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Academic Pharmacy

The News Magazine of the American Association of Colleges of Pharmacy

NOW

Volume 10 2017 Issue 3

Hitting the Target Pharmacy interventions have a triple aim to improve care, reduce costs, and improve health through better care management. 8 Also in this issue: Cannabis Education in the Curriculum 5 AACP Joins the March for Science 17


who we are @AACPharmacy

Academic Pharmacy The News Magazine of the American Association of Colleges of Pharmacy

American Association of Colleges of Pharmacy 1727 King Street, Floor 2 Alexandria, VA 22314 p: 703-739-2330 P f: 703-836-8982

www.aacp.org

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.

Letters to the Editor

We welcome your comments. Please submit all letters to the editor to communications@aacp.org.

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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Change of Address

For address changes, contact LaToya Casteel, Member Services Coordinator, at lcasteel@aacp.org.

NOW

CEO & Publisher

Lucinda L. Maine

Editorial Director

Lynette R. Bradley-Baker

Editor

Maureen Thielemans

mthielemans@aacp.org

Editorial Assistant

Kyle R. Bagin

kbagin@aacp.org

Art Director

Tricia Gordon

tgordon@aacp.org

Design Assistant

Sean Clark

sclark@aacp.org

Senior Advisor, Outreach and Communications

Stephanie Saunders Fouch sfouch@aacp.org

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For advertising information and rates, visit http://go.networkmediapartners.com/ aacp-mediakit or contact Jeff Rhodes, AACP Media & Event Sales, at jrhodes@networkmediapartners.com Š2017 by the American Association of Colleges of Pharmacy. All rights reserved. Content may not be reprinted without prior written permission.

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Freelance Writer

Athena Ponushis

Freelance Writer

Jane E. Rooney

Volume 10 2017 Issue 3


@AACPharmacy a look inside

campus connection

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Growing Pains When a patient was suffering from the effects of cancer, one pharmacist and UMES faculty member sought relief through medicinal cannabis. Now, she hopes to combat the social stigma of this medication and discuss the role pharmacy schools play in this important area of practice.

community impact

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A New Standard of Stewardship

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Pharmacists are key players in fighting the increasing threat of antimicrobial resistance.

Hitting the Target Pharmacy interventions have a triple aim to improve care, reduce costs, and improve health through better care management.

@AACPharmacy

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And the March Goes On Support for science shines bright during a rainy day in D.C.

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Annual Meeting on the Horizon The electric sights and sounds of Nashville provide the perfect backdrop for Pharmacy Education 2017.

AACP Annual Meeting Gaylord Opryland Resort & Convention Center

Nashville, Tennessee

P

July 15–19, 2017

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community note publisher’s impact

Dear Colleagues: I grew up in the sometimes turbulent 1960s and 1970s, but in a relatively sheltered environment. Thus it may be no surprise that my first march for something was the April 22 March for Science in Washington, D.C. It was a wet and wonderful experience as I joined tens of thousands of caring and committed individuals at approximately 600 locations around the world to express our support and concerns about the state of science. The world needs discovery, innovation and the translation of all this great work into solutions to the most pressing problems of our times. Support for science transcends politics as demonstrated by strong bipartisan support from public research funding on Capitol Hill. The messages from marchers were poignant, funny and clear—science is serious business and essential to our future. We will celebrate the work of outstanding scientists and other academic leaders at Pharmacy Education 2017 in Nashville in just a few short weeks. Drs. Taylor and Schmidt will receive our highest research awards. Dr. Nicholas Popovich will be the recipient of the inaugural Lifetime Achievement Award recognizing his outstanding teaching, scholarship, mentoring and other leadership contributions that have impacted the lives of so many. And more than 2,000 members and friends will immerse themselves in four days of intense education and networking. The energy of our meeting continues to amaze me.

And speaking of amazing, I hope everyone will take the time to read and/or listen to the progress AACP has made in the year since our delegates approved the 2016 AACP Strategic Plan. Emphasis in this first phase of implementation has been on Priority #1 and #2, our recruitment and repositioning priorities that are closely linked. What has been so striking in this work is the readiness of so many individuals and institutions to actively engage in our work to reverse the trend in the pharmacy applicant pipeline and to effectively communicate to audiences of consumers and other stakeholders that careers in pharmacy are varied, rewarding and, yes, plentiful. Pharmacy graduates have high rates of employment upon graduation and so many avenues to career fulfillment. We just need everyone’s help to get that word out to those who need to hear it, right down to elementary-age students. Enjoy the waning days of Summer 2017 and the jumpstart that the Annual Meeting provides. I look forward to seeing many of you in Nashville, July 15–19. Sincerely,

Lucinda L. Maine, Ph.D., R.Ph. CEO and Publisher

Have You Connected Yet?

connect.aacp.org

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AACP Connect is the new online community where members can communicate and collaborate with each other 24/7. Use your AACP member login to join AACP Connect and create your profile, start sharing ideas, posting questions, discussing challenges and much more. Get to know your colleagues virtually before connecting in-person at the Annual Meeting in Nashville!


campus connection

Growing Pains When a patient was suffering from the effects of cancer, one pharmacist and UMES faculty member sought relief through medicinal cannabis. Now, she hopes to combat the social stigma of this medication and discuss the role pharmacy schools play in this important area of practice. By Kyle R. Bagin A bond between a pharmacist and a patient can be special. Over time, a dialogue about pain, suffering and solutions for relief grows between the two people. And oftentimes, other caregivers become involved. As a result, the pharmacist plays many roles: medication expert, counselor, listener. Dr. Mary Pat Hoffman, clinical director of Peninsula Alternative Health and clinical assistant professor at the University of Maryland Eastern Shore School of Pharmacy and Health Professions, had one such relationship with a patient who was dying of cancer. As a result, she has devoted her career to studying, teaching and promoting the healing properties of medicinal cannabis.

