Pharmacists in Action, March 2014
What Pharmacists Are Doing Across the Nation
Pharmacists provide care
Pharmacists have talked a lot about provider status over the past year, but does the general public understand what pharmacists actually provide? Simply put, pharmacists provide care, and that’s the message—Pharmacists Provide Care—that APhA will be communicating to the profession, voters, Congress, state legislators, and private payers as we proceed with the “federal ask” as part of our provider status initiative. We all know we must do more than accurately dispense medications to support our practices, but it’s going to take a big effort to overcome the “counting tray” image the public sees on television news. Our message is that when pharmacists are involved in patient care services, quality and access improve and costs go down.
Today’s pharmacist is a highly trained health professional who works as part of the patient’s health care team to provide the highest quality care and help patients achieve optimal health outcomes. Today’s pharmacist is the most accessible health care provider, with the greatest expertise about medications, their actions and interactions, appropriate use, monitoring, and costs. Today’s pharmacist helps patients manage complex medication regimens for multiple chronic conditions and advocates for the patient. In every practice setting across the country right now, pharmacists are providing care to patients. Yet we are not recognized as health care providers under federal law.
In conjunction with the 2014 APhA Annual Meeting & Exposition on March 28–31 in Orlando, FL, APhA is launching a new initiative to champion pharmacists as providers. But we can’t do it without you. The Pharmacists Provide Care campaign is designed to help pharmacists achieve federally recognized provider status, enabling patients to have easier access to our patient care services and allowing pharmacists to be compensated for these services. How do we do this? By spreading the word and demonstrating that every day, in every health care setting, “pharmacists provide care.”
I am calling on all pharmacists to take part in this initiative. Support APhA, call your Members of Congress and state legislators, encourage fellow pharmacists to get involved, educate your patients about how your involvement improves their care, and be an advocate for pharmacy within your community as well as in professional and social networks. Remember, patients are voters, and voters change laws. We can achieve provider status, and sooner rather than later, if we are unified with a common message that advocates for patient access to pharmacists’ patient care services and recognition of our role on the health care team.
Please join me in spreading the message. It’s just three small words, but the depth of meaning that surrounds those words can change the face of health care. Pharmacists Provide Care. Spread the word.
Thomas E. Menighan, BSPharm, MBA, ScD (Hon), Executive Vice President and CEO
“Tobacco products have no place in a setting where health care is delivered.”
Larry Merlo, President and CEO of CVS (and a pharmacist) announcing the recent decision by CVS to stop selling tobacco products by October 2014.
Patient safety is focus of face-to-face live event
The Patient Safety and Clinical Pharmacy Services Collaborative (PSPC) hosts a face-to-face event each year. For the first time, this PSPC live event will take place in conjunction with the 2014 APhA Annual Meeting & Exposition on March 28–31 in Orlando, FL. The PSPC event, titled PSPC Learning Session 1 Part 2, is open for all to attend and is free of cost. You just need to preregister for the event. Event registration is located on the APhA Annual Meeting website. Select “Registration” and “Pre-Meeting Education and Additional Offerings Information.”
During Learning Session 1, PSPC teams, quality improvement organizations, pharmacists, physicians, and other health professionals come together and learn from one another. Discussions are centered on strategies to improve patient health outcomes through a multidisciplinary team model. Topics to be discussed include growing the delivery systems that work for high-risk patient populations, measuring health status and safety of high-risk populations, and managing improvement in the patient populations’ health and safety.
If you are interested in attending this all-day March 28 event, don’t forget to register for PSPC Learning Session 1 Part 2 at www.aphameeting.org today!
Stephanie Grimsby, Communications Manager, APhA Federal Contracts & Grants
A minute with …
Kristen Binaso, BSPharm, CCP, FASCP
Associate Director, Patient Advocacy and Professional Relations, Boehringer Ingelheim Pharmaceuticals, Inc.
APhA member since 1991
I first become interested in being a pharmacist... when I started working in an independent pharmacy in New Jersey when I was 15 years old.
