus. Laurel Sampson is Assistant Professor with the College of Dental Medicine at the South Jordan, Utah campus. Dr. Gillian Silver-Rodis is Adjunct Faculty and Assistant Professor for the MBA program. Kathleen Stieren was promoted from parttime Adjunct Clinical Faculty to Skills Laboratory Coordinator for the College of Nursing at the Henderson, Nevada campus. Rachael Wadley is Marketing Communications Specialist, based at the Henderson, Nevada campus. Cheyenne White is Administrative Assistant in the College of Nursing at the Henderson, Nevada campus. Ken Wilkins is Controller. He is based at the Henderson, Nevada campus. Katherine Zanolli is Administrative Grants Officer, based at the Henderson, Nevada campus.
Awards, Recognition and Appointments Angela Bigby, Registrar and Director of Student Services, has been named to the Advisory Board of the Academy of Math, Science, and Applied Technology (AMSAT) magnet program at Clark High School in Las Vegas. Dr. Prashanti Bollu, Director of Dental Research and Assistant Professor for the College of Dental Medicine at the Henderson, Nevada campus, was selected by the Nevada Diabetes Council to serve as a panelist representing dentistry at the Diabetes Professional Education Conference on November 13, 2012 in Las Vegas. The conference serves as a collaborative effort by the Nevada State Health Division's Diabetes Prevention and Control Program to bring together health care professionals to discuss and make recommendations as needed for better prevention and control of Diabetes. Dr. Arup Chakraborty, Assistant Professor of Pharmaceutical Sciences, has been selected for the Editorial Board of Oncology, Gastroenterology and Hepatology Reports. Dr. Jene Hurlbut, Associate Professor with the College of Nursing at the Henderson, Nevada campus, has been appointed to the Education Committee for the national Rural Nurse Organization and the Membership Committee of the Western Institute of Nursing Research Board of Governors for the 2012-2015 term. Dr. Hurlbut also passed the National League for Nursing's Certified Nurse Educator (CNE) examination. The certification is significant for academic nurse educators as it
establishes nursing education as a specialty area of practice and creates a means for faculty to demonstrate their expertise in this role. Dr. Manas Mandal, Associate Professor of Pharmaceutical Sciences for the College of Pharmacy, served as a reviewer for manuscript proposals for the American Journal of Pharmacy Education’s special theme issue on student leadership development in May 2012. In July, he served as a reviewer for abstracts submitted to the American Association of Colleges of Pharmacy Annual Meeting. Dr. Mandal was also invited to serve in the Programming Committee of the American Association of Colleges of Pharmacy on behalf of the the organization’s Curriculum Special Interest Group. He was also invited as an item writer for the Foreign Pharmacy Graduate Equivalency Examination and the Pharmacy Curriculum Outcomes Assessment. Dr. Jaleh Pourhamidi, Dean of the College of Dental Medicine and Program Director of the AEODO/ MBA residency program at the Henderson, Nevada campus, has been selected as an examiner by the American Board of Orthodontics for Clinical Examinations in 2013. She was also named one of Orthodontic Products' "Best of 2012 Orthodontists" in the magazine’s August 2012 issue.
Barbara Wood, Director of University Relations, was awarded the Philanthropist In Education Award by the Asian American Group of Las Vegas during an awards ceremony on September 8 at the Gold Coast Hotel & Casino. The group, the largest of its kind in Nevada, helps foster the success and development of Asian Americans in Southern Nevada. Roseman University has been awarded a Target Campus Grant for $2,000 to support the University's community outreach for health. According to Barbara Wood, the grant applicant, the grant money will be used to buy supplies required for administering free health screenings, such as cholesterol and blood glucose testing. Dr. Wendell Jones was recently inducted into the Outsourcing Hall of Fame for his stream of contributions to outsourcing theory and practice for the past twenty years. Dr. Jones is an Adjunct Professor of Management, and former fulltime professor who helped establish and enhance the MBA program at Roseman University.
In the same issue of Orthodontic Products, Dr. Jeffrey McMillan, alumnus of the inaugural AEODO/MBA Class of 2011, was featured on the magazine's cover and is profiled in an article about his choice to enter a new business model to practice orthodontics. Fall/2012 29
ROSEMAN PEOPLE May 2012 to Present
Faculty Research, Publications and Presentations
Dr. Arup Chakraborty
Dr. Edward Deschepper
Dr. Jene Hurlbut
Dr. Manas Mandal
30 Fall/2012
"Impact of Body Size Descriptors on Initial Treatment Response and Thirty-Day Mortality in Patients with Gram-Negative Infections," by Drs. Meghan Jeffres, Sean Barclay and Mark Decerbo from the College of Pharmacy, along with Dr. Michael Daley of St. Louis College of Pharmacy and Dr. Peter Golenia of Boston Medical Center, has been published in the most recent issue of the Journal of Applied Research. The reasarch was funded by Roseman University's former Intramural Research Grant Program. In November, an abstract by Dr. Arup Chakraborty, Assistant Professor of Pharmaceutical Sciences, and Dr. Renee Coffman, Executive Vice President of Quality Assurance and Intercampus Consistency and former Dean of the College of Pharmacy, and Jessica Jorvig, Laboratory Coordinator, will be presented at the 2012 Joint American Association of Colleges of Pharmacy/International Association of Pancreatology Annual Meeting in Miami. The abstract is titled “Zerumbone, a phytochemical from Asian ginger is a novel inhibitor of Jak2/Stat3, inhibits promigratory gene expression, growth and migration of pancreatic cancer cells.” A study by Dr. Edward Deschepper, Professor and Director of Clinical Foundations for the College of Dental Medicine at the South Jordan, Utah campus, and two colleagues was published in the Journal of Esthetic and Restorative Dentistry. The study is titled “Effect of a Nano-hydroxyapatite Paste on Bleaching-related Tooth Sensitivity.” Dr. Jene Hurlbut, Associate Professor with the College of Nursing at the Henderson campus, presented at the National Faithbased Nursing Conference on research findings related to spirituality and healthpromoting behaviors among homeless
women. She also presented a poster at the Nevada Public Health Association Annual Conference on the same subject. Dr. Manas Mandal, Associate Professor of Pharmaceutical Sciences for the College of Pharmacy, presented a roundtable session on Biologicals as Emerging Therapeutics in Patient Care at the American Association of Colleges of Pharmacy Annual Meeting in July 2012. In October, he presents a poster, “Immunomodulatory Properties of Statin,” as the American Association of Pharmaceutical Scientists Annual Conference in Chicago. Dr. Brandon Markley, Assistant Professor of Pharmacy Practice at the South Jordan, Utah campus, presented a poster at the October 2011 ACCP Annual Meeting held in Pittsburgh, PA. The poster, “Evaluation of MDRD and Cockroft-Gault equations for sitagliptin dosing,” sought to decipher sitagliptin dosing discordance versus agreement in adult patients with type 2 diabetes mellitus using both MDRD and CockroftGault equations. Dr. Markley, along with former colleagues, also had an article published in the January 2012 issue of Southern Medical Journal, titled “Role of Aggressive LDL Reduction in Patients With Coronary Heart Disease.” The aim of the article was to integrate research evidence with the care of patients with coronary heart disease, focusing on the beneficial effects from intensive LDL reduction with the use of statin medications. In the July 2012 issue of Journal of Nephrology, Dr. Markley had an original research article published. The article focused on the appropriate dosing of sitagliptin in patients with type 2 diabetes mellitus using the Cockroft-Gault and MDRD equations.
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