IPA Journal - Oct/Nov/Dec 2013

The Journal of the Iowa Pharmacy Association | A Peer-Reviewed Journal

OCT/NOV/DEC 2013 Features: Affordable Care Act Midwest Pharmacy Expo

OCT/NOV/DEC 2013 | Vol. LXVIV, No. 4

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 Lynndi Koester, Managing Editor lkoester@iarx.org Kate Gainer, PharmD kgainer@iarx.org Anthony Pudlo, PharmD, MBA, BCACP apudlo@iarx.org Jennifer Moulton, RPh jmoulton@gotocei.org Joan Stover jstover@iarx.org

OFFICERS Chairman Julie Kuhle, RPh, Indianola 515.273.8876, jwkuhle@aol.com President Michele Evink, MS, PharmD, CGP, FASCP, Osceola 641.342.5322, mevink@clarkehosp.org President-Elect John Swegle, PharmD, BCPS, Mason City 641.428.7182, john-swegle@uiowa.edu Treasurer Steve Firman, RPh, Cedar Falls 319.277.7540, steve@pmgrx.com Speaker of the House Randy McDonough, PharmD, MS, CGP, BCPS, Iowa City 319.337.3526, mcdonough9@mchsi.com Vice Speaker of the House Connie Connolly, RPh, DeWitt 563.652.5611, conniejconnolly@hotmail.com

TRUSTEES REGION 1 Steven Martens, PharmD, Grundy Center 641.366.3440, steven@nucara.com REGION 2 John Daniel, PharmD, Fort Dodge 515.573.3431, jfdaniel@frontiernet.net REGION 3 Lori Schirmer, PharmD, BCPS, BCNSP, West Des Moines 515.241.3264, lori.schirmer@drake.edu REGION 4 Ashley Dohrn, PharmD, Le Claire 563.324.5004, ashley.dohrn@me.com REGION 5 Pat Thies, RPh, MS, FACHE, Cedar Rapids 319.265.3647, thiespw@crstlukes.com AT LARGE Marilyn Aldrich, RPh, Urbandale 515-276-4845, marilyn.aldrich@dahlsfoods.com Cheryl Clarke, BPharm, RPh, CHC, Des Moines 515-271-3899, cheryl.clarke@drake.edu Felix Gallagher, PharmD, Des Moines 515.334.4293, fgallagher@pharmservstaffing.com Justin Rash, PharmD, CGP, Ankeny 515.331.2594, rash.justin@gmail.com HONORARY PRESIDENT Mark Jones, RPh, Davenport jonesma@genesishealth.com, 563.421.4458 PHARMACY TECHNICIAN Michelle Garvin, CPhT, Wilton 563.732.5238, mgarvin@westerdrug.com STUDENT PHARMACISTS Matt Farley, University of Iowa matthew-farley@uiowa.edu Kelsey Lawfer, Drake University kelsey.lawfer@drake.edu

TABLE OF CONTENTS COVER ACA - A Duffy Cartoon . . . . . . . . . . . . . . . . . . . . . . Cover

FEATURES

President’s Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Affordable Care Act . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Midwest Pharmacy Expo . . . . . . . . . . . . . . . . . . . . . . . 10

IN EVERY ISSUE

Health Care Hot Topics . . . . . . . . . . . . . . . . . . . . . . . . Iowa Pharmacy News . . . . . . . . . . . . . . . . . . . . . . . . . IPA Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Public Affairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Peer Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Member Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Technician’s Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . College of Pharmacy News . . . . . . . . . . . . . . . . . . . . . Iowa Residents Section . . . . . . . . . . . . . . . . . . . . . . . . Student Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Last Laugh . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Calendar of Events . . . . . . . . . . . . . . . . . . . . . . . . . . .

12 14 18 22 24 28 31 34 38 42 42 42

ADVERTISERS

PharmServ . . . . . . . . . . . . . . . . . . . . . . . . . . Inside Cover PQC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 PACE Alliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Onnen Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Career Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 IPRN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 OutcomesMTM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Hansen, McClintock & Riley . . . . . . . . . . . . . . . . . . . . 30 PTCB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 TakeAway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Buy-Sellapharmacy.com . . . . . . . . . . . . . . . . . . . . . . . 41 McKesson/RxOwnership . . . . . . . . . . . . . . . . . . . . . . . 43 Pharmacists Mutual . . . . . . . . . . . . . . . . . . . . . . . . . . 44

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. “The Journal of the Iowa Pharmacy Association” (ISSN 1525-7894) is published 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 $20. Printed by Purcell Printing Graphics; Graphic Design done by Iowa Pharmacy Association.

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President’s Page

change is in the air

R Michele Evink

MS, PharmD, CGP, FASCP IPA President

ather than a topic for a column, perhaps this could be a permanent sign in any pharmacy or workplace. After all, it’s reasonable to accept the only constant is change. This time of year, change seems more evident around us as fall begins to show its colors, the school year settles in, new residents become familiar and the outcome of the football season reveals itself. With many things changing, you are probably as challenged as I am to define what my role is and will be. I have a new battle cry when faced with this question. When faced with how to react to change or answer to change, I now focus on returning to purpose.

“. . . you are probably as challenged as I am to define what my role is and will be.” Return to purpose! Why do we do what we do? Who do we serve? What unique place do we hold as professionals? How can I ensure change today means positive outcomes in the future? A profession is defined many ways. Merriam-Webster tells us it is: • A calling requiring specialized knowledge and often long and intensive academic preparation • A principal calling, vocation or employment • The whole body of persons engaged in a calling Pharmacy as a profession certainly encompasses all of these parts of the above definition. The more exciting part of being within a profession is defining what the profession, this calling and specialized knowledge, means to you. Personally, I have found my place in rural hospital practice. This setting allows me to touch patients in a way that matches my

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“I’m proud of the leadership we have taken as health professionals to advance this very important key to preventive medicine.” skills and personality. I’ve found sparkly pharmacists that know your family tree get along better in a rural setting. As I look around the state, I see many pharmacy professionals that have found a similar match. Even better, I see professionals involved in change every day to make sure they optimize the way they practice and the way their practice functions to meet the needs of their patients. One change this year is expanded immunization authority for pharmacists in Iowa. I’m proud of the leadership we have taken as health professionals to advance this very important key to preventive medicine. Vaccines have repeatedly been shown to save not just dollars in avoided health care costs, but increase the quality of life for our patients.

“Never forget your professional purpose.” Our purpose, as pharmacists, is to optimize our patient’s health. An advantage of being in pharmacy is the high level of trust our patients and the general public is willing to place in us. Make it your personal goal to advocate for proper immunization at every opportunity. Speak to those around you, because they will listen. Arm yourself with knowledge and details so you’re ready to have positive conversations that promote immunization. Be prepared to be the credible source for information around this sometimes touchy subject. Change is in the air. Never forget your professional purpose, to optimize the health of our patients through safe and effective medication use.

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feature: aca

Understanding the Patient Protection and Affordable Care Act in Iowa A Primer for Iowa Pharmacists The Patient Protection and Affordable Care Act (PPACA) will transform health care and health care insurance nationwide. PPACA is commonly referred to as the ACA, Affordable Care Act, or Obamacare* as cartoonist Brian Duffy used on this JIPA cover. Significant changes under PPACA include: the elimination of any consideration of a pre-existing condition for acceptance of an application for coverage, the removal of all annual and lifetime benefit maximums, the extension of coverage for children covered under a parent’s plan to age 26, the creation of health insurance

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marketplaces, and minimum essential benefit standards to be followed by all plans in the marketplace. Rates for coverage for these plans will vary based on the plan chosen, your age, where you reside, whether or not you smoke, and the number of individuals within your family. Under the leadership of Gov. Terry E. Branstad and Lt. Gov. Kim Reynolds, Iowa tried to take a common sense approach to implementing the insurance exchanges under PPACA. The creation of a state-federal partnership plan for the insurance exchanges is being implemented in Iowa, along with six other states. (Figure 1) The Iowa Insurance Division played a valuable role in reviewing

qualified health plans and certified that the plans comply with statutory requirements. The Department of Health and Human Services signed contracts with those companies approving the offering of their plans in the marketplace. Two of the medical health plan carriers offer plans in every county in the State of Iowa— CoOportunity Health and Coventry Health.

