Academic Pharmacy
The News Magazine of the American Association of Colleges of Pharmacy
NOW
Volume 15 2022 Issue 1
Scaling Innovation AACP’s new Transformation Center will promote and disseminate innovations in pharmacy practice and education to further optimize patient care. 18
Also in this issue: Advancing Anti-Doping Education 7 Equitable Pharmacy Access 13
Pharmacists Help People Live Healthier, Better Lives.
who we are @AACPharmacy
Academic Pharmacy The News Magazine of the American Association of Colleges of Pharmacy
Pharmacists Help People Live Healthier, Better Lives.
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Founded in 1900, the American Association of Colleges of Pharmacy is the national organization representing the interests of pharmacy education. AACP comprises all accredited colleges and schools of pharmacy, including more than 6,600 faculty, approximately 63,800 students enrolled in professional programs and 4,800 individuals pursuing graduate study.
NOW
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About Academic Pharmacy Now
Academic Pharmacy Now highlights the work of AACP member pharmacy schools and faculty. The magazine is published as a membership service.
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Emily Jacobs
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Academic Pharmacy NOW 2022 Issue 1
Volume 15 2022 Issue 1
@AACPharmacy a look inside
campus connection
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Meeting Mental Health Needs
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A Compelling Case for Sports Pharmacy Dr. Marina Suzuki is pushing for pharmacists to take an increasing role to promote safe use of drugs among patient-athletes.
A mental health education focus area at the University of Minnesota College of Pharmacy encourages comprehensive patient care.
community impact
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Center for Psychoactive Substances Research Accelerates the Search for Therapeutics
Access for All As pharmacy deserts proliferate, more must be done to examine barriers to access and prepare future pharmacists to address the needs of underserved communities.
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Scaling Innovation AACP’s new Transformation Center will promote and disseminate innovations in pharmacy practice and education to further optimize patient care.
Center
Transformation
The new center at the University of Wisconsin-Madison School of Pharmacy leverages clinical and transdisciplinary expertise in the emerging field of psychedelicassisted therapy.
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@AACPharmacy
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There’s Still Time to Register for INvigorate 2022
AACP INterim Meeting
2022 February 19–22 * San Diego, CA www.aacp.org/invigorate2022
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community note publisher’s impact
Dear Colleagues: My favorite season of the year is definitely spring. I used to get a bit depressed if on February 2nd the news reported that the groundhog saw his shadow. As I grew wiser (and time flew faster), I realized that no matter what happened that day, the first official day of spring was truly six weeks away. That said, in my garden beginning as early as January the first signs of spring begin arriving in the form of green shoots that will soon be daffodils, hyacinths and tulips in glorious colors of a new season. The days get a little longer…I’ll make it out of winter yet again! As we reach the end of the second year of the COVID-19 pandemic, I’m looking for the “signs of spring” in our profession and in our lives. No one has escaped the challenges of the last 24 months. Lockdowns that have interrupted both our personal and professional lives; the stark realities of the inequities in our communities laid bare how some groups are disproportionately the most vulnerable to the morbidity and mortality of the virus; and the difficulties of maintaining our professional responsibilities while ensuring that our school-age children are safe and able to progress in their education while perhaps also taking care of our own elderly parents or other relatives. This list could go on but I’m reciting the too well-known realities of these times. Emerging from the pandemic presents the pharmacy profession with some choices that our leaders must work together to address. This issue of Academic Pharmacy Now highlights the reality that the pandemic has accelerated the closure of pharmacies in vulnerable communities, compounding the lack of healthcare resources in inner cities and rural communities. This is a crisis that can’t be ignored. Pharmacists and pharmacies have filled holes in the fabric of the public health architecture across the U.S. throughout the pandemic, administering more than 200,000,000 doses of COVID vaccines and countless tests. These access points remained open when so many other health facilities either closed or were unavailable. Deliberate attention to strategies to reverse this trend must be a top priority if we are to continue promoting pharmacists and pharmacies as the most accessible healthcare asset. Our leaders must also confront the reality that our workforce is spent. No matter the setting in which our brothers and sisters in the pharmacy workforce are practicing, they are worn out, burned out and ready in many cases to say, “I’m done!” Pharmacists and pharmacy technicians are not unique in this reality. Serving on the Steering Committee of the National Academy of Medicine Clinician Well-being Collaborative, I am acutely aware that this is true across the healing professions. Despair, moral injury and frustrations with employers permeate the health workforce. This too must be a priority for AACP and our colleagues in state and national pharmacy associations. I am inspired by the priorities articulated in the AACP strategic plan approved by the House of Delegates in July 2021. At the top of the list is working to accelerate pharmacy practice transformation with the establishment of the AACP Transformation Center at the heart of this commitment. Please take time to read this article and engage with AACP as we prioritize where the Association and our members can add the greatest value in securing the gains realized in the pandemic in terms of our expanding scope of practice and the recognition by the public and policymakers that pharmacists represent solutions to addressing vulnerabilities in our health delivery systems. AACP can’t do this alone, but by supporting and expanding the work of our member faculty and institutions and partnering with other organizations both inside and outside of pharmacy, we can make a difference. Addressing academic innovation, the imperative of health equity and racial justice, and reversing the downward trends in wellbeing and resilience are also top priorities for the immediate and longer term for pharmacy education. Let’s celebrate the arrival of spring TOGETHER again at our meetings, commencement celebrations and other uplifting events. We have important work to do together, but as my friend and colleague Rebecca Snead, CEO of the National Alliance of State Pharmacy Associations, quotes, “If you want to go fast, go alone; if you want to go far, go together!” Together we can. Sincerely,
Lucinda L. Maine, Ph.D., R.Ph. CEO and Publisher
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campus connection
Meeting Mental Health Needs A mental health education focus area at the University of Minnesota College of Pharmacy encourages comprehensive patient care. By Emily Jacobs Health experts across the United States are looking for every opportunity to ease an increasing demand for mental health services. Mental health patients can have complex needs and often require the expertise of multiple providers. Minnesota is no exception to this demand. At the same time, many primary care providers throughout the state do not feel qualified to treat mental health conditions like depression and anxiety. Instead, they often refer patients to specialized psychiatric providers. This approach can cause delayed care and a lack of coordinated, comprehensive care. “Mental health psychiatric care is often thought of as a specialty area, and it is, just like every other area,” said Dr. Amy L. Pittenger, professor and the head of Pharmaceutical Care & Health-Systems at the University of Minnesota (UMN) College of Pharmacy. “But it is also a chronic condition that can and should be managed within the primary care setting by ambulatory care, primary care providers.”
