Academic Pharmacy Now: 2023 Issue 2

Academic Pharmacy

The News Magazine of the American Association of Colleges of Pharmacy

NOW

Volume 16 2023 Issue 2

AI: Friend or Foe? Artificial intelligence holds immense promise but poses worrisome questions. Pharmacy schools are using AI to prevent adverse drug events and leveraging tools like ChatGPT to enhance student engagement. 20 Also in this issue: Insights from a NAM Fellow 5 VIP Treatment for Vets 12

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.

1400 Crystal Drive, Suite 300 P Arlington, VA 22202 703-739-2330 P 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.

NOW

CEO & Publisher

Lee Vermeulen

Editorial Advisor

Lynette R. Bradley-Baker

Editorial Director

Maureen Thielemans

Letters to the Editor

Managing Editor

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

Jane E. Rooney

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.

Editorial Assistant

Kyle R. Bagin

Change of Address

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

Art Director

©2023 by the American Association of Colleges of Pharmacy. All rights reserved. Content may not be reprinted without prior written permission.

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Tricia Gordon

Freelance Writer

Joseph Cantlupe

Freelance Writer

Emily Jacobs

Freelance Writer

Athena Ponushis

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Academic Pharmacy NOW  2023 Issue 2

Volume 16 2023 Issue 2

@AACPharmacy a look inside

campus connection

5 An Elevated Experience As a NAM Pharmacy Fellow, Dr. Adam Bress relished the opportunity to expand his research on preventing cardiovascular disease and optimizing medication use.

community impact

10 NIH Grant Supports

Research on Possible Alzheimer’s Treatment

Students at the Auburn University Harrison College of Pharmacy help to develop a novel drug that may become a therapeutic for patients who are at risk for early onset Alzheimer’s disease.

12 VIP Treatment for Vets

20 AI: Friend or Foe?

COPD CARE began with one University of Wisconsin-Madison pharmacy professor’s vision to help veterans. The primary care service is expanding to VA clinics across the country to reach patients in rural communities.

Artificial intelligence holds immense promise but poses worrisome questions. Pharmacy schools are using AI to prevent adverse drug events and leveraging tools like ChatGPT to enhance student engagement.

@AACPharmacy

30 A Peak at the Mountain of

Programming at #PharmEd23

More than 1,900 pharmacy educators, practitioners and students will head to Aurora, Colorado, July 22–25, to gain new perspectives and skills at Pharmacy Education 2023.

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campus connection publisher’s note

Dear Colleagues, With the arrival of summer comes the excitement and anticipation of “The Big Show,” or more fondly referred to as the AACP Annual Meeting. Every year, pharmacy faculty, deans and administrators look forward to connecting with new and old friends, discussing the latest challenges our profession is facing, and returning to their institutions with new tools and techniques to use in their classroom or practice settings.

A few of the timely session topics that will be addressed during Pharmacy Education 2023, July 22–25, are highlighted in this second issue of Academic Pharmacy Now. In the feature article, “AI: Friend or Foe?,” Dr. Andrea Sikora at the University of Georgia is utilizing AI to prevent adverse drug events in the ICU. Critical care pharmacists are busy, often responsible for too many patients, making it hard to perform such timely interventions. Enter AI and its ability to alert a pharmacist to prevent an ADE before it happens. Dr. Sara Trovinger at Manchester University explains how she is using innovative AI teaching tools in the classroom, such as ChatGPT, to help her students embrace and utilize them effectively. AI will also be featured during our upcoming AACP Annual Meeting, with Dr. Paul Leonardi, author of “The Digital Mindset: What it Really Takes to Thrive in the Age of Data, Algorithms, and AI,” serving as keynote speaker.

Moving from artificial to human intelligence, we profile Dr. Adam Bress as he applies an expert’s eye to preventing cardiovascular disease and optimizing medication use. The associate professor of population health sciences at the University of Utah School of Medicine is using his role as 2020 National Academy of Medicine (NAM) Fellow in Pharmacy to expand new ventures in his research, collaborating with policy experts, clinicians and fellow researchers nationwide. Read about his new perspectives before joining him and 2022 NAM Fellow Dr. Inmaculada Hernandez in a discussion on “Research, Health Science and Policy in Academic Pharmacy” at Pharmacy Education 2023.

Finally, I encourage you to read the article “VIP Treatment for Vets,” which shines a light on the importance of COPD management for veterans. While COPD is the sixth-leading cause of death in the U.S., veterans are three times more likely to experience it than the general population. Dr. Edward Portillo, assistant professor at the UW–Madison School of Pharmacy (and I’m proud to say, a past student of mine!), created the program COPD CARE to deliver treatment to vets thanks to pharmacists practicing at the top of their license within a network of nurses, primary care providers and other healthcare team members.

I look forward to seeing many of you at the Gaylord Rockies in Aurora, Colorado, in just a few short weeks. Until then, enjoy your summer and thank you for supporting pharmacy education and AACP. Sincerely,

Lee Vermeulen, B.S.Pharm., M.S., FCCP, FFIP CEO and Publisher

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campus connection

An Elevated Experience As a NAM Pharmacy Fellow, Dr. Adam Bress relished the opportunity to expand his research on preventing cardiovascular disease and optimizing medication use.

By Joseph A. Cantlupe As an associate professor of population health sciences in the Division of Health System Innovation and Research at the University of Utah Spencer Fox Eccles School of Medicine, Dr. Adam Bress loves diving into research. He focuses on cardiology issues, particularly hypertension, which impacts millions of people across the country. Talking to Bress, you get the sense of his commitment and passion, with the power of his academic training solidly the impetus and driver behind his data-driven science.

