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A Peer-Reviewed Journal | Vol. LXXVII, No. 1 | JAN.FEB.MAR. 2022

PHARMACY BURNOUT:

AN HONEST CONVERSATION INSIDE:

Deans’ Columns PharmaCE Expo 2022 Executive Intern Reflection

TABLE OF CONTENTS 8515 Douglas Avenue, Suite 16, Des Moines, IA 50322 Phone: 515.270.0713 Fax: 515.270.2979 Email: ipa@iarx.org | www.iarx.org

PUBLICATION STAFF Allison Hale, Managing Editor Kate Gainer, PharmD Emmeline Paintsil, PharmD, MSLD, BCPS Elizabeth Orput, PharmD Kellie Staiert, MPA

COVER STORY Pharmacy Burnout pg. 6

OFFICERS CHAIRMAN Diane Reist, PharmD, RPh – Cedar Rapids PRESIDENT Christopher Clayton, PharmD, MBA – Manchester PRESIDENT-ELECT Cheri Schmit, RPh – Ames TREASURER CoraLynn Trewet, PharmD – Ankeny SPEAKER OF THE HOUSE Deanna McDanel, PharmD, BCPS, BCACP – Coralville VICE SPEAKER OF THE HOUSE Heather Ourth, PharmD, BCPS, BCGP – Ackworth

TRUSTEES REGION #1 Wes Pilkington, PharmD – Waterloo REGION #2 Pamela Wiltfang, PharmD, MPH, BA, CHES – North Liberty REGION #3 Candace Jordan, PharmD, BCPS, MBA – Winterset REGION #4 Grant Houselog, PharmD, CSPI – Sergeant Bluff AT LARGE Emily Beckett, PharmD, BCPS – Johnston Nancy Bell, PharmD – West Des Moines Jackie Gravert, PharmD, MPH – Cedar Rapids Angie Spannagel, PharmD, BCACP – Maquoketa HONORARY PRESIDENT Sharon Cashman, RPh – Waverly

Oath of a Pharmacist pg. 10

PharmaCE Expo 2022 pg. 20

FEATURES Deans' Columns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Peer Review: Insulin Dosing After Bariatric Surgery . . . . . . . 14 2022 Eggleston-Granberg Golf Classic . . . . . . . . . . . . . . . . . . . 17 PharmaCE Expo 2022 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Insight to Advocacy Pharmacy Law Series . . . . . . . . . . . . . . . . 22 2022 IPA Legislative Priorities . . . . . . . . . . . . . . . . . . . . . . . . . . 23 2021 Executive Internship Reflection . . . . . . . . . . . . . . . . . . . . 34

IN EVERY ISSUE President’s Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 CEO's Column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

PHARMACY TECHNICIAN Tammy Sharp-Becker, CPhT, CSPT – Des Moines

Practice Advancement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

STUDENT PHARMACISTS Mahi Patel – Drake University Jose Rodriguez – University of Iowa

Technician Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

The Journal of the Iowa Pharmacy Association is a peer reviewed publication. Authors are encouraged to submit manuscripts to be considered for publication in the Journal. For author guidelines, see www.iarx.org/journal. “The Journal of the Iowa Pharmacy Association” (ISSN 1525-7894) publishes 4 issues per year: January/February/March issue; April/ May/June issue; July/August/September issue; and October/November/December issue by the Iowa Pharmacy Association, 8515 Douglas Avenue, Suite 16, Des Moines, Iowa 50322. Periodicals postage paid at Des Moines, Iowa and additional mailing offices. POSTMASTER: Send address changes to: The Journal of the Iowa Pharmacy Association, 8515 Douglas Ave., Suite 16, Des Moines, IA 50322. Published quarterly, The Journal is distributed to members as a regular membership service paid for through allocation of membership dues. Subscription rates are $100 per year, single copies are $30. Printed by Mittera; Graphic design done by the Iowa Pharmacy Association.

Public Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 IPA Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Members Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 IPA in Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Calendar of Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Mission Statement The Iowa Pharmacy Association empowers the pharmacy profession to improve the health of our communities. JAN.FEB.MAR. |

PRESIDENT’S PAGE

INCLUSION: IT IMPACTS US ALL

n the summer of 2020, I had the pleasure of starring in my own video. This was an opportunity for the IPA membership to meet the incoming president. When Kate [Gainer] first told me, I was excited but also nervous.

Christopher Clayton, PharmD, MBA IPA President Director of Pharmacy & Population Health, Buchanan County Health Center

As a pharmacist and leader, I have always gone to work in business attire. It was a shirt and tie every day, until the ties became optional. (I always thought they were an infection control risk…) Professional events were much the same. For over twenty years, there was a work version of myself and a non-work version of myself. Why? I didn’t always feel comfortable showing or sharing the non-work version of myself in professional settings. I felt I wouldn’t be accepted, that I was not good enough for the role I was given, or that due to stereotypes I would be viewed differently. So, when I had the opportunity to share all versions of myself in a video for all of you to see, I was excited but nervous. This is because of the tattoos on my arms. This past year, I attended the Decker-Temple Leadership Pharmacy conference in Galena, Illinois as an officer of IPA, a different capacity than when I participated many years ago. As a participant, this event really changed my level of engagement in the profession. This year's event included a great session on diversity, equity and inclusion (DEI), and I am thankful for having attended. Something I learned that day was that we could all use some training on this topic. Why? In short, I learned that my preconceived idea of the training was narrow, and the topic is much bigger than many think it is. I truly believe that when we hear about the topic of DEI,

If you haven’t seen it yet, scan the QR code to watch President Chris Clayton’s introductory video!

| The Journal of the Iowa Pharmacy Association

some might make assumptions about what it is; I certainly had some of my own assumptions. As leaders in our departments or organizations, we work with diverse teams. People come from many different backgrounds, and like me, may be coming to work as a different version of themselves. One of the themes in the DEI training that really struck me was the discussion around inclusion. The idea of an organization, department or individual leader helping every team member feel like they belong made me realize that I didn’t always feel that way due to various policies or comments made at times regarding something as simple as having a visible tattoo. For that reason, I always presented myself in a different way. I wonder how many of us do the same thing day after day and how exhausting that must be. How does this relate to my experience with IPA? Interestingly enough, I think there is a lot of correlation. Our organization represents One Profession. One Voice. across numerous areas of pharmacy practice. This comes with diverse perspectives that have shaped us, and sometimes we do not agree on topics of legislation, policy or how our area of practice may be impacted by another. As I enter this year as President of IPA, one challenge to myself—and to all IPA members—is to do a better job of stepping outside of those immediate emotions or thoughts and realize we truly are all working together for a common purpose, our patients. ■

RENEW

TODAY

COLLABORATION | ENGAGEMENT | EXCELLENCE INCLUSION | INNOVATION | INTEGRIT Y | LEADERSHIP Live and Virtual Events • CE through CEimpact • IPA Member Forums • COVID-19 Resources Advocacy for the Profession • IPA Journal • Leadership Opportunities • 2/2/2 Monthly Webinars Medicaid Resources • Weekly Communications • Podcasts • Burnout Resources • Study Groups Legislative Resources • Partner Discounts • Grant Funding • Statewide Protocols • Staff Support

www.iarx.org/JOIN_RENEW OCT.NOV.DEC. |

PHARMACY BURNOUT

PHARMACY BURNOUT: “Burnout” is a term that has been pushed to the forefront of everyone’s mind in the profession of pharmacy. The workload of the pandemic coupled with the recent labor shortage has brought many in pharmacy to their wits’ end. Anyone working in a pharmacy knows how to be adaptable, reacting and interacting with a diverse set of situations and people each day, but with recent COVID-19 surges, the end of the pandemic and return to “normal” workflow appears further away. It is important for pharmacy professionals to be able to identify burnout and learn ways to prevent and manage it. In order to prevent and manage professional burnout, a universal definition of it is required. The 11th Revision of the International Classification of Diseases (ICD-11) defines burnout as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” The three cardinal symptoms of burnout are emotional exhaustion, depersonalization, and diminished personal accomplishment.1 There has been no greater workplace stressor in the last year than the pandemic, which has been unavoidable. While burnout can affect anyone in the profession of pharmacy, evidence shows that those in their first five years of work are most at risk.2 A 2020 study examining pharmacist burnout found that 64% of critical care pharmacists and 74.9% of community pharmacists have experienced burnout in at least one area.1 Burnout may not be a transmittable disease, but it is time to begin taking steps to prevent and treat it just like any other illness. Prevention is the first crucial step in managing the problem of professional burnout. There are a myriad of helpful resources out there for preventing burnout including the American Pharmacists Association’s (APhA) dedicated webpage to promoting resilience and wellbeing. The concept of resiliency is a useful tool in the prevention of burnout. Resiliency is more than the ability to bounce back in the face of adversity; it is how you use your coping skills to navigate stressful situations. Here are a few coping skills to utilize in preventing and managing burnout. The first skill is to speak up. Pharmacists are master communicators, speaking to and on behalf of patients and their interests daily. Now, it is time for pharmacy professionals to advocate and speak up for themselves. If managers and employers do not know how their employees feel,

| The Journal of the Iowa Pharmacy Association

PHARMACY BURNOUT

AN HONEST CONVERSATION nothing will change. The only way to address workflow issues or other workplace stressors is by initiating a discussion about them. A second skill is to practice reframing. While it can be difficult, viewing challenges from a different perspective and focusing on the positive can help manage the depersonalization aspect of burnout. Pharmacy professionals can only do the best they can under the current circumstances. The last skill is to practice physical and self care. Taking walks, eating a healthy diet, getting proper sleep, listening to music, and other leisure activities can do wonders in managing exhaustion and anxiety.1 Pharmacists do an amazing job of caring for patients, but it is time to take a similar approach in caring for themselves. Burnout is a pervasive phenomenon across the healthcare profession, and workplace stressors will not cease when the pandemic ends. Pharmacy professionals need to equip themselves with the skills and knowledge to prevent and manage professional burnout. An important aspect to remember is the noble nature of the profession. More than 215 million COVID-19 vaccines have been administered and reported by retail pharmacies across programs in the U.S.3 This statistic may induce a migraine or stressful flashbacks for some, but it should inspire pride for the work that pharmacy has accomplished in the adverse environment of the pandemic. The pharmacy profession will never be a stranger to adversity and stress, but pharmacy professionals can better equip themselves to face it.

1. Speak Up 2. Change Your Perspective 3. Practice Self Care

REFERENCES:

1. English T. The pharmacist’s guide to recognizing and preventing burnout. Pharmacist. com. Published July 30, 2021. Accessed January 18, 2022. https://www.pharmacist.com/ Publications/Transitions/the-pharmacists-guide-to-recognizing-and-preventing-burnout 2. Traynor K. Pharmacists examine risks, remedies for burnout. Ashp.org. Published January 30, 2019. Accessed January 18, 2022. https://www.ashp.org/News/2019/01/30/ Pharmacists-Examine-Risks-Remedies-for-Burnout?loginreturnUrl=SSOCheckOnly 3. CDC. The Federal Retail Pharmacy Program for COVID-19 Vaccination. Cdc.gov. Published December 27, 2021. Accessed January 18, 2022. https://www.cdc.gov/vaccines/ covid-19/retail-pharmacy-program/index.html

Access APhA’s Well-being and Resiliency Resources

www.pharmacist.com/wellbeing

JAN.FEB.MAR. |

CEO'S COLUMN

10 YEARS OF PROGRESS AT THE IOWA PHARMACY ASSOCIATION

I Kate Gainer, PharmD IPA Executive Vice President & CEO

t's hard to believe I’ve had the opportunity to serve as CEO of the Iowa Pharmacy Association for ten years. Last quarter, I reflected on the impact this decade has had on my life personally. This quarter, I would like to share highlights from the past decade for the pharmacy profession in Iowa. Flipping through ten years of IPA Annual Reports was such a fun activity – and overwhelming to recollect just how much our association accomplishes every year. It was a tough task to trim this list down to one page!