To help alleviate some of these issues, UMN College of Pharmacy established the Interprofessional Integrative Mental Health Focus Area, initially as a grant-funded effort through the U.S. Health Resources and Services Administration. Within this focus area, Pharm.D. students are paired with psychiatric Doctor of Nursing Practice (D.N.P.) students on a 1:1 ratio. This helps them “develop additional collaborative practice skills and expanded knowledge of psychiatric-specific practice approaches,” according to UMN. Rather than creating a specialty psychiatric pharmacy path, the focus area encourages collaboration among primary care clinicians. This prepares them to offer better team-based care for patients with mental health needs. Focus area participants gain additional knowledge and experience in caring for the whole patient, both physically and mentally. In particular, student pharmacists are better prepared to provide medication management for chronic mental health conditions.
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“Students do come in much more comfortable with that patient encounter, how to interact with other health professionals within the clinical setting, and so they definitely have a head start and a bit of an accelerated path toward those important practice goals.” —Dr. Amy Pittenger A More Robust Perspective In their second year of pharmacy school, UMN students receive an invitation to join the focus area. The focus area begins in the fall semester of the third year and lasts through the end of the program. Student pharmacists must complete several additional courses, as well as a Patient Care Elective Psych APPE. The first semester of the focus area concentrates on clinical interviewing. With their interprofessional partner, students interview patients while under academic observation. The students learn to plan meetings with patients, debrief with their partner afterward and make clinical decisions based on the interview. The second semester focuses on diagnosis and therapy selection as a team. As the Pharm.D. and D.N.P. students develop knowledge and skills specific to their respective degrees, they can increasingly contribute a more robust perspective to their collaborations throughout the academic year. Over the yearlong elective series, focus area participants deliver 15–16 hours of team-based care to standardized patients.
Within their APPE year, students must also demonstrate three additional learning objectives around the delivery of care as an interprofessional team. They must consider the whole patient, including physical and mental health, and incorporate knowledge from multiple clinicians in their decisions. Focus area participants complete the program under direct observation and preceptor evaluations in a clinical setting. While many pharmacy schools build mental health experience into their curriculum, UMN considers its approach unique. The focus area provides essentially a two-year academic, hands-on experience that is not widely available elsewhere. By focusing on interprofessional partnerships, UMN has provided a way for Pharm.D. and D.N.P. participants to learn from each other and contribute to patient care in distinct ways. Almost 100 students have completed the focus area so far. After their experience in the focus area, student pharmacists who go on to pharmacy careers show more interest in collaborating with other primary care providers. They intentionally seek practices that follow a team-based, interprofessional care model that allows for comprehensive patient care. “Students do come in much more comfortable with that patient encounter, how to interact with other health professionals within the clinical setting, and so they definitely have a head start and a bit of an accelerated path toward those important practice goals,” Pittenger observed. While some students from this cohort have gone on to board-certified psychiatric pharmacy careers, most have pursued ambulatory care and generalist positions. Rather than referring all patients with mental health needs to specialists, Pittenger noted that these graduates recognize that “as a generalist, this is a part of their responsibilities, but they’re confident in helping patients across the spectrum of chronic conditions.” P Emily Jacobs is a freelance writer based in Toledo, Ohio.
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A Compelling Case for Sports Pharmacy Dr. Marina Suzuki is pushing for pharmacists to take an increasing role to promote safe use of drugs among patient-athletes. By Joseph A. Cantlupe
As the Olympic Winter Games take place this month in Beijing, there will be plenty of competition in the 109 medal events. At the same time, there will also be scrutiny regarding anti-doping efforts. These efforts will be made to promote “the spirit of sport” among competing athletes, according to Dr. Marina Suzuki, associate professor & director for the Office of Global Pharmacy Education and Research at the Pacific University School of Pharmacy, who also serves as a pharmacist for the United States Anti-Doping Agency. She is an author of an article that appeared in the August 2021 issue of the American Journal of Pharmaceutical Education (AJPE) that argues the importance and uniqueness of sports pharmacy and asks pharmacists to take on a larger role to promote safe use of drugs among patient-athletes. Here, Suzuki discusses the importance of anti-doping education and the role pharmacy schools can play in helping pharmacists become better equipped with awareness, knowledge and skills so they can be advocates in the fight for clean sports.
Has anti-doping education been part of pharmacy school education generally? Many pharmacy schools cover the concept of what drugs might cause doping. However, I believe it’s rare that students are taught about detailed anti-doping regulations and how exactly to address special needs of patient-athletes. Some countries have a dedicated postgraduate degree and/or certification programs in the discipline of Sports Pharmacy or Sports Medicine. In the article published in AJPE, I introduced the certification program currently and successfully implemented by a national anti-doping organization in Japan. It would be ideal if all graduating students can offer appropriate assistance to patient-athletes and if pharmacy education can give them
the confidence, so that our graduates at least know when and where to refer patient-athletes to avoid any violation of anti-doping rules.