Q: What was your first experience with cannabis and patient care? What caused you to recognize its medicinal benefits? A: About 12 years ago, I had a patient I saw regularly for about three years—a sweet elderly woman who always wanted to talk to you and know about your day. She had cancer. It really took a toll; she was not tolerating chemotherapy or other treatments very well. Her son came to me late one night, leaned over the counter and said his mother wasn’t doing well—she used to be very active in the community, but hadn’t been out of the house, couldn’t

eat, was weak and growing depressed. He wanted her to try smoking marijuana, but she wouldn’t do it unless I said it was ok, because I had been her pharmacist for a couple years and we had a really good relationship. At that time I didn’t know much about it. Twelve years ago there was a lot less information out there than there is now. I understood his concerns, and thought if my mother was 83, how would I want the end of her days to be? Would I be worried about smoking, or would I be worried about quality of life? I said “I can’t promise that this is going to make a difference in her wellbeing, but I also can’t find any good reason to say no. If she’s comfortable with the physical act of smoking, give it a shot.” She came in two weeks later, looked at me and said, “Honey, you changed my life!” She was sleeping, eating and her mood had been lifted. She said she smoked a couple joints a day, and had never felt better. It eased her nausea, increased her appetite, improved her mood, lifted her energy levels and she was able to get some sleep. I thought, “Wow, there’s gotta be something to this.” So I spent the next 12 years researching and learning what I could about medical marijuana.

Q: How did this experience lay the groundwork for a course at the University of Maryland Eastern Shore? A: In fall 2015, I applied for a medical dispensary permit with three partners, situated on the Eastern Shore of Maryland, which is a great area for cannabis and hemp cultivation. And with a great university nearby in the University of Maryland Eastern Shore, which has a pharmacy school, a physical therapy school and a physician assistant program, we sought their support in our endeavors to open this dispensary. After meeting with the school’s administration and explaining the approach we were taking, which was a medical-based model of care that I have a lot of experience in—they gave us their support. Then in April 2016, Dr. James L. Bresette, associate dean of development and external relations and associate professor of pharmacy practice, called me and asked what I thought of coteaching a medicinal cannabis class. I didn’t even have to think about it—it’s pretty groundbreaking.

Q: What topics did the course address? A: Dr. Bresette and I wrote the curriculum: it was a one-credit elective class, with 10 students, and covered all the important topics, such as the history of the plant, the variety of the plant,

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the pharmacology, the pharmacokinetics, the endocannabinoid system and associated medical conditions. We had an analyst from Steep Hill Laboratories weigh in, along with a private sector attorney, a public sector attorney and an addiction specialist. It was an allinclusive and very complete introductory class.

It was important for me to teach this specialty area of pharmacy because I believe erasing the stigma is a huge part of the success of cannabis therapy. Patients have to be open and honest, and if they’re afraid to tell their pharmacists or physicians that they’re using cannabis, they’re not going to get the best outcome. Cannabis can interact with some medications and can When these students graduate next decrease the need for others. If you’re year, cannabis will be legal to use as a pain patient, and you’re prescribed medicine in our state. And we have opiates, but you’re also using cannabis many pharmacists and physicians who to control your pain, how is your predon’t know anything about it. I think scriber going to know to cut your dose, bringing it into the pharmacy school or help you step down your dose, and curriculum is an important first step. let the cannabis step in and supplement Q: How important do you think it is for that? We need to have an open dialogue pharmacy schools to provide this type with our patients.

of education and training for students? Q: Do you think it’s up to schools to A: I think it should be mandatory. Can- lead a change in practice? Or do you nabis therapy is legal as medicine in think change starts from practice and more than half of our states now. As works toward schools? pharmacists, we are positioning ourA: Starting in the schools is important, selves as experts on the way medication because there is so much of a social works in the body, but we’re leaving stigma, and if you’re learning about this one drug out and it’s one that has been in a professional program, it’s going to around for almost 5,000 years. Canhelp to break that stigma. nabis has been used as a medicine a lot longer than it has not been used as a medicine.

Dr. Mary Pat Hoffman, clinical director of Peninsula Alternative Health and clinical assistant professor at the University of Maryland Eastern Shore, first recognized the medicinal benefits of cannabis during a relationship she developed with a cancer patient. “It eased her nausea, increased her appetite, improved her mood, lifted her energy levels and she was able to get some sleep. I thought, ‘Wow, there’s gotta be something to this.’”

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If you’re a medical professional, turning to traditional professional journals, the information isn’t there. This is a grassroots effort and I think that we start hearing more personal accounts from people using it, that’s when people are going to see the benefits and realize that this is an incredibly useful plant.

Q: What’s next for the UMES course? A: This was a great first step. It’s the first time we’ve offered the course and so we definitely have some changes to make. If we can start while students are still in school, by the time they graduate and are out as practicing pharmacists, it’s just going to be another medicine to them. It’ll be part of the science and part of drug therapy. The majority of people that are using it are very serious about using it as a proper medicine. We still have a lot of work to do, but we’ve come a long way, and I think it’s important to keep moving forward. P Kyle R. Bagin is digital media manager at AACP and editorial assistant for Academic Pharmacy Now.


community impact

A New Standard of Stewardship Pharmacists are playing key roles in the increasing threat of antimicrobial resistance. The need to reduce the use of inappropriate antimicrobials across all healthcare settings in response to growing antimicrobial resistance is among the most discussed topics in healthcare today. As reported by the World Health Organization in its May 2016 fact sheet, “Antimicrobial resistance threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi.” Adding to the threat, 20 to 50 percent of all antibiotics prescribed in U.S. acute care hospitals are either unnecessary or inappropriate, according to the Centers for Disease Control and Prevention (CDC). Held in June 2015, the White House Forum on Antibiotic Stewardship sought the commitment of The Joint Commission and more than 150 representatives of major healthcare organizations, food companies, retailers and animal health organizations to implement changes over the next five years. Through the responsible use of antibiotics, the changes are intended to slow the emergence of antibiotic-resistant bacteria, detect resistant strains, preserve the efficacy of existing antibiotics and prevent the spread of resistant infections. “This issue is far reaching because 70 percent or more of antibiotics used in the U.S. in a single day are used in the animal industry,” said Dr. Ryan P. Moenster, associate professor of pharmacy practice and interim director of the division of specialty care pharmacy. “The cocktail of antibiotics given

to livestock makes its way into our food and into wildlife from industrial waste, which breeds resistance. Organisms are rapidly developing resistance to the available antimicrobial agents, and we are not developing new antibiotics at a very fast rate.”