I joined APhA because... I was active in the APhA–ASP chapter at Rutgers and joined as a student. My first meeting was in 1997 in Los Angeles when I represented Rutgers at the National Patient Counseling Competition. Once I became a pharmacist, I enjoyed traveling to the APhA Annual Meetings and meeting other pharmacists from all over the country. I have not missed a meeting since!
My most memorable APhA experience... was being on staff at APhA for 7 years. It was great to be a part of an organization that created so many valuable programs to educate pharmacists so they can provide better care … especially seeing so many pharmacists participate in immunization training—it was very inspiring!
The advice I give to pharmacists who want to follow my career path... is to network! Go to association events to meet new people, volunteer at the national or state level, never forget where you came from, and stay in touch with people throughout your career, which I feel has gotten easier with social media. So many doors opened for me because of this!
If I weren’t a pharmacist, I’d be an… airline pilot or a television personality.
Become ‘in demand’ @ APhA2014
Join your colleagues at the 2014 APhA Annual Meeting & Exposition on March 28–31 in Orlando, FL, for the premier event in pharmacy. Connect with experts in pharmacy to learn more about enhancing your career and your practice. Connect with your peers to exchange ideas and engage. Connect with all APhA has to offer using Facebook and Twitter (@APhA2014).
The APhA2014 education sessions are designed to enhance your career, your profession, and your patient care. Take advantage of more than 70 different learning opportunities by using the Interactive Planning Tool to identify what you want to learn. Use the tool to create a customized plan and select activities that will benefit you and your practice.
Engage and connect
Download the APhA2014 App today to engage with the other attendees using the Friends tool and to get the most out of your time in Orlando with dining and entertainment recommendations. The easy-to-use APhA2014 App includes features that will allow you to access session scheduling information, import your customized plan for your education sessions, and rate the sessions that you attend. Also, use your app to interactively visit the exhibitors on the virtual showroom floor. The exhibitors represent the latest and greatest in pharmacy innovation.
Get more with ‘on demand’
Continue to benefit from APhA2014 even after you return to your practice by purchasing the APhA2014 Premium Registration Package. The package includes 11 sessions from APhA2014 equaling 22 hours of Continuing Pharmacy Education credit, allowing you to get extra education in the comfort of your home.
Please visit www.aphameeting.org for more details and to register.
Natosha McNeal, contributing writer
Social media 101: LinkedIn
In the December 2013 issue, we listed the various APhA social media sites. For the past few months, we have been discussing the most popular social media sites in more detail. This month, we focus on LinkedIn.
Unlike Facebook, which was discussed in the January 2014 issue, and Twitter, discussed here in February 2014, LinkedIn is most useful as a professional tool. Users have profiles that are very similar to résumés. A complete profile will list jobs (past and current), education, degrees received, publications, honors and awards, activities, and more. Most users also include a photo, generally a headshot.
The purpose of LinkedIn is to network with current and former colleagues, exchange ideas with those in your industry, and make professional connections. For these reasons, LinkedIn is popular as a job-seeking tool. Users may refer prospective employers to their LinkedIn profile, or recruiters may find potential employees this way.
Rather than “friend” people (as with Facebook) or “follow” them (as with Twitter), LinkedIn requires you to have a connection to someone you want to connect with, meaning you need to have worked with, gone to school with, been in a LinkedIn group with, or have the e-mail address of someone you want to connect to. The other person must accept your invitation to connect, so it’s best to stick with people you know or have a connection to. LinkedIn has a huge variety of special interest groups you can join, including numerous pharmacy-related groups. Groups allow you to start or contribute to discussions on topics of interest to group members.
LinkedIn also provides a job search and the ability to post articles in a news stream (similar to Facebook). It helps you use your connections to link to other people you want to connect with and thereby expand your network.
Join the APhA LinkedIn discussion group
If you are on LinkedIn, be sure to join the APhA discussion group. This lively group has more than 20,000 members and is a great way to interact with other pharmacists and share ideas. To join the group, visit http://linkd.in/1m8gxfs.