If it is not part of the curriculum, what steps are needed to include it? The first step is to recognize that patient-athletes constitute a special patient population. Many pharmacists would agree to categorize pregnant women, pediatric patients, geriatric patients and patients with renal/hepatic failure as a special population. Patientathletes should also be recognized as such because standard treatment might not be appropriate among patient-athletes, based on the type of sports they play and the timing of their competitions. In the AJPE article, we discussed a few examples such as patient-athletes
needing an infusion in an outpatient care setting. I would imagine concepts on how to treat patient-athletes could be covered as part of special population courses or lectures without creating a new course or elective in the current pharmacy curriculums. It would be helpful to apply the same type of learning objectives and competency statements present for other special patient populations to patient-athletes as well.
What role can pharmacists play in promoting antidoping? Pharmacists should be aware of basic anti-doping rules and what medications need to be avoided when taking care of patient-athletes. We should be medication experts with the ability to
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campus connection
provide safe and appropriate drug therapy. Also, pharmacists can help athletes and physicians seek exemptions to use treatments deemed necessary for their health when the use might be considered as a violation of anti-doping regulations otherwise. As the use of supplements and natural products is expanding among patient-athletes, pharmacists can also play an important role in educating patient-athletes so that they do not commit any unintentional anti-doping violations.
Is there a specialty in antidoping education that student pharmacists can pursue? While some physicians specialize in Sports Medicine, for pharmacists it
might be ideal to have basic anti-doping knowledge no matter where we practice. We encounter patient-athletes in various settings rather than specialty care settings, especially in community and ambulatory care settings in general. If pharmacists have a high volume of patient-athletes, such as those working with athletic teams on campus or in their community, or if more specialized training is desired, many national antidoping organizations, including the U.S. Anti-Doping Agency, offer training modules applicable for providers including pharmacists. These are not certification programs for pharmacists, but the modules provide useful information for pharmacists.
What career options exist for student pharmacists interested in this area? I’ve worked with pharmacists serving at national anti-doping organizations, so this could be an option. But if pharmacists are interested in working more directly with patient-athletes, they can collaborate with athletic teams or physician groups that take care of athletes. Actually, this type of collaboration might be rewarding, especially for pharmacists with ambulatory care or community pharmacy backgrounds. We must remember that patient education plays a huge role in promoting clean sports among patient-athletes, and pharmacists have a unique knowledge and training to help patients get educated. That’s important because anti-doping rules apply not only for prescriptions but also for over-thecounter medications, supplements/natural products and recreational drugs.
Do you think there could be a greater need for sports pharmacists going forward as a developing field? 8
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In medicine, more training is becoming available for physicians to specialize in this area and to treat patient-athletes. This is a trend that I hope pharmacy will follow, especially because there is a need from patient-athletes. Currently, the responsibility for not breaking anti-doping rules rests with each athlete. Athletes are expected to collect, interpret and follow information regarding all substances they are taking or applying to their system. This could be overwhelming for many athletes. It would be helpful if more pharmacists can get involved and offer help. This would ease the burden not only for the treating physicians and their medical teams but also for patient-athletes.
or dispense medications if patients identify themselves as athletes who are scheduled to be tested against doping substances and to compete for medals soon. Pharmacists want to make sure the medications they recommend, prescribe or dispense will keep the patientathletes in the competition for which they worked so hard, without violating any anti-doping rules. If pharmacists can play a role in preventing any intentional or unintentional doping and also promote clean sports, I believe that’s what we want as a profession. P Joseph A. Cantlupe is a freelance writer based in Washington. D.C.
What is the importance of anti-doping education among patient-athletes? It is vitally important to emphasize that patient-athletes need to check their anti-doping rules each time they use a medication, a supplement or any other substances. There is a Prohibited List that gets updated annually. There are substances prohibited across the board, but for some substances, whether it is prohibited or not can depend on different factors, such as substance formulations, doses, administration routes and the timing of administration. Even though a patient-athlete may not have violated anti-doping regulations in the past, he or she should diligently check substances each time they use because of changing regulations and potentially multiple factors that need to be considered.
Is there enough awareness about the need for training in the field of sports pharmacy? Many pharmacists are obviously aware of the importance of avoiding doping, but the level of their awareness toward training needs might not be satisfactory. I wonder how many pharmacists today would confidently provide care
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community impact
Center for Psychoactive Substances Research Accelerates the Search for Therapeutics The new center at the University of Wisconsin-Madison School of Pharmacy leverages clinical and transdisciplinary expertise in the emerging field of psychedelic-assisted therapy. By Katie Gerhards In 2014, the University of Wisconsin–Madison campus beulty Randall Brown and Christopher Nicholas co-authored a came the site of the first Phase 1 clinical trial for psilocybin. paper published in Nature reporting that MDMA helped 67 Since that study, which was led by UW–Madison School of percent of study participants drop below the diagnostic critePharmacy Professor Paul Hutson, the campus has steadily ria for PTSD and 33 percent meet the criteria for remission. become a powerhouse of psychedelic research aimed at treatments for mental health conditions ranging from severe post- “There appears to be real promise in the treatment of a numtraumatic stress disorder (PTSD) to opioid use disorder. “We ber of often refractory conditions related to addiction and mental health,” said Brown. “We have a lot to learn yet about are one of a handful of academic sites in the U.S. that have possibilities and about optimal implementation and disa history of doing research with psychedelics,” said Hutson. semination.” Four clinical trials in phases 1 to 3 are currently “And we’re one of even fewer to do it at a quality and caliber underway at UW–Madison to prepare for submitting applicahigh enough to be acceptable by the U.S. Food and Drug tions for new drugs to the FDA, such as studying the efficacy Administration for a New Drug Application.” of psilocybin as treatment for major depression and opioid To provide infrastructure and other resources to stay on the addiction. cutting edge of this emerging field, the School of Pharmacy Cody Wenthur, assistant professor in both the School of is launching the UW Transdisciplinary Center for Research Pharmacy’s Pharmaceutical Sciences and Pharmacy Practice in Psychoactive