That purpose was augmented for him—in sometimes surprising ways—when Bress was selected for the 2020 class of National Academy of Medicine (NAM) Fellowships. The two-year appointment as a Pharmacy Fellow was inspiring, Bress said, as he initiated collaborations with researchers, policy experts and clinicians nationwide and explored new and expanding ventures in his research. The NAM Fellowship is an opportunity for an early career health science scholar to participate in the work of the National Academies and develop as a leader in the field. Under the program, endowed

by AACP and the American College of Clinical Pharmacy, the Fellows continue their regular academic assignment and carry out National Academies’ health and science policy work. Each Fellow also works with an expert study committee or roundtable related to his or her particular interest.

ever before, perhaps more dreams are then open to us, that we wouldn’t have experienced previously.”

In addition to serving as the vice chair of research for the Department of Population Health Sciences at the university, Bress is also an Investigator at the VA Salt Lake City Health Care System. As a cardiovascular clinical pharmacist with training in epidemiology and pharmacogenetics, Bress has concentrated his research on the treatment and prevention of cardiovascular disease, exploring medication usage and targeting health disparities. His work, reputation, accomplishments and qualifications all led to his selection as the fifth Pharmacy Fellow in the NAM program. During that time he served on the committee that wrote the consensus statement titled “Improving Representation in Clinical Trials and Research: Building Research Equity for Women and Underrepresented Groups,” which led to changes in the FDA around requirement for diversity in clinical trials.

“It really elevates the potential for impact of pharmacist-scientists at the highest levels of science and medicine and health policy,” he noted. “It gave me and other Fellows the experiences, the networks—the seats at the table, the opportunities we wouldn’t have had otherwise. Our confidence and skills and experiences go on to a higher level than

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campus connection

“It actually broadened my focus, as my experience and skills evolved, and I learned more about myself, my strengths and weaknesses.” Among other things, it provided “rare and variable skills of collaboration and scientific experience.”

—Dr. Adam Bress

His research focusing on hypertension as well as preventing cardiovascular disease and dementia has been published in the New England Journal of Medicine, The Journal of the American College of Cardiology and Circulation. Bress’s research exploring the application of the Systolic Blood Pressure Intervention Trial results to the U.S. adult population has been cited more than 160 times and he was involved with the new U.S. High Blood Pressure Guidelines in 2017, according to the university. In 2018, he received the American College of Clinical Pharmacy’s New Investigator Award, which recognizes an ACCP member who has made a significant impact on an aspect of clinical pharmaceutical science.

Lessons on Pharmacy’s Impact For Bress, his interest in optimizing medication use and improving health equity made the lessons learned from the pandemic particularly relevant. As the country turns the corner on COVID-19, he reflected on the takeaways for healthcare professionals. “The people with the highest mortality rates were the elderly and also those with chronic conditions, obesity, diabetes and cardiovascular disease,” he said. “Those conditions can be prevented or delayed to some degree through evidence-based behaviors and interventions.”

The Fellowship program has had an extensive impact on his work, he emphasized. He made new connections and found mentors, in addition to discovering opportunities to share his research thanks to relationships fostered through NAM activities. “It actually broadened my focus, as my experience and skills evolved, and I learned more about myself, my strengths and weaknesses.” Among other things, it provided “rare and variable skills of collaboration and scientific experience.”

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Academic Pharmacy NOW  2023 Issue 2

From Zoom meetings to real-life sessions and various events, to “how are you doing?” text messages, he continued, “it opened my eyes to the many roles of government and advocacy groups and nonprofits” related to pharmacy, particularly the CDC (Centers for Disease Control and Prevention) and its attention to opioid issues. Bress said he was inspired by the work that generated “pathways for me to contribute, with deep meaning and purpose.”

Bress has continued to establish collaborations with a multidisciplinary team of investigators in hypertension, cardiology, health services research, epidemiology and pharmacogenetics at the University of Utah and around the country. He is a member of the hypertension working groups for two ongoing NIH-funded cohort studies, including the Jackson Heart Study (JHS), the Coronary Artery Risk Development in Young Adults (CARDIA) Study and the Women’s Health Initiative (WHI). He is also an active member of the Systolic Blood Pressure Intervention Trial (SPRINT) Research Group.

In his clinical work, academic instruction and studies, Bress considers himself to be, above all, a researcher. “Research is what I do 80 percent of the time; 10 percent educator and 10 percent administrator,” he said. “Combining clinical pharmacy and cardiovascular therapeutics and quantitative epidemiology research has been a wonderful synergy and his primary path: “I love the work and training early-stage investigators, coming up with ideas and testing in data. It’s super exciting to me.”

Bress wants to build mentor research programs and “generate information to the public that helps change the narrative around blood pressure and cholesterol screening and earlier

campus connection

treatment” and hopes that will encourage people to be “more comfortable and motivated to consider medication to prevent heart disease, dementia, stroke and kidney disease.”

From his own work and that of other Fellows, Bress sees inspiration for a next generation of pharmacy scientists, “people who are interested in optimizing the medication process, discovering new therapeutics, learning how to use already existing safe and effective medications to help people live healthier and happier lives.”

Looking back on his time as a Fellow, Bress noted that he was grateful “for the vision and experience that changed our professional lives and a huge difference maker, and grateful for the vision to get it started.” P

Learn More at AACP’s Annual Meeting Bress will be a featured speaker at the session “Research, Health Science and Policy in Academic Pharmacy” during AACP’s Annual Meeting next month in Aurora, Colorado. He and other current and past NAM Fellows in Pharmacy will share thoughts on U.S. policy as well as how NAM promotes pharmacy research.

Joseph A. Cantlupe is a freelance writer based in Washington, D.C.

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community impact

NIH Grant Supports Research on Possible Alzheimer’s Treatment Students at the Auburn University Harrison College of Pharmacy help to develop a novel drug that may become a therapeutic for patients who are at risk for early onset Alzheimer’s disease.