Value Added As healthcare organizations work to reduce the threat of antimicrobial resistance, pharmacists are playing an integral role. The Joint Commission’s recent Medication Management standard on antimicrobial stewardship, MM.09.01.01, recognizes the value of pharmacists as it outlines the latest requirements for hospitals, critical access hospitals and nursing care centers. “Antimicrobial stewardship is multifaceted,” said Dr. Scott Micek, associate professor of pharmacy practice. “To fully practice this approach, interdisciplinary teams that include pharmacists must ensure the optimal selection, dose and duration of antimicrobials leading to the best clinical outcome while producing the fewest possible side effects. The risk for subsequent resistance can be minimized. A pharmacist’s knowledge of antimicrobial pharmacokinetics, pharmacodynamics and local antibiograms, along with a detailed understanding of the research for various infections, promotes stewardship in every sense of the definition.” The new standard was developed with significant support from the Centers for Medicare & Medicaid Services, the CDC and the Society for Healthcare Epidemiology of America, and consists

of seven core elements: leadership commitment, accountability, drug expertise, action, tracking, reporting and education. A particular emphasis is placed upon the role of the pharmacist as part of a multidisciplinary team. As outlined in The Joint Commission requirements, each antimicrobial stewardship multidisciplinary team must include an infectious disease physician, infection preventionist(s), pharmacist(s) and a practitioner. To comply with the drug expertise component of element five of the standard, a single pharmacist leader must be appointed and made responsible for working to improve antibiotic use. “This new standard increases the need for pharmacists to be trained in antimicrobial stewardship or infectious diseases,” Moenster said. “As approaches on how to address antimicrobial stewardship in outpatient settings are being developed, community pharmacists will be key in educating their patients on the appropriate use of their antibiotics.” The success of the standard and reduction of the inappropriate use of antimicrobial agents relies heavily upon collaboration from a wide range of industries and specialists. However, it is clear pharmacists will play a critical role in the fight against antimicrobial resistance. From pharmacy researchers in labs developing new antibiotics to community pharmacists educating patients, a pharmacist’s commitment to antimicrobial stewardship will be inherent in every step of the process. P This story was originally published in the Spring 2017 Issue of Script, St. Louis College of Pharmacy’s alumni magazine. Read the current issue at stlcop.edu/script.

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community impact

Hitting the Target Pharmacy interventions have a triple aim to improve care, reduce costs, and improve health through better care management. By Jane E. Rooney

A recent American Hospital Association Annual Survey reveals that there were approximately 35 million hospital stays in the United States in 2015. As many as one in five patients is readmitted within 30 days of his or her discharge, according to the Agency for Healthcare Research and Quality (AHRQ). With an aging population, increased life expectancy and about half of adults suffering from one or more chronic conditions, hospital visits and medication use are increasingly common. Expenditure projections from the Centers for Medicare & Medicaid Services (CMS) indicate that the U.S. healthcare system is the most expensive in the world, accounting for 17 percent of the gross domestic product. Pharmacists are among the many healthcare stake-

holders exploring interventions that will lead to healthier patients, thereby lowering costs. The Institute for Healthcare Improvement, for example, is one organization pursuing initiatives with these goals in mind. The IHI Triple Aim is a framework that describes an approach to optimizing health system performance. The Triple Aim includes improving patient care, improving health and reducing costs. IHI suggests that when communities achieve the Triple Aim, patients can expect less complex and more coordinated care. Reducing the per-capita cost of care for populations will lessen the pressure on publicly-funded healthcare budgets. To put the Triple Aim into action, IHI recommends broadening the role of primary care and other community-based services. Academic Pharmacy NOW  2017 Issue 3

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community impact

AHRQ, part of the U.S. Department of Health and Human Services, is another entity that is focused on interventions that improve care. AHRQ partnered with researchers at the Boston University Medical Center to develop the Re-Engineered Discharge toolkit to assist hospitals, particularly those with diverse populations, with reducing readmissions and post-hospital emergency department visits. The toolkit helps patients prepare to care for themselves when they leave the hospital. Hospital staff and patients review the steps to take upon discharge, such as which medications to take and when to follow up with medical appointments. Pharmacists play a key role in ensuring that patients have the necessary information to keep their recovery on track. Other examples of the increasing use of evidence-based interventions illustrate the heightened focus on making the Triple Aim goals a reality. Million Hearts, a national initiative co-led by the Centers for Disease Control and Prevention and CMS, set a goal in 2012 to prevent a million cardiovascular events in five years. The initiative suc-

The Pharm2Pharm model developed by Dr. Karen Pellegrin, University of Hawaii at Hilo, aims to reduce medication problems after hospital discharge. “That’s a common place for problems to arise, so why not put a medication expert on that to prevent subsequent hospitalizations?” said Dr. Pellegrin.

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cessfully aligned disease prevention efforts around a select set of evidence-based public health and clinical goals and strategies. Involving community pharmacists in such interventions “fosters a true collaboration between these pharmacists and researchers such that the nature of the intervention can be transformed and better account for the practicalities of implementing the intervention sustainably,” said Dr. Meagen Rosenthal, assistant professor of pharmacy administration, at the University of Mississippi’s department of pharmacy administration. “These kinds of considerations can also improve our ability to scale up interventions from single clinics and pharmacies to larger communities and health systems.”