Substances. The new center reaches across campus to accelerate scholarly research into the science, his- Division and a member of the center’s executive committee, is also seeking ways to make ketamine a better therapeutory and cultural impact of psychedelic agents, in addition tic for depression by blocking some of the drug’s negative to the potential therapeutic use of psychoactive substances. impacts. He is collaborating with Hutson and Nicholas to find “From cannabis to psilocybin (magic mushrooms) and MDMA out if it’s possible to observe therapeutic effects of psilocybin (ecstasy), psychoactive agents are the new frontier for potential new therapies and medications,” said Hutson, the center’s in the absence of memory of the psychedelic experience. founding director. In addition to his findings about MDMA and PTSD, Brown is also working toward the therapeutic use of psilocybin for opioid use disorder and major depressive disorder. Nicholas “Early studies have showed a dramatic impact on depression is applying psychedelic therapy to methamphetamine use from one dose of psilocybin in a structured research setting. disorder. “I anticipate FDA approval of psilocybin and MDMA Similarly, when combined with psychotherapy for the treatwithin the next five years, and the UW Transdisciplinary ment of PTSD we’re seeing dramatic benefits of the inclusion Center for Research in Psychoactive Substances will help of MDMA, with a tripling of the response rate or remission meet the need for more research into these applications, as rate for PTSD,” Hutson said. Importantly, the MDMA was not well as others, that could dramatically improve patients’ used alone, but as part of active, professional psychotherapy. lives,” said Hutson. Earlier [in 2021], School of Medicine and Public Health fac-
Therapeutic Promise
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Infrastructure and Services Although numerous researchers around campus are already engaging in this work, the center will help provide infrastructure to help them expand their studies and even attract new researchers. “Similar to other types of chemical or biological research that need specific, expensive instrumentation, doing work with psychedelic-assisted psychotherapy requires dedicated infrastructure—trained guides, a study space, proper DEA licensing—all of the things that surround the study design itself,” said Wenthur. Center members will have access to the School of Pharmacy’s current study space, which is one of few facilities like it in the world. Set up like a living room, it’s equipped with the comforts of home alongside monitoring devices to ensure participant safety and study replicability. Studies involving psychoactive agents require keeping a close eye on participants, both their physical and mental state. For each study, one or two trained guides or therapists protect the space and take care of the patient throughout their dosing session. The center plans to have one trained psychotherapist on staff to serve as a treatment guide and will also offer trainings to members of research groups. “By having these resources available to other investigators, we can potentially increase the number of available grants that are awarded to UW,” said Wenthur. Another benefit of the center is in the paperwork: Hutson is one of few researchers who hold the necessary investigational new drug exemption and Schedule 1 license for clinical projects that involve drugs like marijuana, psilocybin and LSD. By collaborating with the center, researchers will be able to leverage Hutson’s proven expertise and licensing.
Increasing Accessibility and Representation Over the past two decades, just 2.5 percent of psychedelic-assisted psychotherapy study participants were African-American, 2.1 percent were Latinx and 4.6 percent were Indigenous. Without adequate racial and ethnic representation in clinical trials for new therapeutics, study findings may only be applicable to a narrow set of individuals, exacerbating a gap in mental health treatments.
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“I anticipate FDA approval of psilocybin and MDMA within the next five years, and the UW Transdisciplinary Center for Research in Psychoactive Substances will help meet the need for more research into these applications, as well as others, that could dramatically improve patients’ lives.” —Dr. Paul Hutson
Finding ways to increase participation by BIPOC community members is central to the center’s mission. “The Wisconsin Idea is really forefront, and that’s one of the reasons why I want to get broad representation on our executive and advisory committees, not only with Black and Hispanic populations but also with First Nations and in particular the tribes of the Northwoods,” said Hutson. Indigenous cultures have long used psychoactive compounds like peyote and ayahuasca for healing and ceremony, and including these groups in clinical trials and strategy can yield new insights. Modern clinical trials have even borrowed best practices from Indigenous groups, such as the presence of a trained guide to stay with the patient throughout treatment. Wenthur recently launched a study in collaboration with center members that’s geared toward understanding the basis for asymmetric participation and increasing representation by measuring the effects of increasing participant engagement in personalizing the study space and incorporating cultural competency training on study recruitment and results. “Closing health equity gaps must be a priority if we want to effectively address the heavy burden of mental health disorders present in America right now,” he said. To help overcome barriers to recruitment and participation, the center will seek to add more study locations—in addition to the School’s facility—that will be easier for people to access. “It’s hard for people in some socioeconomic situations to access these trials,” said Hutson, citing work schedules, childcare and transportation as hurdles to the numerous appointments for preparatory sessions, treatments and followup visits. “More accessible study sites and more trained guides will help accelerate and augment this research on the
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UW–Madison campus, because those are the pinch points that are currently keeping us from moving forward.” The new center is a partner of the School of Pharmacy’s Master’s of Science program in Psychoactive Pharmaceutical Investigation (PPI), which offers the first accredited U.S. degree focusing on the study and therapeutic development of psychedelic compounds and related psychoactive drugs. The center also is part of the Capstone Certificate in Psychoactive Pharmaceutical Investigation. “The center dovetails very nicely with our recently launched master’s program, particularly because the education needs to be supported by real-world expertise,” said Wenthur, who is the director of the PPI program. “The center and the master’s program work synergistically to provide an integrated vision for improving mental health.” Hutson aims to position the UW–Madison campus as a training site, both for clinical facilitators and for students in the School’s PPI and capstone programs, which will continue to fuel future research. Although the National Institutes of Health awarded its first grant to medicinal psychedelic research just earlier in 2021, most studies into the therapeutic use of psychoactive substances rely on private donors or nonprofit organizations. To offer more researchers an opportunity to pursue and expand their projects, the center has created the Wisconsin Psychedelic Research and Education Fund, open to donors who want to maximize the impact of this emerging area of medicine. “Having this center gives us a home to engage in the future of scholarship, breaking down silos between traditional disciplines and asking tough questions at the interface of science, humanities, the arts and the human condition,” said Wenthur. P Reprinted with permission from the University of Wisconsin-Madison School of Pharmacy.