NEW MEMBERSHIP MODELS ENGAGED. CONNECTED. INFORMED. Platinum Business Partners. Employer Packages. Traditional membership models are outdated. The IPA Board of Trustees has continually pushed forward for innovative membership structures. This includes membership tiers and membership packages. IPA’s membership is growing and strong!

COVID-19 PANDEMIC RESPONSE

In the 2+ years since the pandemic began, our association has supported IPA members by pivoting to virtual programming and events, providing media training for pharmacists in the news, and advocating to state agencies, the executive branch and legislators, as well as federal agencies and Iowa’s members of Congress.

CPESN-IOWA & WELLMARK’S VBPP

IPA was integral to the formation and development of two important community pharmacy initiatives. The IPA Board of Trustees approved CPESN-Iowa as a separate entity and committed to providing support in 2016. IPA also worked closely with Wellmark to identify pharmacies, design metrics and ensure success of their Value-Based Pharmacy Program (VBPP).

PROVIDER STATUS AND PAYMENT FOR PHARMACIST SERVICES While a long, slow journey...many steps have been made in the past ten years. Iowa Medicaid approved pharmacists as providers and created a pathway for provider enrollment and credentialing with the state’s managed care organizations. IPA passed legislation leading to provider status, as well as statewide protocols (for pharmacist prescriptive authority) and modernized collaborative practice. Just this year, IPA launched a new task force to continue this work: Payment for Pharmacist Professional Services.

| The Journal of the Iowa Pharmacy Association

EXECUTIVE FELLOWSHIP IN ASSOCIATION MANAGEMENT

IPA’s staff has grown from seven to ten individuals who work each day to advance the mission of IPA. Creating an Executive Fellowship program not only contributes to the success of IPA’s staff, it is a training ground for leaders in the profession.

PBM LEGISLATION

IPA has passed PBM legislation in 2013, 2014 and 2019, and there is a strengthened PBM bill working its way through the legislature in 2022. Iowa’s PBM legislation from 2013 led to a PCMA lawsuit in the state. This lawsuit (PCMA v. Gerhart) was challenged to the 8th Circuit and paved the way for Rutledge v. PCMA at the Supreme Court of the United States.

SUPPORT OF LEADERSHIP AND INNOVATION: IPA FOUNDATION

The generosity of IPA members has helped fund three unique endowments: Thomas R. Temple Leadership, Bill Burke, and Outcomes Innovative Grants.

PHARMACIST WELL-BEING, MENTAL HEALTH AND RESILIENCE

As a membership organization, bringing professionals together for support is inherent to the networking benefit of IPA. Additional focus on mental health, well-being and resilience has been highlighted with Mental Health First Aid trainings, IPA Goes Local training on health care provider burnout, and the ResilienceRx podcast.

ADVANCED TECHNICIAN ROLES

Iowa has been a leader in researching and passing legislation to allow for technician product verification (TPV) in all pharmacy practice settings in Iowa. The New Practice Model task force and pilot paved the way for other states to follow Iowa’s lead. To each and every IPA member – thank you for being part of the past ten years at the Iowa Pharmacy Association. Your engagement, leadership and support from across the state has created these successes and milestones in IPA’s history and has made a difference! ■

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PRACTICE ADVANCEMENT

PHARMACY ORGANIZATIONS UPDATE OATH OF A PHARMACIST From the American Pharmacists Association (APhA), www.pharmacist.com/APhA-Press-Releases The American Association of Colleges of Pharmacy (AACP) Board of Directors and the American Pharmacists Association (APhA) Board of Trustees have approved updates to the profession’s Oath of a Pharmacist to incorporate contemporary language and address diversity, equity, inclusion, and antiracism. The updates were recommended by a joint AACP and APhA Oath Revision Steering Committee and approved by the boards of AACP and APhA at their respective November 2021 meetings. “The joint committee led a critical charge of boldly expanding our professional oath to include the necessary elements of equity, inclusion, and diversity. The revised oath challenges all pharmacists to take an active responsibility in promoting health equity and commit to being change agents in the system of pharmacy practice and beyond,” said Lakesha M. Butler, PharmD, CDFT, Director of Diversity, Equity and Inclusion at Southern Illinois University Edwardsville School of Pharmacy. The Oath of a Pharmacist was first developed in 1983 by the AACP Board of Directors and revised in 1994 and 2007 by the joint APhA Academy of Student Pharmacists (APhA–ASP) and AACP Council of Deans Task Force on Professionalism. The 2021 Oath Revision Steering Committee conducted several joint sessions from June to October to review and discuss the oath. In addition, the committee developed and conducted a survey and town hall meetings for faculty members, student pharmacists, and pharmacists to address concerns. "The Oath of a Pharmacist’s intent is to be both a fluid and long-lasting representation of pharmacists and student pharmacists’ dedication toward our profession and patients. Our collective efforts in recognizing and leading these efforts is a proud moment for the entire profession," said Juan Rodriguez, APhA–ASP National President and student pharmacist at the University of Tennessee Health Science Center College of Pharmacy. The newly revised Oath of a Pharmacist should be utilized for all Spring 2022 pharmacy commencement ceremonies.

OATH OF A PHARMACIST I promise to devote myself to a lifetime of service to others through the profession of pharmacy. In fulfilling this vow: I will consider the welfare of humanity and relief of suffering my primary concerns. I will promote inclusion, embrace diversity, and advocate for justice to advance health equity. I will apply my knowledge, experience, and skills to the best of my ability to assure optimal outcomes for all patients. I will respect and protect all personal and health information entrusted to me. I will accept the responsibility to improve my professional knowledge, expertise, and self-awareness. I will hold myself and my colleagues to the highest principles of our profession’s moral, ethical and legal conduct. I will embrace and advocate changes that improve patient care. I will utilize my knowledge, skills, experiences, and values to prepare the next generation of pharmacists. I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.

| The Journal of the Iowa Pharmacy Association

PRACTICE ADVANCEMENT HEARTLAND AEA PHARMACY CAREER MODULE UPDATE

In December, IPA staff met with faculty of Drake University College of Pharmacy and Health Sciences and the University of Iowa College of Pharmacy to review the Heartland AEA Pharmacy Career Module. The module is being designed for seventh through twelfth graders in the state of Iowa to promote the profession of pharmacy. During the meeting, IPA gathered valuable feedback from the colleges and is in the process of sharing this information with the module designer. Once updates have been made, IPA will have a second meeting with the colleges for a final run-through before the module goes live in schools across Iowa. The module is expected to launch in March. If you or someone you know is interested in reviewing the Pharmacy Career Module, please contact Elizabeth Orput at eorput@iarx.org.

1815 UPDATE

IPA continues to work closely with the Iowa Department of Public Health (IDPH) in partnering with Iowa pharmacies to advance education and services that improve outcomes for patients with chronic diseases. The 1815 project largely focuses on diabetes but also looks at expanding care and addressing the needs of patients with hypertension and dyslipidemia. IPA is excited to work with the new cohort of pharmacies for the 2021-2022 grant cycle. If your pharmacy is interested in expanding diabetes services as future grant opportunities arise, please contact Emmeline Paintsil at epaintsil@iarx.org.

NEW TEST & TREAT TOOLKIT

On July 1, 2021, all Iowa pharmacies became eligible to provide test and treat services for individuals six years of age and older. Along with testing for influenza, strep and COVID-19, pharmacies can prescribe treatment following a positive test result via the Statewide Protocols developed by the Iowa Board of Pharmacy in collaboration with IDPH. To assist your pharmacy in implementing test and treat services, IPA has developed a toolkit of resources with information on the CLIA waiver process, education requirements, supply procurement and much more!

Specific chapters of the toolkit include: 1. Point-of-care Testing FAQ 2. CLIA Certification 3. Education and Training 4. Supplies 5. Billing & Payment 6. Statewide Protocols 7. Sample Screening Tool & Patient Evaluation 8. Sample Follow-up Documentation & Communication

The Test & Treat Toolkit is available in IPA’s online store and is a FREE member benefit for ENGAGED Pharmacists, Associates, Platinum Business Partners and Pharmacy Technician members. The toolkit is available for purchase for INFORMED and CONNECTED Pharmacist members. Visit www.iarx.org/store_home.asp.

VACCINE EQUITY GRANT

IPA continues to partner with IDPH in working to increase COVID-19 vaccine confidence, engaging trusted messengers, and addressing vaccine hesitancy for populations that have been disproportionately affected by the COVID-19 pandemic. The IPA team has been exploring new and innovative ways to engage the membership and deliver timely information. To revamp the association’s Connecting Over COVID-19 webinars, IPA will be shifting this content to a podcast format to provide members a new way to engage and listen at their leisure. In addition, IPA is looking forward to getting back on the road and into communities for IPA Goes Local events starting in April of 2022. We look forward to engaging with trusted messengers across the state and providing education on how to address hesitancy, navigate misinformation and promote confidence in COVID-19 vaccines. A full listing of upcoming IPA Goes Local events is available on Page 38. For more information on this project and how to collaborate with IPA, please contact Emmeline Paintsil at epaintsil@iarx.org.

HIV TESTING PROJECT ENTERS YEAR 4

In collaboration with IDPH’s Bureau of HIV, STD and Hepatitis, IPA has been managing a multi-year project implementing HIV screenings in community pharmacies since 2019. Ten community pharmacies from across the state have been offering free HIV screenings for their communities. In the fall of 2021, two additional pharmacies joined the project and are also offering free HCV screenings. The CDC estimates 50% of persons living with HCV are undiagnosed. HIV and HCV cases in the state of Iowa have been steadily climbing since 2009; HCV diagnoses have tripled since 2009. The Bureau recently worked with the Bureau of Substance Use to conduct a vulnerability study, assessing the risk of HIV and HCV outbreaks as well as the risk of opioid overdoses. The full report is available on IDPH’s website. Based on this vulnerability study, the project will begin strategically identifying locations for HCV testing. IPA is working to add additional pharmacies to both the HCV and HIV project. With the goal of 40 sites, IPA looks to gain interest in offering HIV testing in the following counties: Palo Alto, Pocahontas, Calhoun, Webster, Humboldt, Kossuth, Clarke, Decatur, Wayne, Lucas, Monroe, Appanoose, Lee, Wapello. These are areas of the state the Iowa Department of Public Health considers focus areas based on their epidemiology reporting. To participate in the project or to learn more, please contact Kellie Staiert at kstaiert@iarx.org.