Smooth Moves While researching transitions of care during her sabbatical three years ago, Dr. Judith Kristeller, professor of pharmacy practice at the Wilkes University Nesbitt School of Pharmacy, realized that pharmacists could play a bigger role in reducing hospital readmissions. “I saw an opportunity for pharmacists to improve care during transitions and I saw a lot of problems with medication management as patients transition from hospital to home,” Kristeller said. “I thought that pharmacists could have a positive role during that transition, and even beyond that, for patients with chronic disease to optimize medication management and keep them out of the hospital.” Last fall she and Dr. Dana Manning, a fellow pharmacy professor at Wilkes, received a three-year, $150,000 grant from the Cardinal Health Foundation to help improve patient medication use and ease the transition from hospital to home. They are developing a model where hospital and community pharmacists can work together to provide care as patients experience this transition. “We are exploring ways to develop a process that is efficient, effective and sustainable,” she noted.


community impact

“I thought that pharmacists could have a positive role during that transition, and even beyond that, for patients with chronic disease to optimize medication management and keep them out of the hospital.” ­— Dr. Judith Kristeller Kristeller said that she believes pharmacists are highly underutilized. “If [pharmacists] had information about the patient and knew what medications were being used and why we are using them, they could provide ongoing assessment and could counsel patients on adherence issues, non-pharmacological treatment strategies, self-care issues and could encourage them to talk about potential medication-related problems.” She added that giving pharmacists regular access to patients allows them to talk directly to patients’ primary care physicians. She encourages pharmacists to do continuous patient education and counseling to keep patients with chronic conditions from having to return to the hospital.

A pharmacist-focused model. Similar research is underway at the University of Hawaii at Hilo Daniel K. Inouye College of Pharmacy. Dr. Karen Pellegrin, the college’s director of continuing education and strategic planning, also wanted to explore what happens with care transitions when patients are moved from one place to the next in the healthcare system. While there have been many models that attempt to improve that transition, she explained, none had really focused on the unique expertise of the pharmacist. Funded by a CMS Innovation Center Health Care Innovation Award, the Pharm2Pharm model focuses on reducing medication problems after hospital discharge.

Some of the grant money is devoted to technology-related aspects, but some goes into building the project’s sustainability. “We have pharmacy students that do a lot of the clinical work in terms of evaluating patients, meeting with patients, developing an assessment and plan and communicating with the patients,” she said. She assesses how the model is working from the patients’ perspective by collecting patient satisfaction surveys and tracking the success of the interventions. “We also want to evaluate from the perspective of the community pharmacist to identify opportunities and barriers to bringing them into this collaborative practice with hospital pharmacists to provide continuity of care,” Kristeller added. “We want to survey the community pharmacists to find out what we can do to “That’s a common place for problems make that process better.” to arise, so why not put a medication expert on that to prevent subsequent

The Pharm2Pharm model connects a discharging patient’s hospital pharmacist with a local community pharmacist. “It started with an interest in getting community pharmacists better positioned in the broader healthcare system,” said Les Krenk, independent pharmacy owner.

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“If we really want to improve quality of care and be more cost effective, we have got to get pharmacists better positioned and compensated across all healthcare settings.”

­— Dr. Karen Pellegrin hospitalizations?” she said. The model works like this: Hospital pharmacists screen newly admitted patients with evidence-based criteria. They start working with patients while they are in the hospital and then do a handoff to the community pharmacist. From that point forward, the community pharmacist handles the patient post-discharge for up to a year. The inspiration for the Pharm2Pharm model came from Les Krenk, independent pharmacy owner, who wanted to better utilize community pharmacies. Pellegrin and Krenk realized that the hospital setting would allow them to identify high-cost, high-risk patients. “It started with an interest in getting community pharmacists better positioned in the broader healthcare system,” she explained. “That’s what we did by creating a medication management system that really leverages that expertise. We thought that if we could do a better job taking care of medications, we could reduce hospitalization rates.” With three years of baseline data showing the stable medication-related hospitalization rate among those 65 and older, the Pharm2Pharm model was implemented in about half of the general acute care hospitals in the state and yielded a significant decrease compared to those hospitals without Pharm2Pharm. The model was associated with an estimated 36 percent reduction in the medication-related hospitalization rate for older adults.

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Pellegrin’s data reveal that the avoided cost of those hospitalizations was about $6.6 million. The cost of the pharmacists delivering those services was $1.8 million, a robust return on investment. These results were published this past year in the Journal of the American Geriatrics Society. “We surveyed pharmacists and patients and tried to get everyone’s perspective on the model,” she noted. “The patient ratings were through the roof. They were so happy to have these services. These patients typically have multiple chronic conditions. Having that expert pharmacist who was able to take the time to sort through to get them on the best medication regimen and work on adherence… that’s the most attention many of these patients had ever had.” In a population-level project such as this one (as opposed to a clinical trial), the team was constantly working to improve the model. “We had a systematic outreach program with physicians.” Pellegrin said. “We implemented really novel health information technology. That was phased in to give the pharmacists more efficient and timely access to clinical information, which is so critical to doing medication management properly. It was all continuously developed. We had mandatory training that was updated as we made changes. That allowed us to refine the model over time.” While Pellegrin said she is confident that Pharm2Pharm is a scalable model, she is still working to drill down to see which factors predicted better success and where it had the biggest impact. “These follow up analyses will help health plans, ACOs and others adapt the model within their unique setting. We have standard operating procedures, training, and tools, such as a more user-friendly pharmacist


community impact

recommendation template based on physician feedback. People can adapt these tools as much as they would like. Our online training (a six-hour continuing pharmacy education program) ensures each learner knows the concepts before they complete the program.” As people live longer and rely more on medications, she said, pharmacist involvement will be crucial to reducing hospital readmissions and helping with medication management. “If we really want to improve quality of care and be more cost effective, we have got to get pharmacists better positioned and compensated across all healthcare settings.”