community impact
Access for All As pharmacy deserts proliferate, more must be done to examine barriers to access and prepare future pharmacists to address the needs of underserved communities. By Jane E. Rooney The term “pharmacy deserts” is popping up with greater frequency as pharmacy closures become more widespread and independent pharmacies struggle to survive in some areas. Even chain drugstores are not immune from the changing healthcare landscape. Late last year, CVS announced that it would be closing 300 stores a year across the country in the next three years, and Rite Aid said it plans to close at least 63 stores in the next several months. The implications are most striking for minority populations: A 2021 University of Southern California study revealed that Black and Latino neighborhoods in the 30 most populous U.S. cities had fewer pharmacies than white or diverse neighborhoods in 2007–2015.
In an effort to address concerns about barriers to pharmacy access, the National Community Pharmacists Association partnered with the University of Southern California School of Pharmacy and Leonard D. Schaeffer Center for Health Policy and Economics to launch the Pharmacy Access Initiative in 2021. The multiyear effort will produce research to help identify communities lacking pharmacy access. The goal is to help national, state and local policymakers and industry leaders ensure equitable pharmacy access for all communities in the United States. “This is an ongoing problem that is only getting worse. More needs to be done and needs to be done soon,” said Dr. Dima
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“We should be training students to understand structural competency. Health is not just biology. We need to do more to integrate some of those social and structural aspects that shape different communities’ health.” —Dr. Cheryl Wisseh
M. Qato, associate professor of pharmacy and director of the Program on Medicines and Public Health, University of Southern California School of Pharmacy. “We are seeing frequent announcements that pharmacies are closing, and reimbursement rates aren’t getting better. The closure problem is getting worse and it affects minority communities more than others. We really can’t address medication access and health disparities if we’re not addressing pharmacy access.” She said that the Initiative was motivated by a need to translate academic research for policy audiences and to develop tools that enable change. “The collaborative will identify pharmacy deserts and areas at risk for closures and provide recommendations for effective policy solutions at the local, state and federal levels,” she continued. “We are partnering with public agencies and community organizations so we can better ensure that these solutions are effective and equitable.”
not outdated—evidence base that captures in detail at the community level for all communities in the United States and identifying those that are pharmacy deserts affected by closures so we can direct policymakers to informed decision making.”
Lacking Critical Services Pharmacy deserts are defined as areas that have no pharmacy within a one-mile radius or limited vehicle access (within a half hour or more radius). Dr. Cheryl Wisseh, assistant clinical professor, Department of Clinical Pharmacy Practice, University of California Irvine School of Pharmacy & Pharmaceutical Sciences, authored a study last year, published in the Journal of Racial and Ethnic Health Disparities, examining pharmacy deserts in the state of California in terms of social determinants of health.
“Based on what we found there were two distinct types of pharmacy deserts. We found it speaks to some structural Qato emphasized that it is crucial to identify the extent of inequity and structural racism that are in the foundation the problem so policymakers can prioritize the communities of these communities,” Wisseh noted. “Type 1 pharmacy that need interventions. “It gets down to creating a current— deserts had more social determinant of health factors that
“We need more data and evidence on the impact of pharmacy access on health outcomes and on medication use outcomes. From what we know so far, we should at least ensure equitable access to pharmacies. There shouldn’t be fewer pharmacies in neighborhoods that need them more. Policies that encourage pharmacies to stay open should be a priority.” —Dr. Dima M. Qato
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would negatively affect having access to a pharmacy. We asthma and COPD, you run the risk of them being unconlooked at census-level population data on social detertrolled. That’s one of the key things I would think would be minants of health indicators, statistics on crimes against an issue for not being able to get medication. Another one is property and people and HRSA data on Health Professional not having insurance—are you going to spend your money Shortage Areas. We found that more people who live in these on medication when you have to pay rent or buy food?” As communities didn’t have vehicles, there were higher crime Qato noted, getting prescriptions filled on time is often not rates, there were more people with no health insurance related to personal choice but rather a function of living in coverage, English was not their first language…all of that minority neighborhoods, which can make it more difficult to can contribute to that distance they have to travel to get to a get to the pharmacy. pharmacy. Residents in these communities were living under “We need more data and evidence on the impact of pharmacy the federal poverty level, which imposes more barriers to getting to a pharmacy, especially in a pandemic. Do you want access on health outcomes and on medication use outcomes,” Qato said. “From what we know so far, we should at least to go to the pharmacy after work if it’s an hour ride on the bus? You’re also not going to walk to a pharmacy if your com- ensure equitable access to pharmacies. There shouldn’t be munity is not as safe. In a Type 2 desert, such barriers do not fewer pharmacies in neighborhoods that need them more. Policies that encourage pharmacies to stay open should be a compound the distance and thus, distance to the pharmacy priority.” is not as much of an issue. One of the things that continuously proves true is that residential segregation is shaping Training Students to Examine Root Causes what we’re seeing.” One concrete step that can reduce barriers to access is increasing pharmacy reimbursement rates, according to Qato. Early on in the pandemic, access was an issue in these Type But she cautioned that any policies aimed at increasing ac1 pharmacy deserts, which led to lower vaccination rates in those communities. The pandemic impacted closures as well, cess must address equity. An Illinois program that began two years ago intended to ensure that the state would increase Qato pointed out. “There were more temporary closures but pay to pharmacies for Medicaid prescriptions. However, also many pharmacies that closed permanently,” she said. some pharmacies in urban areas did not meet eligibility cri“At the same time, pharmacies are playing a more important teria, so while rural communities benefitted, many minority role in providing and responding to the covid pandemic with neighborhoods with pharmacy shortages did not. testing and vaccines. The importance of pharmacies was underscored during covid—they have always been important in addressing public health emergencies.”