JAN.FEB.MAR. |

DRAKE UNIVERSITY

THE ONES WHO ADMINISTER HOPE

A Renae Chesnut, EdD, MBA, RPh Dean & Professor Drake University CPHS

s we reflect on the past year, we are proud of the Iowa pharmacy community for its continued dedication to the profession. A phrase that has been a staple at Drake University College of Pharmacy and Health Sciences over the last year is "administering hope." As we pass the one-year anniversary of administering vaccines, we appreciate the immense work the Iowa pharmacy profession has done to protect and instill a sense of hope in our communities. The College administered hope through 10,000 vaccines to Polk County residents on Drake’s campus in the 2021 spring semester in partnership with the Iowa Public Health Department and Hy-Vee. This number does not include the thousands of vaccines administered by students and faculty at their sites and volunteer clinics throughout Iowa and the country to date.

post-graduate positions. Our program was ranked first among private Midwest programs and third among all Midwest programs in the 2021 ASHP residency match. Several students were also the recipients of national honors: • Gustavo Flores (P2) was one of five pharmacy students in the nation among 489 applicants to receive a CVS Health Minority Scholarship. • Isabelle Tharp (P4) was named one of three 2021 Next-Generation Future Pharmacist Award finalists by Parata Systems and Pharmacy Times. She also received the APhA-ASP Good Government Award. • Anna Braun (P1), Ali Goldensoph (P2), and Anna Parr (HSCI-JR) were three of 18 students in Iowa awarded 2021-22 Iowa Space Grant Consortium Research Scholarships. Recent recognitions and awards for the faculty include the following:

Administering hope also occurred through several initiatives: • The University kicked off a new fundraising campaign – The Ones: The campaign for the Bold and the Brave, with priority areas in digital proficiency, strengthening America’s heartland, creating a University for all ages and walks in life, developing leaders and changemakers, and transforming lives every day. • A $1.6 million federal grant to the CPHS will fund a new telehealth initiative for rural communities in partnership with Certintell Health and Tabula Rasa HealthCare, Inc. • Several new scholarship awards were announced for students including a research award, a first-generation college student award, and an award for students who plan to serve rural Iowa in their careers. • We welcomed the third Drug Development Fellow at Drake in partnership with Vanadro Drug Development Consulting. Our students continue to excel in obtaining residencies, highly competitive fellowship positions, and other

| The Journal of the Iowa Pharmacy Association

• Lynn Kassel was named the 2021-22 Drake University Troyer Research Fellow. • Erik Maki was appointed to a three-year term on the Iowa Board of Pharmacy by Governor Kim Reynolds and received the 2021 Drake University Levitt Distinguished Community Service Award. • Tim Welty was appointed to a five-year term on the International League Against Epilepsy – North American Board. • Sally Haack received the University’s 2021 Principle Financial Group Global Citizenship Award. In addition, congratulations to Drake pharmacy alum and retired otolaryngology head and neck surgery physician, Steven Herwig, who received the 2021 Lawrence C. and Delores M. Weaver Medal of Honor, the highest honor given by the College. As a result of the work of our faculty, staff, preceptors, alumni and students that led to these collaborations and accomplishments, the College of Pharmacy and Health Sciences continues to live up to its mission of preparing today’s learners to be tomorrow’s health care leaders. To all of the IPA members who support our College and assist us in these endeavors, thank you for your commitment to our College and your communities as you administer hope. ■

THE UNIVERSITY OF IOWA

RESILIENCE: PROCESSING AND OVERCOMING

or nearly two years, I have observed a persistent and profound measure of ‘can-do.’ Family, friends and professional associates of all kinds, including student colleagues, have exhibited a level of inner strength that merits admiration. Through sheer grit and determination, many have more than survived the travails of the pandemic…they have flourished! News outlets and other forms of media saturate the senses with relentless negativity. It would be easy to cave to such pessimistic thought. Instead, on so many fronts—among them educational pedagogy, scientific inquiry, patient care delivery, innovative conceptualization and actualization, and community service engagement— individuals have rolled-up their sleeves, shifted personal resolution into high gear, and found the means, often without precedent, to overcome the adversity they were facing. I recall vividly how, in a matter of days in mid-March 2020, our faculty and preceptors, along with the enabling assistance of a highly talented team of IT specialists, literally turned on a dime to address the needs of students… didactically, skills-based, and experientially…to ensure that students fulfilled all requirements for that academic year. Yes, remarkably, the Class of 2020 graduated ontime! On one hand, I still harbor a profound sense of sadness, an emotional void if you will, regarding the way we said “goodbye” to the Class of '20. On the other hand, I gush with pride at the way our College family came together to provide all students the opportunity to maintain their intended course of study to continue progressing through the program on-time and on-schedule. Moreover, during the darkest days of the pandemic when the lack of a vaccine limited social interaction, our Offices of Professional and Graduate Education working in concert with student-led learning communities, fraternities and professional organizations found much-needed ways to stay connected. Their actions served to greatly bolster spirits. Through my lens, their actions were a Godsend knowing that so many were hurting mentally and emotionally because of persistent isolation, the likes

of which none of us had ever experienced before, no matter one’s age. Now, here we are again at the start of a new year and dark clouds prevail. The pre-pandemic freedoms we have worked feverishly to restore seem to constantly slip through our fingers as new viral variants emerge. Frustration blossoms anew, yet so does determination… the ebb and flow of those two countervailing emotions seem as constant as a sine wave. Resilience…the word flows from one’s lips so easily but exercising what it means requires more than lip-service. Resilience is the ability to withstand adversity and bounce back from difficult life events. Being resilient does not mean that individuals do not experience stress, emotional upheaval, and suffering. Rather, resilience provides the strength needed to process and overcome hardship.

Donald E. Letendre, BSPh, PharmD, FASHP Dean & Professor UI College of Pharmacy

Being part of such a special pharmacy family both within the University itself and more broadly across the state, especially during these challenging times, infuses a sense of pride and honor that defies explanation except that you know it when you have it. The sum of the collective effort is always greater than the addition of the individual contributions. I have felt it; I have seen it. However, what truly takes my breath away is observing the resilience demonstrated day in and day out by those who collectively comprise our profession…students, residents, faculty, preceptors, practitioners, scientists, technicians and so many more. I have witnessed their strength countless times throughout my career but never more profoundly than I have the past two years. Yes, undeniable resilience. Like a well-conditioned boxer, I observed colleagues’ relentless perseverance as they persistently got up off the mat after they had been beaten down…countless times… countless ways. This pandemic will one day end, or at the very least find a reasoned coexistence with our need to embrace a redefined sense of normalcy, and when it does, we need to take pause and celebrate the manner in which pharmacy demonstrated unequivocally extraordinary resilience. ■

Word Cloud Credit: pharmacy.uiowa.edu

JAN.FEB.MAR. |

PEER REVIEW

INSULIN DOSING AFTER BARIATRIC SURGERY: PREDICTABLE DOSE DECREASES? AUTHORS

Katherine Hadsall, M.S. Kathryn Vollmer, Drake University College of Pharmacy and Health Sciences Natalie Ake, Drake University College of Pharmacy and Health Sciences Lynn Kassel, PharmD, BCPS, Associate Professor of Clinical Sciences, Drake University College of Pharmacy and Health Sciences, Acute Care Pharmacist, MercyOne West Des Moines Medical Center Jamie Pitlick, PharmD, BCPS, BC-ADM, Associate Professor of Pharmacy Practice, Drake University College of Pharmacy and Health Sciences, Clinical Pharmacist, MercyOne Diabetes and Endocrinology Center Michael Daly, PharmD, MSCI, BCPS, Associate Professor of Clinical Sciences, Drake University College of Pharmacy and Health Sciences, Informatics Pharmacist, The Iowa Clinic Joel Rand, MPAS, PA-C, Des Moines Bariatric Surgery, MercyOne West Des Moines Medical Center Mark Smolik, MD, FACS, FASMBS, Medical Director Des Moines Bariatric Surgery, MercyOne West Des Moines Medical Center

Conflict of interest: The authors declare no conflict of interest. A preliminary assessment of the project was presented at the 2019 ACCP Annual Meeting in New York, NY.

ABSTRACT Introduction: The prevalence of obesity is increasing in the United States and worldwide, and obesity is associated with chronic diseases such as type 2 diabetes. Bariatric surgery, including procedures such as laparoscopic sleeve gastrectomy (LVSG) or Roux-en-Y (RYGB), represent one solution to reduce weight, hemoglobin A1c, and insulin doses in patients who are overweight or obese. However, the long-term data and predictability of decreasing insulin doses in the individuals who have received these surgeries is limited. Methods: This was a retrospective study of individuals, ages 18-89 years with type 1 or 2 diabetes (n=39), who underwent LVSG or RYGB at MercyOne West Des Moines Medical Center and followed up at MercyOne Des Moines Endocrinology Care between March 1, 2012 and September 30, 2018. Descriptive statistics were used to analyze data. Results: Of the 40 patients included, almost half (45% (n=18)) remained on insulin in the immediate post-op period. At 12-months post-op, 20% (n=8) of patients remained on insulin. Even though fewer patients were on insulin at 12-months post-op, the mean A1c increased from 7.01 ± 0.83 to 7.93 ± 1.42. On average, bariatric surgery reduced mean weight by 19.2% (or a mean of 24.6 kg) at 12-months post-op. Conclusion: Bariatric surgery decreases weight and insulin requirements over 12 months in individuals with obesity and type 1 or 2 diabetes. However, insulin doses required were not predictable for the entire population. Key Points: • Insulin doses often decrease following bariatric surgery, and can cure diabetes.

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• Insulin doses immediately drop following surgery and up to the 12-months after. • Glucose control, by A1c, returned to baseline within 12-months of surgery. • The time frame of insulin dose decreases are not predictable following LVSG or RYGB.

INTRODUCTION

Diabetes is currently the 7th leading cause of death in the United States, with the economic burden on the healthcare system costing an estimated $327 billion annually for diagnosed individuals1,2. The prevalence of diabetes continues to grow, due in part to the obesity epidemic3, as obesity is the leading risk factor for the development of type 2 diabetes mellitus4,5. Weight loss, as low as 5 to 15% of total weight, can help decrease the number of risk factors for the development of diabetes in individuals with obesity5. Bariatric surgery is recommended as a treatment option for type 2 diabetes in adults with a BMI greater than or equal to 40 kg/m2 and with a BMI 35.0 – 39.9 kg/m2 who do not achieve weight loss with non-surgical methods. Several studies have compared health outcomes in patients undergoing surgical versus non-surgical interventions. Two studies demonstrated that patients who underwent bariatric surgery had a higher remission rate of type 2 diabetes, greater reductions in A1c, and decreased body weight compared to patients receiving no surgical intervention6,7. The surgical group had a significant decrease in body weight that continued four years post-op, while the A1c decreased until two years post-op6. Bariatric surgeries are classified as either restrictive, malabsorptive, or a combination of both8. Two of the most common bariatric surgeries are Roux-en-Y Gastric Bypass (RYGB) and laparoscopic sleeve gastrectomy (LVSG). The RYGB is considered a mixed procedure because it restricts stomach volume and affects how nutrients are absorbed into the bloodstream. The RYGB alters the gastrointestinal tract, causing food to bypass most of the stomach and upper small intestine. This type of surgery has been shown to induce remission of type 2 diabetes mellitus

PEER REVIEW in 80% of patients, with an additional 15% receiving improvement in control9. The LVSG is a restrictive procedure as it solely decreases the stomach volume by removing a portion, thus increasing feelings of fullness8. Remission rates of type 2 diabetes mellitus are close to 60% with the LVSG9. These surgeries’ primary purpose is to reduce caloric intake, leading to weight loss and increased insulin sensitivity over the short and long term10. Both RYGB and LVSG result in similar weight loss over a 4-month time frame7. Reduction in A1c, weight loss, shortened duration of diabetes, and decreased insulin doses11 were associated with improved insulin sensitivity following bariatric surgery. Yan et al.12 demonstrated that nearly 85% (n=71) of patients with a duration of diabetes less than 9.5 years achieved complete remission within one year after RYGB. For patients with diabetes for longer than 9.5 years, only 36.7% (n=11) achieved complete remission. Current literature on changes of insulin dosing post-op is limited and includes studies that only focus on short-term post-op (< 20 weeks). Middlebeek and colleagues13 found that RYGB rapidly decreased BMI, A1c, and insulin requirements in women with obesity and type 1 diabetes mellitus. In the study, insulin requirements were reduced by 38% in the 20 weeks following surgery. There is minimal evidence for the long-term effects that bariatric surgery has on insulin dosing. The purpose of this study is to determine if there is a predictable long-term decrease in patients’ insulin requirements during the 12 months following bariatric surgery.