Using the American Pharmacists Association national program Operation Immunization—which allows pharmacy students to brainstorm ideas they have to promote immunization in the community—as a framework, Long and Hayney set out to increase HPV immunizations on campus. “The pharmacy students helped with outreach in Immunization Revelation 2015,” Long noted. “In 2016, Mary was At the University of Wisconsin-Madison University Health Services, an idea for able to arrange for pharmacy students an M.P.H. research project turned into an intervention that focused on keeping to actually administer the HPV and students healthy by promoting immunization. Angela Long, an independent pubflu vaccines. We wanted to showcase lic health professional, was looking for a project to pursue when she thought about pharmacy student involvement.” By her two college-age daughters and the struggle around getting the HPV vaccine. piggybacking the HPV intervention on Of the 14 million new HPV infections in the United States annually, more than 50 the flu shot clinic, the university saw percent are estimated to occur in persons age 15–24. a 37 percent increase in HPV vaccinations in 2015 and a 76 percent increase “Immunization is one of a number of things that have brought clinical pharmacists in 2016 during the months of September closer to patients,” said Long, who approached the University of Wisconsin about through November each year, resulting taking on the project in 2014. She had observed nursing students administering in a 140 percent increase in HPV vacinfluenza vaccines and wanted to get pharmacy students involved in the same way. cination from 2014 to 2016. The university was looking for a quality improvement program to increase HPV vaccination rates. Long connected with Dr. Mary Hayney, a professor with the Long did not formally evaluate the School of Pharmacy, and they decided to target the international student populaimmunization campaign, but she said tion because those students had insurance that covered vaccines administered at the key to the program’s success was University Health Services, which simplified billing. targeting a specific population. “We

A University of Wisconsin—Madison student pharmacist immunizes a patient. By including HPV vaccines with their ongoing flu shot clinic, the university saw a 140 percent increase in HPV vaccination from 2014 to 2016.

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really tapped into the Chinese student population by way of two pharmacy students who spoke Chinese,” she said. “They were able to reach out on social media. We felt that the second year we were able to reach further into that community because we had done it the previous year.” Long, Hayney, and their third collaborator, Craig Roberts, M.S., PA-C, are helping other campuses replicate the campaign by providing the methodology via presentations and professional interactions. “Each school will have a unique approach to increasing HPV vaccination,” Long continued. “Mary had to work through the Wisconsin Pharmacy Examining Board to gain a waiver to the supervisory rule; each state has different rules in terms of student pharmacist immunization. Insurance coverage is different at every school. The main concept of piggybacking with the fall flu campaign is to reach an immunization-ready audience, which is a common thread we feel can be successful in any situation.”

Added Hayney, “Any time health professions students get the opportunity to practice with their peers, it benefits the whole community. Students gain experience. Pharmacy students get to practice in a setting where they are supervised. It also gives them some exposure to emergency preparedness.” She said that another benefit of involving pharmacy students is that undergraduates who hadn’t thought about pharmacy school might reconsider when they see their fellow students in action. “Peer-to-peer outreach is key,” she noted. “Have a champion and make sure that champion can relate to students who might be ready to get the vaccine but need a recommendation from a peer.”

A Valuable Relationship Another professor at the UW–Madison School of Pharmacy is also exploring how pharmacists can use their interactions with patients to promote lasting healthy habits. Dr. Betty Chewning teaches a required class for Pharm.D. students that involves them collaborating with community pharmacies to plan services that will raise patient expectations about pharmacist roles. “In addition to teaching students program planning methods, the goal is to help the pharmacies offer new, high-quality sustainable services to enhance the health of their patients,” explained Chewning. Her research aims to support and promote an active partnership between pharmacists and patients. Recently, she and her students worked with community pharmacies to help individuals orchestrate their regimen schedule to take medication doses safely and efficaciously at the fewest unique times per day. “The individual identifies his or her ‘typical day’ and preferences for best times to take medications, and in partnership with the pharmacist, determines the best schedule,” she said, noting that this simplifies medication management. In another example, a one-question assessment at the pharmacy provided smokers with the opportunity to connect with telephone

A University of Wisconsin–Madison program specifically targeted the international student population due to their specific insurance covering vaccines administered at University Health Services.

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Dr. Mary Hayney, professor at the University of Wisconsin—Madison School of Pharmacy, found the student pharmacist-administered program beneficial to the whole community. “Students gain experience. Pharmacy students get to practice in a setting where they are supervised. It also gives them some exposure to emergency preparedness.”


community impact

tobacco Quit-Lines. Chewning also worked with physician and pharmacist dyads to refer individuals with complicated regimens to a community pharmacist for MTM consultations. This referral process reinforced the legitimacy of the pharmacists’ delivery of MTM. Chewning teaches students to follow planning steps when developing interventions. These include conducting SWOT analysis, comparing options, identifying relevant literature, writing objectives, describing the intervention, flowcharting the preparation process preceding implementation, conducting a cost/benefit analysis, developing a quality improvement plan, testing the service and summarizing what revisions are needed. Deciding which interventions are needed is based on pharmacy experiences and reviews of the research literature on patient needs. The dose orchestration approach originated in part when Chewning had to help her husband manage his complicated medication schedule. One of her students undertook the Quit Line referral study as part of her dissertation, which involved a randomized controlled trial with 16 Walgreens pharmacies. “Each year the student pharmacists in my course plan and pilot tests of services with about 20 community pharmacies,” she noted. “Pharmacists are an important, underused resource that patients need to help them manage their medications effectively. The challenge is to help patients understand what pharmacists can offer, and to help pharmacists understand how grateful patients would be to receive this help.” P Jane Rooney is a freelance writer based in Oakton, Va.