APhA External Communications and Media Advisors responded to 15 media inquiries in January, including:
- Healthcare Finance News and Healthcare Payer News: Advanced practice expansion into new states
- CNN’s Sanjay Gupta, MD: Prescription combination drugs with more than 325 mg of acetaminophen
- Kaiser Health News/USA Today: Changing role of pharmacists and the changes in California
- Modern Healthcare: FDA’s unapproved drugs initiative
- P&T Journal: The important aspects of CMS’s Part D proposed rule
- Everyday Health: OTC medication warnings and instructions that people frequently ignore
- Health Affairs: New compounding pharmacy laws
Here is this month’s top trending DrugInfoLine article
Focus on Endocrinology
Frank Pucino, Section Advisor
Widespread prescribing of levothyroxine for borderline TSH levels
The median thyroid stimulating hormone (TSH) level threshold to initiate levothyroxine treatment declined from 8.7 mIU/L to 7.9 mIU/L between 2001 and 2009, leading to a significant risk for developing suppressed TSH levels after therapy.
The use of thyroid replacement therapy has almost doubled in the past decade. Whether this is a result of better screening or a consequence of a lower TSH threshold to begin therapy is unknown. Understanding the rationale behind recent increases in levothyroxine prescribing is important because overtreatment can raise risks for atrial fibrillation and/or bone fractures.
In this study, investigators used data from the United Kingdom Clinical Practice Research Datalink to identify 52,298 individuals who received a levothyroxine prescription between 2001 and 2009 and had a TSH level measured within 3 months of initiation. The study objective was to examine whether the TSH level threshold to initiate levothyroxine therapy had changed since 2001 and assess the potential for adverse outcomes.
During the study, new levothyroxine prescriptions increased 1.74-fold, while TSH level threshold for initiating levothyroxine fell from 8.7 mIU/L to 7.9 mIU/L. The greatest rise in prescribing occurred in individuals with a baseline TSH in the range of 4.0 mIU/L to 10.0 mIU/L. Among 34,808 individuals with a free thyroxine (FT4) level available, one-third had TSH levels below 10 mIU/L with normal FT4 and no clinical symptoms of hypothyroidism or cardiovascular risk. This trend suggests overtreatment, which is inconsistent with current guidelines.
Older individuals had the highest odds of being prescribed levothyroxine with a TSH level between 4.0 mIU/L and 10.0 mIU/L. At 5 years after levothyroxine initiation, 5.8% of these individuals had a suppressed TSH level (i.e., <0.1 mIU/L). Thyrotropin levels of <0.1 mIU/L were more likely in individuals with tiredness or depression at baseline but not those with diabetes, weight gain, or cardiac risk factors.
What you need to know
This retrospective cohort used large population-based data to identify cases of primary hypothyroidism and exclude pregnancy, hyperthyroidism, pituitary disease, and thyroid surgery. Investigators paired laboratory findings, cardiovascular risk factors, and clinical symptoms with levothyroxine prescribing patterns. “If current practice continues, up to 30% of persons receiving levothyroxine therapy may have been prescribed it without an accepted indication and with the potential for net harm if they develop even a low thyrotropin [TSH] level,” study authors concluded.
Limitations of the study included a retrospective design, lack of data about individuals who did not receive levothyroxine, FT4 measurements not performed in all patients, and follow-up TSH values available for only 39.7% of the cohort at 5 years.
Pharmacists should counsel patients about the signs and symptoms of excessive amounts of thyroid hormone, including palpitations, rapid weight loss, restlessness or shakiness, sweating, and insomnia. Routine monitoring to ensure TSH levels are within therapeutic range should be part of the patient’s follow-up.
What your patients need to know
A recent study raised the possibility that levothyroxine, a drug used as thyroid hormone replacement therapy in individuals with hypothyroidism, may be overprescribed and could lead to more harm than benefit when used outside the current guidelines. Patients should talk to their pharmacist or health professional if they have any concerns.
JAMA Intern Med. 2014;174:32–9.