Basics of the Marketplace

One of the more visible components of the PPACA is the new health insurance marketplaces, also known as exchanges. With uninsured people required to obtain health insurance (or face a financial penalty from the IRS), these online portals ask consumers

feature: aca

to enter information about themselves and select the level of coverage they desire to receive and a list of plans they can purchase. The marketplace also allows individual consumers to determine if they qualify for an individual subsidy from the federal government. Open enrollment for 2014 began October 1, 2013 and will end March 31, 2014. Plans purchased on the exchanges become effective January 1, 2014. You can find a link to Iowa’s official exchange at healthcare.gov. Bogus websites that purport to be part of the exchanges have been appearing online for more than a year, so beware of scam websites that your patients may ask you about. In addition to healthcare.gov, consumers can purchase coverage through the marketplace by mail or in-person. Paper applications will be available to

download online through healthcare. gov. The application is five pages for individuals and 12 pages for families.

Coverage Options

The individual mandate included in PPACA requires that beginning in 2014 individuals must obtain minimum essential coverage. This is defined as insurance coverage with an actuarial value of 60% (called a Bronze level plan on the Marketplace). If consumers do not have minimum essential coverage, the individual may be required to pay the individual fine of $95 or 1% of income, whichever is greater in 2014. Other levels (Silver, Gold and Platinum) feature plans with increasing actuarial values of 70%, 80% and 90% respectively. Insurers who participate in the exchange must offer at least one silver and one gold plan. Actuarial value is the percentage of total average costs

for covered benefits that a plan will pay. For example, if a plan has an actuarial value of 70%, on average, a person would be responsible for 30% of the costs of all covered benefits. While bronze plans will have lower premiums, they will have higher deductibles, co-pays and coinsurance levels that will increase consumer’s costs if they need medical care. See Table 1 for options of coverage levels.

Enrollees Plan Pay on Levels of Pays on Average (plus Coverage Average monthly plan premium)

Bronze

60%

40%

Silver

70%

30%

Gold

80%

20%

Platinum

90%

10%

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feature: aca Essential Health Benefits:

All plans must cover 10 essential health benefits (EHBs): • outpatient services • emergency services • hospitalization • maternity and newborn care • mental health and substance use disorder services • prescription drugs • rehabilitative and habilitative services and devices • laboratory services • preventive and wellness services and chronic disease management • pediatric services The Marketplace will also offer catastrophic plans. Like the name suggests, these plans will only cover consumers if they require extensive care. Catastrophic plans are available for individuals under 30 years old or for those with very low incomes who cannot afford other plans. An individual’s premiums may be offset by tax credits as determined by the IRS upon enrollment. Individuals from 100% of federal poverty level (FPL) up to 400% of federal poverty level ($11,490.00-$45,960 for an individual and $23,550.00-$94,200.00 for a family of four) will qualify for tax credits. Iowans must provide certain information in the application process to determine eligibility for an advance premium tax credit.

Navigating the Exchange

While the federal government is responsible for consumer assistance and education, the Iowa Insurance Division will supplement federal efforts, working with interested parties to help educate Iowans. Iowans will be able to enroll in qualified health plans through three Navigator organizations throughout the state, certified application counselors and insurance agents and brokers. • A navigator can be an individual or an organization, and they are trained to help consumers learn about

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Navigator Organizations in Iowa Genesis Health

1-563-421-3675

Planned Parenthood of the Heartland

1-877-811-7526

Visiting Nurse Services of Iowa

1-515-288-1516

the available choices and guide consumers through the application process once open enrollment begins. • Application counselors and inperson assisters will also be able to help consumers through the application process. Neither a navigator nor the assisters are licensed insurance agents. They cannot recommend a specific insurance plan or sell insurance. • Your insurance agent or broker will be trained to help consumers find the right plan as well. They can recommend a specific plan, but they may only be allowed to sell plans from a particular company if they have a contract with that insurer. Collectively, these individuals and organizations will be critical in helping Iowans through these complex decisions. Individuals and small businesses can also seek help through healthcare.gov with the online chat feature or call the toll free number 800-318-2596 for the marketplace to talk to someone for assistance with enrolling or questions. When the exchanges opened on October 1, 2013, there was a significant delay and backlog on healthcare. gov and the online assistance and customer service numbers due to the large volume of users and health care consumers participating in the first days of operation.

What Consumers Need to Know Before Enrolling

• Make sure their healthcare providers are in the network of the plan they are purchasing. Some plans in the marketplace are narrow network plans and consumers may need to locate a new provider if their current

provider is not in the plan’s network. • Make sure medications are covered if they require certain medications for ongoing treatment. A qualified health plan is only required to cover one drug from each United States Pharmacopeia (USP) category. Individuals will have a right to appeal to get medically necessary drugs covered. • Understand the costs related to their plan. Depending upon the plan purchased, the amount the individual will be required to pay for deductibles and coinsurance may vary. • Understand that consumers will not qualify for a tax credit if they have access to affordable minimum essential coverage through their employer. Affordable coverage is defined as 9.5% of their household income based upon the single employee’s premium and coverage of 60% of their insurance costs. • Tax credits are available only for plans purchased on the Marketplace. Consumers are not eligible for tax credits if they purchase insurance outside of the Marketplace or if you continue on the health insurance plan you have currently. • Failure to obtain minimum essential coverage will subject consumers to a penalty based on a minimum flat rate or a percentage of their income, whichever is greater. • Medicare coverage is not impacted by these changes. Consumers must still enroll for Medicare or supplemental insurance during the separate open enrollment held every year for those types of coverage. • All plans certified by the Insurance Division will be available on www. healthcare.gov on October 1st and will meet the definition of minimum essential coverage. The federal number to call for assistance is 800-318-2596.

feature: aca • Be wary of fraud. There may be more opportunities for bad actors to steal identities or promote nonexistent or minimal coverage plans as qualified health plans meeting new health plan standards. Use a licensed agent or broker or work with a navigator.

