Why Idaho? Two Pharmacists’ Perspectives on Practice

While this past year has been a challenge, the pharmacy profession in Idaho has continued to move steadily forward. Let’s take a closer look at the past, and especially the future of pharmacy in Idaho. In his 2018 Professional Achievement Award speech, Ed Snell spoke to the graduating class; he said he was so excited for their future and that he wished he was entering the profession all over again with them because of the clinical practice advancement. Two years later, the sentiment has only become more true. Both authors are so glad to be pharmacists in Idaho. If you’re reading this, you likely made the great decision to practice pharmacy. Next step is to consider where and how you’re going to practice

Where to practice? Idaho, for lots of reasons

Simply put, Idaho is the place to practice in the United States. For over forty years, and particularly in the more recent past, Idaho pharmacy practice regulation has evolved to best support access to quality patient care. The result is that Idaho has the most advanced practice act in the nation. When you’re choosing where to practice, please carefully examine your options as though your career satisfaction and happiness depend on your decision, because it does! The authors know of nowhere else a pharmacist has as many options to help patients (which is, of course, the pharmacist’s ultimate goal) Imagine how you can positively impact the lives of patients. Imagine how satisfying that career would be. Look at these practice enhancements found right here in Idaho: • Independent prescriptive authority: Do you realize there are at least 19 protocols you can develop to help ensure access to care for patients and ensure you, as a pharmacist, are integrated into the network of providers for patients?

Examples include uncomplicated UTIs, oral contraceptives, uncomplicated candida, acute mild sunburn and more! • Lab ordering: Consider all the instances the drug therapy your patient is on requires lab follow up. You can order them to keep therapy going forward as needed; having a pharmacist’s perspective on the healthcare team has so much potential for patient care quality and outcomes! • Prevention Care: As accessible providers, pharmacists can provide preventative care like immunizations (full range of immunizations to a broad population with no age restrictions), referrals for screenings, and provide services like PPD (purified protein derivative) skin test placement for tuberculosis--again, the expanded access for patient-centric care is unparalleled elsewhere. • POCT (point-of-care-testing): Pharmacists are now depended on to deliver these tests as a result of the demands the pandemic has put on the healthcare system. We are a proven source of reliable results and professional care and ensuring results are connected not just to the patient but to their other care providers. • Collaborative practice agreements (CPA):

Idaho’s flexible approach CPAs truly support additional clinical service delivery. Because of the flexibility, pharmacists can offer enhanced and expanded services in all areas of practice in conjunction with other providers. • Removal of the tedium in dispensing and support for patient-centered dispensing: • Pharmacists in Idaho can use professional judgement to resolve small issues with prescriptions that pharmacists in other states have to bother prescribers with--things like therapeutic substitution based on insurance coverage and refilling a prescription when the prescriber can’t be reached. While a seem-

ingly small thing, it has been nice to be able to give a patient up to a thirty day supply of their maintenance medication after their refills have expired but the patient’s appointment is not until next week. • From a workflow perspective, pharmacists are able to shift their focus to caring for patients more than ever before. This impacts other professions as well--Idaho pharmacists make professional decisions, taking some of the workload off of other providers and their staff, which frees them to spend their valuable time in more productive care of their patients. Not only can pharmacists do more to help their patients and collaborate with other providers, with the recent (April 2020) addition of pharmacists as recognized providers to Idaho Medicaid, Idaho pharmacists are even better poised to support their patients. By allowing pharmacists to bill the medical benefit for patient care within their clinical ability, support is being solidified for the sustainability of pharmacist-driven patient care across the outpatient spectrum. The process for advocating for additional credentialing of pharmacists and inclusion of pharmacists as part of the covered medical benefit is continuing, with collaborations across organizations helping to ensure pharmacists are embedded in the network of providers delivering care to patients.

How to practice? At the top of our clinical ability

It’s not enough to just physically be in Idaho, although that is great--the next step is to intentionally take advantage of the advanced practice here. It can be overwhelming trying to tackle all of the advanced practice opportunities available here in Idaho, so if you’re feeling a bit stretched, consider starting with small tweaks and changes. How can you pivot to have a broader role in patient care? Can you offer expanded immunization consultations? If you’re already doing that, what protocol for independent prescribing can you do? If you’ve maxed that patient care option out, how can you collaborate with other health providers to provide care to targeted patients? What health plans can you partner with? What do your Medicaid patients need that you can provide to help close gaps in care? What is exciting about Idaho is that we, as pharmacists, get to ask these questions while pharmacists in most other states do not. Idaho offers so many ways to support patient care; the next step is considering how you can take advantage of them. Please also know that you’re not in this alone--the College of Pharmacy at Idaho State University is here to support! Updates to the curriculum are already in place to ensure graduates of the program are not just ready for entry-level positions but can help drive the profession forward and be prepared to practice independently. The College offers continuing education for practicing pharmacists and technicians as well as partnering with other disciplines to ensure the delivery of interprofessional education that is the highest quality and specific to Idaho opportunities. Faculty experts in the full spectrum of patient care are embedded within the college--from practice implementation (inpatient to outpatient), quality assessment, legislative perspectives...if you have an interest, there’s a decent chance the College has an expert interested in collaborating. The College is available to partner with pharmacists on projects, contracts, and grants as well--if you have an idea for how we can partner to be drivers of change, please let us know! You, the reader, are as (if not more) important to this message as the authors, and we sincerely hope you are as excited as we are to be part of the Idaho pharmacy family!

Ed Snell and Shanna O’Connor