New! APhA’s Precision Search: Medline made simple
With APhA’s Precision Search, searching Medline has never been easier or more powerful. Designed to be the first search tool you use to find the Medline articles you need, Precision Search offers five features that distinguish it from all other Medline search tools:
- It delivers Medical Subject Heading (MeSH)–specific results without the user needing to know how to conduct a MeSH term search.
- It displays search results sorted by specific topics. The Precision Search taxonomy features more than 3,000 topics in more than 140 specialties in the health sciences.
- Users can filter their searches to just the articles in APhA journals.
- Users can link to full text of journal articles when they are available from Medline.
- Users can link to a number of related articles when viewing an article’s abstract.
APhA’s Precision Search provides simple, straightforward access to evidence you need from Medline but with an easy-to-use interface. You love how easy it is to search Google, but finding the most credible information in a Google search result list is time consuming and difficult. You value the authority of the journal articles contained in Medline, but you’re frustrated by the PubMed search interface. APhA’s Precision Search makes Medline more accessible than any other tool with Google-like search simplicity.
Locate evidence any time, any place in just two clicks—download APhA’s Precision Search to your smartphone and access the information you need quickly, efficiently, and anywhere at any time. Enjoy two additional benefits. You can save your searches so that you can instantly retrieve the latest results of favorite searches. And, you can save abstracts of articles that you want to refer to later. Searches and abstracts of articles can be exported to e-mail, Twitter, and Facebook.
Frequently Asked Questions
What is APhA’s Precision Search?
APhA’s Precision Search is an innovative search tool for the Medline database. Precision Search is designed to demystify searching Medline for the articles you need. The hallmark features of Precision Search are its user-friendly interface and the powerful filters it provides to deliver precise results at your fingertips with minimum effort. While PubMed takes multiple steps to retrieve results, those same results are delivered by Precision Search in just three clicks.
Who is the intended user of APhA’s Precision Search?
APhA’s Precision Search is targeted primarily to the busy pharmacy student or pharmacist. No prior knowledge of how to construct a sophisticated, detailed search is required.
How does APhA’s Precision Search compare to PubMed?
Both APhA’s Precision Search and PubMed are search interfaces for the Medline database, which is the premiere index of the biomedical journal literature. The revolutionary software of APhA’s Precision Search delivers the articles you are looking for much more quickly in far fewer steps than PubMed, and requires no knowledge or experience using the MeSH terminology that structures the Medline database. What’s more, with APhA’s Precision Search you can narrow your search to the articles that are in APhA’s journals, leading you quickly and effortlessly to the full text of the articles you need.
How do I get access to Precision Search?
APhA’s Precision Search is available in the iTunes and Google stores. You must either be a member of APhA or a registered guest user at www.pharmacist.com.
Are there other notable features?
Users can save their searches and export lists of citations and abstracts of articles. Export outlets include email, Facebook, and Twitter accounts. Another handy feature is a “My Articles” clipboard where you can store and export citations.
Book review: Motivational Interviewing for Health Care Professionals: A Sensible Approach
Health care is increasingly shifting to a focus on patient-centered care. In Motivational Interviewing for Health Care Professionals: A Sensible Approach, Bruce A. Berger and William A. Villaume illustrate how health professionals can use motivational interviewing (MI) to collaborate with patients and promote positive changes in health behaviors and outcomes.
The authors set the stage by reviewing the history, spirit, and skills of MI. Next they introduce a new theory of MI tailored to the specific needs and backgrounds of health professionals. The book is filled with examples of patient interactions that contrast MI with a more traditional style of communication, thereby presenting MI in a context that health professionals understand well. Well-timed breaks within the content highlight learning points, common pitfalls, and reflective questions.
A key strength of the book lies in one of the final chapters, where the authors guide the reader through several cases. For each case, a full conversation between a health professional and patient is presented, with and without the use of MI. There is a clear discrepancy between the two styles of communication, and the reader can recall how the concepts of MI relate to each situation. The authors also provide an analysis of each case to reinforce and clarify important points. To emphasize the message further, a link and QR code allow the reader to view brief videos for each case. Watching these interactions drives home the benefits of using MI and helps the reader better understand how to apply these principles in practice.