What about Medicaid Expansion? The Iowa Health and Wellness Plan

On May 23, 2013, the Iowa Legislature enacted the “Iowa Health and Wellness Plan”. This plan is a compromise between the Governor’s Healthy Iowa Plan and Medicaid Expansion. The Governor’s proposed “Healthy Iowa Plan” was intended to provide access to affordable health insurance, ensure quality care, establish an outcomes-based reimbursement method, and require personal responsibility measures and stability for Iowans with sustainable funding, as Governor Branstad opposed Medicaid expansion under PPACA. The compromise – Iowa Health and Wellness Plan – will replace Iowa’s current program to cover low income adults, IowaCare, which is set to expire on December 31, 2013. The Iowa Department of Human Services (DHS) initiated steps to apply for CMS waiver to implement the Governor’s Healthy Iowa Plan in order to comply with federally required due dates for such a waiver. Beginning January 1, 2014, the Iowa Health and Wellness Plan will cover all Iowans age 19-64 with income up to and including 133 percent of the Federal Poverty Level. The Plan will provide a comprehensive benefit package and provider network, along with important program innovations that will improve health outcomes and lower costs. The Iowa Health and Wellness Plan offers comprehensive benefits covering a wide range of medical services, without limits on amount of care received. A primary difference that will be seen from a pharmacy’s perspective is

Eligibility Requirements for the Iowa Health and Wellness Plan Be an adult age 19-64 Have income that does not exceed 133 percent of the Federal Poverty Level ($15,282 for a family of 1 person, $20,628 for a family with 2 people) Live in Iowa and be a U.S. citizen Not be otherwise eligible for Medicaid or Medicare coverage for prescription medications at any statewide Medicaid provider pharmacy including local community pharmacies. This coverage will look similar to current Iowa Medicaid coverage. As part of the new program, the Iowa Health and Wellness Plan will provide two options to cover Medicaid expansion in Iowa.

with other aspects of PPACA implementation. People who are not current IowaCare members can apply for the Iowa Health and Wellness Plan several ways: • Visit HealthCare.gov and complete an application online. • Call 1-800-318-2596 to complete an application over the phone.

• Iowa Wellness Plan: Covers adults ages 19-64 with income up to and including 100 percent of the Federal Poverty Level. The Wellness Plan will be administered by Iowa Medicaid and members will have access to the Medicaid provider network. • Iowa Marketplace Choice Plan: Covers adults 19-64 with income 101 percent up to and including 133 percent of the Federal Poverty Level. The Marketplace Choice Plan allows members to select certain commercial health plans available on the Health Insurance Marketplace. Medicaid pays the premiums for the commercial health plan on behalf of the member.

As a pharmacy professional, you are seen as a trusted resource for all health related information, which now includes PPACA. In a recent poll conducted by Kaiser Family Foundation1, pharmacists are listed as fourth as the most trusted resource for information on the PPACA. Doctors/nurses are listed first on this poll, followed by federal agencies, and then state agencies. Take the time now to educate yourself on the ongoing implementation of the PPACA in order to help your patients today and in the future.

The Department of Human Services will verify all current IowaCare members’ income to confirm if these members can get coverage from the Iowa Health and Wellness Plan. IowaCare members will receive letter in late October 2013 telling them if they are eligible. If a member is eligible, they do not need to apply for the Iowa Health and Wellness Plan. If a member is not eligible, they will receive instructions on how to apply for coverage. Program enrollment began October 1, 2013 with coverage beginning on January 1, 2014 in conjunction

*While the term Obamacare was started by Republicans who opposed President Obama’s health care reform bill, it has become more widely used, even by President Obama himself, who has stated, “And once it’s working really well, I guarantee you they will not call it Obamacare.” President Obama continues by making the prediction, “A few years from now, when people are using this to get coverage and everybody is feeling pretty good about all the choices and competition that they’ve got…It will not be called Obamacare.” 1. Kaiser Family Foundation. (2013). Health Tracking Poll August 2013, [Data set]. Princeton Survey Research Associates International (PSRAI) [Distributor]. Retrieved from http://kff.org/healthreform/poll-finding/kaiser-health-trackingpoll-august-2013/.

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midwest pharmacy expo

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8 STATE PHARMACY EXPO!

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Attend the Same Great Expo - This year joined by colleagues from Illinois, Minnesota, Missouri, Nebraska, North Dakota, South Dakota, and Wisconsin!

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midwest pharmacy

F e b r u a ry Friday, Feb. 7, 2014

8:30am – 4:45pm Together. Providing Quality Care to Patients in Pain

A day in the life of a Pain Patient: Join your colleagues and

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peers as we work through the most difficult pain management issues, together. As identified by clinicians throughout the Midwest, we will be discussing the challenging scenarios you face every day, including: | Oct/Nov/Dec 2013

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• Appropriate opioid prescribing, including adverse effect management • Use of non-opioids and adjunctive therapy to treat non-malignant pain • Patient engagement and the health care team’s responsibility in pain management • Identifying and taking action when a patient is misusing pain medication • Pain management at the end-of-life This interactive, interprofessional conference will present evidencebased data, best practices, and

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innovative solutions to help you, as a primary care provider, safely and effectively manage your patients who live with acute or chronic pain.

5:00 – 7:30p

OPENING Reception and EXHIBIT Welcome to the Midwest Pharmacy Expo! Network with your colleagues, peruse the exhibit hall, and enjoy dinner and a beverage before a weekend filled with best practice examples, clinical pearls, and professional engagement. We’ll see you there!

Saturday, Feb. 8, 2014

7:00-8:15a Annual Pharmacy Political Leadership Breakfast

For 15 years, pharmacists have embraced the opportunity to participate in an annual fundraiser for their state association’s Political Action Education Fund through participation in this educational breakfast. This year’s discussion is especially important as we discuss the most current updates on the Affordable Care Act and pharmacist’s provider status. You won’t want to miss this informative annual favorite!

8:30-8:45a Welcome 8:45-9:30a 1st General Session: Personalized Medicine 9:30-10:30a 2nd General Session: The Lacks Family: An Onstage Interview

The Lacks Family has enthralled audiences across the country talking about their mother, grandmother and great-grandmother, Henrietta Lacks and her important contribution to science. The international success of Rebecca Skloot’s New York Times bestseller, The Immortal Life of Henrietta Lacks, has left people keenly interested in the Lacks Family and Henrietta’s legacy. The family will share what it meant to find out—decades after the fact—that Henrietta’s cells were being used in laboratories around the world, bought and sold by the billions. They will provide us with a sincere first-person perspective on the collision between ethics, race and the commercialization of human

tissue, and how the experience changed the Lacks family from generation to generation. Their discussion serves to honor Henrietta’s unparalleled contributions to science, and above all— celebrates Henrietta’s life and legacy. Books are available for purchase on the registration form and the Family will be available for book signings during the morning break.

10:45-11:45a Breakout Sessions: • Update in Anticoagulation • Update in Autoimmune Diseases • Update in Psychiatry • Update in Cholesterol (Technician Activity) • In-no-va-tion (Student Activity)

• Integrating Natural Medicine in your Pharmacy Practice • Nutrition’s Impact on Medications (Technician Activity) • Ask Not What Pharmacy Can Do For You… (Student Activity)

4:30-5:30p Breakout Sessions:

• Managing Change in Turbulent Times • Managing The Patient Experience • Managing Death and Dying • The Art of Managing Up (Technician Activity) • Managing NAPLEX – How to Start and What to Expect (Student Activity)

7:00p Leadership Pharmacy Conference Reunion 7:30p Exhibit Theaters

11:45-12:45p Lunch

Theater times and topics to be announced

12:45-1:45p Breakout Sessions: • Difficult to Treat Diabetes • Difficult to Treat Asthma • Difficult to Treat Delirium • Management of Hypo and Hyperglycemia (Technician Activity) • State Pharmacy Law Exam: Plan to Pass! (Student Activity)

2:00-3:00p Breakout Sessions: • Drug-Induced Kidney Injury • Appropriate use of Medications in Pregnancy • Balancing the Risks & Benefits of Pharmacotheraphy for Insomnia • Medications in the Aged (Technician Activity) • Oh, The Places You’ll Go! (Student Activity)

3:15-4:15p Breakout Sessions: • The Case for Nutritional Supplements • Electrolite Management in Adult Parenteral Nutrition

This year we are excited to offer Presentation Theaters! Each Presentation Theater session provides attendees with an opportunity to ask product-specific questions of key experts and industry representatives, find out information on new pharmaceutical products and services, and learn the latest in data and research findings.