“You need to develop policies that have equity at their core,” she noted. “The distribution of pharmacies is totally inequitable. We have to address the problem focusing on policy Even prior to the pandemic, Qato continued, pharmacies changes to prevent closures, to encourage new pharmacies offered key services such as immunizations, point-of-care testing and access to things like contraceptives and naloxone. to open. Pharmacy networks and plan requirements don’t allow people to use any pharmacy they want to. Most of the “Anything you can get at a pharmacy is less accessible if you time the ones in networks that are preferred are pharmadon’t have a pharmacy nearby. It’s a real problem with real cies that are chains, and we know that if there’s a pharmacy health impacts. It was reinforced during the pandemic. The nearby [in minority communities] the closest one is usually communities that really need vaccines don’t have a pharmacy to go get them. That’s important because 80 percent of co- an independent. And they are excluded from these networks. vid vaccines are administered at retail pharmacies. Minorites Insurance doesn’t cover the medications if they fill them at that pharmacy.” are most affected and disproportionately die from covid but have the hardest time getting the vaccine.” To prepare future pharmacists to address access issues, Wisseh’s study found that a pharmacy shortage often equates Wisseh said schools must examine social determinants of health and any social identities that have consistently faced to fewer clinical pharmacy services, such as health screensystemic discrimination. “We should be training students ings and medication management. “In regards to medication to understand structural competency. Health is not just adherence, access becomes an issue,” she said. “It can lead biology,” she said. “We need to do more to integrate some of to primary medication nonadherence where people don’t those social and structural aspects that shape different comfill the prescription at all. If you are not filling prescriptions munities’ health.” for chronic conditions such as high blood pressure, diabetes,
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Exploring why medication access is the way it is regarding who gets insurance coverage and why certain groups are marginalized is also necessary, she added. “It’s also making sure faculty are prepared to teach on such topics. From what we’ve found in our recent review article (https://www. ncbi.nlm.nih.gov/pmc/articles/PMC8655146/) on the incorporation of social determinants of health with regards to structural racism, sometimes faculty don’t know how to teach it. Being able to educate students on these issues and partnering with community organizations to work with the underserved would definitely help.” Qato agreed that while pharmacy school programs that focus on outreach in underserved neighborhoods are a good start, she said it is crucial to expose student pharmacists to community-level barriers in accessing medications. “Getting into those communities and talking to pharmacies that had to close and why they closed. Meeting with community organizations and patients affected by closures. Getting students to understand what’s happening on the ground,” she explained. “Students are trained to focus on clinical care and ensuring that patients get the right medications. What’s missing is before we get there—before we get patients to control their diabetes or hypertension—we need to know why it’s not controlled. Getting at the root causes of medication safety and adherence is important, and we do that by looking at people not just by race but also where they live and how that may impact medication use. We don’t see a lot of that training.” She acknowledged that this has only recently become a research priority, but it presents an opportunity for student pharmacists to learn how to interact with patients and understand the why behind their situations. “We want students to understand the policy issues that impact these problems that their patients may be reporting,” Qato continued. “What tools do pharmacists and students have to address those problems? For pharmacy schools to equip students with
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whatever solutions are available and make sure pharmacists and trainees use them would go a long way. If a non-adherent patient comes in or has uncontrolled blood pressure, it’s important to investigate why. Do they experience barriers in getting prescriptions filled? Did their pharmacy close? There should be options for them so they can take the medications they need without that getting disrupted. Maybe it’s making them aware of a mail-order option, but students aren’t trained to ask or respond to those barriers.” Wisseh said pharmacy schools across the country are at various stages of addressing these issues, but many are working toward building community partnerships and integrating diversity, equity, inclusion and antiracism in the curriculum. “At UCI, I am currently developing a series with an interprofessional education course that looks at deeper understanding of culture and group-based trauma for minority communities so students can have understanding of cultural and structural competencies,” she said. “We’re trying to be more aware and move toward cultural humility.” She echoed Qato’s sentiment that a major step toward greater understanding involves working with populations that lack access. “On a population level it has to do with working within the community and having programs that would help. We need more data to understand how this is affecting communities.” P Jane E. Rooney is managing editor of Academic Pharmacy Now.
community impact
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The upward trend of the pharmacy industry Pharmacy retains a moderate future employment outlook despite challenging market conditions. Pharmacist Wages & Employment Trends* Median wages (2019) $61.58 hourly, $128,090 annual Employment (2018) 314,300 employees Projected job openings (2018-2028) 15,300 Top industries (2018) Retail Trade, Health Care and Social Assistance
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*Source: Retrieved from O*Net on October 15, 2020. Original source: Bureau of Labor Statistics 2019 wage data and 2018-2028 employment projections. Copyright © 2020 Pearson Education, Inc. or its affiliates. All rights reserved. Pearson and PCAT are trademarks, in the US and/or other countries, of Pearson plc. CLINA23931 MJL 10/20 Academic Pharmacy NOW 2022 Issue 1
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Transformation
AACP Center Center to Accelerate Pharmacy Practice Transformation and Academic Innovation
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Scaling
Innovation AACP’s new Transformation Center will promote and disseminate innovations in pharmacy practice and education to further optimize patient care. By Athena Ponushis
Against the backdrop of a pandemic, pharmacists are taking more active roles in public health. Pharmacy schools are rethinking the reach of education, delivering healthcare to communities that need it. To amplify this work, AACP has established the Center to Accelerate Pharmacy Practice Transformation and Academic Innovation. The AACP Transformation Center hopes to become a center of attention, lifting up the work of members to help pharmacy reach the heights of its potential. The center will share the stories of members who are reaching people in need of healthcare so pharmacy can further its mission to improve health outcomes for all populations.