By Emily Jacobs Alzheimer’s disease is the most common form of dementia, affecting more than 6 million Americans age 65 and older.

However, early onset Alzheimer’s can begin even as soon as a person’s 30s. Among all people who develop Alzheimer’s disease, approximately 30 percent have the APOe4 allele, a genetic variant that may increase the risk for early onset Alzheimer’s.

Pharmaceutical research out of Auburn University could lead to new treatment options for these at-risk individuals. Dr. Raj Amin, associate professor in the Department of Drug Discovery and Development at the Auburn University Harrison College of Pharmacy, has received a $1.18 million grant from the National Institutes of Health (NIH) to develop a compound to help fight Alzheimer’s. This grant comes to Amin’s laboratory through the NIH Blueprint Neurotherapeutics Network, which aids the development of new drugs for nervous system disorders.

The NIH funding is focused on a set of compounds that target individuals who express the APOe4 allele. The compound AU403IS, which Amin’s lab discovered through in silico modeling, may activate the nuclear receptor liver-X receptor beta, or LXR beta, which may help regulate APOe4 in the brain.

The hope is that this compound could be developed into a therapeutic to help prevent the harmful effects or progression of Alzheimer’s disease.

“This class of compounds actually changes the cholesterol pattern in the brain,” Amin said. “This will turn on certain genes or certain proteins and helps clear away many of the bad effects [of Alzheimer’s].” Such effects include amyloid beta plaques, damaged or dead neuronal material and some neurofibrillary tangles, which accumulates inside or surrounds the neurons, leading to neuronal degeneration.

To apply for the NIH grant, Amin’s team had to write up a proposal for submission to a review panel. The program officer discussed the project and offered feedback to the lab. “The IGNITE program is for advancing compounds with

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high promise,” Amin said. “It goes through a very rigorous review panel…you have people who are from pharma, basic science and clinicians.” According to some of the reviewers, the compound “could transform the way we look at the LXR class of drugs.”

From Compound to Therapeutic The three-year NIH grant will allow the researchers to develop a formulation for the current compound. This formulation can then be applied to a variety of animal models to better understand which population may benefit the most. This will also help the lab determine which stage of Alzheimer’s disease the eventual drug is best suited for and how long it should be used.

When the compound is developed further, the lab can partner with a pharmaceutical company to help conduct additional studies for toxicity, absorption, distribution, metabolism and excretion (ADME) analysis. Next would be applying to the FDA for the Pre-Investigational New Drug Application (PreIND) Consultation Program, an early step in bringing a drug to market, before launching human studies. This lengthy process could take many more years to complete. “The compound is always a step,” Amin said. “It helps us understand how we could develop a better therapeutic.”

Auburn’s Department of Drug Discovery and Development functions much like a biotech firm, with three branches that serve different purposes. Medicinal chemists help design and synthesize the compounds; pharmacology scientists then test these compounds in animals and cell cultures. Those in the third group, pharmaceutics, study the effects of the compound, its bioavailability and other factors that help determine whether a compound is feasible as a pharmaceutical.

This type of work allows pharmacy schools to develop intellectual property from drug discovery, which they can license to pharmaceutical companies. Most of all, it provides valuable experience for faculty and students. “The development of an intellectual property at the university basis is really to

community impact

“This class of compounds actually changes the cholesterol pattern in the brain. This will turn on certain genes or certain proteins and helps clear away many of the bad effects [of Alzheimer’s].”

—Dr. Raj Amin help educate and advance our field of pharmacy,” Amin said.

“Programs like this help advance the knowledge depth for students as well as for faculty.”

students for alternative paths including careers in industry such as Merck, Pfizer or Lilly or regulatory affairs such as the FDA and CDC.”

Both student pharmacist Ariel Dulaney and graduate student Ian Steinke were closely involved in developing the compound AU403IS. This has provided students with hands-on learning about different classes of therapeutics, current challenges in drug development and how to improve the drug development process.

With that goal in mind, students at the college of pharmacy learn about pharmacokinetics and toxicology, which helps them understand drug dosages and target populations for certain pharmaceuticals. This can better prepare them for roles in industry and research. The college also partners with the Industry Pharmacists Organization, an association that works to advance the careers of industry pharmacists. Noted Amin, “The opportunity to train students for alternative careers can diversify the field of pharmacy and attract more students who are wanting to go into these types of settings or professions, and that’s great for the field of pharmacy.” P

Students also gain exposure to alternative pharmacy careers.

Many students narrow down their choices to clinical or community-based pharmacy roles when considering options to pursue after graduation. However, Amin hopes to encourage students to think beyond these two options. “To broaden the field of pharmacy, we have to educate them in alternative perspectives,” he said. “And that would mean training

Emily Jacobs is a freelance writer based in Toledo, Ohio.

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community impact

VIP Treatment for Vets COPD CARE began with one University of WisconsinMadison pharmacy professor’s vision to help veterans. The primary care service is expanding to VA clinics across the country to reach patients in rural communities.