Sunday, Feb. 9, 2014

General Sessions: 8:00 – 9:00a Rooting out Errors in Your Pharmacy 9:00 – 10:30a New Drug Update 10:45a – 12:45p Gamechangers in Pharmacy 2013 12:45 – 1:00p Box Lunch Pick Up 1:00 – 2:00p State Law Outreach Sessions

REGISTER TODAY AT WWW.GOTOCEI.ORG

Hear it from participants “I really appreciate how knowledgeable the presenters always are. The material is often complex and I always know more when I leave each year. Thank you for bringing these quality programs close to me!” “The Expo is very well organized and I have been impressed by the importance, scope, and practicality of the topics included. The presentations, as well as the hallway discussions, are a positive learning experience.”

“I’ve been attending Expo for almost 15 years. I can think of no other forum that offers as much timely, high-quality continuing education as Expo does and that includes many national pharmacy organization meetings.” “I highly enjoyed this session. It was technician based and I learned a lot from it. I felt like I could use the material in everyday cases and work.” - Technician participant Oct/Nov/Dec 2013 |

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health care hot topics The profession of pharmacy and health care continue to change and evolve with each day that passes. Here is a short summary of events that have had an effect on our profession. Employer Mandate Delayed

• The Obama administration delayed the implementation of the employer mandate of the Affordable Care Act (ACA). This delay will allow businesses an extra year to comply with federal regulations. This decision resulted from employer concerns about the complexity of requirements. The employer mandate is now expected to take effect in 2015, while a bulk of the provisions of ACA take effect in 2014.

ACPE Grants First International Certification

• In July 2013, the Accreditation Council for Pharmacy Education (ACPE) certified the first international pharmacy degree program at King Saud University in Saudi Arabia. The International Quality Criteria application for certification reflects professional and educational qualities identified by ACPE through international discussion and feedback. The certification process does not conclude or grant eligibility for licensure or registration to practice as a pharmacist in any other jurisdiction. Certification is only available to professional degree programs outside the United States and its territories.

July 1st: New Reimbursement for Durable Medical Equipment (DME) • Centers for Medicare and Medicaid Services (CMS) unveiled an expanded competitive-bidding program in effort to curb DME spending. The aim was said to be a system to better set accurate payment rates to providers of DME. Although these changes affect all avenues of DME, some of the most dramatic pricing changes have been to diabetic testing

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supplies. Effective July 1, 2013, new rules were implemented to discourage DME overuse by discouraging mailorder facilities from automatically sending out refills of diabetic testing supplies and restricting mail delivery practices in all settings, be it mailorder or retail sending testing supplies through the mail.

Two New Weight Loss Medications In the Mix

• As Americans spend approximately $60 billion dollars a year to lose weight, two new weight loss medications recently hit the market. Weight loss of approximately 5% is expected from both medications if taken for a year, which may significantly improve health measures such as blood pressure, cholesterol, and blood glucose. Belviq (locaserin) is a serotonin 2C agonist, increasing feelings of satiety (fullness) so patients feel the need to eat less. Qsymia (phentermine/topiramate ER), while possibly the more effective option, requires a REMS program due to risks of birth defects.

FDA Investigating Cyclosporiasis cases in Iowa as part of a multi-state outbreak

• The FDA investigated a multi-state outbreak of an intestinal infection called cyclosporiasis. The CDC has been notified of 285 cases nationwide, with almost half (138) of these reports originating in Iowa. Cyclosporiasis is an illness associated with infection of a parasite called Cyclospora, which is indigenous to tropical and subtropical

regions of the world. The illness can be spread through ingestion of contaminated food or water and is generally not considered transmittable from person to person. Most of the illnesses in Iowa reported an onset date between mid-June and early-July. Currently there is no known cause for the outbreak, and there has been no established link between any of the cases. Past outbreaks in the United States and Canada had been linked to imported fresh produce. The CDC encourages consumers to continue to enjoy the health benefits of eating fresh fruits and vegetables.

Pharmacy Technician Training Accreditation • ASHP and the

Accreditation Council for Pharmacy Education (ACPE) are working together to create an accrediting body for pharmacy technician training programs similar to how ASHP currently accredits pharmacy residency programs. The collaborative group will be deemed the Pharmacy Technician Accreditation Commission (PTAC) and will work to standardize pharmacy technician education. Although accreditation practices currently exist through ASHP, the partnership hopes to capitalize on the expertise of both groups.

IPCA Receives Grant For Safety Net Community Care Coordination • The Iowa Primary

Care Association (IPCA) received funding from the 2013 Iowa legislature to develop and implement a safety net program that addresses the health needs of the uninsured and other high risk patient populations. Social and behavioral health in addition to primary care initiatives are anticipated

health care hot topics

to be some focal points for the communities involved in the project. Care coordination plans involving pharmacy are to be of particular interest to IPCA moving forward.

Compounding Legislation Compromise • The US House of

Representatives approved the Drug Quality and Security Act on September 28th as bipartisan and bicameral legislation to address pharmaceutical compounding and the prescription drug supply chain. The legislation stems from

the Government Accountability Office (GAO) report on FDA oversight of largescale pharmaceutical compounders in follow-up to the New England Compounding Center incident. This bill distinguishes compounders engaged in traditional pharmacy practice from those making large volumes of compounded products without individual prescriptions. It also defines the FDA’s role in oversight of outsourcing facilities, and clarifies current federal law regarding pharmacy compounding.

before the start of the new fiscal year and the government went into partial shutdown. Some government functions – those deemed essential services –continued to be performed as usual, while others were suspended. The stalemate to reach a compromise centered on funding of the Patient Protection and Affordable Care Act (ACA). President Obama signed a bill on October 16th to reopen the federal government and lift the debt limit.

Government Shut Down Lasts 16 Days • At midnight on

Prior to this, the last government shutdown occurred during two periods that totaled 26 days in late 1995 and early 1996.

September 30th, Congress failed to fund the federal government

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iowa pharmacy news

Medicaid Dispensing Fee Increase – APPROVED

• IPA successfully lobbied for a 1% Medicaid dispensing fee increase in 2013. In late September, CMS approved the fee increase ($10.02 to $10.12), which will be retroactive to July 1, 2013. Iowa Medicaid Enterprise (IME) will begin processing pharmacy claims submitted with the new dispensing fee of $10.12 going forward. In addition, pharmacy claims that have been submitted between the dates of July 1, 2013 and October 1, 2013, will be adjusted by the IME to reflect the dispensing fee of $10.12. This adjustment will only be applied to pharmacy claims submitted during this time period that were reimbursed a $10.02 dispensing fee; it will not include pharmacy claims reimbursed at the usual and customary price. Watch IPA communications and IME Informational Letter to pharmacies for additional information on the fee increase and timeline.

Watch IPA communications for how YOU can join in the fight against PBMs. Your voice is needed!

New Practice Model Receives Board of Pharmacy Approval

• In response to the call for improved patient safety and coordination of chronic care, the IPA New Practice Model (NPM) Task Force developed a new model for community pharmacy practice in early 2010. The model uses the foundation of pharmacist education to maximize their use in medication use and patient care services. Given the proven utility of medication therapy to manage chronic conditions, pharmacists should be engaged in the medical home team and their communities providing MTM, immunizations, health screenings, and other clinical services.

regulation. This issue doesn’t impact pharmacy owners alone, but every member of our profession. If PBMs force pharmacies to close due to unfair business practices, pharmacists will be unable to provide increased access to immunizations, face-toface MTM services, and medication reconciliation across care transitions to home. PBMs are also infringing on the ability of healthcare providers to practice evidence based medicine by preferring clinically inferior drug products on their formularies. PBM regulation is important to all members of the pharmacy profession!