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Corrigan sees the center’s mission to accelerate pharmacy practice transformation and academic innovation as a true means to improve health outcomes and reduce health disparities. She pointed to Dr. Jacinda Abdul-Mutakabbir, (“Dr. JAM”) assistant professor of pharmacy at Loma Linda University School of Pharmacy and a critical care infectious disease pharmacist, as an example of someone working to magnify and rectify health inequities in minoritized communities. She saw that the COVID-19 vaccine clinics in California were not reaching the most vulnerable populations. She talked with her journal club and her colleagues and asked, ‘What can we do? What can we do differently?’ They reached out to Black churches, engaging pastors, to reach the Black community where they live, learn and pray. Vaccine rates increased significantly and Dr. JAM’s work was published in The Lancet Global Health. “A lot of the initiatives that we are talking about in pharmacy relate to education and that’s what Dr. JAM provided. She questioned why is there vaccine hesitancy, how can we educate the most vulnerable about the vaccines and what does that look like moving forward. She has continued to support the important role of the pastors and has worked collaboratively. These are the principles that we are talking about with the center,” Corrigan said. “So, I just stand in awe of Dr. JAM and others who are out there trying things. It’s their work that we want to uplift at the center.”
Opportunity Abounds Corrigan has built her career on blazing trails and bringing groups together. She led the national Scope of Pharmacy Practice Project in 1992 and guided the creation of the Pharmacy Technician Certification Board in 1995. In her role as executive director of the transformation center, she intends to work with pharmacy organizations as well as other disciplines in the broader healthcare ecosystem. She’s eager to learn from those doing innovative work in higher education, connect with foundations supporting innovative work, like the Gates Foundation or Lumina Foundation, and she’s interested in talking with people who are doing disruptive things in areas like digital health. “We are not alone in doing this work,” Corrigan said. “And I think the transformation center has an openness to it, what I call a ‘come with us’ attitude. We want to know, how do we widen the path? How do we bring groups together? We will look at strategy, mission and values, and say, ‘Join us.’ That’s how we will align our efforts.” When Corrigan thinks of all the work member institutions and individual members are doing, when she thinks of folding their work into the center, she hears one word clearly: opportunity. She foresees the center elevating values
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Transformation
“The launch of the center is very timely because we are in an era of change,” noted Melissa Murer Corrigan, executive director of the center. “A number of changes have happened the last couple of years related to curriculum, teaching methods and innovation. We have also seen innovations in practice that we could not have envisioned before. The center will help build and scale these changes. I think that’s one of our greatest endeavors as a center, to not only promote, highlight and encourage innovation, but allow it to scale up and happen in more places.”
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Dr. Jacinda Abdul-Mutakabbir (far right), assistant professor of pharmacy at Loma Linda University School of Pharmacy, reached out to Black churches in her community to increase vaccine rates. AACP’s new transformation center will share such examples from members and scale up these innovations.
that are intrinsic to pharmacy—curiosity, accessibility, empathy—as well as what she believes to be the power of transformation: collaboration. “We are looking at project models we can replicate, scale and grow to truly focus on medication use optimization, improving health outcomes and reducing health disparities. We are looking at our relationships with other healthcare disciplines. How can we learn from them? And we are looking at how do we address big-picture issues, whether that be related to policy or building up our pharmacy workforce pipeline, what does that look like?” she said. Corrigan believes the pervasiveness of health disparities and the toll of the pandemic affirm the need for the transformation center. “We need the center now because pharmacists are mission critical in the healthcare ecosystem,” she emphasized. “We have been through a lot the last couple of years, and if anything, I think covid has taught us that having pharmacists around the table is vital.” She considers innovations that are happening now, such as a pharmacist in Iowa who created a vaccine taxi program for community impact, the University of Minnesota College of Pharmacy’s project, “Advancing Kidney Health Through Optimal Medication Management,” and the Academia-CPESN Transformation (ACT) Pharmacy Collaborative, a collaboration between colleges/schools of pharmacy and clinically integrated networks of communitybased pharmacies. “There are so many things happening that we want to amplify,” she said. Sometimes a pharmacist or a professor will have an idea but they don’t know how to follow it through. That’s where a case study or a
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“We are looking at project models we can replicate, scale and grow to truly focus on medication use optimization, improving health outcomes and reducing health disparities. We are looking at our relationships with other healthcare disciplines. How can we learn from them? And we are looking at how do we address big-picture issues, whether that be related to policy or building up our pharmacy workforce pipeline.” —Melissa Murer Corrigan
toolkit comes in. The center hopes to become a hub where these resources reside so those who are willing will find ways to engage in interprofessional collaborative care. “When we talk about transformation and innovation, I also want to put out there that sometimes things aren’t going to work,” she continued. “In this world of social media where everything’s curated and looks so good, you hear about things and it’s like, ‘Oh, they hit it out of the park.’ The reality is, when you try something new, there are going to be bumps in the road, or not even bumps— you may go off the road—but the key is to pick yourself up and figure out what happened so you know what to do differently in the future. When you look at it that way, these missteps are lessons that help us grow and do bold things. I hope the center will be a way for us to learn these lessons collectively.” Corrigan also sees pharmacists playing a more active role in an area that cannot be talked about enough: mental health. “First, we need to take care of the caregivers. It’s tough right now and we need to make sure pharmacists are taking care of themselves as they are taking care of their patients,” she said. “Second, we talk about the accessibility we have in pharmacy, being in the community…mental health is a concern and the idea of pharmacists playing a role is something we are just touching on.” Pharmacists tend to see patients more than physicians do, so Corrigan looks forward to seeing the role the center can play in meeting the need for mental healthcare.