By Jane E. Rooney

As someone who treats patients in a pulmonary clinic, Dr. After COPD CARE was selected as a National Gold Status Edward Portillo, assistant professor, University of Wisconsin- Practice by the Veterans Health Administration in 2018, Madison School of Pharmacy, Pharmacy Practice and Transwhich provided support to train hundreds of clinicians, the lational Research Division, has seen firsthand the damaging service expanded to more than 20 facilities and 500 praceffects of Chronic Obstructive Pulmonary Disease (COPD). titioners nationwide. In 2021, the program received a Best He has had patients whose breathing is so labored that they Practice Award from the American Society of Health-System cannot go up a flight of stairs in their own home. For othPharmacists thanks to impressive results such as reducing ers, the condition interferes with social connections and hospital/emergency department readmissions from 18 pertheir ability to work. While the statistics are sobering for the cent to 8 percent. general population—COPD is the sixth-leading cause of death COPD CARE received yet another boost last year with a in the United States—the disease takes an even greater toll five-year, $16.7 million grant from the U.S. Department of on the veteran population. Veterans are three times more Veterans Affairs Office of Rural Health, which will fund new likely to experience COPD, and it is the second leading cause positions within the program and support an additional of hospitalization for VA healthcare users. For his residency 22 full-time pharmacists in advanced primary care setproject in 2016, Portillo wanted to develop a primary care service to deliver high-quality COPD management to veterans. tings across the country. “COPD CARE has taken the VA’s team-based model and positioned our pharmacists to use The result was COPD CARE (Coordinated Access to Reduce their expertise managing chronic diseases,” Portillo noted.

Exacerbations), which began at one VA clinic in Madison and “We’ve leveraged our skillset to support our veterans. We as has since expanded to more than 30 medical centers and 100 pharmacists are well positioned to not only serve on these clinics across the country. teams but be the ones managing the medications and pre“My goal has been to develop a team-based program that posi- scribing the right treatments.” tions pharmacists to benefit our veterans,” Portillo explained.

An Action Plan to Empower Veterans “There are treatments and best practices that we know will improve the lives of those with COPD. The difficulty is deliver- COPD CARE began with Portillo brainstorming ways to ing these best practices routinely to patients. Every healthcare optimize team-based care delivery. Patients in the program setting is different. Providing optimal care for a high number visit VA clinics and have a primary care provider as well as a clinical pharmacist, termed a Clinical Pharmacist Practitioof patients is difficult. Half of patients with COPD do not ner (CPP), to prescribe medications, optimize therapy, place receive recommended treatment, and 85 percent of patients with inhalers do not use them as prescribed. There have been critical referrals and prescribe tobacco cessation treatment.

Other team members often include nurses and respiratory examples of programs that integrate COPD best practices therapists who are essential to the program’s success. “It’s at one clinic or medical center, but to scale these programs a collaborative service,” Portillo emphasized. “The pharmabecomes incredibly difficult. As you scale you often lose the cist is practicing at the top of his or her license. COPD is a ability to deliver the program with high fidelity, so the effecprogressive disease so if we can administer treatment early, tiveness drops.” we can slow the progression of this disease and help patients

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community impact

feel better. The pharmacist, nurse, primary care provider and members of the team deliver all of these best practices.”

adherence review, tobacco use screening and management of COPD comorbidities such as hypertension and diabetes.

After patients have been admitted to a hospital or ER following a flare, a nurse from the program calls them 48 hours after discharge to evaluate symptoms, and then the patient is seen at a COPD wellness visit. “We want to empower our veterans to know what to do when they are having symptoms,” he continued. “We developed a COPD action plan. It gives a lot of the power to the patient so they have a plan.

We do a follow-up a month later to make sure interventions have been carried out. That leads to an annual visit with a primary care provider. Then there are clear next steps in place so we are optimizing every member of the team.”

CPPs are key to the VA’s team-based model because “they are so incredibly highly trained as healthcare leaders and clinicians,” he said. “We know these medications, we know how to treat patients and we are so good at tailoring treatment regimens to the needs of our patients. Within the VA, CPPs are accustomed to serving on clinical teams and collaborating with team members.”

In addition to improved access to care and reduced readmission rates, the service identifies more patients for referral services such as pulmonary rehabilitation, tobacco treatment services and telehealth. A significant portion of veterans (92 percent) complete follow-up with a clinician within 30 days after a hospital visit compared to standard of care (49 percent). The service also leads to much greater delivery of COPD best practices, including inhaler technique and

Portillo initially applied for support through the VA Diffusion of Excellence Office in 2018 with an eye toward broadening the service to communities throughout the United States. His proposal was one of 11 selected from 622 submissions. He worked on creating the COPD CARE Academy, a five-week training program to teach other VA medical centers how to implement COPD CARE and scale it to meet their specific needs. Through his collaboration with the VA Clinical Pharmacy Practice Office, funds were allocated to hire pharmacy student interns, and he noted that those student pharmacists were instrumental in engaging with VA leaders to engineer and build out the Academy.

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community impact

Dr. Molly Lehmann, a clinical pharmacist practitioner and Primary Care/Patient Aligned Care Team (PACT) clinical pharmacy supervisor at the William S. Middleton Memorial Veterans Hospital in Madison, got involved with COPD CARE during her first-year residency project as the team was considering how to expand the service beyond the original clinic in Madison. She worked closely with the students as they analyzed data and revamped educational materials to help CPPs learn the program’s infrastructure.

“Students developed videos to help with education and resources, patient cases, quick guides and other materials.

They were huge in the education piece and helped lead and organize meetings as we spread nationwide,” Lehmann said.

“What an incredible opportunity for a student to be able to be involved in a project directly supporting veterans on such a large scale, learning from our clinicians and seeing them practice at the top of their license. It was amazing for students to gain that exposure and have the leadership support to elevate them to the next level and support as many patients as possible. [They saw] the steps that are needed to create a new service, how to get key stakeholders involved and how to finetune that service over time. This experience is applicable to any setting as long as you’re looking at quality improvement to take care of patients and manage chronic disease states.”

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She pointed out that data show that many patients do not take medications as prescribed or need reinforcement about how to optimize use, and that’s where pharmacists come in: adjusting and monitoring therapy based on guidelines. “We serve as another resource for that patient to reach out to us with questions. There are a lot of other comorbidities that factor into this disease, things that increase the complexity of the clinical picture, so pharmacists are providing that additional support and meeting patients’ changing needs over time.”