The Iowa Board of Pharmacy recently approved an IPA proposal that allows a pilot group of community pharmacies to implement a TechCheck-Tech (TCT) program to expand pharmacist services. In collaboration with the Board of Pharmacy, as well as researchers from Drake University College of Pharmacy & Health Sciences, IPA will assess the program’s effect on the community pharmacy business model, provision of patient care services, and patient safety measures. This project will provide a strong foundation for the New Practice Model initiative. The proposal was submitted to the Board of Pharmacy and approved on August 28th for 18 months once the project commences.

In a continued effort to regulate the pharmacy benefit manager (PBM) industry, IPA has worked closely with the Iowa Insurance Division (IID) on their investigation of PBM practices. In response to draft rule amendments from IID, IPA submitted written

IPA has collaborated with multiple stakeholders for this initiative. In addition to members of the New Practice Model task force, IPA will be closely working with the Collaborative Education Institute (CEI) to provide technician training for participating

PBM concerns – impacting YOU • A top priority of IPA is PBM

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comments in support of clarifying the IID’s oversight of PBMs, enhanced audit provisions, and MAC pricing reporting.

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pharmacies. When the pilot project begins in early 2014, the pilot community pharmacies will amplify the knowledge and skills of all members within the pharmacy to promote optimal medication use to improve patient health outcomes. Pilot sites: NuCara Pharmacy, Lenox, Story City, Traer, and Washington Medicap Pharmacy, Ames Towncrest Pharmacy, Iowa City Mercy Family Pharmacy, Cascade

Iowa Medicaid State Innovation Model (SIM) Project

• The State of Iowa is moving forward on an initiative to reform the current health system to provide more efficient and complete patient care in a more sustainable way. Iowa applied and attained a grant from the Centers for Medicare and Medicaid Services (CMS) to develop a health care model known as the State Health Care Innovation plan. Iowa Medicaid is proposing a model using an accountable care organization (ACO) backdrop that allows for greater provider communication and emphasizes the importance of patient outcomes. While currently in the planning phase of the innovation process, several workgroups have met over the last few months to each assemble a list of objectives for the plan moving forward. Representatives from various stakeholders came together to decide what needed to be addressed by the SIM. IPA represented pharmacy at several workgroup meetings and expressed the importance of pharmacy in considerations, as pharmacists can have a significant impact on patient care and ultimately, patient outcomes. As the innovation process moves forward, IPA is committed to giving pharmacy a voice in the future of Iowa health care.

IPA Members in DC • IPA’s

executive vice president & CEO, Kate Gainer, attended the APhA Board of Trustees and Provider Status Retreat

iowa pharmacy news

in Washington DC on September 23-24. Matt Osterhaus, APhA president-elect, was also in attendance along with Bill Doucette, University of Iowa, who served as a session moderator. APhA looked to state execs from 12 invited states to share stories of local successes, barriers, and strategies in achieving provider status, and payment, for pharmacists at the state and national level. Following the provider status retreat, Gainer and Osterhaus met with health policy staffers from Senators Harkin and Grassley as well as Congressmen Braley and Loebsack’s office to discuss APhA’s provider status initiative.

IPA Goes Local wraps up Year 1 • Throughout 2013 IPA has partnered with local pharmacy associations across Iowa. This partnership allows IPA to provide one hour of continuing pharmacy education on patient safety to attendees. IPA Goes Local events also create opportunities for IPA staff and leadership to visit pharmacy practices and local communities across the state. In the spring IPA had already ‘gone local’ with BlackhawkBremer County Pharmacy Association (March 14th), Dubuque Area Pharmacy Association (April 15), Central Iowa Pharmacy Association (May 6th) and North Iowa Pharmacy Association (May 14th). This Fall IPA visited Kate Gainer & Laura Miller visit Southwest Iowa Pharmacy the Oard Ross Drug in Council Association (August 29) Bluffs, IA. and Johnson Co Pharmacy Hosted by IPA Member, Tony Beraldi Association (September 19). The final 2013 IPA Goes Local event was in Spencer, IA at the Northwest Iowa Pharmacy Association (October 22). Over 360 pharmacists and pharmacy technicians attended these events.

IPA offers 2/2/2 Virtual Engagement Sessions

• What’s 2/2/2? The 2nd Tuesday of each month, at 2pm, IPA hosts a webinar on hot topics. This virtual engagement series was designed by IPA to meet the needs of members in all four corners of the state that wish to stay up-to-date and connected to IPA but may have difficulty traveling to live meetings. IPA held its inaugural 2/2/2 Virtual Engagement Session on Tuesday, September 10th, focusing on the recently expanded immunization rules. 40 participants joined the call and 56 downloaded the recorded presentation from IPA’s website. October’s 2/2/2 session featured David Lyons from CoOportuntity Health to present on the Iowa Health Insurance Marketplace. Upcoming topics include: • November – 340B Drug Pricing • December – PBM Regulations • January – Grassroots Advocacy 101 • February – MTM Pearls Oct/Nov/Dec 2013 |

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iowa pharmacy news

Trinity Pioneer ACO MTM Program Begins • Pharmacists began seeing patients in the ACO project mid-October!

Since 2011, IPA has been working with UnityPoint Health, previously the Iowa Health System, to integrate pharmacist services within their pioneer ACO model. Support from the Community Pharmacy Foundation and McKesson was critical to the early development of this initiative and the inclusion of community pharmacists within UnityPoint’s Trinity Pioneer Accountable Care Organization (ACO) model over an eight-county region in Central Iowa. Under the Pioneer ACO Model, CMS provides incentives for participating health care providers who form an organization to coordinate care for patients. Providers who band together through this model are required to meet quality standards based upon, among other measures, patient outcomes and care coordination among the provider team.

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ACO patients. Through this project, IPA has provided pharmacists and pharmacy technicians working in the eight-county region in Central Iowa the opportunity to further their professional development and involvement in the ACO MTM study with monthly pharmacy support meetings. Nearly 10,000 Medicare beneficiaries of Trinity Pioneer ACO will be eligible for MTM services, and approximately 25 local pharmacists will deliver MTM services for the study. The program commenced in October by piloting the MTM program through two physician practices in Fort Dodge and Humboldt. Full scale implementation is planned for November 2013 and is scheduled to continue through August 2015. Findings will be distributed via reports to all stakeholder groups, presentations at national meetings and conferences, and various scholarly publications.

Immunization Authority Expansion Begins September 1st • With the signing on Senate File

Meetings throughout 2011-2012 progressed into opportunities to develop and help shape the model for community pharmacists within UnityPoint’s Trinity Pioneer ACO. In 2013, additional funding was secured through the National Association of Chain Drug Stores (NACDS) Foundation to compensate community pharmacists for services provided within the ACO model. The services provided by pharmacists to targeted Trinity Pioneer ACO patients include consultations for newly diagnosed chronic conditions, post-discharge medication reconciliation and ongoing medication management to address issues of non-adherence.

353 and subsequent adoption of Board of Pharmacy rules, Iowa pharmacists have an expanded authority to provide immunization services via a written protocol to patients across the state. Beginning on September 1st, pharmacists may administer influenza and other emergency declared vaccinations to children ages 6 years and older as well as administering any Advisory Committee on Immunization Practices (ACIP) recommended vaccination and vaccines for international travel to adults ages 18 years and older.