Interventions From Bench to Bedside By Kirsten F. Block Although all interventions are aimed at improving health and patient care, some interventions begin long before a healthcare team interacts with a patient. In some cases, interventions can start in the laboratory, far from direct interaction with patients but always with patients in mind. And when society encounters health crises, this “all hands on deck” approach to interventions can have a huge impact on improving patient outcomes. To explore how basic research synergizes with practice interventions to improve health and the quality of care, and how the academic pharmacy community is making critical contributions in these indirect patient interventions, look no further than the opioid epidemic. Without a doubt, research at colleges of pharmacy—some of which was highlighted in a December 2016 feature in Academic Pharmacy Now—has enhanced our understanding of the epidemic’s impact and continues to seek new ways to address it. With the rate of prescription painkiller use climbing dramatically in recent decades, a diverse array of tools and interventions are needed to combat the consequences. One such tool already employed to curb abuse and misuse of opioids stems from basic research in drug delivery technology by Dr. James W. McGinity of The University of Texas at Austin. Using a process called hot-melt extrusion, a technique that has long been utilized by the plastics industry but has only recently gained momentum in the pharmaceutical industry, McGinity, a professor emeritus and the Johnson and Johnson Centennial Chair Emeritus in Pharmacy, and his then-graduate student, Dr. Feng Zhang, were able to fuse the active drug component of OxyContin with a polymer carrier that produced a nearly indestructible OxyContin tablet. Just how does this technology translate to patient outcomes? The new formulation creates tablets strong enough to survive a direct blow by a hammer while remaining intact, greatly reducing the risk of a pill being crushed and snorted. The tamper-proof design also prevents extraction of the active component in water, diminishing the ability to inject the drug into the bloodstream. By tackling two common paths for opioid abuse, McGinity’s technology has the potential to reduce the number of opioid overdoses and save many lives. In recognition of this and his many other advances in drug delivery technology, McGinity was recently inducted as a fellow of the National Academy of Inventors. As a result of McGinity’s research, OxyContin was reintroduced to the market in a new abuse-deterrent form around 2010. It was the first abuse-deterrent formulation approved by the U.S. Food and Drug Administration, and since its initial rollout, a handful of other abuse-deterrent opioids have received FDA approval. Although not completely abuse-proof, abuse-deterrent formulations have become a valuable asset in combatting one aspect of the opioid epidemic, and their inclusion in the FDA’s Opioid Action Plan is a reminder of the ways in which innovation at the bench can shape patient interventions. Kirsten F. Block is Associate Director of Research and Graduate Programs at AACP.

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community impact

BIGGER FOOTPRINT. BOLDER VISION. The role of the pharmacist is expanding. So are we. Our 60,000-square-foot building addition opens this fall on Rutgers’ health sciences campus.

Ernest Mario School of Pharmacy

A PREMIER PHARMACY SCHOOL WITHIN A POWERHOUSE ACADEMIC HEALTH CENTER

WE’RE CELEBRATING A

BIG YEAR (OUR 125TH ANNIVERSARY) with a new home for the way 21st-century pharmacy is practiced. Our expanded building puts patient-centered, team-based care at the center of pharmacy education—by design. That’s right. Now we’re all set for . . .

A N OT H E R E R A O F I N N OVAT I O N . 16

Academic Pharmacy NOW  2017 Issue 3


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And the March Goes On Support for science shines bright during a rainy day in D.C. By Athena Ponushis Marching for Science on Capitol Hill, Dr. Kirsten Block, saw witty protest signs and snarky protest signs, signs expressing anger and showing scientists grappling with all stages of grief, others alluding to hope and the infinite possibilities of science. But there was one sign she saw that went straight to the heart of the matter: A little girl, maybe 7 or 8 years old, holding up the words, “I want to be a scientist.” “That is why we are marching,” Block said. “We’re marching for our future, plain and simple, whether it’s the future of the research workforce, like that little girl who wants to be a scientist, or the future of a healthy society, we’re marching for everybody.” Block does not want that message to get lost. Scientists are marching for the greater good, not just the money to do the research. “I’m not marching for our faculty members to have more funding because then I’ll have a job. I’m march-

ing for our faculty members to make a difference.” Block, AACP associate director of research and graduate programs, spent much of her childhood in hospital hallways. She lost her dad to cancer when she was a teenager, inciting her lifelong passion to be a cancer researcher. Not long after finishing her postdoctoral fellowship and hanging up her own lab coat to work at AACP, her mom was diagnosed with a rare uterine cancer. Block felt helpless and frustrated. She saw potential for research that could make a difference in her mom’s life, in other lives, but that potential was being diminished as research funding was continually being cut. She found hope through her work with AACP, seeing the sincere passion of pharmacists to improve societal health. That’s part of the reason why she went to the march. She needed to feel re-inspired. She also felt it was important for AACP to

have a presence there, to show members how much the Association supports their research endeavors. “Research is a vital part of the colleges of pharmacy,” Block said, “so if we can be that example of enthusiasm for advocacy and for standing up for what we believe in, in terms of supporting evidence-based policy and scientific fact not being vilified, then I think we’re moving a step in the right direction, and hopefully empowering our members to take action, too.”

‘Science is inherently political,’ So Speak Up To those who worried that the march might be seen as science becoming too political, Block said she initially had similar apprehensions, “but it’s important for us as scientists to remember, considering how much of our research is funded by the taxpayers, science is inherently political.” The rainy April conditions didn’t deter attendees at the Washington, D.C. March for Science. “Whether it’s the future of the research workforce, like that little girl who wants to be a scientist, or the future of a healthy society, we’re marching for everybody,” said Dr. Kirsten Block.

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Cross-Country Activism Marches in Los Angeles, San Francisco and Minneapolis were attended by pharmacy academicians. UCSF organized a teach-in and rally coinciding with the events held across the country and around the world on April 22. Learn more by reading about the activities in the major media outlets: • Los Angeles Times: http://lat.ms/2psjxOK • UCSF News Center: http://bit.ly/2p2hsHN • Minneapolis Star Tribune: http://strib.mn/2p5VJNB

A Budget Battle Ahead

Block believes there’s been a disconnect between the ivory tower and the real world, and that there hasn’t been enough communication between the research enterprise and the people it’s serving. She would like to see the march serve as a catalyst for conversation, so people can see how their lives are intertwined with science and see that science, and scientists, are accessible. More than anything, she hopes people stay engaged.

