Pharmacists in Action, June 2013
What pharmacists are doing across the country
Integrity of products: Challenges create opportunities for pharmacists
Our profession should be proud of the significant progress over the past few years in advocating for and then providing medication therapy management services, gaining recognition as valued members of multidisciplinary care teams, and helping patients through transitions of care. But we are just getting started, and many challenges remain, including significant ones with product integrity.
In today’s world, what you see isn’t always what you get. Counterfeit medications and questionable drug manufacturing processes in distant locations challenge pharmacists to identify what is best for patients when it comes to medication safety and supply chain integrity. I’d like to highlight recent events that illustrate the importance of the pharmacist’s role in helping patients access safe medications.
Last month, Ranbaxy Laboratories’ guilty plea on federal criminal charges for selling adulterated drugs resulted in the company paying $500 million in civil and criminal fines. An investigative report published in Fortune painted a picture of fabricated information, contaminated drugs, and data intended to deceive FDA inspectors. As pharmacists, we often feel frustrated because the integrity of the supply chain is beyond our control, but while this situation is challenging, it offers us an opportunity to get closer to our patients.
As the Ranbaxy story was unfolding on the media stage, one of the country’s largest pharmaceutical companies launched its solution to combat counterfeit medications. Viagra is Pfizer’s—and perhaps this country’s—most frequently counterfeited drug. To help ensure the integrity of Viagra, Pfizer and CVS/pharmacy recently developed a website that would allow patients to buy the drug online directly from Pfizer (page 48). The company’s goal is to offer a safe outlet for buying Viagra, and although we all want patients to have safe medications, a manufacturer selling a product online does raise questions about continued disruption of the pharmacist–patient relationship.
As we noted in a May 20, 2013, joint letter from the National Alliance of State Pharmacy Associations, National Community Pharmacists Association, and APhA, “Patients with [erectile dysfunction (ED)] often have other chronic conditions such as diabetes or high blood pressure that contribute to their ED. Steering those patients away from their local pharmacist into a mail order plan for one prescription medication would seem to be the opposite of providing the needed care for these patients.” Our goal with the letter is to open a dialogue with Pfizer about real solutions to the challenges to supply chain integrity, rather than a quick fix with unintended consequences.
I wish we could assume that our supply chain is secure, but as long as greed exists, so will counterfeiters. We will do our best to find constructive solutions to this pressing issue, while every pharmacist who handles products must retain a healthy skepticism of deals that are too good to be true. Our patients are counting on us!
Thomas E. Menighan, BSPharm, MBA, ScD (Hon)
APhA Executive Vice President and CEO
During the month of April, APhA external communications and media advisors responded to more than 10 media inquiries, including the following:
- New York Times: New York judge’s decision to mandate FDA to make emergency contraception available OTC to all women
- Her Campus: Pharmacist’s perspective on painkillers
- Columbus Dispatch: Changes in the pharmacy career market and trends of pharmacists opening their own stores
- NBC iVillage: Seasonal allergies
- Lexington Herald: Provider status initiative
Pharmacists help reduce health disparities with Project IMPACT: Diabetes
On April 22, Mindy D. Smith, BSPharm, APhA Foundation Executive Director, and Benjamin M. Bluml, BSPharm, APhA Foundation Senior Vice President of Research and Innovation, attended the National Minority Quality Forum’s Health Disparities and Leadership Summit in Washington, DC. This summit brings together legislators, policy makers, clinical experts, and distinguished honorees to discuss solutions to help reduce disparities in health care quality.
At the summit, Bluml gave a presentation on expanding access to evidence-based practices for heavily burdened populations that provided an overview of the APhA Foundation’s Project IMPACT: Diabetes, part of the Bristol-Myers Squibb Foundation’s Together on Diabetes initiative. Bluml described the 25 participating communities, outlined the Foundation’s process model including the role of the pharmacist, summarized community resources including the Patient Self-Management Credential, and reported on interim national results. He also gave insight into patient and physician perspectives on the program.
“Diabetes has a devastating impact on our health care system, especially in communities disproportionately affected by diabetes where access to care may be limited,” Bluml told Pharmacy Today. “Pharmacists are one of the most accessible health care providers available to the patient, and their collaborative care efforts with patients, physicians, and other health care providers have consistently helped people with diabetes improve therapeutic outcomes, increase activity, and lead healthier lives.”