The book is eye-opening for health professionals who may not be familiar with MI, and it introduces a new way to communicate effectively with patients. Readers can use the tools and real-world examples to immediately begin implementing MI in their practice.
Rachel Maynard, PharmD, Therapeutic Research Center
2013 • 240 pp • Softcover
List Price $39.95
Place your order via www.pharmacist.com/shop
APhA currently accepting applications for 340B Peer-to-Peer program
APhA is seeking entities of all sizes and types to apply for the prestigious status of a 340B Peer-to-Peer leading practice site. The Peer-to-Peer program, created in 2011 by the U.S. Health Resources and Services Administration (HRSA) Office of Pharmacy Affairs (OPA) and APhA, showcases high-performing 340B entities and recognize them as Leading Practice sites.
Applicants that have demonstrated proven leading practices are accepted into this expanding program based upon objective criteria that identify the strengths of these organizations in a variety of settings. Each application is evaluated based upon clinical, quality, and cost-effectiveness in the following areas of practice: access to affordable medications, efficient business practices, outcomes-driven pharmaceutical care, quality assurance, and program integrity.
Benefits of being a 340B Peer-to-Peer recognized site
340B Peer-to-Peer leading practice sites set the highest standard for other 340B entities and will be able to help other 340B organizations become leading practice sites. Entities that are accepted will be able to demonstrate their exceptional practices. Participation in this recognition program will help to increase understanding of the issues that covered entities face in implementing and maintaining the 340B program.
The program will facilitate 340B stakeholders to form strategic partnerships, strengthen pre- and postgraduate training of the next generation of pharmacists in 340B, promote the expansion of clinical pharmacy services in underserved communities, and allow covered entities to share their experiences with the 340B program with APhA, OPA, and other stakeholders.
Selected entities will receive the following:
- $20,000 stipend for 2 years of participation
- Acknowledgement in publications
- APhA membership for three leadership team members
- Financial support for select conference attendance to represent 340B stakeholders
- Networking opportunities
- A participation plaque
All types of 340B entities are welcome to apply, especially those organizations that fall under one of the following categories:
- Rural entities—critical access hospitals, sole community hospitals, and rural referral centers
- Hospitals—disproportionate share hospitals, free standing cancer hospitals, and children’s hospitals
- Community health centers—330 grantees, centers for patients who are homeless or disadvantaged
- HIV Ryan White/AIDS Drug Assistance Programs (ADAP): Part A, Part B, non-ADAP, B-ADAP, direct purchase, and rebate models
- Family planning, tuberculosis, or sexually transmitted disease clinics
How to apply
Applications must be submitted by a 340B entity listed on OPA’s 340B database as a participating 340B entity. For more information, visit http://opanet.hrsa.gov/opa/CESearch.aspx. Submitted applications must be received by March 31, 2014, to be considered for the summer 2014 class of leading practice sites. Limited spots are available, and qualified sites will be selected on a “first come, first served” basis. To learn more about the 340B Peer-to-Peer program or to apply, visit www.hrsa.gov/opa/peertopeer.
340B network webinars
The 340B Peer-to-Peer webinars allow participants to interact with 340B leading practice sites. The biweekly webinars cover a plethora of topics related to 340B matters and are the main communication channel for leading practice sites to share information and experiences. Peer-to-Peer webinars are held on the second and the final Wednesday of each month. Participants must register in advance to attend the webinar. All archived webinars and registration can be found on the OPA website.
Allison Gross, Communications Associate, APhA Federal Contracts & Grants
The latest drug news
Check out APhA DrugInfoLine, an online pharmacotherapy news resource for APhA members. Each week, DrugInfoLine editors work with a panel of pharmacy experts in 20 disease states to highlight the most relevant studies and guidelines published in peer-reviewed journals that affect drug therapy choices.