“Even if we feel like we’ve gotten over the hill with this current fiscal debate, there are more battles on the horizon,” Block said. “Everybody needs to stay charged.”

Block encourages AACP members to step away from their offices and their lab benches, to talk with their neighbors and community leaders. “Explain to them what it is that you do and why it should matter to them,” Block said. “There’s only so much we ourselves can do, but if we amplify our voices with everyone else, that’s when we can actually make a real difference.”

When Block speaks with her legislators, she tells them about her experience as a caregiver and as a child growing up in the face of cancer, how she felt like research and the biomedical enterprise was the way she could help another child not have to sit through what she did. She tells them of all the good that’s being done at pharmacy schools and connects legislators to the scientists doing the work.

Every year, there seems to be debate about: ‘Is AHRQ really necessary? ‘Do we need to support the NIH at the level that we do?’ ‘How important is STEM education?’

Above left: (Left to Right) Dr. Kirsten Block with Dr. Cynthia Boyle, AACP past president, and Dr. Lucinda L. Maine, AACP executive vice president and CEO. Above right: A teacher displays a sign of support with her students’ signatures. Block encourages educators to talk with neighbors and community leaders about the importance of their work. “Explain to them what it is that you do and why it should matter to them.”

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It’s those stories that go a long way in helping lawmakers understand the reach of science, Block said, so she’s organizing a postcard writing campaign for AACP’s Annual Meeting, where members can write a note to their legislators about why pharmacy research is so important and why it needs to be supported in full.

Schools Step Into the Action Faculty, administrators and students didn’t miss the opportunity to show their support for science on April 22. Below is a snapshot of activities in which schools participated. Albany College of Pharmacy and Health Sciences: ACPHS students, along with President Dr. Greg Dewey and his wife Cindy, walked from campus to the state capitol in Albany.

“As much as a scientist may want to sit back and do the research and say, ‘My results will speak for themselves,’ no, they won’t,” Block said. “It’s not enough to just do successful research anymore. You have to be your own advocate and you have to be engaged.” P Athena Ponushis is a freelance writer based in Ft. Lauderdale, Fla.

AACP’s Will Lang showed his support in Chapel Hill during the Tar Heel 10 Miler.

University of Wisconsin-Madison: Dr. Jeanette Roberts, former dean, professor and director of the UW Center for Interprofessional Practice and Education, gathered with other participants at James Madison Park. The Washington, D.C. march saw a wide range of signs supporting research and science: from the displeased and sarcastic, to the witty and hopeful.

(Not pictured) The University of Mississippi: Members of the School of Pharmacy marched from the Lyceum, the main building on campus, and into the downtown Oxford Square. The same day, marchers held an indoor rally on the UM campus where participants spoke about why they support science and how to promote STEM activities in the community.

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Annual Meeting on the Horizon The electric sights and sounds of Nashville provide the perfect backdrop for Pharmacy Education 2017. With the summer heat comes the hottest educational and networking event of the year—the AACP Annual Meeting, July 15–19. Topics important to pharmacy and pharmacy education will be explored over the course of four days, including a critical look at the current healthcare environment and anticipated changes, and the emphasis on patient care and counseling. Three valuable pre-conference workshops, more than 50 special sessions and nearly 500 educational posters await attendees at the Gaylord Opryland Resort and Convention Center.

Opening General Session

Building Bridges in a Dynamic, Ever-Changing Healthcare Environment Kevin E. Lofton, MBA

Kevin E. Lofton is the chief executive officer of Englewood, Colorado-based Catholic Health Initiatives. He joined CHI in 1998 and has served as CEO since 2003. Mr. Lofton is widely recognized at the national level as an experienced healthcare executive whose background includes top positions in public, university, community and faith-based hospitals, including serving as the chief executive officer of the UAB and Howard University Hospitals.

Mr. Lofton will kick-off the Annual Meeting with a dynamic discussion of his health-systems leadership experience, reflecting on the amount and direction of change as the U.S. strives to embrace value and performance as key tenets of patient-centered healthcare delivery, and the inclusion of pharmacists and pharmacy as we move from volume to value.

Thank you to our generous sponsors whose contributions make Pharmacy Education 2017 possible:

Happy Feet While attendees are making their way from one session to the next, their steps could be adding up. AACP’s first-ever Walking Challenge, which uses the Challenge Runner app, will track individuals’ steps Sunday through Wednesday. Top steppers will win prizes! More information will be available within the Annual Meeting app or at the Registration and Help Desk.

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Educational Day Sponsor

As health care in the United States shifts to a patient-centered, value-based system that rewards positive outcomes, the NACDS Foundation is examining innovative care delivery that improves patient health, system efficiency and the quality of care. The Foundation is particularly interested in initiatives that are scalable and sustainable which increase accessibility, improve chronic disease conditions, and generally improve patient outcomes.


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AACP Annual Meeting Gaylord Opryland Resort & Convention Center

Nashville, Tennessee Science Plenary

Science=Solutions: The Opioid Crisis in the USA Wilson M. Compton, M.D., M.P.E.

P

July 15–19, 2017

Join Dr. Wilson M. Compton, deputy director of the National Institute on Drug Abuse (NIDA) of the National Institutes of Health, as he describes how the misuse of and addiction to opioids is a serious national problem that affects public health, as well as social and economic welfare. At NIDA, Dr. Compton provides scientific leadership in the development, implementation and management of NIDA’s research portfolio and works with the director to support and conduct research to improve the prevention and treatment of drug abuse and addiction. At the Science Plenary he’ll address the opioid crisis in the United States, the

rising incidence of neonatal abstinence syndrome (due to opioid use during pregnancy), and the increased spread of infectious diseases, including HIV and hepatitis C. Primary approaches to addressing the crisis include prevention, addressing the underlying addiction issues, and treating overdoses directly by increasing access to naloxone. Longerterm research includes the development of pain medications with reduced abuse/ addiction potential. In addition, the ways that pharmacists can play central roles in changing prescribing practices, increasing access to naloxone, and improving access to methadone and buprenorphine with pharmacy dispensing will be reviewed.

