Expanding Opportunities thru Patient Care: Pharmacists Provide Care…Let Me Tell You About It

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Lawrence "LB" Brown, 2014-15 APhA President-elect, speaks at the Second General Session of APhA2015 in San Diego, CA.

Good morning friends.  I could not be more excited to serve as the American Pharmacists Association 160th president.  While I have been blessed with many opportunities and honors in my career, I am perhaps most proud of the confidence that you, my colleagues and peers, have placed in me.  I will not let you down.

Thank you for this opportunity to serve, and for your patience for a few moments as there are many individuals I want to thank today.

First, thanks to all my friends and family for their love and support.  It has been a long road, and they have been there for me every step of the way.  My dad Verne Brown is here, as are all my brothers, Verne Jr., Lester, and Lance. My dad always challenged me to be better, and my brothers always inspired me to be the best I could be. Thank you guys so much.

Also here are my kind-hearted and sweet daughters: 13 year-old Leilani, and 11 year-old Kalea.  Thanks so much for being great kids and for being so understanding when I had to miss a birthday, a performance, or a softball game; I love you so much.  Before I thank my wife, I have to thank my wife’s mother, Lolita Torres.  She is more like a mother to me than a mother-in-law.  Mom has lived with us since Leilani was born, and it has been a true blessing.  There is no way that I can ever thank you enough for all of the things you have done for the family and me.  We wouldn’t be where we are without you.

And to my beautiful and loving wife of over 20 years, May, thank you for being my partner on this journey.  No one but you knows all of the struggles and joys I have experienced over the years.  You truly have been the woman that I was looking for.  Roses are Red, Violets are Blue, what makes the journey worth it, is that the journey is with you.  Thank you so much.

Before I tear up too much, I want to particularly acknowledge the influence, support and guidance from my pharmacy mother and former APhA President Mary Runge, who passed away last year.  I owe her for being the trailblazer she was, and for all of the love she showed me.  She continues to guide me from heaven. But I also have to thank my actual mom, Loretta Colleen Brown.  You guys never knew her.  She passed away from colon cancer when I was stationed overseas in Okinawa, in 1989, but you would have loved her.  She was fiery, tenacious, and had a great sense of humor.  I love you mom.

Second, I want to thank all of the faculty and staff at the Chapman University School of Pharmacy, but especially Dean Ron “the Don” Jordan, Nancy “full of sweetness” Alvarez, Siufun  “don’t call me Sue” Wong, and Key “the money” Parang; you guys are like family to me, and I wouldn’t trade you for anything.  Forget the Fantastic Four, we are the Fantastic Five!  Also deserving of thanks is Chapman University President Doti and Chancellor Struppa, and the Vice-Chancellors, faculty and staff at Chapman main campus for all of their support of the pharmacy program. And I want to thank all my former colleagues, teachers and mentors at the University of Tennessee, University of Minnesota, and University of the Pacific, some of whom are here today, as well as all of the pharmacists from Tennessee, Minnesota, Illinois, Iowa, and California.  It is a privilege to have worked with all of you.

Third, I want to thank my predecessor Matt Osterhaus.  Matt and Marilyn you and your family have given so much to the pharmacy family, and to me.  I am proud of your work as president and proud to follow in your footsteps.  And to Steve Simenson and Wendy, we go all the way back to my days in Minnesota.  You were awesome back then, and you are even more awesome now.  Thank you.

Those that know me, know that I have been the proud beneficiary of many mentors and friends. I hate that I can’t list you all, but you know who you are and I am eternally in your debt. But there are a few that I have to mention. There is Steven Schondelmeyer and Jon Schommer, Lucinda Maine, Metalou Henderson, Larry Kocot, Kevin Host, John Clayton, Ron Keil, and Alex Adams; former APhA President Bob Gibson, as well as Wilma Wong, George Yatsuzake, and Glen Yokoyama have really been there for me since the beginning, as have Don Floriddia, Ralph Saroyan, Fred Hirning and John Clayton who were my very first mentors. And not to be forgotten are my Kappa Psi brothers, especially Norm Campbell, Eric Gupta, Chris Amaral, and Latha Radharkrishnan. You guys are great.

And thanks to the APhA staff, many of whom have seen me grow up in APhA.

I also want to thank another family who has given me their love and support for over 24 years. Rick and Gwen Hatfield, and their daughters Amy and Emily, have treated me as a member of their family since I first met them.