METHODS

The Institutional Review Boards at MercyOne Medical Center and Drake University approved this retrospective cohort study. For this type of study, informed consent was not required and was waived by the IRBs involved. Subjects were identified utilizing information from MercyOne West Des Moines Medical Center and the Bariatric and Weight Loss Center. In total, 125 patients who had RYGB or LVSG surgery between March 1, 2012 and September 30, 2018 were identified from the surgical-reporting data. After cross-referencing with patients receiving care at MercyOne Des Moines Diabetes and Endocrinology Care, a total of 40 subjects were identified. One patient was excluded because insulin dosing could not be confirmed at any time point. Thirty-nine subjects were included in the final cohort for analysis. The patients were de-identified in data collection and reported in aggregate. Demographics were collected from medical records. The study’s primary outcome was to determine the difference in total daily units of insulin between the pre-op and post-op time periods. To be included, follow-up appointments had to be within a 30-day window of 3-, 6-, and 12-months, respectively. For collecting data in patients utilizing continuous insulin pumps and insulin to carbohydrate ratios (ICR), the highest number in the range was recorded, as this was the maximum dose the patient could have received (e.g., ICR is 1:5 with a maximum amount of 75 units; therefore 75 units was utilized for data collection and analysis). Secondary outcomes included percent change in A1c and weight (in kilograms (kg)) at the prespecified time points. To determine the primary outcome, mean total insulin doses were calculated and compared pre-op to post-op. Insulin changes in patients remaining on insulin at 3-, 6-, and 12-months and immediately post-op were calculated. Mean percentage changes in A1c and weight from baseline were calculated to determine secondary outcomes. The last value carried forward method was used for missing data throughout the study.

RESULTS

The baseline characteristics of the study subjects (n=39) are included in Table 1. For the primary outcome, mean insulin doses decreased during the study period from 126.6 ± 67.5 units pre-op to 82.4 ± 57.4 units at 12-months post-op using the last value carried forward (Table 2). The decrease in insulin dose is even more robust at 12-months if only documented doses are used to calculate the mean (48 ± 43.4 units), as shown in Table 3. While many patients, 82.4% (n=28 out of 34), remained on insulin on day 0 (the day of surgery), the number of patients remaining on insulin decreased throughout the hospital stay (Table 2). The day 3 data may be skewed by the number of patients (n=4) remaining eligible for insulin, as discharge frequently occurred on day 1 or 2 for these patients. Individual dose decreases throughout the immediate perioperative period can be seen in Table 3. Weight decreased during the first 12-months following surgery with a mean weight loss of 18.6% from baseline (Table 4). This decrease in weight is maintained if only documented weights are used rather than the last value carried forward (19.1%). The A1c decreased by an average of 0.1% between pre-op and the 3-month follow-up. However, the A1c increased to 7.4% and 7.5% at 6- and 12-month post-op, respectively (Table 4).

CONCLUSION

The mean total daily insulin doses decreased from the pre-op to postop period within a population that reflects current bariatric surgery patients in the United States. These results corroborate previous literature that LVSG and RYBG procedures decrease weight and insulin requirements, with some patients ultimately discontinuing insulin use. Middelbeek et al.13 found a 45.5% decrease in insulin from 59.7 ± 43.8 to 32.6 ± 20.9 units at the first post-surgical visit at 7.7 ± 5.8 weeks. This study yielded a decrease of 63% ± 27.1% for documented insulin doses at a similar point. Mean insulin doses continued to decrease throughout the year-long follow-up period. This study analyzed both long-term insulin dosing in the first year after surgery and the immediate perioperative period. Most patients (82.4%, n=28) remained on insulin on post-op day 0, while 50% (n=2) of those still hospitalized continued insulin by post-op day 3, as shown in Table 2. This finding is most likely attributed to the significant reduction in caloric intake immediately post-op. Of note, not all patients remained hospitalized for three post-op days within the institution. There were five surgeries without documented immediate post-op insulin doses, as the health system had not utilized electronic medical records for medication administration recording during that time. While A1c showed a slight improvement at 3-months post-op, it eventually increased above baseline by 12-months. This trend is similar to that seen in other literature13-18. The increase in A1c may be attributed to patient non-adherence to necessary medication and non-pharmacological therapy in the post-op period, a desire to no longer take medications for diabetes mellitus, or other factors that cannot be identified through retrospective analysis. In addition, the standard deviation was increased from pre-op to 3-, 6-, and 12-months post-op, which demonstrates that the level of variability increased, suggesting there were a few patients who skewed the increased A1c at the follow-up time periods. As expected, weight was shown to decrease from baseline at each follow-up period. However, this is expected given the known association between lack of insulin, rising A1c, and weight loss.

JAN.FEB.MAR. |

PEER REVIEW The present study’s findings are useful to patients and healthcare team members when discussing options for the treatment of diabetes. The study also looks at the consistency of long-term effects from the surgery, rather than short-term insulin dose requirements. Future studies could include patients using continuous glucose monitoring systems to monitor blood glucose levels, as this would monitor blood sugars with insulin doses in the perioperative time period. Additional studies are also needed to assess subjects more thoroughly with continuous insulin infusion pumps, limiting the potential inflation of insulin dosing in our research. To do this, researchers would need access to the insulin pump reports with actual pump settings and insulin use documented. This study has several limitations. First, this is a small study of 39 subjects; therefore, generalizability to the whole population may be affected. Second, there was incomplete data due to inconsistencies in the follow-up period, as some patients did not follow up as instructed. Researchers utilized both last observation carried forward and all specified data points to demonstrate variation. Third, data were based on medical records inputted by prescribers. Still, some patients reported (within provider documentation) being non-adherent to therapy, so the actual insulin dose the patient was taking was unknown to the researchers. The insulin doses may not have been consistently documented within the medical record in the same manner by all the different providers; however, using the same documentation for data collection standardized the procedure for collecting data. Finally, the surgery team providing care during the study period was comprised of only one surgeon, further limiting the generalizability in practice but maintaining consistency within this study. The limitations are balanced out by the strengths of the studying including that the baseline characteristics of the study subjects were reflective of patients seeking bariatric surgery in the United States. In conclusion, the results of this study demonstrate RYGB and LVSG consistently decrease insulin intake over a 12-month post-op time period, as well as immediately post-op. Additionally, weight decreased during the first 12-months following surgery. The A1c decreased between surgery and the 3-month follow-up time; however, on average, it increased to even higher than pre-op measurements at 6- and 12months post-surgery.

References:

1. Statistics About Diabetes [article online], 2018. Available from http://www.diabetes. org/diabetes-basics/statistics/. Accessed 19 November 2020 2. Diabetes [article online], 2020 Available from https://www.who.int/news-room/factsheets/detail/diabetes Accessed 19 November 2020 3. Adult Obesity Facts [article online], 2020. Available from https://www.cdc.gov/ obesity/data/adult.html Accessed 19 November 2020 4. Barnes AS. The epidemic of obesity and diabetes: Trends and Treatments. Tex Heart Inst J 2011;38(2): 142-144 5. Obesity in America [article online], 2018. Available from https://asmbs.org/resources/obesity-in-america. Accessed 19 November 2020 6. Wu G, Cai B, Yu F, Fang Z, Fu X-L, Zhou H-S, et al. Meta-analysis of bariatric surgery versus non-surgical treatment for type 2 diabetes mellitus. Oncotarget. 2016; 7(52):87511-87522. DOI: 10.18632/oncotarget.11961 7. Douglas IJ, Bhaskaran K, Batterham RL, Smeeth L. Bariatric Surgery in the United Kingdom: a cohort study of weight loss and clinical outcomes in routine clinical care. PLoS Med 2015;12(12). DOI: 10.1371/journal.pmed.1001925 8. Koliaki C, Liatis S, le Roux CW, Kokkinos A. The role of bariatric surgery to treat diabetes: current challenges and perspectives. BMC Endocrine Disorders 2017; 17(50). DOI: 10.1186/s12902-017-0202-6 9. Surgery for Diabetes [article online], 2019 Available from https://asmbs.org/patients/ surgery-for-diabetes. Accessed on 19 November 2020 10. Bradley D, Magkos F, Klein S. Effects of bariatric surgery on glucose homeostasis and type 2 diabetes. Gastroenterology 2012;143(4): 897-912. DOI: 10.1053/j.

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gatro.2012.07.114 11. Ramos-Levi AM, Sanchez-Pernaute A, Marcuello C, Galindo M, Calle-Pascual AL, et al. Glucose variability after bariatric surgery: is prediction of diabetes remission possible? Obes Surg 2017;27(12):3341-3343. DOI: 10.1007/s11695-017-2960-7 12. Yan W, Bai R, Li Y, Xu J, Zhong Z, Xing Y, et al. Analysis of predictors of type 2 diabetes mellitus remission after Roux-en-Y gastric bypass in 101 Chinese patients. Obes Surg 2019; 29:1867-73. DOI: 10.1007/s11695-019-03783-x 13. Middelbeek RJW, James-Todd T, Patti ME, Brown FM. Short-term insulin requirements following gastric bypass surgery in severely obese women with type I diabetes. Obes Surg 2014;24:1442-1446. DOI: 10.1007/s11695-014-1228-8 14. Kirwan JP, Aminian A, Kashyap SR, Burguera B, Brethauer SA, Schauer PR. Bariatric surgery in obese patients with type 1 diabetes. Diabetes Care 2016; 39(6): 941-948. DOI: 10.2337/dc15-2732 15. De Block CE, De Leeuw IH, Van Gaal LF. Impact of overweight on chronic microvascular complications in type 1 diabetic patients. Diabetes Care 2005;28:1649–1655. DOI: 10.2337/diacare.28.7.1649 16. Fernández-soto ML, Martín-Leyva A, González-Jiménez A, Garcia-Rubio J, CozarIbanex A, Zamora-Camacho FJ, et al. Remission of type 2 diabetes mellitus after bariatric surgery - comparison between procedures. Endokrynol Pol 2017;68(1):1825. DOI: 10.5603/EP.2017.0004 17. Barry RG, Amiri FA, Gress TW, Nease DB, Canterbury TD. Laparoscopic vertical sleeve gastrectomy: A 5-year veterans affairs review. Medicine (Baltimore). 2017;96(35):e7508. DOI: 10.1097/MD.0000000000007508 18. Cruijsen M, Koehestani P, Huttjes S, Leenders K, Janssen I, de Boer H. Perioperative glycaemic control in insulin-treated type 2 diabetes patients undergoing gastric bypass surgery. Neth J Med 2014; 72(4):202-9

Table 1. Baseline Characteristics Age, years (mean ± standard deviation, range)

53.8 ± 9.9 (24 – 72)

Female (n, %)

22 (56.4)

Previous Weight Loss Surgery (n, %) No

38 (97.4)

Yes

1 (2.6)

Type of Surgery (n, %) LVSG

35 (89.7)

RYGB

4 (10.3)

Type of Diabetes (n, %) Type 1 diabetes mellitus

3 (7.7)

Type 2 diabetes mellitus

36 (92.3)

Duration of Diabetes (n, %) 0-9 years

6 (16.2)

10-20 years

18 (48.6)

≥ 21 years

13 (35.1)

Comorbidities (n, %) Cardiovascular Disease

35 (89.7)

PCOS

1 (2.6)

Psychiatric Disorders

15 (38.5)

Neuropathic Pain

6 (15.4)

General Pain

11 (28.2)

Thyroid Disorders

9 (23.1)

LVSG = Laparoscopic Vertical Sleeve Gastrectomy, PCOS = Polycystic Ovarian Syndrome, RYGB = Roux-en-Y Gastric Bypass

PEER REVIEW Table 2. Insulin Doses Throughout the Study Period Ave Insulin Doses, units (range)

Median Insulin Doses, units

Patients off insulin (n, %)

Pre-Op (n=38)