Other speakers who presented as part of the Together on Diabetes initiative included the BMS Foundation, Feeding America Diabetes Initiative, Mingo County Diabetes Coalition, Camden Coalition of Healthcare Providers, and Harvard Center for Health Law and Policy Innovation.
“Project IMPACT: Diabetes is demonstrating that the patient-centered model of collaborative care helps underserved and highly affected populations learn to understand and manage their diabetes,” Bluml told Today. “Working with the Together on Diabetes initiative and our national partners, we look forward to creating a meaningful framework for getting more evidence-based diabetes care to the people who need it the most!”
Members are looking at …
PharmacyLibrary (www.pharmacylibrary.com) has become an indispensable part of the pharmacy curriculum across the country. Whether researching the latest OTC medications and treatments in The Handbook of Nonprescription Drugs, brushing up on professional communication with Communication Skills for Pharmacists, or preparing for the board exams and assessing student knowledge using the NAPLEX review functionality and The APhA Complete Review for Pharmacy, PharmacyLibrary is used daily by students and faculty alike.
To further establish PharmacyLibrary as the authoritative resource for pharmacy practice education, APhA and the University of Iowa College of Pharmacy have jointly developed a completely new set of active learning exercises. Edited by Jeffrey C. Reist, PharmD, Mary J. Starry, PharmD, and Michelle Fravel, PharmD, along with substantial contributions from several faculty members, the material covers the 11 different areas of practice required by the Accreditation Council for Pharmacy Education. These exercises provide exercises and evaluation tools necessary to teach today’s students application-oriented practice skills in areas such as therapeutics, drug information/literature evaluation, patient counseling, and lifelong learning.
The first 80 exercises will be live on PharmacyLibrary by July 1, 2013, and the site will eventually offer 270 exercises. These materials are easily adaptable to enhance existing lectures and develop new areas of study. Faculty will also be able to collaborate with preceptors to use these materials as part of students’ IPPE and APPE rotations.
Staff from APhA and faculty from the University of Iowa will debut this new material at the American Association of Colleges of Pharmacy annual meeting in Chicago, July 13–17, 2013.
To learn more, visit www.pharmacylibrary.com.
Addressing ethical dilemmas in pharmacy
Ethical dilemmas and complicated situations with no one “right” answer come up daily in pharmacy practice. Pharmacists need to consider all possible implications of their professional decisions, and student pharmacists must learn the challenges and intricacies of ethical decision-making. Pharmacy Ethics: A Foundation for Professional Practice provides strategies for both pharmacists and student pharmacists to develop an ethical compass that can guide them in practice.
The book is logically organized for ease of use and understanding. Authors Robert A. Buerki and Louis D. Vottero lead the reader through a history of ethics in pharmacy practice and the Code of Ethics for Pharmacists serves as the foundation of the book. The authors then outline a step-by-step process that readers can use to evaluate and address an ethical dilemma.
Although the ethical concepts presented at first seem theoretical, they are made practical with the integration of over 40 realistic case studies. Each case study is followed by a commentary and additional background. These case studies, a highlight of the book, provide an opportunity for readers to consider how they might approach the situation in practice. In some cases, the reader is left wanting additional discussion or guidance from the authors. The open-ended nature of the content forces readers to develop their own ideals and principles. In fact, the many questions the authors pose throughout the text are a critical part of the learning experience. The book contains a glossary as a useful resource to clarify concepts.
Although the intended audience of the book is student pharmacists, pharmacists in all practice settings can benefit from the self-reflective exercises and thought-provoking questions the book raises. Pharmacy Ethics gives readers a strategy that they can use to approach ethical dilemmas, which will continue to be important as pharmacy practice evolves.
Rachel Maynard, PharmD
Therapeutic Research Center
Softcover; 210 pp.
$32.00 for APhA members; $39.95 for nonmembers
Also available at www.pharmacylibrary.com
Number of years that the United States has been polio-free
Read more at www.cdc.gov/features/poliofacts/
Paul Cady, PhD, Associate Dean and Associate Professor at Idaho State University (ISU) College of Pharmacy, along with pharmacy staff and the ISU Foundation, formed Bengal Pharmacy to bring together the world of pharmacy business and education. Bengal Pharmacy will take over the pharmacy operations at the ISU Student Health Center in May and eventually help underserved rural areas throughout the state.