Lastly, I want to take a moment to thank those who serve our nation, particularly, as pharmacy technicians. I was an Air Force Pharmacy tech, and had the honor of serving under two of the best. Tech Sgt Sheryl Cockerham-Rogers, and Chief Master Sgt Gregory Hepburn. If you want to know what started me down this wonderful path in pharmacy, it was Hepburn. When I was a 19 year old one-striper he told me “It isn’t time itself that matters, it’s what you do with that time that counts. The time will pass no matter what you do, so you might as well do something great.” I followed that wonderful advice and I even have that quote in the signature line of my emails as a constant reminder and hopefully as a way to pass on his advice to others.

And as for the current pharmacy techs and pharmacists in all of the uniformed services I know they work hard to protect our nation’s security while taking care of their patients. Let us recognize those efforts.  [Applause]

While I am sure each of those men and women appreciate the recognition, it is not why they joined the military, not why they studied pharmacy, and it is not why they go the extra mile each day, be it in Afghanistan or Alabama.  Our service members epitomize one of my favorite quotes from Abraham Lincoln. He said, “Don't worry when you are not recognized, but strive to be worthy of recognition.”  Those service members don’t worry about recognition, but each day they work to be worthy of it.  We as a profession must be the same way: focused more on being worthy of recognition, and recognizing that it doesn’t happen overnight. 

Our success as a profession to attain provider status depends on pharmacists across all practice settings improving the health of our patients.  Thanks to your efforts we have stories to tell and APhA’s Pharmacists Provide Care Campaign provides the vehicle for you to tell your story.

There are numerous needs and opportunities to assume expanded roles on the health care team.  Increasingly, others are recognizing the value we provide to health care outcomes.  As we heard President Osterhaus say, “keep the patient’s needs as your central focus and the recognition you seek will come.”  And as Dr. Bob Cipolle from the University of Minnesota used to say, "Patients don't care how much you know, until they know how much you care."

Before and during pharmacy school I worked for Kaiser Permanente Northern California, and my future goal was to become a Kaiser Pharmacist, and then progress into higher management positions.  But during the 1999 APhA Annual meeting, Dr. Schondelmeyer asked me a question that would change my life.  That question was, "What do you really want to do with your life?"  After much thought my answer was, "I don't know, but I know I want to be at the Big Tables where decisions are made about how to improve health care and how pharmacists can be a part of that change."  His reply was, "Well you need to come do your PhD in Social and Administrative Pharmacy under me at Minnesota."  That moment would have a profound impact on me as it started me on an amazing career path.

It was at Minnesota where I began my work on consumer perceptions of pharmacists and their roles in health care.  For that I have to thank both Dr. Schondelmeyer and Dr. Jon Schommer, who had done previous research in that area.  Things I have learned from the consumer perception research are: 

  • Most consumers don’t know about any type of pharmacist except those who work in community pharmacy
  • Most consumers are not aware of the depth of knowledge pharmacists have about therapeutics
  • When consumers learn about all of the different practice settings for pharmacists and what they do, their perception of all pharmacists improves
  • Consumers’ perception of pharmacists doesn’t differ based on age or gender
  • When patients learn all of the quality control checks performed by their pharmacist behind the counter, they actually become more “patient”

The major lesson to be learned from this consumer research is that we must share our stories on how we help and protect patients.

Now, allow me to focus on demonstrating our contribution to patient care.

Safety

My years as an Air Force Pharmacy Technician instilled in me the important role of patient safety.  To begin with, the patients we served were responsible for the safety and defense of our nation.  And secondly, if I made a dispensing error that led to the harm or death of a military person, I was at risk for being court-martialed and put in military jail for damage to government property.  Or at least that's what my sergeants implied, but I have learned since that we need to promote a non-punitive culture of safety, not fear.

That focus on patient safety is the right thing for our patients - it is smarter, healthier and more economic in the long run. Ensuring safety is a role that is common among all areas of pharmacy practice.

When un-safe events occur, we gain recognition we don’t want.  We can get things right thousands of times, but one slip hurts our patients, and damages our profession.  The psyche of pharmacists is to get it right 100 percent of the time (some have a special word for that).  We know there are numerous factors that contribute to the problem when things don’t go right, and we learn and grow from our experiences.  Maintaining safe medication use for patients is one of the greatest roles pharmacists can play in the health care system, but patient safety is a quest that unifies us all.