126.6 ± 67.5 (32 – 290)

120

0 (0)

POD 0 (n=34)

9.1 ± 12.4 (0 – 56)

6 (17.6)

POD 1 (n=34)

9.7 ± 12.4 (0 – 58)

6 (17.6)

POD 2 (n=33)

4.3 ± 8.2 (0 - 39)

15 (45.4)

POD 3 (n=4)

15.2 ± 27.8 (0– 64)

2 (50)

3-months PostOp (n=39)

92.4 ± 60.2 (0 – 255)

1 (2.6)

6-months PostOp (n=39)

88.5 ± 60.7 (0 – 255)

1 (2.6)

12-months PostOp (n=39)

82.4 ± 57.4 (0 – 255)

1 (2.6)

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Data shown as a mean with standard deviation and (range), data includes last value carried forward; Pre-Op = pre-operative; Post-Op = post-operative; POD = postoperative day

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Table 4. Weight Changes Weight (kg) n=39

Mean Percent Weight Decrease from Baseline (kg)a

P-Valueb

Pre-Op

130.6 ± 22.0 (93.4 – 179.5)

3-months Post-Op

113.2 ± 20.7 (78.6 – 158.8)

13.4%

p < 0.001

6-months Post-Op

107.1 ± 19.7 (68.9 – 148)

17.9%

p < 0.001

12-months Post-Op

106 ± 17.7 (71.8 – 147.8)

18.6%

p < 0.001

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Kg = kilogram; Pre-Op = pre-operative; Post-Op = post-operative a a reported negative here indicates a gain (in weight or A1c) during that time period b compared to baseline

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Table 5. A1c Changes A1c (%) n=39

Mean Percent A1c Decrease from Baselinea

P-Value

7 ± 0.8 (5.4 – 9)

3-months Post-Op

6.9 ± 1.1 (5.4 – 10.7)

0.8%

p = 0.63

6-months Post-Op

7.4 ± 1.5 (5.4 – 10.7)

- 5.3%

p = 0.08

12-months Post-Op

7.5 ± 1.6 (5.1 – 11.0)

- 7.7%

p = 0.04

Pre-Op

Kg = kilogram; Pre-Op = pre-operative; Post-Op = post-operative a a reported negative here indicates a gain (in weight or A1c) during that time period b compared to baseline

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PEER REVIEW

Table 3. Patient Specific Factors Per Time Period Recorded Insulin Dose (units)a Subject

Age (years)

Sex

Surgery Type

Type of Diabetes

Duration of Diabetes (years)

Pre-Op

3-Month

6-Month

POD 0

POD 1

POD 2

POD 3

RYGB

50†

RYGB

200

48 (76)

36 (82)

LVSG

174

100 (42.5)

20 (88.5)

LVSG

226

46 (79.6)

LVSG

65 (P)

LVSG

145

185

LVSG

110

LVSG

124

LVSG

248

43 (82.7)

LVSG

255

15 16

LVSG

105

LVSG

200

LVSG

290

0 (100)

70 (75.9)

LVSG

110

LVSG

120

LVSG

10 (85.7)

20 (71.4)

24 (65.7)

LVSG

160

30 (81.3)

LVSG

220

84 (61.8)

76 (65.5)

LVSG

120

80 (33.3)

64 (46.7)

LVSG

120

LVSG

150

30 (80)

LVSG

190

LVSG

150

150 (0)

LVSG

145

10 (93.1)

LVSG

150

LVSG

110

60 (45.5)

LVSG

40 (4.8)

0 (100)

LVSG

: number in parentheses indicates percent change from baseline : no baseline data with which to calculate percent change from baseline F = Female; M = Male; LVSG = Laparoscopic Vertical Sleeve Gastrectomy; RYGB = Roux-en-Y Gastric Bypass; P = pump patient; POD = Post-Operative Day a

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With patient safety and quality patient care at the center, employers must address workplace conditions, and pharmacy team members must identify personal stressors and learn self-care techniques to address mounting performance pressures. During this presentation, pharmacy team members will learn about and engage in a number of brief, evidence-based practices that can be used “in the moment” to transform stress.

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LEADERSHIP DEVELOPMENT Brandon Jennings, PharmD, BCACP Brandon Jennings is the Founder and President/CEO of Abilyn Consulting, LLC. Prior to this role, Dr. Jennings was the Executive Director of the Dr. Terry Sinclair Health Clinic in Winchester, VA. Dr. Jennings received his Doctor of Pharmacy from Virginia Commonwealth University in 2006, and since has spent over 15 years in the pharmacy education and health care environments. Serving as a clinical faculty member at both the University of Utah College of Pharmacy and Shenandoah University School of Pharmacy, Dr. Jennings helped to establish collaborative relationships between community partners and the University.

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PHARMACY LAW SERIES

AVAILABLE ON-DEMAND – 0.1 CEU PBMs and Antitrust, PBMs and Retaliation While no secret to pharmacists, the increasing vertical integration of PBMs, health plans, and their subsidiaries has resulted in enormous market control and leverage with a few mega-corporations. Hear from experts on the potential antitrust issues this presents and how state and federal government may be pushing back.

MARCH 18, 1:30-2:30 PM – 0.1 CEU Funnel Update: What bills are still alive? Iowa’s “funnel” process means many bills are considered dead for the remainder of session. IPA will provide an update on what pharmacy priorities are still alive and what bills failed to advance for the year.

APRIL 15, 1:30-2:30 PM – 0.1 CEU PBM Legislative Action – National & Iowa Hear from the National Community Pharmacists Association (NCPA) on the progress made in dozens of states across the country following the landmark SCOTUS decision in Rutledge v PCMA.

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PUBLIC AFFAIRS

2022 LEGISLATIVE PRIORITIES The Iowa Pharmacy Association’s Legislative Committee and Board of Trustees have established the following legislative priorities for 2022.

State Legislative Priorities

State Policy Positions

PRESERVING ACCESS TO PHARMACY SERVICES

IOWA MEDICAID

PBM Regulation: Ensure Pharmacy Viability

Pharmacists and pharmacies are vital to meeting public health needs. Financial sustainability is critical to ensuring that they can meet patient and community needs across Iowa. Following the landmark decision in 2020 from the U.S. Supreme Court in Rutledge v. PCMA, Iowa now has clear legal authority to pass legislation that will ensure effective regulation of PBMs. Iowa must pass and enforce pharmacy benefit manager (PBM) regulations to protect consumers and patient access.

Non-Discrimination: Payment for Pharmacist Services

Pharmacists across Iowa serve as an important point of access to patient care services, such as testing and treatment, immunizations, and medication management. However, third-party payers often differentiate pharmacists from other providers by not offering same the coverage and payment for pharmacist services as other healthcare providers. It is essential that Iowa and payers begin investing in pharmacists to preserve and expand innovative access to care across the state. Updating Iowa’s laws to recognize and treat pharmacists equal to other providers is a crucial step to begin this process.

Maintain the Integrity of the 340B Program

The 340B drug program enables covered entities to stretch scarce federal resources, reaching more eligible patients and providing more comprehensive services. Ensuring the 340B Drug Pricing Program remains protected is essential to preserving access to care. Faced with increasing threats from PBMs and drug companies, it is imperative that Iowa enact new regulations to ensure the intent of the 340B program is not further eroded.

IPA supports laws, regulations and policies that ensure prescription drug reimbursement under Medicaid is sustainable, predictable, and transparent. This includes maintaining patient access by paying pharmacies at average acquisition cost, plus a cost of dispensing fee set by bi-annual survey. With pharmacists now enrolling as providers under Medicaid, a significant opportunity exists to provide convenient patient care services at reduced cost to the state. IPA supports increasing the provider administration fee for vaccinations to a fair rate for all pharmacies and expanding the services pharmacists can bill for under Medicaid to expand access for Medicaid members.

RESTRICTED DRUG DISTRIBUTION MODELS

Drug distribution models known as white bagging and brown bagging undermine hospitals’ patient safety protections and jeopardize patient care. IPA supports regulations that prohibit third-party and PBM mandated brown and white bagging, which interrupts safe chain of custody of medications and risks misuse by patients.

MODERNIZE THE IOWA PRACTICE ACT

Iowa’s policy makers continue to explore innovative ways to address workforce challenges. Allowing pharmacists to practice at the top of their license is one solution help attract and keep pharmacists in Iowa, as well as addressing shortages of other healthcare professionals throughout the state. Pharmacists are now trained to provide an array of clinical services, but excessive regulation and red tape prevent them from being able to serve their patients to the fullest. IPA supports modernizing the Iowa Pharmacy Practice Act and reducing licensing regulations to match the evolving practice of pharmacy to improve patient care delivery and outcomes.

JAN.FEB.MAR. |

PUBLIC AFFAIRS

IPA ADVOCACY:

2021 IPPAC & LDF DONORS

IPPAC IOWA PHARMACY POLITICAL ACTION COMMITTEE

LDF

The Iowa Pharmacy Political Action Committee (IPPAC) is a fund used to strategically strengthen relationships with legislators who are supportive of pharmacy interests. The IPPAC is funded by contributions from individual pharmacists, technicians or student pharmacists, as well as member PACs of other organizations. This fund plays an important role in enhancing legislative action for the profession. Learn more at www.iarx.org/ippac.

IPA’s Legislative Defense Fund (LDF) consists of contributions from corporate sponsors. Since corporations are prohibited from contributing to candidates (and therefore, the IPPAC), these funds are used to pay for advocacy activities, which include IPA’s Legislative Day and Capitol Screenings, contracted lobbyists and external consultants, and IPPAC administration and fundraising costs. Learn more at www.iarx.org/ldf.

THANK YOU DONORS:

Amanda Abdulbaki Michael Andreski Isabella Blankenship Brent Bovy Carl Chalstrom Christopher Clayton Connie Connolly Kyra Corbett William Evans Steve Firman Thomas Greene Bob Greenwood Robert Greenwood John Hamiel Charles Hartig Thomas Johnsrud Shane Madsen

Erik Maki Gary Maly Deanna McDanel Kristin Meyer Robert Nichols Matt Osterhaus Marilyn Osterhaus Wes Pilkington Matthew Pitlick Lisa Ploehn Anthony Pudlo Diane Reist Susan Shields Isabelle Tharp CoraLynn Trewet Stevie Veach Brian Wall

| The Journal of the Iowa Pharmacy Association

LEGISLATIVE DEFENSE FUND

Brent Bovy Olivia Welter Gregory Johansen Lisa Ploehn

Make your contribution today! WWW.IARX.ORG/ADVOCACY

PUBLIC AFFAIRS

BOARD OF PHARMACY: REGULATORY UPDATE The Iowa Board of Pharmacy convened for open session on January 11, 2022 to discuss multiple requests, hear from the public, and consider several proposed rules.

IPA PRESENTATION

Tune in to IPA’s BOP: What, Why & How podcast following each Iowa Board of Pharmacy meeting to recap the board’s actions and earn Pharmacy Law CE!

2022 Legislative Priorities

IPA’s Vice President of Government Affairs, Brett Barker, PharmD, gave a presentation to the Board regarding IPA’s priorities for the 2022 legislative session. These included PBM reform, non-discrimination for pharmacist payment, maintaining the integrity of the 340B Program, modernizing the Iowa Practice Act and monitoring restricted drug distribution models (white/brown bagging). At the conclusion of the presentation, the Board of Pharmacy voted to support IPA’s legislative priorities this year.

VOTE OF ADOPTION ON NEW REGULATIONS

Each episode will focus on WHAT actions were taken by the Board of Pharmacy, WHY the BOP took the actions it did, and HOW BOP action will impact practice in Iowa.