Positive feedback from students indicated that they appreciated the hands-on learning opportunity and the chance to polish their skills. Lehmann praised Portillo for providing a unique opportunity that allowed students to take on responsibilities that played to their strengths. “One student really loved writing and was interested in manuscript development and the research component, and we had another student who really got into making the videos and being creative,” she noted. “Ed has been able to see those strengths and empower them to make that area of COPD CARE their own and make the program shine.”

community impact

Providing Essential Medication Management Efforts to expand COPD CARE began with a few clinics in Illinois and Wisconsin, as well as the healthcare system in Fayetteville, Arkansas. Timothy Hagen, VHSO Systems Redesign and Improvement Coordinator, Veterans Health Care System of the Ozarks, worked with his facility’s medical center director to scale Madison’s program to fit their size and needs. “Thinking about how to implement the process from a large into a small facility was a learning curve. Our resources weren’t the same so we had to look outside the box,” Hagen said. “First I went through all the departments and collaborated with the chief stakeholders: primary care, pharmacy, respiratory—and we added telehealth. That was new to the process. I reached out to them because our telehealth folks communicate with all of our outgoing patients.

That allowed us to identify the COPD patients. Having the ability to catch them as they were being discharged, we were able to develop a tool that would enable our telehealth folks to focus on that diagnosis.”

“It’s a collaborative service.

The pharmacist is practicing at the top of his or her license.

COPD is a progressive disease so if we can administer treatment early, we can slow the progression of this disease and help patients feel better. The pharmacist, nurse, primary care provider and members of the team deliver all of these best practices.”

—Dr. Edward Portillo

Dr. Michelle Balli, associate professor, pharmacy practice, University of Arkansas for Medical Sciences College of Pharmacy Northwest Campus, and a clinical pharmacist We can also identify additional care referrals and preventapractitioner with the Veterans Health Care System of the tive care strategies including tobacco cessation interventions Ozarks, participated in brainstorming sessions about how to as appropriate. Assistance with medication selection and facilitate the program’s rollout at the telehealth ambulatory education can improve efficacy for COPD symptom relief care clinic she runs in Branson, Missouri. “I shared informa- and improvements in lung function and quality of life.” tion on the program with my clinic site director and comHagen agreed that pharmacists are integral to the program’s municated with my team nurses to provide information on success thanks to their medication management expertise. how this program can be beneficial for our patients,” Balli said. “I receive COPD CARE referrals for patient enrollment “Teaching the veterans the proper use of inhalers, and then being available to do the follow up…that was missing in the directly from care coordination nurses at our facility and picture. [It was typical for a patient] to have a 30-day readam able to order appropriate diagnostic tests or proceed mission after an acute exacerbation,” he continued. “How do with medication management dependent on the patient we limit that? The pharmacists’ knowledge of the medication scenario.” was the key component to providing clear understanding to Because COPD is prevalent in the veteran population, she the veterans. During the pilot we went down to zero readsaid, “direct, focused attention to this disease state immissions.” proves patient outcomes. The unique collaboration between One of the crucial things the program does, he added, is team nurses and pharmacists allows for open communicaimpress upon veterans the need to stay on top of treatment tion and quick referral for veterans recently admitted for and pay attention to symptoms. “The connection 48 hours COPD exacerbations.” after discharge was the big component that was the winner.

“Optimal medication selection is of utmost importance With the telehealth people contacting them and setting up based on a patient’s past medical history, history of COPD appointments for them with primary care, it created awareexacerbations and current COPD-related symptoms,” she ness that the condition requires urgency,” Hagen said. “If we continued. “There are many different types of inhalers used did not make that contact and get them in within two weeks for COPD management. Pharmacists can directly assist to see the pharmacist, we would have continued to have with appropriate inhaler selection and thorough patient readmission rates within 30 days. The constant communicaeducation to ensure proper technique for administration. tion built into the process is key to its sustainment.”

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community impact

“Depending on when they were involved, [students] could have seen the expansion process, implementation, the impact of the service or may have been directly involved with care. All levels of the project provided a significant learning opportunity about the importance of interprofessional care, clinical service development and expansion, utilization of population health management tools, comprehensive medication management and the impact pharmacists can make on patient care.”

—Dr. Amanda Stahnke

A Multidisciplinary Model Dr. Amanda Stahnke, clinical associate professor at the University of Missouri-Kansas City School of Pharmacy, was one of several PACT clinical pharmacist practitioners who piloted COPD CARE at the Kansas City Veteran Affairs clinics. She provided training sessions that began a few months before rollout and coached stakeholders in implementation to help expand the program across all of PACT. “Our knowledge of chronic disease states and evidence-based medication management allow us to assist in providing the highest-quality care to our veterans,” she noted. “An important aspect of the COPD CARE service is how it utilizes the multidisciplinary model of care extremely well with inclusion of all members of the PACT (primary care providers, registered nurse care managers, advanced medical support assistants, telehealth clinical technicians and CPPs), along with a clinical pharmacy technician and pharmacy trainees (residents and students).”

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Student pharmacists were involved in identifying more than half of the veterans during the initial phases of the COPD CARE expansion using population management databases, Stahnke said. “These students also assisted in increasing utilization of VA Video Connect (virtual video care visits) and assisted the CPP with care management visits with veterans.

Depending on when they were involved, they could have seen the expansion process, implementation, the impact of the service or may have been directly involved with care. All levels of the project provided a significant learning opportunity about the importance of interprofessional care, clinical service development and expansion, utilization of population health management tools, comprehensive medication management and the impact pharmacists can make on patient care.”