As a researcher focused on consumer perception, I recognize the importance that consumers place on the patient safety roles of pharmacists - just look at the extensive media coverage that occurs when pharmacists lose their focus on patient safety.  Subconsciously, consumers know that they rely on pharmacists to focus on patient safety, but we need to bring those thoughts from the subconscious to the conscious level if we want to be successful in gaining more support and appreciation for what we do, rather than having patients question how it can take so long to just put tablets in a bottle.

Every facet of the profession has a responsibility to patient safety whether we are practicing in community, hospital, ambulatory, long term care, managed care, or nuclear pharmacy practice.  Even academicians, who train each new generation of pharmacists and pharmaceutical scientists, also work to create new drugs and drug delivery systems that are not only effective, but that are also safe for patients.  Though there are major differences in the roles and practice settings of pharmacists, patient safety links us all – it is an essential and valuable role.

Patient safety is a unifying force well beyond pharmacy.  The injunction “first do no harm” is unifying for all members of the health care team.  At this time in the evolution of our profession, moving beyond the perception that our contribution to safety is limited to the provision of a product, to one of a provider of patient care services that improve and resolve medication use issues, is crucial.  I believe that if we keep our focus on the positive impact that expanded roles for pharmacists have on patient safety, we will be successful in gaining allies and supporters outside of pharmacy.  And our progress should inspire us to continue the hard work of changing minds!  OF COURSE, pharmacists need to be on the team!

So as we campaign for nationwide provider status, let’s help consumers understand the important patient safety role we play.

APhA HAS that focus!  We are raising awareness, and, frankly, the expectations of so many as we promote patient engagement with pharmacists.  We’re making tremendous progress toward getting pharmacists on the team and in the game.  Payers and policy makers are getting it, and our patients are definitely getting it!  And, importantly, our colleagues in medicine, nursing and dentistry are supportive of pharmacists’ roles in an increasingly team-based health care system.  Patient safety is at the core.

Compounding is another area where patient safety is paramount, and in the headlines.  In 2014, APhA continued to work with the FDA on implementation of the Drug Quality and Security Act (DQSA), which maintains patient access to needed and properly prepared compounded medications while protecting patients from harm from improperly manufactured drug products.  The Act also helps to secure the drug supply chain with the creation of a track-and-trace pathway, which tracks drugs from the manufacturer to the pharmacy.  We worked to ensure that the law made sense, and we are continuing to do the same with its implementation.  APhA has ongoing dialogue with FDA, educates Congressional staffers regarding issues that have arisen during implementation, and joined a coalition of other organizations advocating for improvement in DQSA implementation.

APhA is also working on multiple initiatives to address prescription drug abuse while at the same time promoting patient access to medications needed for legitimate purposes.  Through work with the Pain Care Forum and a National Association of Boards of Pharmacy Stakeholder Group, APhA is helping to create solutions for prescription drug abuse.  APhA regularly informs pharmacists about medication safety problems.  And even though we opposed the decision, APhA is working with the FDA and DEA to ensure the effective implementation of its rescheduling for hydrocodone to Schedule II.  We cannot allow fear of DEA enforcement, or the bad behavior of a few, get in the way of providing timely and appropriate pain relief to legitimate users.

Getting pharmacists integrated into electronic health record systems is essential to team based care, AND to patient safety.  APhA, with funding from Boehringer Ingelheim Pharmaceuticals, convened a stakeholder meeting to discuss the National HIT network in support of safe, efficient, and effective medication delivery.  These stakeholders came from every sector of technology and health care.  And most came to the event with little appreciation for pharmacists’ need for access to E H R.  We assessed best practices to minimize risk for medication errors and optimize practice, developed methods to evaluate implementation of interoperable HIT systems, and identified strategies to ensure the most advanced delivery platforms that maximize medication safety and promote enhanced patient care delivery.  We can honestly say that participants left the gathering with a new appreciation for pharmacists’ roles in HIT.

Patient trust is the key to great opportunity.  Meeting public expectation, and protecting and serving the well-being of our patients will surely secure new roles.  Through the work of APhA and the APhA Foundation pharmacists have tools to assist patients with medication adherence through medication synchronization. Whether it’s medication adherence programs, standardized REMS programs, or medication monitoring systems, APhA seeks expanded opportunities for pharmacists. 