Expanded Practice Standards

The rules implementing the 2021 legislation relating to prescription and administration of vaccines and collaborative pharmacy practice were finalized and adopted by the Board. Effective in 2022, the rules update Iowa’s administrative code in regard to collaborative pharmacy practice and collaborative practice agreements. The new rules establish requirements for collaborative practice agreements, including, but not limited to, identification of the parties to the agreement, the establishment of the delegating practitioner’s scope of practice, the protocol, formulary or clinical guidelines that describe or limit the pharmacist’s authority to perform the patient care, a description of the process to monitor compliance with the agreement and clinical outcomes of patients. These rules now move on to final approval by the Administrative Rules Review Committee.

IARX.ORG/BOP_PODCAST

JAN.FEB.MAR. |

Patient safety. Professional practice. Community impact.

PTCB’s Certified Pharmacy Technician (CPhT) Program is fundamental across pharmacy practice and is the foundation for all PTCB specialty and advanced credentials.

Assessment-Based Certificates

State pharmacy associations like ours work with PTCB because PTCB chooses excellence. Advanced Certifications

Build your team with confidence. Employers who rely on PTCB consistently report improved employee performance, greater efficiency, lower turnover, and reduced time and expense to train and advance pharmacy technicians.

Choose PTCB. Choose Excellence. View PTCB’s full suite at ptcb.org/credentials

Compounded Sterile Preparation Technician® (CSPT®) Certification

Advanced Certified Pharmacy Technician (CPhT-Adv) Certification

TECHNICIAN CORNER

TECHNICIAN SPOTLIGHT: KELLY ANDERSEN

elly Andersen’s pharmacy journey began during her freshman year at Simpson College in Indianola. She was considering a major in biochemistry and met with her advisor about potential careers and education paths. Pharmacy came up in the discussion, and she learned she could become a pharmacy technician while in school. Kelly took that opportunity in stride and started gaining work experience as a PRN pharmacy technician at MercyOne Hospital in 2000. Since then, she has worked a diverse set of roles, including as a pharmacy trainer, third-party audit coordinator and pharmacy central scheduling coordinator with Hy-Vee, as well as a prior authorization technician with CatalystRx. Currently, Kelly is the administrative assistant for MercyOne’s Pharmacy Department. While the concept of work-life balance in the profession of pharmacy may inspire nervous laughter (especially with the added stress and workload of the pandemic), Kelly still finds time to enjoy her hobbies of camping, hiking, and canoeing with friends. She also enjoys relaxing and connecting with her family, whether it be her dog, Jax, her cat, Emery, or the rest of her extended family that live in town, including her parents, brother and sister-in-law, and her two nieces. She loves spending time with her family and feels blessed to have them so close. Kelly’s roles and responsibilities have evolved since her first pharmacy job in 2000. In her current role, she supports a great team of managers and staff across both MercyOne Hospitals in Des Moines and West Des Moines. Her responsibilities are not limited to the hospitals; she also assists with the three MercyOne outpatient pharmacies in Ankeny, Clive and Des Moines.

Kelly says the most rewarding part of her job is knowing that every day she is a source of knowledge within her department, and, alongside her team, she is working to directly improve patient care. She notes the most challenging part of her job has been the 340B process and auditing. She compares this challenge to a very big puzzle – requiring multiple pieces, many people and a lot of time to make it work. Since the start of the COVID-19 pandemic, Kelly has learned a lot about adaptability. She states, “The ability to change direction on a moment's notice is the only way to survive and move forward in the healthcare industry.” Especially in her current role, Kelly recognizes how the pandemic has affected pharmacy on all levels, from staffing to the availability of patient services. Even in the face of these challenges, she looks forward towards the future of the profession.

Kelly Andersen Administrative Coordinator, Pharmacy Department, MercyOne Des Moines

Kelly envisions a future with numerous changes to the role of pharmacy technicians. She hopes that more companies develop career ladder programs to support changes in the pharmacy technician's role. Kelly also believes in IPA's role to direct change. She looks to IPA to continue giving healthcare professionals events and opportunities to connect, network and share information. She feels the ever-growing speed at which things in healthcare change will increase the need for pharmacy professionals across practice settings to share information about processes that work (or don’t work) so that we can continue to provide the best possible care to patients every day. Thank you, Kelly, for all you do in serving your patients and profession! ■

MEMBER TIP: Make Note of License Renewal and Recertification Deadlines! PHARMACISTS: The Board of Pharmacy sends a license renewal notice via email to each licensee 60 days prior to license expiration. Licenses at the end of their 2-year renewal period will expire June 30th. Failure to renew before July 1st following expiration will cost an additional fee. TECHNICIANS: On May 12, 2021, the Board of Pharmacy began converting registration expiration dates to the date that the technician’s national certification expires. Previously, the registration expired on the last day of the birth month of the registrant every two years. The updated registration period is valid for 2 years. FOR MORE INFORMATION: Visit pharmacy.iowa.gov

JAN.FEB.MAR. |

TECHNICIAN CORNER

HIV TESTING & THE ROLE OF THE TECHNICIAN

OCTOBER 1 – DECEMBER 31, 2021

From IPA’s Nov. 2021 Tech Tidbits

Congratulations to the following pharmacy technicians on becoming PTCB-certified!

Human Immunodeficiency Virus (HIV) is an autoimmune disease which attacks the cells of the body’s immune system. Pharmacy technicians have the potential to play a significant role in the treatment journey of HIV patients. As increased HIV testing in pharmacies continues, technicians can encourage proper care of HIV patients, make sure patients feel comfortable asking questions about the disease and their medications, and help end the stigma associated with HIV. HIV-related stigma includes negative attitudes or beliefs about people with the disease, and it can affect an individual's emotional well-being as well as their treatment. Many times, this kind of discrimination can steer people away from telling their loved ones they have HIV or even seeking the medical help they need. It is important to know that anyone can contract HIV, and although it can be a difficult disease, there have been many medical advancements making it more manageable. Although HIV does not have a known cure, there are therapy options. Antiretroviral Therapy (ART) reduces the viral load of HIV and slows the progression of the disease. There are also therapies such as post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) which can stop the spread and protect those who may have come in contact with someone who has HIV. Currently, there is a push for pharmacists to have the ability to test for HIV in the pharmacy. Pilot programs have already begun in various pharmacies across the state of Iowa, which will lead to increased access to testing. More patients may come to pharmacies to get tested for HIV or ask HIV-related questions. Often the first face in the pharmacy, technicians can play an important role in making sure patients are comfortable coming to the pharmacy and asking for help.

SOURCES:

1. https://www.pharmacytimes.com/view/how-stigma-unconsciousbias-impacts-health-outcomes-for-patients-seeking-using-prep-forhiv-prevention 2. https://idph.iowa.gov/Portals/1/userfiles/40/Final_2020_Fact%20 Sheet_HIV%20in%20Iowa.pdf

| The Journal of the Iowa Pharmacy Association

NEWLY CERTIFIED IOWA TECHNICIANS

Ayishah Armstrong Taylor Hays Marissa Poe Ashlyn Bahnsen Angela Helton Taylor Porter Nicole Balk Michelle Herch Rebecca Rhodes Jaidyn Ballard Nayeli Hernandez-Lopez Lacey Ricardes Claire Baudler Jordan Hobbs Sharon Roberg Sangdao Bixby Kellie Holub Adelle Rogers Shelby Boston Jennifer Hongphao Rocio Romero-Ramirez Elyss Brackett Merica Hornback Amber Rose Christina Burns Shelby Hulsebus Anna Roshek Nyah Chamberlain Kelsey Ihns Elise Rouse Sereena Cheney Svetlana Ilnitsky Gabriela Saez Jennifer Clarke Elizabeth Joakim Chelsea Sanders Sarah Conrad Mica Johnson Nathaniel Santos Lakrista Corder Alyssa Kafer Hannah Schmitt Riley Crabtree Laurel Kelly Natalie Schmitz Austin Craig Laurel Kimber Sarah Schwien Emma Crossett Kathleen Kwiatkowski Madison See Margaret Cullum Anne Laakso Fallon Shakespeare Natalie Cunningham Courtney Lewis Heather Shook Brittney Davis Isabel Libke Jared Simon Sophia Dehl Kayla Limberg Grace Stackhouse Madison Doak Jon Loeschen Christina Stuerman Preston Edmonds Madison Mann Mallory Suhr Larson Victoria Eichenberger Quinntessa Kinney Emma Sullivan Alia Elmakki Sally McDonald Kristen Sumpter Travis Errthum Erica Metz Selena Sykes Katherine Fischer Kelly Miller Andrew Thomas Teresa Fisher Mouiz Mohammed Angela Trembly Marchelle Flood Jessica Monroe Thomas Tungett Erin Foster Maggie Murphy Cadence Vivian Dusty Freeman Marina Nagib Nicholas Watters Angela Goodrick Theresa Nelson Kaylee Weaver Jenah Greiner Richelle Nodland Alyssa Wiley LeAnn Guntren Connie Pa Alexa Winkel Tyler Halsey Amber Peterson Zoe Yolish Amber Hamel Bradley Pickhinke

TECHNICIAN CORNER

TYPES OF COVID-19 TESTING From IPA’s Dec. 2021 Tech Tidbits It is important to understand the differences between the types of COVID-19 tests available, what they detect, and how they can be used for different testing activities. There are two different types of coronavirus tests: diagnostic tests and antibody tests. An antibody test looks for antibodies that are made by the immune system in response to a threat, such as a specific virus. Antibodies can help fight infections but can take several days or weeks to develop after being infected. They may stay in the blood for several weeks after recovery. These tests are also known as serological tests, and the sample is taken by finger stick or blood draw. The other type of test, a diagnostic test, can show if there is an active coronavirus infection. If positive, one should take steps to quarantine or isolate from others. Currently there are two types of diagnostic tests, molecular (RT-PCR) and antigen tests.

MOLECULAR TESTS

Molecular (RT-PCR) tests detect the virus’ genetic material. It can be collected by nasal, throat swab or saliva.

ADVANTAGES: • Positive and negative results are typically accurate • Highly specific and sensitive

DISADVANTAGES: • Often requires a laboratory to process the specimen • Takes longer to generate results

ANTIGEN TESTS

Antigen tests detect specific proteins on the surface of the virus. It can be collected by nasal or throat swab.

ADVANTAGES: • Available at point-of-care • Results available quickly • Positive results are typically accurate (highly specific) • Low cost

DISADVANTAGES: • Negative results may not be accurate (less sensitive) • May need to confirm a negative result with a molecular test

SOURCES:

1. https://aphanet.pharmacist.com/sites/default/files/audience/APhACOVID-19TestingBasics1120_web.pdf 2. https://aphanet.pharmacist.com/sites/default/files/audience/APhACOVID-19AuthoritytoTest1120_web.pdf 3. https://www.fda.gov/media/138094/download

JAN.FEB.MAR. |

IPA FOUNDATION

The Iowa Pharmacy Foundation sincerely thanks those members who make a contribution to the future of the profession by supporting the efforts of the Foundation...these contributions truly make a difference!

The following list of contributors is for January 1-December 31, 2021.