Portillo said that the program fosters collaboration and patient empowerment, which is important for students to witness. “What I hope our students are seeing is that when we empower each other as healthcare teams, really good things can happen for patient care,” he said. “You can drive forward this initiative and support the relationship building. It’s all been trainees who have done this. Empowering the learners has allowed this to happen.”

A key outcome has been better access to care for veterans, particularly those in rural communities. “Seeing the improvement in veterans’ daily function, comfort with their inhalers and how appreciative they are of this and our other services demonstrate the success of the CPP clinics,” Stahnke added.

For Molly Lehmann, being involved with COPD CARE transformed the direction of her clinical career. “It absolutely ignited my interested in innovation and administrative leadership within health systems pharmacy. As a resident being able to work with students in that capacity gave me an introduction into project management as a primary preceptor,” she said.

Portillo is now focused on the next steps that are needed to sustain the service. “We want to understand what type of clinical settings are able to most effectively deliver the program. We hope to continue to deliver COPD CARE across the country,” he said. “And of course, learning from our veterans. Their voice is the most important so we can further enhance our work.” P Jane E. Rooney is managing editor of Academic Pharmacy Now.

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AI: Friend or Foe?

One University of Georgia professor looks to algorithms to predict and prevent adverse drug events, while academia begins to explore ways to teach with ChatGPT while preserving learning.

By Athena Ponushis

Artificial intelligence has the potential to be lifesaving, helping physicians detect signs of disease and helping pharmacists offer more personalized care. Such technology holds the promise of improving health outcomes while reducing healthcare costs. It sounds like a dream, albeit a little bit daunting.

AI has become the center of conversation as it continues to permeate our everyday lives. Chatbots, like ChatGPT (a large language model released by OpenAI), have seeped into the classroom, posing a potentially Goliath-sized threat to education—enabling cheating and plagiarism, while inhibiting comprehension and aspiration.

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But just as Goliath was defeated, the technology might not be as big a threat as perceived, suggested contributing writer Ian Bogost in an essay in The Atlantic entitled, “ChatGPT is Dumber Than You Think.” As Bogost writes in the article, large language models that mine the text they have been fed to predict the next pleasing word “are surely not going to replace college or magazines or middle managers. But they do offer those and other domains a new instrument—that’s really the right word for it—with which to play with an unfathomable quantity of textual material.” By embracing AI as an “instrument,” or rather, as an assistant, pharmacists and professors are finding ways to help patients and students, all for the benefit of public health.

A Tool to Guide Clinical Decisions

“With every decision in the ICU, there’s a reason we are doing it and there’s a risk associated with it. You are weighing risks and benefits. We hope that AI-based tools like this can give you more nuanced information…and that might sway your decision as a clinician because you have more patientspecific data.”

—Dr. Andrea Sikora

Each year in the United States, 1.5 million patients admitted to the intensive care unit (ICU) experience a serious adverse drug event (ADE). The related healthcare costs to treat such ADEs exceeds $1 billion.

Dr. Andrea Sikora, clinical associate professor at the University of Georgia College of Pharmacy and critical care pharmacist at Augusta University Medical Center, has found that patients in the ICU suffer three times more ADEs than other patients because of their complex, high-risk drug regimens. When critical care pharmacists are part of the ICU team, pharmacists make preventative medication interventions, reducing ADEs by 70 percent.

The problem remains that critical care pharmacists are busy, often responsible for too many patients, making it hard to perform such timely interventions.

Wanting to help patients and pharmacists, Sikora turned to AI. In 2016, she developed a clinicianfriendly IT tool, called the Medication Regimen Complexity-Intensive Care Unit (MRC-ICU) Scoring Tool. Essentially, the tool adds up the medications on a patient’s chart, giving the patient a score (similar to a Body Mass Index (BMI) score) and that AI-informed score makes a prediction, alerting a pharmacist to prevent an ADE before it happens.

“With every decision in the ICU, there’s a reason we are doing it and there’s a risk associated with it,”

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Sikora said. “You are weighing risks and benefits. We hope that AI-based tools like this can give you more nuanced information…and that might sway your decision as a clinician because you have more patientspecific data.”

When Sikora first started playing with the MRC-ICU scoring tool, she used traditional statistical methodology. She saw some good things, but nothing great.

Then someone approached her at a meeting and asked, ‘Have you ever thought about using machine learning for this?’ She hadn’t, and she wasn’t even sure what machine learning meant. “That’s the beauty of attending national conferences,” she quipped.

What struck her about machine learning was not just its ability to deal with so many data points, but its capacity to deal with nonlinear relationships and nonmonotone patterns that are more difficult to model using traditional logistic regression to predict disease outcomes. “That sounded very much like the problem we were facing,” Sikora said. “ICU data is very heterogeneous, very complex, and there are lots of different factors put into any situation. Looking at the preliminary data, my team and I thought, ‘Wow. We think this is going to work,’ and that was really exciting.”

Sikora defines AI as the science and engineering of creating intelligent machines that can achieve goals like a human, whereas machine learning is a computer’s ability to learn without being explicitly programmed. Using the analogy of a traffic light, Sikora said, “You tell a computer, ‘Every time the light is green, cars go,’ but machine learning watches the traffic light and after a while, it determines, ‘it seems like cars stop on red and go on green,’ so it’s able to infer the pattern on its own.”

Sikora and her team have been trying to predict which patients are most at risk for fluid overload so pharmacists can give them diuretics, concentrate their medications or offer other interventions. When they did traditional logistic modeling and ran logistic regression, the team found a decent way to predict fluid overload but it had nothing to do with medications. “It was weird to us that drugs were not significant predictors of fluid overload, because fluids come from drugs,” she noted. But when they ran their machine learn-

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ing analysis, it created better prediction algorithms.

When they looked at the feature importance graph, which tells you what was important to the algorithm, medications were at the top.