APhA and MediMergent recently announced a partnership to develop and implement a national medication safety training program for pharmacists and their staff.  If we do this right, post-marketing surveillance will be revolutionized, and for the better.  Further, the infrastructure for many new patient care services will be built.  The National Medication Safety Outcomes and Adherence Program (NMSOAP) has been launched by MediMergent under a collaborative research agreement with FDA.  NMSOAP is a partnership among patients, providers, payers, regulators and pharmacists to collect near real-time data on patient safety, health outcomes and medication adherence.  The pharmacist is the essential new team member in the program.  The direct involvement of pharmacists with patients to promote data collection, safety and effective medication use over time will not only enhance safety and knowledge of medications with risks, but will create new covered service opportunities for pharmacists related to newly approved and marketed drugs.

Participating pharmacies will recruit and obtain consent for study enrollment and then coach patients in the benefits and outcomes of NMSOAP.  Pharmacists play an integral role in coaching patients about safe and effective medication use.  We are optimally positioned to ensure that good data is collected on medication use, adverse effects, and outcomes from patient treatments, and use the system to improve medication use, protect patients from harm, and maintain patient access to new therapies.  This program can serve as model for other programs, such as REMs, providing a standardized and quality approach to program implementation.

Education

Safety is just one way we get better by working together.  We are also getting smarter.

APhA continues to be a principal source of professional education for pharmacists.  Each year, APhA offers about 200 different education activities, accredited by the Accreditation Council for Pharmacy Education (ACPE).  These educational offerings are designed to advance the role of the pharmacist in the constantly changing field of health care by providing pharmacists with knowledge, skills, and performance behaviors for optimal patient care.  By late 2015, APhA will have doubled its training programs and updated all its programs. And our programs set the standard for excellence!

We have surveyed members and listened to what you and the health care environment tell us are needs that pharmacists can fill.  We are launching one new program at this meeting – the APhA Pharmacy-Based Cardiovascular Disease Risk Management course recognized by Million Hearts®, for its quality, content and impact.  Million Hearts is an initiative of the U.S. Department of Health and Human Services that brings together public and private -sector partners for a common goal: to prevent a million heart attacks and strokes in five years..  You can stop by the Education Resource Center to learn more about this program.

APhA’s training and educational programs help pharmacists stay current in practice and clinical issues, and to be prepared to take on expanded roles.  APhA also collaborates with other stakeholders to advance education on important topics.  For example, as part of our role in the Pharmacy Quality Alliance (PQA), we worked on and provided access to the new resource paper, Perspectives: Applying Value-Based Incentive Models Within Community Pharmacy Practice.  It aims to inform community pharmacists about new value-based incentive programs, and provides guidance for starting these programs in community pharmacies.  Another important note is that this year PQA also released EPIQ, Education Programs in Quality, a series of updated  educational modules designed to train students and pharmacists in measuring, improving, and reporting quality of care in pharmacy practice. 

The best way to effect change is to focus on the bright spots.  150,000 of you receive Pharmacy Today, a publication that presents those bright spots every month.  Through practice profiles, continuing pharmacy education articles, and practical tips for readers, the content of Pharmacy Today informs the profession of new drugs, advances in pharmacotherapy and pharmacy practice, and developments in the legal and regulatory arenas.  But that is not our only publication.  APhA’s books and electronic products continue to advance the profession of pharmacy by providing pharmacists with the tools to create a more patient-centered practice, as well as to develop as leaders and advocates.  Hopefully by now you’ve adopted the habit of reading our daily e-mail news offering.

And a great deal of attention was focused on completing our online PharmacyLibrary (www.pharmacylibrary.com) in 2014. PharmacyLibrary currently houses about 26 textbooks and reference works, plus 3,000 NAPLEX review questions and answers, as well as 450 case studies and 250 active learning exercises.  By summer, the PharmacyLibrary Preceptors Center will provide preceptors access to important and timely information, and provide colleges and schools of pharmacy with a way to enhance precepting by experiential educators.  Because they do perform an important educational role within every pharmacy program in the nation, many would say that preceptors are not thanked nearly enough for the work they do to make student pharmacists practice-ready.  If you are a preceptor, please stand and accept a hearty round of applause in thanks.

As for APhA, we do all of these things because knowledge is power and a key path to recognition.  Never is that more true than in today’s health care landscape which is dominated by scientific, legal, and economic changes.  Pharmacists need to be able to adapt and stay up to date in order to succeed.  APhA is committed to providing pharmacists with the tools needed – in the form they desire – to elevate their practice, and bring cost-effective care to patients.

Recognition

Those safety and education efforts are two reasons membership in APhA pays off.  And it keeps getting better.  In 2014, APhA added and launched new technologies to make becoming a member easier and more rewarding, and to capture more information in order to tailor the membership experience more fully.