PLATINUM LEVEL ($1,000+) Carl Chalstrom Renae Chesnut Connie & Chris Connolly Jay & Ann Currie Michele Evink Kate & Bob Gainer Bob & Chery Greenwood Tom Halterman Rick Knudson Lisa & Andy Ploehn Anthony Pudlo Al Shepley Bob Stessman

GOLD LEVEL ($500-$999) Amanda Abdulbaki Bill Baer Brett Faine Steve Firman John Hamiel Charlie Hartig Jim Hoehns June Johnson TJ Johnsrud Kelly Kent Carson Klug Julie Kuhle

Nic Lehman Lindsey Ludwig Lyudmyla Lyashenko Gary Maly Gary Milavetz & Mary Teresi Stephen Mullenix Matt & Marilyn Osterhaus Rachel Otting Chuck & Janalyn Phillips Wes Pilkington Susan Shields Angie Spannagel Katherine Waack

SILVER LEVEL ($250-$499) Cindy Buys Sharon Cashman Jordan Cohen Bill Doucette John Forbes Morgan Herring Terry Jacobsen Dennis Jorgensen Tyson Ketelsen Craig Logemann Nick Lund Susan Lutz Ed Maier Deanna McDanel

| The Journal of the Iowa Pharmacy Association

Kristin Meyer Mary Mosher Bob & Ann Osterhaus Emmeline Paintsil Matt & Jamie Pitlick Diane & Jeff Reist CoraLynn Trewet Tom Truong

BRONZE LEVEL ($100-$249) Mike Andreski Nancy Bell Michelle Bottenberg Cheryl Clarke Chris Clayton Sarah Derr Dena Dillon Ashley Dohrn Jessica Frank Philip Greazel Elise Houselog Sandra Johnson Carrie Koenigsfeld Donald Letendre Steven Martens Alex Mersch Jen Moulton Phyllis Olson Heather Ourth

Mike Pursel Heather Rickertsen Carol Sanders Cheri Schmit Michael Schnackenberg Chelsea Schott Nora Stelter John Swegle Tom Temple Katherine Thaut Stevie Veach JP Webb Sara & Terry Wiedenfeld

BUSINESS PARTNER CONTRIBUTIONS Cardinal Health Drake University CPHS Evans Cross Pharmacy Greenwood Pharmacy Hawarden Regional Healthcare Hy-Vee Main at Locust Pharmacy McKesson McGowen, Hurst, Clark & Smith North Iowa Pharmacy, Inc. NuCara Pharmacies Towncrest Pharmacy Univ. of Iowa College of Pharmacy Wildwood Hills Ranch

2021 Recipients of the “Bowl of Hygeia” Award

Rebecca Sorrell Alabama

Richard A. Holt Alaska

Michael R. Blaire Arizona

Paul Ackerman Florida

Laird Miller Georgia

Chris Lynch Illinois

Robert E. Hodge II Arkansas

Omolola A. Adeoye-Olatunde Indiana

Katherine E. Bass California

Nancy Stolpman Colorado

Jill Fitzgerald Connecticut

Megan Willey Delaware

Steven W. Sayler Iowa

Doug Funk Kansas

Melinda C. Joyce Kentucky

TJ Woodard Louisiana

Bill Mosby Mississippi

Salim (Sam) Tadrus Missouri

Mike Bertagnolli Montana

Jennifer Ortega New Mexico

Gary A. Rotella New York

Mollie Ashe Scott North Carolina

Cheri Kraemer South Dakota

Thomas Marcrom Tennessee

Amelia Arnold Charmaine Rochester-Eyeguokan JoAnn Sanborn Maine Maryland Michigan

Jennifer Tilleman Nebraska

Cheryl Durand New Hampshire

Lucio R. Volino New Jersey

Terry Altringer North Dakota

Greg Adams Oklahoma

Amy D. Valdez Oregon

Gregory Myers Utah

Troy D. Spaulding Vermont

The “Bowl of Hygeia”

Trish Klatt Pennsylvania

Charles Tarasidis Virginia

Tara Higgins Rhode Island

C. A. Leon Alzola Washington Photo Not Available

David E. Burke Ohio

Merrie Kay Alzola Washington Photo Not Available

John T. Johnson South Carolina

Carolyn Rachel-Price Washington DC

Charlotte Weller Texas

Krista D. Capehart West Virginia

Photo Not Available

Fran D’Egidio West Virginia

2020 Recipient Presented in 2021

Hashim Zaibak Wisconsin

Craig Frederick Wyoming

The Bowl of Hygeia award program was originally developed by the A. H. Robins Company to recognize pharmacists across the nation for outstanding service to their communities. Selected through their respective professional pharmacy associations, each of these dedicated individuals has made uniquely personal contributions to a strong, healthy community. We offer our congratulations and thanks for their high example. The American Pharmacists Association Foundation, the National Alliance of State Pharmacy Associations and the state pharmacy associations have assumed responsibility for continuing this prestigious recognition program. All former recipients are encouraged to maintain their linkage to the Bowl of Hygeia by emailing current contact information to awards@naspa.us. The Bowl of Hygeia is on display in the APhA History Hall located in Washington, DC.

MEMBERS SECTION

PHARMACIST SPOTLIGHT: JAMIE PITLICK, PHARMD, BCPS

A Jamie Pitlick, PharmD, BCPS, BC-ADM Clinical Pharmacist Iowa Diabetes

career in pharmacy is pursued for various reasons. Some may be drawn to the accessibility of the profession to patients and communities. Others may find the versatility of the profession to be very appealing. Rather, Jamie Pitlick chose a career pharmacy because she saw the impact pharmacists can have on patients through education. First exposed to the profession in high school, Dr. Pitlick shadowed her aunt and saw how much patients value a pharmacist's education and advice. She decided that was the path she too wanted to follow. Dr. Pitlick went to pharmacy school at Drake University and upon graduating, pursued a residency in St. Louis through a family practice program. Soon after her residency, Dr. Pitlick found she greatly enjoyed working in ambulatory care and continued to do so, in addition to working as an Assistant Professor at St. Louis College of Pharmacy. In this role, Dr. Pitlick was able to fuel her passion for education by educating patients in the ambulatory setting and pharmacy students in the classroom. As the next step in her career, Dr. Pitlick moved to Des Moines and began working at MercyOne in endocrinology. In 2017, she became an educator once again, teaching diabetes classes and leading lab as an Associate Professor in the Clinical Services Department at Drake University. Three years later, Dr. Pitlick transitioned from MercyOne to her current position at Iowa Diabetes, a research clinic and diabetes education hub in West Des Moines. Here, she has a unique role, working as a clinical pharmacist hand-in-hand with the physician on-site and other health professionals (CMA, ARNP, and dieticians). The team works to formulate the best plan of action to help a patient gain and maintain control of their diabetes holistically through routine check-ups and various resources. At Iowa Diabetes, Dr. Pitlick not only takes on the traditional role of a clinical pharmacist, but also works to educate patients through different mediums including telehealth, social media and blogs. She works diligently with her patients daily to ensure they are receiving reliable information and are educated on their new medications. Dr. Pitlick attributes the success of Iowa Diabetes to the interprofessional collaborative environment at the clinic and the hard work of its employees. The health professionals at the clinic are always working together and seeing what they can do to improve the patient journey. Dr. Pitlick explained that the physician on-site,

| The Journal of the Iowa Pharmacy Association

Dr. Bhargava, truly understands and appreciates her work as a pharmacist and values her skills. Dr. Pitlick says the most rewarding part of her work as a pharmacist is seeing anyone she educates grow, whether it's her students at Drake University improving their clinical skills or her patients at the clinic seeing improvement in their blood glucose levels. She believes that pharmacists have a niche role to play in the healthcare landscape, and pharmacists need to continue to advocate for their profession. When Dr. Pitlick first entered the pharmacy profession, the role of the pharmacist largely involved dispensing. Today, pharmacists have taken on countless roles and can be found in almost every healthcare setting—from an insurance company to a hospital. Dr. Pitlick believes pharmacy has the potential to continue to expand into non-traditional avenues, and pharmacists should continue to be entrepreneurial and look for new opportunities to serve patients. Dr. Pitlick has worked to advocate for the pharmacy profession throughout the years by staying involved in the community and state and national associations. She is an active member of the Iowa Pharmacy Association (IPA), American College of Clinical Pharmacy (ACCP), and Rho Chi at Drake University. At IPA, Dr. Pitlick serves on the Policy Committee on Professional Affairs and recently attended the 2021 Decker-Temple Leadership Pharmacy Conference. At ACCP, Dr. Pitlick serves on the endocrine and ambulatory subcommittees and helps to create educational materials. Professional involvement has always been a priority for Dr. Pitlick, but in her free time, she enjoys spending time with her three kids and family, staying active and cooking. The pandemic has given her more time to try new recipes and even learn to bake bread! She stays involved in her community by coaching soccer and teaching the youth how to be young leaders. Jamie Pitlick is a notable example of what it means to be an involved pharmacist in her community and profession. She continues to advocate for pharmacy through her professional affiliations, her role as a professor, and her job at Iowa Diabetes, all while being driven by her passion for education. As pharmacists, we have great potential to grow in our profession and see perpetual change. Remind yourself of your passions, and let that be a driving force for your career. Thank you, Dr. Pitlick, for the impactful work you have done for your patients, students and profession. ■

MEMBERS SECTION

WELCOME NEW IPA MEMBERS! OCTOBER 1, 2021 – DECEMBER 31, 2021 Ruben Abraham

Eric Gallagher

Jason Lin

Michaela Schick

Ruba Alagha

Christina Gassman

John Loomis

Ethan Schultz

Benjamin Allington

Rylee Goosen

Cole Ludolph

Rebecca Scribano

Deena Alsabbah

Lauren Gravert

Emily Luu

Megan Seiler

Noor Alwaan

Sandra Guckian

Eric Macak

John Sheahan

Ademola Are

Isaak Hansen

Suzy Mahalick

Ibrahim Shnati

Alicia Baccam

Lauryn Hanson

Teresa Malanda

Mohamed Sobi

Emily Barmore

Erica Heinrichs

Rebecca Manternach

Gavin Soppe

Tristan Bautista

Anna Holden

Steven Mather

Karl Stadler

Shae Becker

Rayne Hollenback

Taylor McIntosh

Taylor Streck

Taylor Beebe

Jillian Hood

Anthony Medina

Abigail Stumpner

Mahsa Behnami

Mathew Hosford

Madeline Mews

Lucy Sundrup

Claire Behymer

Sarah Hou

Jacob Miller

Eric Thai

Lexie Behymer

Courtney Howe

Maleena Moretti

Hannah Thillman

Jenna Bemiss

Erin Hubbard

Ellise Mueller

Kaitlyn Thomas

Samson Bishop

Porter Hummel

Aubrey Myer

Kisara Thompson

Ruth Black

Stacia Humphrey

Jonathan Nguyen

Jason Torossian

Amanda Bolton

Elizabeth Hunter

Sophie Nguyen

Christ Tran

Natalie Boyer

Fenicia Hutt

Will O'Brien

Tammy Tran

Anna Braun

Sabah Ibrahim

Imor Okwaramoi

Ryanne Trpkosh

Douglas Cammann

Charles Iles

Doaa Omer

Rachel Turin

Arin Chinchilla

Jonathan Issa

Sanny Ong

Dylan Valley

Ashley Christenson

Brooke Jasper

Grady Orwig

Dante Vicini

Mitchell Coleman

Kali Jensen

Mushtaha Osman

Kelly Vu

Abigail Crowner

Ben Jones

Mumtaj Patel

John Ware

Peyton Cuddeback

Jenna Kane

Janki Patel

Ryan Weber

Megan Day

Deeya Karkera

Lacy PettyJohn

Tim Weippert

Jennifer Diaz

McKayla Karr

Karla Plender

Emily Weyenberg

Kylie Duesing

Khalid Khalid

Stephen Presti

Lori Wilson

Rami El-Khateeb

Sejin Kim

Bethany Reed-Jahncke

Kaley Wolff

Amber Elliott

Vicky King Dow

Davis Rieckenberg

Xiaoxuan Xu

Ashley Engle

Kayla Kinney

Andrew Russo

John Faulks

Joshua Kinsey

Morgan Ryan

BUSINESS PARTNERS:

Luke Ferguson

Ally Kinsey

Marianne Said

Eby Dug

Angelica Fic

Jacob Kokko-Ludemann

Andrew Schemmel

Covetrus Pharmacy Services

Lauren Finn

Olivia Kulaszewicz

Mitchell Schemmel

CR Care Pharmacy

Abigail Fiorentino

Kristi Lee

Courtney Schenkelberg

Reagan Fritz

Elma Lidjan

Meghan Schick

Healthcare Development/ Medicure Pharmacy

JAN.FEB.MAR. |

EXECUTIVE INTERNSHIP

IF IT DOESN’T CHALLENGE YOU, IT DOESN’T CHANGE YOU

I Keaton Higgins, ATC 2021 IPA Executive Intern The University of Iowa College of Pharmacy

n August of 2019, I was sitting in a lecture hall with 111 of my future classmates during pharmacy school orientation. Admittedly, I was half-listening while we were learning about typical pharmacy careers and clinicals roles we could end up in when we graduated. Then, a man in a gray suit walked in and changed everything I thought I knew about being a pharmacist. His talk centered around advocating for the future of pharmacy, professional networking, and making a difference for the people that matter most to us. Probably to no one’s surprise, this man was IPA’s former Vice President of Professional Affairs, Anthony Pudlo. This was my first experience seeing a pharmacist that was not working in a traditional pharmacy role. While I was already excited to begin my journey of becoming a pharmacist, this was the moment I realized that a PharmD degree was not just a piece of paper required for our future career, but it was much more so a passport to take us wherever we would like to go and achieve whatever we believe is possible. Using this moment to fuel me, I have spent my time in pharmacy school discovering and promoting the ever-growing opportunities for pharmacists to thrive within their careers. It has been made clear to me that if our profession wants to continue moving forward and pharmacists want to continue increasing the value they can provide to their communities, then we need strong leaders to advocate for our abilities and educate others on the potential impact that we can have. As someone with a non-traditional background before beginning pharmacy school as a certified Athletic Trainer, this is especially important to me and my dreams of integrating my pharmacy knowledge into sports medicine. Even more so, it is important to me that I help my fellow student pharmacists discover these roles as we begin our careers to avoid the burnout that is more evident than ever in healthcare. The Iowa Pharmacy Association has played an integral role helping me achieve these goals in pharmacy school. I have had the pleasure of participating in several IPA events such as the Bill Burke Student Pharmacist Leadership Conference, Legislative Day, Annual Meeting and PharmaCE Expo, while serving in the House of Delegates and on the Student Pharmacist Advisory Committee. Not only are these events and committees crucial elements to the advancement of pharmacy in Iowa, but they have given me the opportunity to build strong relationships with leaders across our state that keep me motivated to continue the incredible work that they are doing every day.

| The Journal of the Iowa Pharmacy Association

This past summer, I was blessed to further my involvement with IPA in my role as the 2021 Max W. Eggleston Executive Intern in Association Management. I will be the first to admit that between moving to a new city for 12 weeks, starting this new role, the uncertainties of the COVID-19 pandemic, and dealing with the loss of a parent all within one summer, I was OVERWHELMED. And that’s okay. A common theme for my summer was that of change, both for me personally and for the staff at IPA. From the going-away parties for individuals that were moving on to new and exciting roles, to being a part of the hiring and onboarding process for current staff members, it was inspiring to experience firsthand the resiliency and continuation of culture that is deeply embedded within the IPA team. This speaks volumes about the level of servant leadership and the commitment to a vision that has been a mainstay at IPA—values that I hope to instill in my own teams one day. On a personal level, I was tasked to complete many exciting projects that challenged me and required me to develop new skills and become more resourceful. Two main projects that I worked on included the new Test & Treat Toolkit and ASHP reaffiliation reports. These projects challenged me in different ways and were also rewarding in different ways. My time spent on the Test & Treat Toolkit educated me on the legislative process of implementing new laws for pharmacy practice. Working on the toolkit, which was created in response to Senate File 296, gave me the unique opportunity to see how closely IPA interacts with the Iowa Board of Pharmacy as they worked through guidelines and regulations for the new service. My time spent on ASHP reaffiliation reports further opened my eyes to how widespread and engaged IPA is in their efforts to support all of their pharmacy members, no matter the practice setting. My time was spent researching and documenting events, committees, policies, and social media content while interacting with ASHP representatives to highlight the value that IPA provides to its health-system pharmacy members. While these projects were equal parts demanding and fulfilling, perhaps my favorite part of my experience as the Executive Intern last summer was meeting with numerous IPA members across the state who all had their own unique story about finding success in nontraditional pharmacy career paths. While I was seemingly a fish out of water getting accustomed to Des Moines, each

EXECUTIVE INTERNSHIP of the individuals that I met made me feel welcome, and left me feeling inspired, hopeful, and ready to write my own unique story of the future with many lessons learned and countless lives touched along the way. If I have learned anything during my time in pharmacy school, it would be two things: 1) It’s not what you know, it’s who you know, and 2) pharmacy is very small world. I look forward to these ringing true. As humans, we are inherently averse to change, but last summer it was more obvious to me than ever before that change can be a beautiful thing. As I reflect on my time as IPA’s Executive Intern, I can confidently say that it was by far the most challenging yet rewarding experience of my life. I would not trade a second of my time spent, any lesson learned, or a single relationship that I built for the world. I truly believe the future of pharmacy is bright, and I am excited to use my time as the Executive Intern as a springboard for my career as we continue to expand the value pharmacy teams can provide for a healthier tomorrow. It would be impossible for me to thank everyone that impacted my life last summer, so I’ll end with this... Thank you, IPA, for the best summer of my life. ■

IPA MEMBER BENEFIT Have You Accessed Your FREE Continuing Education Beneﬁts Yet? WWW.IARX.ORG/ACCESSCPE

IPA ENGAGED Pharmacist and Pharmacy Technician members receive a FREE membership to CEimpact’s Pharmacist or Pharmacy Technician Course Catalog, which includes all required CPE for pharmacist relicensure and pharmacy technician recertification. JAN.FEB.MAR. |

MEMBERS SECTION

MEMBER MILESTONES George Papineau, PharmD, RPh, has been named Pella Regional Health Center’s new Director of Pharmacy. In this role, George will provide leadership to the hospital pharmacy department in planning, directing, and monitoring all financial, operational, professional, regulatory and clinical activities. Best of luck from IPA!

IN MEMORIAM Iowa pharmacy leader John (Jack) Kiburz passed away on January 29, 2022. Jack attended the University of Iowa College of Pharmacy and spent his career as a pharmacist and owner of Kiburz Drug. He served as Treasurer of IPA from 19821991 and as Honorary President from 1990-1991. Jack also received the prestigious Bowl of Hygeia award in 1983. Previous IPA member William Abel, Jr., passed away on February 11, 2022. William was a 1966 Drake University College of Pharmacy graduate and was recognized by IPA for practicing pharmacy for 50 years. He previously worked at Lampe Drug Store (1966-1998) and ShopKo Pharmacy (1998-2005).

IPA INTRODUCES VICE PRESIDENT OF GOVERNMENT AFFAIRS

IPA would like to introduce its newest staff member, Brett Barker, PharmD, Vice President of Government Affairs! Starting this part-time role in early January, Brett has already been a great asset this legislative session in helping advance pharmacy priorities. Brett is a graduate of the University of Iowa College of Pharmacy and currently works for Nucara Management Group as Vice President of Operations. Aside from his professional roles, Brett serves as the mayor of the city of Nevada, enjoys weightlifting, and is a father to his four daughters with his wife, Tracy.

SAVE THE DATE!

SEPT. 22-23, 2022 Cedar Rapids, IA DoubleTree by Hilton Convention Complex

RESERVE YOUR ROOM TODAY!

www.iarx.org/IPAAnnualMtg 36

| The Journal of the Iowa Pharmacy Association

You Need a CQI Program Mistakes happen. Risky processes become normalized and your operations can shift slightly with staffing changes, new products, and new procedures. The APMS Patient Safety Organization (PSO) provides Pharmacy Quality Commitment+ (PQC+) Compounding, a confidential, highly secure, continuous quality improvement program. Track and analyze how, when, and where the risk in your workflow occurs so you can reduce Rx corrections and operational costs. Our program includes: 1

Pharmacy Quality Commitment+ A web-based reporting portal to collect patient safety events Tools to chart, graph, and analyze data Expert advice, tips, and safe practices Resources to help you meet accreditation and quality improvement requirements Support to build a just culture of safety QA Continuing Education and training opportunities

APMS PSO Services Patient Safety Organizations (PSOs) provide a safe space for members to conduct patient safety work. When you partner with our PSO for your Quality Improvement activities, the collection of quality assurance data and patient safety work is in a protected environment.

Customer Service

We are passionate about medication safety in community pharmacy and are here to walk you through the entire process. Our customer service team has years of experience in pharmacy and is excited to help.

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CALENDAR OF EVENTS

UPCOMING IPA EVENTS

IPA GOES LOCAL RETURNS IN 2022

Find additional details to these events and more at www.iarx.org. Click on “Calendar of Events” under the Events tab.

APRIL 2022 8-10 Bill Burke Student Pharmacist Leadership Conference

2/2/2 Webinar

IPA Payment for Pharmacy Services Forum

IPA Goes Local – Mason City

MAY 2022 3

IPA Goes Local – Davenport

3-4

Iowa Board of Pharmacy Meeting

NAPLEX-MPJE Virtual Review Course

Day 1: PharmaCE Expo 2022

Day 2: PharmaCE Expo 2022

IPA Goes Local – Council Bluffs

IPA Goes Local is a partnership between IPA and Iowa’s regional pharmacy associations to bring live CPE to locations across the state and see what our members are doing on a local level. After taking a short pause during the COVID-19 pandemic, IPA is excited to resume Goes Local events in 2022! Learn more and register today at www.iarx.org/goeslocal.

April 21, 2022, 6:00-8:00 PM North Iowa Pharmacy Inc., Mason City, IA May 3, 2022, 6:00-8:00 PM Quad Cities Area Pharmacy Association, Davenport, IA May 26, 2022, 6:30-9:00 PM Southwest Iowa Pharmacists Association, Council Bluffs, IA November 10, 2022, 6:00-8:00 PM Northwest Iowa Pharmacy Association, Sioux City, IA

IPA MEMBER FORUMS

In November, IPA hosted its first ever Pharmacy Technician Forum. Technicians from across the state gathered virtually to discuss pertinent topics such as wellbeing, technician liability, and the expanding role of the pharmacy technician.

JUNE 2022 9

Eggleston-Granberg Golf Classic

2/2/2 Webinar

IPA Independent and Community Pharmacy Practice Forum

Currently scheduled events are subject to change. Watch IPA communications regarding any updates.

| The Journal of the Iowa Pharmacy Association

Make sure to mark your calendar for the two IPA Member Forums to be hosted in the coming months:

Payment for Pharmacy Services Forum April 20, 2022 Independent & Community Pharmacy Practice Forum June 21, 2022 Learn, network and engage with your profession! IPA Member Forums are an exclusive member benefit for ENGAGED Pharmacist, Technician, and Student Pharmacist members. Visit www.iarx.org/forums.

IPC CONFERENCE

APRIL 12-15

Beyond

SAN DIEGO, CA

Script

The Business of Pharmacy

The IPC Conference is back… and in person! Join us for 3 full days at the historic Hotel del Coronado where you will find opportunities to: ∙ Give back to the community (we’re painting surf boards!) ∙ Earn 10+ hours of CE credit ∙ Visit with industry-leading vendors at trade show (there’s a cocktail hour) ∙ Network with other independents ∙ Meet and mentor pharmacy students ∙ Enjoy exceptional food, drink, and entertainment

Register Today! 3-Night Package = $987* * Includes hotel, breakfast & lunch, CEs, trade show, receptions and entertainment.

SCAN ME!