With support by Community Pharmacy Foundation, McKesson, NACDS Foundation and strategic partnerships with OutcomesMTM and The University of Iowa, IPA continues to promote the impact of community pharmacistdelivered MTM services on hospital readmission rates, incidence of adverse drug events and healthcare costs for

While regulations have existed since 1999 to govern pharmacistadministered vaccinations, there are some changes in the current legislation and regulation that pharmacists need to understand. All protocols will continue to remain effective for one year from the date the protocol was signed by a licensed Iowa prescriber. The protocol must be unique to a

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pharmacy and identify the pharmacists authorized to administer vaccinations at that site. A disclaimer may be added to your protocol to authorize floater pharmacists and student pharmacists to immunize under your protocol. Reporting requirements were included in the legislation as part of the compromise with the medical community. Except for annual influenza vaccine, prior to administering a vaccine, authorized immunizers will need to verify the patient’s vaccine history against the statewide immunization registry or appropriate health information network. Then within 30 days of administration of a vaccine, documentation of the vaccine administration should be reported to the statewide immunization registry (or health information network) and the patient’s primary care provider, if known. Iowa’s Immunization Registry Information System (IRIS) is a secure, confidential, population-based, computerized system that contains immunization information for all ages residing in Iowa. More information on IRIS can be obtained at https://iris. iowa.gov. In addition, continuing education on immunizations will be required as part of each pharmacist license renewal period (2-year cycle). Pharmacists must have at least one hour of continuing education related to vaccines and immunizations every two (2) years. Immunization CE is available through www.gotoCEI.org. If you should require any immunization resources to expand your practice, please notify IPA at ipa@iarx.org. Multiple tools exist and are provided at no charge to IPA membership. □ □ □ □

Sample protocol Needle stick policy IRIS training Pharmacist immunizations – help me get started □ Pharmacist immunizations – help me expand my practice

Oct/Nov/Dec 2013 |

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ipa foundation

thank you iowa pharmacists

A

s we prepare for the hustle and bustle of the holiday season, we not only reflect to thank those that have made a difference but also make a special request that you remember the Iowa Pharmacy Association Foundation as you prepare your year-end giving. When you invest in IPA-F you are making an impact in the philanthropy of pharmacy.

Tim Becker, RPh, FASCP

IPA Foundation President

Charitable contributions to the IPA Foundation can be made through a variety of options and are tax deductible to the donor as allowable by law.

Foundation Institute – The Foundation Institute recognizes contributions from charitable partners that have made a commitment to annual giving. These individuals have identified the charitable purpose of IPA-F and the need to support the profession through education and practice-based research. Annual tax deductible gifts to the Foundation are recognized by various levels of giving: Platinum Contributions $1,000 or more Gold Contributions $500-$999 Silver Contributions $250-$499 Bronze Contributions $100-$249 Sustaining Contributions up to $99

Legacy Society – Legacy Society

members are visionary philanthropists that have included the Iowa Pharmacy Association Foundation in their estate plan, deferred giving or provided perpetual support for deserving students through the creation of a named scholarship.

The generosity of Iowa’s pharmacists is admirable. Please join your colleagues this holiday season and contribute to the future of the profession by making your tax-deductible contribution today. To learn more about your donation options visit http://www.iarx.org/IowaPharmacy/ Foundation/IPF.aspx. Thank you for your commitment to the Iowa Pharmacy Association Foundation as we support students, develop leaders, enhance practice and preserve our heritage.

Tim Becker, RPh, FASCP IPA Foundation President

Laura Miller

IPA Membership & Development Director

IPA Foundation Mission Statement: “Inspiring generosity and fulfilling the aspirations of the pharmacy profession through support of education, practice-based research and practice development.”

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IPA FOUNDATION

2013 Leadership Pharmacy Conference • The new practitioner

leadership conference, was held July 26-29, 2013 in Galena, IL. The conference is available to twenty pharmacists in their first 15 years of practice from Iowa and Wisconsin, ten from each state, who are interested in becoming leaders in the profession of pharmacy. This year’s conference marked 24 amazing years of engaging new practitioners in active dialogue of their leadership skills and professional development. The participants experienced a weekend full of leadership training and workshops, as well as formal and informal networking opportunities with current state association leadership, staff, event sponsors, and one another. Programming was facilitated by Harles Cone of the Cone Resource Group as well as Steve Rough, Director of Pharmacy at the University of Wisconsin Hospitals & Clinics, and Jeff Kirchner, President of Streu’s Pharmacy/Bay Natural. Tom Temple also attended and shared his insight and thoughts for advancing the profession with this year’s participants. IPA would like to thank Teva Pharmaceuticals and the IPA Foundation for their support of the 2013 conference, and McKesson for their lead contribution to the Thomas R. Temple Leadership Legacy Endowment Fund!

Leadership Pharmacy – The Next Chapter • In 2013,

Leadership Pharmacy celebrated its 25th anniversary, and continues to be one of the most valuable programs the IPA Foundation supports. Since

“The Leadership Pharmacy Conference exceeded my expectations. The structure, time allotment, team building, didactic, application sessions were all extremely useful and meaningful. I not only understood the content, but I understood it to an in depth degree that really hit home with me” 1988, over 500 pharmacists have participated in the annual Leadership Pharmacy Conference, many of whom have gone on to leadership positions in their communities, at the state and national level, as well as at their practice sites. To build upon that success, IPA and the Pharmacy Society of Wisconsin, have expanded the annual 3 ½ day conference into an 8-month “Leadership Academy.” Class members of the 2013 Leadership Pharmacy Conference will be the first participants to experience the Leadership Academy. The Leadership Academy begins with the annual 3 ½ day retreat in August, and includes ongoing live and webbased activities from September – May. The participants will graduate from the Academy with a special ceremony at the IPA Annual Meeting in June.

The IPA Foundation looks forward to sustaining a strong return-oninvestment from this initiative. Leadership development has, and continues to be, an important part of IPA’s culture that sets us apart.

In Memoriam • IPA Member, Toni

Shea, owner of Sac City Drug (19712013) passed away on September 28th, 2013. She was raised in Lake City, IA. Following in her parents footsteps, she attended The University of Iowa College of Pharmacy. Toni purchased Sac City Drug and later expanded the pharmacy by adding a Custom Compounding lab to better serve her community. Because she faced firsthand the struggles of battling her own illness, she always knew just what to say to help her patients through their toughest times. Toni will be deeply missed by all those she knew, including the IPA family. Oct/Nov/Dec 2013 |

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ipa foundation

2013 Iowa Pharmacy Association Foundation Eggleston-Granberg Golf Classic - A HUGE SUCCESS

• The IPAF held its 2013 golf classic at Copper Creek Golf course, Pleasant Hill, IA. Over 120 pharmacists, student pharmacists, and friends of pharmacy participated in this important fundraising event in support of student pharmacist scholarships. A very special thank you to all participants, volunteers and sponsors.

THANK YOU Supporters!

The Iowa Pharmacy Association Foundation extends deep appreciation to the generous support of these sponsors of the 2013 IPAF Student Scholarship Golf Classic.

Chris Connolly/Wells Fargo Financial Advisors Jay & Ann Currie Drake University College of Pharmacy and Health Sciences Johnson Country Pharmacists Association Manning Pharmacy-Bob Stessman Medicap –Urbandale-John Forbes North Iowa Pharmacy Association Northwest Iowa Pharmacist Association Nucara Osterhaus Pharmacy Pharmacists Mutual PharmServ Chuck & Janalyn Phillips Quad Cities Pharmacy Association UBS U of IA College of Pharmacy Tom Temple Consulting Wasker, Dorr, Wimmer, Marcouiller Willis Auto Campus

2013 winners of the Iowa Pharmacy Foundation Golf Classic with a score of 14 under par: (L to R) TJ Johnsrud, Jay Goeser, John Swegle, and Mike Johnsrud.