B. Joseph Guglielmo, PharmD, has been appointed the new dean of the University of California, San Francisco School of Pharmacy. A highly accomplished pharmacist and clinical scientist, Guglielmo will continue the school’s focus on shaping the course of the therapeutic sciences, pharmacy education, patient care, and health policy. Guglielmo has served as the school’s interim dean since July 2012. An expert in evidence-based, safe, and effective use of antimicrobials to treat infections, Guglielmo previously led the school’s Department of Clinical Pharmacy as the Thomas A. Oliver Chair in Clinical Pharmacy.
Timothy R. Ulbrich, PharmD, Director of Pharmacy Resident Education at Northeast Ohio Medical University College of Pharmacy and Chair of the APhA New Practitioner Network gave a TEDx talk at the University at Buffalo about provider status, medication therapy management, and utilizing pharmacists to control health care costs.
APhA recognizes Kenneth N. Barker, PhD, from Auburn, AL; Robert G. Strong, Owner, Coles Pharmacy in Mansfield, PA; and Robert Rodriguez from Fremont, CA, for achieving Emeritus Membership status. Emeritus members are long-time members of APhA, many of whom have been members for more than 50 consecutive years. Thank you for your support of the pharmacy profession.
Members can share news about promotions, new positions, and awards with the rest of APhA by e-mailing the details—who, what, when, and where—to PT@aphanet.org. Photographs, in the form of high-resolution TIFF or JPEG files, are welcome.
Pharmacy e-HIT Collaborative involved in PDMP initiative
Health information technology (HIT) can improve timely and accurate access to prescription drug monitoring program (PDMP) information toward reducing prescription drug misuse and overdose in the United States, according to the website of the PDMP Standards and Interoperability (S&I) Framework Initiative. Additional aims of the initiative include connecting PDMPs to HIT with existing technologies and establishing standards for facilitating information exchange.
The Pharmacy e-HIT Collaborative is a committed member of the PDMP S&I Framework Initiative to ensure that pharmacists and prescribers, including those in emergency departments, have access to prescription drug information before prescribing, dispensing, and medication management services, according to Shelly Spiro, BSPharm, FASCP, Executive Director of the Pharmacy e-HIT Collaborative. Standardizing the PDMP process would help pharmacists access medication information to provide quality patient care. APhA is a member of the collaborative.
Did you know?
APhA members receive special pricing to attend APhA2014 in Orlando, FL, so mark your calendars for March 28–31, 2014. APhA’s Annual Meeting provides up-to-date information about some of the most common health-related issues that affect your patients. Learn from the leading pharmacy experts as they present case studies, current research, and innovative best practices, which provide real-time solutions that you can use right away.
APhA’s Annual Meeting is the one pharmacy meeting developed for all practice areas of pharmacy. APhA2014 brings together leaders in the field of pharmacy including world-renowned speakers, researchers, clinicians, educators, advocates, policy makers, and practitioners.
APhA2014 offers more than 20 continuing pharmacy education credits in just one weekend. Choose from more than 80 core sessions that cover a variety of practice areas and current issues, and take advantage of the wide range of supplementary short courses and professional certificate training programs.
Visit www.aphameeting.org for more information. Be sure to save the date for APhA2014. See you in Orlando!
On the go
APhA leaders and staff travel each month to promote the profession and serve as the voice of pharmacy. Here is a sample of their recent travels.