The idea behind the MRC-ICU score was that it did not have to deal with severity of illness but rather the medication regimen complexity of the patient, which Sikora thought was a more meaningful metric for what a pharmacist actually does. In order to apply that metric to predict and prevent ADEs, however, she needed machine learning because it can handle nonmonotone patterns. “The hypothesis that we are working with is that medications are independent risk factors for disease but they are often not included in prediction algorithms, and that doesn’t necessarily make sense,” she explained. “We are basically ignoring this entire wealth of relevant information when we are trying to make decisions, but the problem today has been that medications are messy. It’s not just the drug, it’s the dose, route, frequency and so many other elements, and that’s really difficult for traditional modeling to be able to handle, whereas machine learning is far better able to handle that. So that’s the thing we are exploring.”

Sikora received a $1.86 million grant from the Agency for Healthcare Research and Quality (AHRQ) last August, complementing an earlier AHRQ grant of $296,000 to pursue her research on how AI may guide pharmacists to provide better care. Her vision would be for AI tools to give clinicians more detailed information on the risks and benefits of the decisions they are making. “I see it as clinical decision support, but it’s more like it’s giving you relevant, real-time predictions,” Sikora said. ‘That is what is most exciting about the work that we are doing.”

Sikora can imagine AI helping pharmacists with workflow, improving inventory management, maybe even filling prescriptions. She does not see these tasks as replacing the pharmacist, but freeing up the pharmacist to spend less time on physical labor and more on cognitive skills: ‘Do I agree with this medication?’

‘Have I talked with the patient?’ ‘Have I helped them strategize how to take their medications?’

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“ChatGPT is not going to replace the learning that I want them to experience—they still have to write their reflections. ChatGPT will just help them refine it and that might actually help them become better writers.”

—Dr. Sara Trovinger

Leveraging ChatGPT to Enhance Learning AI is coming under greater scrutiny thanks to the recent proliferation of chatbots. Dr. Sara Trovinger, associate professor of pharmacy practice and director of the Distance Pathway program at Manchester University College of Pharmacy, facilitated an AACP webinar in May focused on how ChatGPT might enhance pharmacy education and student engagement. She compares the release of ChatGPT to that of the calculator: When calculators became ubiquitous in education, math teachers thought, ‘Oh, no. I’m going to lose my job.’ Instead, teachers just learned to teach math in a different way.

They let students use calculators. And when computers and the Internet first appeared, teachers worried, ‘All my students are going to cheat.’ Again, teachers figured out a way to integrate computers. Now that professors are coming around to the idea that students are going to use ChatGPT, they are wondering, ‘If we can’t stop it, how can we teach with it?’

“I think we are going to be better off if we embrace it and use it effectively, appropriately, and teach our students how to do that because they are going to have it in the real world and they need to know how to operate with it in pharmacy,” said Melissa Bray, director of instructional design at Manchester University, who served as one of the webinar’s panelists.

Noting ChatGPT’s limitations, Bray said it does not search the Internet, it does not give up-to-date information, and for that reason, it’s not advantageous for health science education because it’s not timely. Chat-

GPT has been fed thousands and thousands of pages of text through September 2021 and it does its best to predict words that should come next. Bray compares this to grand predictive texting on smartphones, but because of its propensity to spit out misleading information, sometimes it does a good job and sometimes it makes things up.

But the attraction of ChatGPT is so strong, professors are thinking of productive ways to use it. “One potential use is it can help students when they are staring at a blank page,” Bray said. “It can help them brainstorm information. So, if a student needs to do a presentation or write a research paper, they can plug into ChatGPT and say, ‘Give me an outline. Where should I start my research? What are some common questions related to this topic?’ It can be that jumping off point. Then the student can fill in the gaps, do the actual research and find up-to-date information.”

ChatGPT can also help students translate information.

If they do not understand the explanations professors are giving in class, they can ask ChatGPT to rephrase the material into a language they can understand. “I remember when I was a pharmacy student, I was really struggling because I did not know my Greek alphabet,” recalled Trovinger, who hired a tutor to teach her.

ChatGPT gives today’s student pharmacists another place they can go to grasp that base knowledge to help them ask subsequent questions. But again, because ChatGPT has been designed for predictive text, students must make sure to confirm that what they have learned squares with what the professor said.

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Resources To those who may feel trepidatious about AI, Dr. Andrea Sikora recommends the book “Thinking, Fast and Slow,” by Daniel Kahneman, psychologist and winner of the Nobel Prize in economic science. She said the book points out that human intuition is flawed, “we have a lot of biases that we bring into prediction in particular,” but intuition can be aided by providing structure, and oftentimes, that structure comes from using a computer or algorithm. When Kahneman and his longtime collaborator, psychologist Amos Tversky, pitted a person against an algorithm, they found that the algorithm outperformed the person. When the person worked in conjunction with the algorithm, using the algorithm up to a point but still able to apply intuition, the pair outperformed the machine. “I think that makes sense,” Sikora said. “Being thoughtful and structured in your thought process, having more relevant data available to you, sounds like a better way of going about things.”

The AACP webinar “What is ChatGPT and How Can You Leverage It in Pharmacy Education” referenced in this article can be viewed here: www.aacp.org/event/what-chatgptand-how-can-you-leverage-itpharmacy-education

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“To piggyback on that, students can take the actual text from a textbook, just like they can take the words a professor has said about a drug or a process, and ask ChatGPT, ‘Can you rewrite this for a freshman-in-college level?’ And it does a pretty decent job. Because you are providing the text to begin with, it’s not going to go off and make things up, it’s just going to convert words into layman’s terms,” Bray said.