Help Supply a Local Classroom This year, AACP has partnered with PENCIL, a Nashville-based organization that collects donated school supplies—pencils, pens, notebooks, backpacks and more— for local teachers to shop at no cost to them. Annual Meeting attendees will have the opportunity throughout the meeting to donate supplies at the Registration and Help Desk or through the customized donation link: www.pencilforschools.org/aacp. Learn more at www.pencilforschools.org.

Platinum Sponsors

Certiphi Screening is a leader in student screening, creating AACP’s centralized student screening program and helping individual schools and other fields of study build thorough, compliant student screening programs. Certiphi Screening also provides applicant screening services to top healthcare organizations. Certiphi Screening’s applicant screening services are endorsed by the American Hospital Association.

Making Medicines: The Process of Drug Development is an innovative and interactive online course designed to examine the fundamental concepts, techniques of the drug development process.

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Tuesday General Session

Reconciliation Regina Holliday

Regina Holliday is a Maryland-based patient advocate and artist known for painting a series of murals depicting the need for clarity and transparency in medical records. This advocacy mission was inspired by her husband Frederick Allen Holliday II and his struggle to receive appropriate care. Afflicted with kidney cancer, Fred suffered poor care coordination, a lack of access to data and a series of medical errors and, as a result, lost his battle. These institutional flaws spurred Holliday to try to improve care for her husband, as well as for all patients who are abused in this way. As a result, Fred’s death inspired Holliday to use painting as a catalyst for change.

With her passion for advocating for patients to receive timely access to their healthcare data, her artwork became part of the national healthcare debate. Backed by her own patient and caregiving experiences, Regina Holliday travels the globe heralding her message of patient empowerment and inclusion in healthcare decision-making, offering guidance on crowd funding in healthcare. She fearlessly stands before officials and practitioners demanding a thoughtful dialogue on the role patients play in their own healthcare.

www.aacp.org/PharmEd17 On Twitter? Follow us! Tweet @AACPharmacy with #PharmEd17 Add Even More Value to #PharmEd17

AACP TechXPO

Jumpstart your learning at the 2017 Annual Meeting with three outstanding pre-sessions on Saturday, July 15:

Returning for a second year, the TechXPO features new companies, such as Tabula Rasa Healthcare, Lilly USA, CORE Higher Education Group and Pearson, that will present a featured product, service, research study or program information in a highly innovative format that is particularly relevant for education technology and academic pharmacy.

Teachers Seminar: Learning is NOT a Spectator Sport 8:30 a.m.–3:15 p.m. Joseph T. DiPiro Excellence in Publishing Workshop 8:30 a.m.–11:30 a.m. Early Career Faculty Program: Strategies for GrantWriting Success 1:00 p.m.–3:15 p.m.

Gold Sponsors ®

For more than 20 years, Liaison has streamlined the process by which higher education institutions identify, recruit and enroll bestfit students. More than 5,000 programs on over 800 campuses nationwide reach prospective students, outsource administrative tasks and create exceptional experiences for applicants across the full enrollment cycle through our admissions management and enrollment marketing solutions.

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The PCAT is a specialized test that helps identify qualified applicants to pharmacy colleges. It measures general academic ability and scientific knowledge necessary for the commencement of pharmaceutical education. The PCAT is constructed specifically for colleges of pharmacy.

Rite Aid is a Retail Healthcare Company offering a unique consumer experience by providing access to and coordination of health services, products and expert advice.


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Spotlight on Excellence Sunday, July 16 Robert K. Chalmers Distinguished Pharmacy Educator Award

Volwiler Research Achievement Award

Palmer W. Taylor, Ph.D. University of California, San Diego

S. William (Sandy) Zito, Ph.D. St. John’s University

Tuesday, July 18 Lawrence C. Weaver Transformative Community Service Award The Ohio State University College of Pharmacy

Lifetime Achievement Award

Rufus A. Lyman Award “Development and Application of a Stepwise Assessment Process for Rational Redesign of Sequential Skills-Based Courses”

Nicholas G. Popovich, Ph.D. University of Illinois at Chicago

Casey E. Gallimore Andrea L. Porter Susanne G. Barnett University of Wisconsin–Madison

Monday, July 17 Paul R. Dawson Award

Eric W. Schmidt, Ph.D. The University of Utah

Silver Sponsors

Bronze Sponsors

Pharmacy CORE Higher Education Group, an education technology company, provides software solutions for experiential education, competency assessment, and electronic portfolios to over 100 colleges and universities.

Walmart pharmacists are transforming the industry by connecting patients with affordable, accessible healthcare. We help people save money so they can live better.

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Apply Today 2018 AACP NMA Conference: Self-Care on the Horizon

February 23-25, 2018 (Attendees should plan to arrive Thursday, February 22) Renaissance Long Beach Hotel • Long Beach, Calif. Attendees are strongly encouraged to register and stay for the 2018 AACP INterim Meeting, February 24–27. Registration for the AACP NMA Conference is $350.

The AACP NMA Conference is a chance to network with pharmacy colleagues teaching self-care and nonprescription medications throughout the country, share ideas about teaching and scholarship, and stay current with self-care products and therapies that are helping to shape the healthcare of many Americans! Interested faculty will need to submit an abstract related to self-care/nonprescription medication education or practice as part of the full application process.

Visit http://bit.ly/2rMo4Io to learn more and submit an application. To view the conference agenda, visit http://bit.ly/2tE3Xh1. CE will be available! Applications are due August 15.

Academic Pharmacy Now: 2017 Issue 3  

Hitting the Target: Pharmacy interventions have a triple aim to improve care, reduce costs, and improve health through better care managemen...

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