Rachel Smith and Pamela Wong pose for a quick picture at the IPAF hole.

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IPAF also wishes to thank the following Student Sponsors and Birdies for Scholars participants. Wendy Duncan Steve Firman Kate Gainer Dennis Jorgensen Julie Kuhle Nic Lehman Steven Martens Jen Moulton Bob Osterhaus Andy & Lisa Ploehn Anthony Pudlo Morgan Sayler Susan Shields Bob Stessman John Swegle CoraLynn Trewet

(Left side table:) Brandon Patterson, Jay Currie, Al Shepley, and Kieran Connolly (Right side table:) Ann Currie, Jim Scott, Chris Connolly and Connie Connolly.

Carl Lingen, Michael Porterfield (P3-Drake), Rocky Anderson, and Tony Guerra take 1st place in the 2nd flight with a score of 7 under par.

IPAF president Tim Becker launches a drive.

Patty Burkle accepts women’s long drive prize from IPA Executive Vice President and CEO Kate Gainer.

IOWA PHARMACY RECOVERY NETWORK

Assisting Impaired Pharmacists, Student Pharmacists, and Pharmacy Technicians

Where do you turn when you, a coworker or someone you care about needs help with an addiction, physical illness or psychiatric disorder?

Providing support . . . through caring volunteers

HOPE FOR RECOVERY 1-877-890-IPRN

http://www.iowarecovery.org/ Oct/Nov/Dec 2013 |

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public affairs

a message from representative john forbes, rph

I John Forbes, RPh Iowa Representative

n about three months the Iowa Legislature will be back in session, once again tackling some tough issues that affect all Iowans.

The pundits called our work earlier this year a “landmark session” with the Legislature hammering out bipartisan agreements on Medicaid expansion, education funding and commercial property tax reform.

“I will work with the Association to introduce legislation to regulate PBM practices” But the work doesn’t stop when the gavel falls. I have been very busy since May, working on constituent issues as well as matters affecting the pharmacy profession. Much of my time has been spent working with the Iowa Pharmacy Association on issues relating to PBM contracting with PSAO’s (pharmacy service administration organizations). As many of you know, significant changes took place at the beginning of the year relating to pharmacy reimbursement. I have been working with the Iowa Insurance Commissioner’s office to address the concerns of Iowa pharmacists, and the results have been positive. I hope that we will come to a resolution on reimbursement and auditing issues before the session reconvenes in January. If not, I will work with the Association to introduce legislation to regulate PBM practices in our state. Pharmacists can’t serve their patients if they are run out of business by unfair reimbursement practices. Iowans access to quality pharmacy services are placed at risk if we fail to act. An important piece of legislation I pushed

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for this past session was the expansion of immunization services for Iowa pharmacists. Our association and lobbyists worked very hard to ensure children age 6 and older can receive an influenza vaccination administered by a licensed and certified pharmacist or pharmacy student. We will continue to work in the upcoming years to expand immunization services for the benefit of all Iowans. I was appointed earlier this year to the Board of Directors of the children’s insurance program known as HAWK-I. We usually meet quarterly to discuss issues affecting the program to make sure the children continue to receive quality health care services. If you have any questions or concerns about the program, please feel free to contact me.

“I would like to thank all Iowa pharmacists for their support ” The leader of the Democrats in the Iowa House of Representatives, Kevin McCarthy, resigned this summer. I enjoyed working with Kevin and wish him luck in his new role at the Iowa Attorney General’s office. Our new leader is Representative Mark Smith of Marshalltown. I am looking forward to working with Mark on health care issues. His background is in social work, and he has a very good understanding of issues affecting pharmacy. I will work closely with him to make sure these issues are addressed in a timely matter. Finally, I would like to thank all Iowa pharmacists for their support this past year. Although I have not officially announced my candidacy for my House seat in 2014, I will continue to represent pharmacy’s legislative view in the Iowa General Assembly, as well as serving the interests of all Iowans. Please contact me with your comments and concerns.

public affairs

Board of Pharmacy Updates

• The Iowa Board of Pharmacy (BOP) met August 27-28 in Des Moines. The Board met in a closed session on the first day to review administrative hearings, and held an open session the second day to discuss various requests for rule waivers or proposals, proposed legislation, and proposed rule changes. On August 29th, the Board held a retreat to discuss many items in further detail. Highlights from the open session include: Immunization Expansion The BOP filed for adoption new immunization regulations and set Sept. 1st as the effective date. These rules are meant to implement Senate File 353 that was signed by the Governor in March 2013. The rules establish training and continuing education requirements, identify the immunizations that a qualified pharmacist may administer via protocol, and describes the process for verification of a patient’s immunization history. In addition, the regulations clarify that a pharmacist may administer any immunization pursuant to a prescription from licensed prescriber. Telepharmacy The BOP continues to receive requests from pharmacies in various practice settings to implement telepharmacy services. The Board’s Telepharmacy Task Force will evaluate current regulations on telepharmacy practice in Iowa. Each request is considered individually by the Board under their authority to grant pilot or demonstration research projects. Pharmacy Technicians The Board discussed the need to verify various technician training programs within the state in response to changes from PTCB (Pharmacy Technician Certification Board) examination qualifications. The Board continues to focus on the evolving role of pharmacy technicians as it relates to Tech-Check-Tech programs and

other mechanisms to advance the role of the pharmacist. In addition, the Board approved the implementation of the fifth Tech-Check-Tech program in Iowa for the University of Iowa Hospitals & Clinics. Compounding The Board provided an update on its inspections and evaluations of nonresident compounding pharmacies across the country. Proposed federal legislation on compounding practice could push the BOP to collaborate with the FDA to oversee compounding manufacturers or pharmacies that ship sterile compounded products across state lines. The BOP will convene their compounding task force in early 2014 to further evaluate current Iowa compounding regulations.

E H T E SAV : E T A D 2014 LEGISLATIVE DAY & CAPITOL SCREENINGS DAY

Thursday, February 20, 2014 Des Moines Downtown Embassy Suites & Iowa State Capitol

YOUR SUPPORT IS NEEDED!

Does one person’s support matter? The answer is

yes!

Every contribution, large and small, helps pharmacy maintain a visible presence and relationship with legislators.

Please help keep Iowa pharmacy a viable, strong, and active participant in the legislative process. IPA actively advocates on behalf of the professionboth during the legislative session and throughout the interim. We need your continued support in order to remain effective. Please consider making your contribution today by going online: www.iarx.org/Resources/ Legislation/IPPAC.aspx

Oct/Nov/Dec 2013 |

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peer review

The Use of Oral First Generation Cephalosporins in E. Coli Urinary Tract Infections for Hospitalized Patients Karen Kolbet, PharmD Post-Graduate Year-1 (PGY-1) Pharmacy Resident Iowa Methodist Medical Center, Des Moines, IA Geoffrey C. Wall, PharmD, FCCP, BCPS, CGP Internal Medicine Clinical Pharmacist, Iowa Methodist Medical Center Professor of Clinical Sciences, Drake University College of Pharmacy and Health Sciences, Des Moines, IA Corresponding Author: Geoffrey C. Wall, PharmD, FCCP, BCPS, CGP Professor of Clinical Sciences Drake University, College of Pharmacy and Health Sciences 2507 University Ave. Des Moines, IA 50311-4505 Office: 515-241-4297

I

ntroduction Escherichia coli (E. coli) bacteria are commonly found in the gastrointestinal tract of healthy people and animals. Due to the close proximity of the gastrointestinal tract to the genitourinary tract, these pathogens are more likely to be the causative agents of urinary tract infections. According to the Infectious Diseases Society of America (IDSA) 2010 update on the International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis, E. coli was isolated in 75%-95% of patients with acute uncomplicated cystitis and pyelonephritis. Current guidelines recommend the following

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E-mail: geoff.wall@drake.edu KEYWORDS: Urinary Tract Infections, Multidrug resistant, cephalosporin, cephalexin Conflict Declaration: The authors have no other real or potential conflicts to declare.