- William Ellis, BSPharm, MS, Board of Pharmacy Specialties Executive Director, chaired the second-quarter meeting of the Council on Credentialing in Pharmacy (CCP), which provides leadership, guidance, public information, and coordination for the profession of pharmacy’s credentialing programs. Anne Burns, BSPharm, APhA Vice President of Professional Affairs, represented APhA. The vision of CCP and the 10 national member organizations is that all credentialing programs in pharmacy will meet established standards of quality and contribute to improvement in patient care and the overall public health. The meeting focused primarily on continuous professional development. Alexandria, VA
- Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA, APhA Executive Vice President and CEO, participated in a professional development forum for the University of Maryland at its Eastern Shore campus. He spoke to students about opportunities for pharmacists’ and students’ professional development through such things as being involved with national organizations, such as APhA, engaging in the advocacy and legislative process, and promoting the pharmacist’s role to address national health goals. Princess Anne, MD
- Menighan; Burns; Steve Simenson, BSPharm, FAPhA, FACA, FACVP, APhA President; and several APhA staff members attended the quarterly meeting of the Joint Commission of Pharmacy Practitioners. Burns gave a provider status stakeholders update and Simenson shared the many patient care services available in his pharmacy, including medication therapy management, disease state management, immunizations, and compounding. Alexandria, VA
Pharmacy compounding icon passes away
APhA member George J. Malmberg, BSPharm, FACA, FACVP, chief executive officer of Wedgewood Pharmacy, died on April 22, 2013 in Wilmington, DE, following a short illness, according to a news release posted to the Wedgewood Pharmacy website. Malmberg and his wife Lucy Malmberg, BSPharm, FACA, FACVP, cofounded Wedgewood Pharmacy, a community pharmacy that they developed into one of the largest specialized compounding pharmacies in the United States, serving tens of thousands of prescribers with customized animal health and human health prescriptions every year.
Malmberg was a passionate advocate for pharmacy compounding on the national stage and on Capitol Hill, where he championed the rights of prescribers and pharmacists to create individualized medications for patients and animals.
He was also an active member of the pharmacy community, serving as the founding editor of the International Journal of Pharmaceutical Compounding from 1996 to 2001. He was vice president of the International Academy of Compounding Pharmacists from 1995 to 1997, and also served as a board member of the organization.
Malmberg was a member of several pharmacy associations including the New Jersey Pharmacists Association, the National Community Pharmacists Association, and the International Academy of Compounding Pharmacists, and served as an adjunct faculty member and clinical instructor with the Philadelphia College of Pharmacy at the University of the Sciences in Philadelphia.
For more information about Malmberg’s contributions to pharmacy compounding, visit www.wedgewoodpharmacy.com/news/press-room/george-j-malmberg-chief-execu….
340B excellence: Utah’s Wayne Community Health Center
Looking for the regularly occurring column about 340B organizations? Check out pages 46–47 in the practice section of this issue of Pharmacy Today for a special full-length article about the Wayne Community Health Center (WCHC), which is fulfilling its mission of delivering high-quality health services in rural Utah. The center’s success is attributed to its multidisciplinary approach to treat patients, where all providers, including pharmacists, work together in support of a patient’s health. The facility effectively uses their 340B drug savings to support its clinical pharmacy practice in a unique way. WCHC is a leading practice site and a model for excellence for 340B-covered entities.
“Pharmacists all across the country are breaking the traditional chain of receiving a prescription, deciphering the messy handwriting, filling that medication, and providing it to a patient.”
Timothy R. Ulbrich, PharmD, Director of Pharmacy Resident Education at Northeast Ohio Medical University College of Pharmacy and Chair of the APhA New Practitioner Network, highlighting the pharmacist’s role in today’s health care in a TEDx talk at the University at Buffalo
See the whole talk at http://youtu.be/QnCGD05u58k
A minute with …
Javier A. Rodriguez, BSPharm
Community pharmacist, Edgewater, NJ
APhA member since 2010
I first became interested in pharmacy … because my mom was a pharmacist and I grew up with the profession. My mom was pregnant with me when she studied for her boards so she always joked that I must have started learning even before birth.
I joined APhA because … I wanted to be more involved with and learn more about pharmacy on a bigger stage than just New Jersey. APhA has become my vehicle to be more informed about my profession on a national level.
My most memorable APhA experience … was attending my first APhA Annual Meeting & Exposition. The broad scope and the amount of information was eye opening. I go every year now.
The advice I give to pharmacists who want to follow my career path … is to treat every patient as if they were your parent or child, and treat every student as if they were a younger version of you that you were training. Also, enjoy what you do.
Professionally I want to … eventually become a pharmacy school professor and teach full time.
People would be surprised to know that … after I graduated from Rutgers, I partnered with the Office of Student Development and started a scholarship to help pharmacy students in financial hardships complete their professional years. The Alumni Scholarship encourages Rutgers Pharmacy alumni to give back by donating to help future students who walk in their shoes.