But it’s most important because each of us need to be our strongest believer.  No one appreciates your hard work and what it takes as much as someone who is trying to do the same thing, whether it be across town or across the country.  We know better than anyone what it takes to be worthy of recognition.

A few examples of those in our profession who deserve recognition. 

  • Allison Burnett, Gretchen Ray, and their team of residents and others at the University of New Mexico College of Pharmacy who collaborated to launch a pilot quality improvement program by performing admission and post-discharge medication reconciliation activities (Feb 2015 PT), or
  • Michigan pharmacist Hae Mi Choe who is finding ways to understand the barriers her patients are facing and is finding ways to work through these barriers to achieve best possible outcomes.  She is also able to relate and understand the pain points of the physicians who manage these patients. Putting these pieces together, along with an understanding of the quality metrics on which health care providers are getting measured and hence paid has helped her practice get integrated into new models of care delivery (Dec 2014 PT), or
  • Washington, DC community pharmacist Heather Free who takes patient care to the streets where she and her team provide pharmacist-driven HIV and hepatitis C testing and medication management, transplant medications, oral oncology, and mental health in conjunction with other health professionals, area clinics, and government programs to assist patients with prevention, treatment, and medication adherence. (July 2014 PT)

These are just a small number of the thousands of pharmacists who are going above and beyond the call of duty to advance pharmacist-provided patient care.  We know of the important work you are doing out there, and feel that it should be celebrated.

Conclusion

How do we know when we are doing work worthy of recognition?  I think Allison, Gretchen, Hae, and Heather would all tell you: you know when you know.  But that’s hard to work towards right?  Worthy of recognition does not mean getting the right answer once.  It does not mean going the extra mile a few times.  It does not mean coming up with an innovative practice idea.  We will be worthy of recognition when we earn the trust of others.

In some ways, it is easier to tell when you are worthy of recognition at an individual level.  Patients will come to you with deeper and different questions, or to obtain expanded patient care services.  Doctors and nurses will look to you for answers and assistance on different and more complicated cases.  And businesses will trust your pharmacy to help improve their employees’ health and their bottom-line over several years.

At a professional level, I believe we will be more worthy of recognition when patients and other health care professionals consult with any pharmacist and know they will get the answers they need in a timely and accurate manner.  Required interprofessional education is training the next generation of practitioners to expect more out of pharmacists.  We will be more worthy of recognition when the government leaders and the business community consider pharmacists an effective way to achieve better outcomes at reduced costs, and believe we are worthy of compensation that reflects our value.

Many of us are worthy of recognition, but we need to ensure the critical mass of our profession is worthy of the same.  When there are more of us doing more and doing better, we will be harder to ignore, and we will receive the recognition we desire.  APhA is helping us collaborate on big projects and smaller initiatives.  By rallying together, we can change the nation’s view of our role in the health care system.  “Pharmacists Provide Care, let me tell you about it” will be my focus over the next year, and I ask you to join me in spreading the word.  My vision is that pharmacist-provided care in all practice settings will be as common and as expected as flu shots in the pharmacy are today.  My vision for the pharmacy profession is for us to be bigger, better, stronger and more effective at improving the lives of patients than we ever have been before.  Some would say, as Walt Kelly did, “We have met the enemy and he is us.”  But I say, “We today can be the heroes of pharmacy.”  We have the knowledge.  We have a commitment to safety.  We have the capability.  We have the heart and the desire to revolutionize what it means to be a pharmacist.  We have the ability to literally change the definition of pharmacist in the dictionary.

APhA cannot revolutionize the profession alone.  We can only capture your good work and lift it up to be appreciated by all.  And if we don't revolutionize pharmacy, we will forever be left with a bitter taste in our mouths about what could have been.  It is imperative that we take President Kennedy's admonition and "ask not what your profession can do for you, but what you can do for the profession."  And what you can do starts with one simple little sentence: "Pharmacists provide care, let me tell you about it."  Help APhA revolutionize the profession.  All I ask is that once a day for five days, you say that one sentence to one person.  An ancient proverb says you can eat an elephant if you eat it one bite at a time.  Well our elephant is provider status, and we can achieve that if we do it one day at a time, one patient at a time, and spread the word one sentence at a time.  “Pharmacists provide care, let me tell you about it!”     

It will be my honor to work with you over the next year to ensure we are closer to that kind of recognition.  I thank you for your trust, and I look forward to meeting it.

Thank you.

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