Introductory Steps One of the center’s first leading actions will be its Bridging Pharmacy Education and Practice Summit, which will be held simultaneously at six regional locations in early June. “It’s really living our goals, in that we are working with other planning partners to bring it together,” Corrigan said. The summit will focus on four content areas: competency-based pharmacy education; professional identity formation; optimizing the continuum of learning from Pharm.D. to postgraduate education; and continuing professional development and lifelong learning for pharmacists. Engaging members at six locations across the country allows the center to gather a larger group. Event planners anticipate 50 attendees at each site,
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drawing roughly 300 people to participate in the two-day summit. “We currently have about 150 individuals who have expressed interest and the caliber of people, their leadership expertise and background, there’s just a super amount of excitement about this work,” Corrigan said.
The agenda suggests an interactive and engaging summit. Participants will draft consensus and recommendation statements for what should come next. “We are really trying to think through the richness of how do we utilize our relationships and partnerships to make this a living, breathing, ‘what’s next’ activity, so after we have these deep, thoughtful discussions and presentations and reflections, we have a way to keep things going,” she explained. Shortly after the summit, the transformation center will host a session at AACP’s annual meeting to inform and interest members. The poster theme for 2022 will be “Bridging Education and Practice,” allowing schools to feature their work around innovation and transformation while helping the center identify potential collaborative efforts moving forward. “We know that there’s so much already happening out there and we cannot wait to learn more,” Corrigan said. With a goal of sustainability, Corrigan would like all deans at all pharmacy schools to know, “It’s within their leadership that we are looking to scale and grow these initiatives and activities, so to have them involved would be important.” The center also recognizes faculty, who are working with learners each day, and would like to glean from their curriculum how to train pharmacists for today and tomorrow, especially for emerging, innovative roles. Likewise, the center recognizes learners. In the first week of her role as director, Corrigan attended the Academic Leadership Fellows graduation. “I felt this energy, and what I was thinking as I sat at my table, watching and celebrating their accomplishments, was how do we harness the power of these leadership fellows?” she said. “I see the leadership fellows being an integral part of the center.” The transformation center will soon name its expert advisory council, assembling a group across disciplines and geography to lend diversity of thought and experience to help steer the work of the center to expand the scope of pharmacy. “Really figuring out what’s the best use of our time and resources is where we are going to look to this expert advisory council to give us insight based on their experience in real-world healthcare settings to help us identify what we should focus on,” Corrigan said. She believes the future is bright but still looks to history and feels inspired to lift up the work of someone like Zada Cooper, the first female tenured professor of pharmacy in the country, the first secretary of AACP, the mother of Kappa Epsilon and Rho Chi. “She was fearless. She created multiple organizations after the Spanish flu, so I look to Zada, her life and her legacy, to learn from her work as we ponder what’s coming next. I am very optimistic. And I am thrilled to be part of an organization that Zada was so supportive of and loved. I just feel like it’s an exciting time.” P Athena Ponushis is a freelance writer based in Ft. Lauderdale, Florida.
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2022
Call for 2021 Annual Meeting Poster Abstract Submissions AACP members are invited to submit poster abstracts for Pharmacy Education 2022, under the following three poster categories: Research and Education Abstracts, Trainee Poster Competition Abstracts, and School Poster Abstracts. The School Poster theme this year is Bridging Pharmacy Education and Practice. https://bit.ly/PharmEd22Submissions ɋɋ Research and Education Abstracts Deadline: Due March 15 ɋɋ Trainee Poster Competition Abstracts Deadline: March 15 ɋɋ School Poster Abstracts Deadline: March 29
Connect with Best Practices Through AACP Webinars AACP hosts informative and educational webinars presented by members of our Councils, Sections, Special Interest Groups and AACP Connect Communities throughout the year. A full list of scheduled Webinars is available at https://bit.ly/AACPWebinars. AACP offers a variety of Continuing Education webinars. The Spring Schedule is filling up, so make sure to register for any of the upcoming CE Webinars! If your community is interested in submitting a CE Webinar request, visit https://bit.ly/ CEWebinarGuide. If you have any questions regarding the CE Webinar Program, please contact Tom Maggio at tmaggio@aacp.org.
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AACP INterim Meeting
2022 February 19–22 * San Diego, CA www.aacp.org/invigorate2022
AACP greatly appreciates the support from our meeting sponsors, whose contributions make this event possible: Educational Day Sponsor
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Join your colleagues Feb. 19–22 in San Diego, Calif., for three-and-a-half days of networking, learning and problem-solving. You’ll leave re-energized and ready to implement new ideas and strategies to help you prepare for transformation in pharmacy education and practice.
There’s still time to register at www.aacp.org/INvigorate2022.
Informative sessions will address: •
The importance of establishing connections between academic pharmacy and national pharmacy organizations
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Best practices from across the Academy to promote and maintain the well-being of students, faculty and staff
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How institutional leadership can create a welcoming environment to support DEIA efforts
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CAPE outcomes, EPAs, competency-based education and the opportunity to provide input on their implementation
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Innovative approaches to transform pharmacy practice on all fronts, and with everyone who plays a role
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Ways to support faculty at every stage in their career with mentorship and professional development opportunities
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Making global connections with schools of pharmacy and the impact an international experience abroad can have on students
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Pharmacists Help People Live Healthier, Better Lives.
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Increase Your AACP Member Engagement
Renew Your Membership by Dec. 31!
AACP offers unique benefits, services and opportunities for individual members such as educational programming, online member communities and numerous member resources. Here are some of ways to increase your engagement with AACP and stay connected to the broader world of academic pharmacy: Join a New Special Interest Group Member groups are designed to help individuals stay informed and connected to colleagues with similar interests. http://bit.ly/JoinASIG
Post a Question on AACP Connect AACP’s online member community of pharmacy educators contains thousands of discussion posts, resource documents, and countless opportunities to connect with your peers. http://bit.ly/AACPConnect
Participate in an Upcoming Webinar Stay up-to-date on industry news and best practices with our Webinars scheduled for this Spring, many with CE credit. http://bit.ly/AACPWebinars
Find many more opportunities for involvement with AACP: http://bit.ly/AACPIndividualMembership