If I could have dinner with anyone, living or dead, I’d choose … Frank Sinatra because I’m a big Sinatra fan and who was cooler than old blue eyes? We’d probably start with dinner in Manhattan and have breakfast in Vegas.
The latest drug news
Want to catch up on up on the latest clinical trials, medication news, drug approvals, and practice guidelines? 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. To read all of the articles and updates on new drug approvals, alerts, recalls, and product withdrawals, visit www.aphadruginfoline.com. Read this month’s top trending article below.
Cardiology C. Wayne Weart, Section Advisor
Diuretic choice for hypertension in older adults: Chlorthalidone, hydrochlorothiazide, or indapamide?
In older adults with uncomplicated hypertension, chlorthalidone was not associated with fewer cardiovascular events or deaths than hydrochlorothiazide, but demonstrated increased risk for hospitalization with hypokalemia or hyponatremia.
Thiazide diuretics are a first-line treatment for hypertension. Although many experts have argued that chlorthalidone is superior to hydrochlorothiazide for the treatment of hypertension, data are conflicting.
In the current observational cohort study, investigators identified 29,873 Canadian individuals 66 years of age and older newly treated with chlorthalidone or hydrochlorothiazide for uncomplicated hypertension. Each chlorthalidone patient was matched to up to two hydrochlorothiazide recipients. Primary efficacy outcome was a composite of death or hospitalization for heart failure, stroke, or myocardial infarction; safety outcomes included hyponatremia- or hypokalemia-related hospitalization.
Efficacy was similar, with chlorthalidone recipients (n = 10,384) experiencing the primary outcome at a rate of 3.2 events per 100 person–years of follow-up, as compared to 3.4 events per 100 person–years of follow-up in hydrochlorothiazide recipients. However, chlorthalidone patients were more frequently hospitalized with hypokalemia or hyponatremia.
What you need to know
There is a longstanding clinical debate regarding superiority of chlorthalidone versus hydrochlorothiazide in treating hypertension. Study investigators stated that “it may be reasonable to conclude that hydrochlorothiazide is safer than chlorthalidone in elderly patients at typically prescribed doses.” However, clinicians should also weigh conflicting evidence in the balance, including results of a recent meta-analysis that showed fewer cardiovascular events in chlorthalidone-treated patients.
Limitations of this study included its relevance to a younger population, variability between treatment groups, and the absence of dose-equivalent comparisons of chlorthalidone and hydrochlorothiazide. Chlorthalidone is approximately twice as potent as hydrochlorothiazide and has a longer half-life. Comparing treatment groups without regard to equipotent dosing makes it difficult to draw conclusions.
For patients in whom chlorthalidone is indicated, pharmacists should recommend the appropriate dose. Chlorthalidone is available alone and in some combination products, including chlorthalidone/azilsartan (Edarbyclor—Takeda), which was approved in December 2011.
Pharmacists should “also consider recommending indapamide, especially for the elderly, based on results of the HY-VET trial and indapamide’s inclusion as one of two recommended thiazide-like diuretics in the current United Kingdom NICE [National Institute for Health and Care Excellence] hypertension guidelines,” suggested APhA DrugInfoLine Section Advisor, C. Wayne Weart, BCPS, FASHP. “Indapamide seems to have less potential for adverse effects and works in patients with impaired renal function.”
What your patients need to know
A recent study of two blood pressure–lowering agents, chlorthalidone and hydrochlorothiazide, showed that both drugs lowered risk of cardiovascular death in patients with uncomplicated hypertension. However, chlorthalidone was associated with a higher risk for electrolyte abnormalities.
- Dhalla IA et al. Chlorthalidone versus hydrochlorothiazide for the treatment of hypertension in older adults: a population-based cohort study. Ann Intern Med. 2013;158:447–55.
- Dorsch MP et al. Chlorthalidone reduces cardiovascular events compared with hydrochlorothiazide: a retrospective cohort analysis. Hypertension. 2011;57:689–94.
- Becket NS et al. Treatment of hypertension in patients 80 years of age and older. NEJM. 2008;358:1887–98.
- National Institute for Health and Care Excellence. The clinical management of primary hypertension in adults. 2011;CG127. www.nice.org.uk/CG127
Also trending on APhA DrugInfoLine