A professor can have ChatGPT generate text that he or she knows is incorrect, maybe using outdated pharmacy guidelines and present it to the class, Trovinger and Bray suggested, to have students find and fix the errors to illustrate the platform’s pitfalls. This kind of reverse engineering, Bray explained, creates an assignment for students to use ChatGPT that does not erase, but may enhance, learning.

Trovinger has even found a way to use ChatGPT in reflective writing assignments. She asks students to write about their rotations. They reflect on their experiences and go through all the revelations of the writing process. Then they can use ChatGPT to finesse their writing. “ChatGPT is not going to replace the learning that I want them to experience—they still have to write their reflections,” Trovinger said. “ChatGPT will just help them refine it and that might actually help them become better writers.”

Even with the sudden integration of AI tools in pharmacy education, Trovinger and Bray believe the adaptation will move slower in pharmacy practice because pharmacists tend to be risk averse. They are trained to trust but verify, knowing that when they go into practice, they have people’s lives in their hands.

Similar to students taking a professor’s words and putting them into ChatGPT to reword the lesson into more relatable language, pharmacists can use ChatGPT when it comes to complex instructions for a particular therapeutic or disease state, asking, ‘How can I explain this to a patient in the hopes that they will understand?’ In that scenario, one can see the beauty of human judgment combined with AI assistance. And from that view, it looks more helpful than harmful. P Athena Ponushis is a freelance writer based in Ft. Lauderdale, Florida.

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American Association of Colleges of Pharmacy 2023 Annual Meeting Gaylord Rockies Resort & Convention Center Aurora, CO | July 22-25 2023

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Check us out at the Employer Panel with Vice President of Pharmacy Practice Innovation & Advocacy Sandra Leal on Tuesday July 25th 9:30am (MST) local time.

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Improving Community Health through Partnership in Research, Education and Scholarship Join NACDS Foundation at 2023 AACP Annual Meeting!

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A Peak at the Mountain of Programming at #PharmEd23 More than 1,900 pharmacy educators, practitioners and students will head to Aurora, Colorado, July 22–25, to gain new perspectives and skills at Pharmacy Education 2023.

AACP Annual Meeting July 22–25

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Set in the shadows of the Front Range Mountains, the 2023 AACP Annual Meeting provides a learning environment perfect for expanding your knowledge, sharpening new skills and returning to your institutions inspired to implement lessons learned.

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Check out some of the Pharmacy Education 2023 highlights: • Attend Timely Sessions: Explore ChatGPT and AI in pharmacy education, the 2022 National Pharmacist Workforce Survey findings, and more across nearly 150 sessions, listed here: https://bit.ly/PharmEd23Sessions.

• Connect and Collaborate In-Person: Whether you’re missing the spontaneous hallway conversations or eager to arrange meetings with colleagues onsite, the meeting has numerous opportunities for in-person networking.

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Earn CE Credits: Attendees can earn up to 13.50 hours of CE credit during Pharmacy Education 2023, up to 4.50 hours of credit for the Teachers’ Seminar and up to 3.00 hours of credit for the DiPiro Workshop.

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Learning Straight from the Source: Browse more than 400 posters and meet their presenters across two full days of the meeting.

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Family Fun For All: At the Gaylord Rockies resort, you’ll enjoy an exciting lineup of outdoor activities and entertainment, top-notch dining, and the Arapahoe Springs Water Park.

Be Social With Us! Use the hashtag #PharmEd23 across your favorite social media platforms to engage with other attendees, and post your thoughts, highlights and reactions during and after sessions.

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Develop a Digital Mindset Rapid advances in digital technologies are threatening to change how we work. To thrive in a world driven by data and powered by algorithms, we must develop a digital mindset— and learn to see, think, and act in new ways.

Meet keynote speaker, professor and author, Paul Leonardi, Ph.D., as he signs copies of his book, co-authored with Tsedal Neeley, The Digital Mindset: What it Really Takes to Thrive in the Age of Data, Algorithms, and AI following the Opening General Session.

Dr. Paul Leonardi, Duca Family Professor of Technology Management at UC Santa Barbara and keynote speaker, will discuss how pharmacy educators and practitioners can build that digital mindset and develop the skills needed to be able to successfully deploy AI tools in the classroom, teach students to take advantage of new digital capabilities, and how to prepare for the changing pharmacy landscape over the next few years.

Opening General Session: Developing a Digital Mindset Sunday, July 23: 8:00 a.m.–9:30 a.m.

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AACP greatly appreciates the support from our meeting sponsors, whose contributions make this event possible: Platinum Sponsor

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Other Highlights: From NAM to GPT Join current and past National Academy of Medicine Fellows in Pharmacy to discuss pharmacy research, health science and policy in the U.S., Monday, July 24, at 9:15 a.m.

Later that day, engage in meaningful dialogue about the implications of ChatGPT in pharmacy education in a 90-minute interactive session, and provide recommendations to AACP staff on additional support needed in this dynamic emerging area, Monday, July 24, at 3:15 p.m., in the session The Future is Now: Using ChatGPT and Other AI in Pharmacy Education and Academic Life.

On Tuesday, interact with a panel of pharmacy employers; and discover strategies on everything from mitigating faculty burnout, curing curricular bloat, instilling empathy in pharmacy learners and more.

Don’t miss this rare opportunity to connect with colleagues, learn from industry experts, and cultivate relationships with Academy leaders, July 22–25, in Aurora, Colorado.

Register today: www.aacp.org/pharmed23

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Pharmacists Help People Live Healthier, Better Lives.

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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.

Upcoming August Webinars Include: ɋ How Wellbeing Related Values & Beliefs Influence Professional Identity Formation ɋ Showcase of the 2023 Laboratory Innovation and Teaching Excellence (LITE) Awards ɋ Compete To Learn: Best Practices for NCPA Business Plan Competition Team Advisor ɋ Getting Comfortable being Uncomfortable