Abstract

Background: Escherichia coli are isolated in 75%-95% of patients with acute uncomplicated cystitis. Recent studies have reported an increased incidence of multidrug resistant E. coli strains in patients with urinary tract infections (UTIs) Objective: The primary objective of this study was to show the rate of clinical cure for patients who were treated with cephalexin for a diagnosis of an E. coli uncomplicated urinary tract infection in our hospital. Secondary outcomes assessed included adverse effects reported to cephalexin therapy, and the number and nature of patients with a relapsed UTI who received this drug.

antibiotics as first-line empiric therapy for patients diagnosed with acute uncomplicated cystitis: nitrofurantoin monohydrate/macrocyrstals, trimethoprim-sulfamethoxazole, or fosfomycin trometamol.1 Second-line agents for empiric therapy include fluoroquinolones or β-lactams. Drug resistance has been an increasing problem in bacterial pathogens for many years due to increased and inappropriate antimicrobial use. Recently, studies have reported an increased incidence of sulfamethoxazole/trimethoprim (Co-trimoxazole) and fluoroquinoloneresistant E. coli strains.2-3 Some have reported that co-trimoxazole resistance

Methods: A retrospective chart review was done on all patients 18 years of age and older who were prescribed cephalexin from 3/1/2011 to 8/31/2012 for a diagnosis of E. coli (culture confirmed) uncomplicated UTIs. Thirty-six patients met our criteria for review. Results: The rate of clinical cure in uncomplicated E. Coli urinary tract infections treated with cephalexin in our institution was 94% (34/36). Twenty out of 36, (55%), had an E. coli strain that was resistant to fluoroquinolones, 12 out of 36, (33%), were resistant to sulfamethoxazole/ trimethoprim, and only 2 out of 36, (5%), were resistant to nitrofurantoin. Twelve out of 36, (33%), had E. coli resistant to two of these three antibiotics. Cephalexin was well tolerated and no significant adverse reactions were reported. Conclusion: Based on our results, cephalexin appears to be a safe and effective treatment modality for uncomplicated urinary tract infections caused by E. coli at our health-system.

has reached or exceeded the 20% cutoff suggested by the IDSA as the maximum allowance for empiric treatment with this agent.4 Another study stated that fluoroquinolone resistance is approaching that 20% cutoff with a value of 17%.3 The rate of rising resistance in these reports occurred over the course of four to seven years. Hospitalized patients often have risk factors for antibiotic resistant E. coli UTIs including older age, chronic indwelling urinary catheters, and co-morbid diseases such as diabetes. In our large tertiary hospital our clinicians were being increasing faced with treating E. coli urinary tract

peer review

infections that were resistant to such “standard” agents as co-trimoxazole and ciprofloxacin. Susceptibility data from recent studies, have found that antibiotic resistance rates among specific resistant E.coli strains to first-generation cephalosporins remains low (<10%).5 Antibiogram data for UnityPoint Health-Des Moines supports this, with E. coli isolates susceptible to first-generation cephalosporins about 91% of time. Using this information prescribers in our institution have been using cephalexin for E.coli UTIs when these isolates are resistant to “standard” therapy. In this study, we assessed the use of first-generation cephalosporins in uncomplicated urinary tract infections to determine the rate of clinical cure in this patient population. Our hypothesis was that in vitro susceptibility results would be corroborated by a high rate of clinical cure. Other data we were interested in evaluating included the duration of therapy of cephalexin, total duration of antimicrobial therapy, and the degree of co-morbidities of our population using the Charlson co-morbidity index. Methods We used the following definitions for our study: a. Uncomplicated urinary tract infection: a symptomatic bladder infection characterized by frequency, urgency, dysuria, or supra-pubic pain in a person with a normal genitourinary tract.1 b. Relapse: a recurrent urinary tract infection after therapy resulting from persistence of the pretherapy isolate in the urinary tract. For this study, we considered a relapse a positive culture with the pre-therapy isolate for up 30 days after discharge from the hospital. c. Clinical cure: documentation of no further symptoms (frequency, urgency, dysuria, or supra-pubic pain) and/or negative urinalysis

(if applicable) without need for changing antimicrobial therapy. Conversely treatment failure in this case was defined as no improvement in symptoms within 48 hours of starting therapy, positive urinalysis and culture within 7 days following completion of therapy and/or a change in antibiotics. We performed a retrospective chart review of all patients admitted to our tertiary-care, community teaching hospital who were prescribed oral cephalexin from 3/1/2011 to 8/31/2012. From this population, we identified patients who met the following inclusion criteria for our study: patients 18 years of age and older with a diagnosis of “uncomplicated urinary tract infection” or “uncomplicated cystitis,” assigned by coders using the International Statistical Classification of Diseases and Related Health Problem-9 (ICD-9) system. We selected these codes to try to eliminate patients with urinary tract infections and complex confounding factors such as nephrolithiasis or sepsis from a urinary source. We did include patients with chronic urinary tract instrumentation such as catheters as, although they are considered to have “complicated” urinary tract infections by the IDSA criteria, these patients are considered at high risk for multi-drug resistant urinary tract infections.1,6 Patients were excluded from this study if they had been coded to have a complicated urinary tract infection or pyelonephritis during their index stay, were pregnant, had known urological abnormalities or co-morbidities other than listed above or had a post-discharge follow-up visit outside of our health system (because of the lack of access to the outpatient medical record in such patients). Our study was granted expedited Institutional Review Board (IRB) approval. This study was conducted in compliance with our protocol, Good Clinical Practice (GCP) and the applicable regulatory requirements.

After reviewing charts on all patients who were prescribed cephalexin in our hospital and had a coding diagnosis of UTI, we identified patients from this group who received cephalexin specifically for an Escherichia coli UTI. A variety of data was extracted from the patients’ chart including demographic data, weight, serum creatinine on admission, as well as estimated creatinine clearance. Clinical data extracted included dose and frequency of cephalexin as well as any concomitant antibiotics given during the index hospital stay. Microbiologic data was collected including identity of bacteria and sensitivity results using the Micro-Scan system (Siemens, Inc, Malvern, PA). The Charlson Co-morbidity index was calculated on each patient to estimate the overall burden of chronic illness in our cohort.7 The Charlson index is a well validated tool used to predict the burden of illness in hospital ward inpatients. It has been used to predict ten-year mortality rates in patients with multiple co-morbid diseases. Higher scores indicate a greater burden of disease. We accessed the follow-up appointment notes from the outpatient electronic medical record to assess efficacy, adverse effects or recurrence of UTI symptoms. Our primary outcome was the percentage of patients who achieved clinical cure using cephalexin for a urinary tract infection caused by E. coli. Secondary outcomes were adverse effects reported to cephalexin therapy, the number and nature of patients with a relapsed UTI as defined above and any occurrence of Clostridium difficile disease. This last outcome was chosen as cephalosporins are associated with a high risk of subsequent Clostridium difficile diarrhea.8 Descriptive statistics such as mean and median were used to assess demographic and background clinic information as well as applicable outcomes. Results 1,896 patients were prescribed cephalexin during the time period Oct/Nov/Dec 2013 |

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peer review

of March 1st, 2011 to August 31st of 2012. Two hundred and sixty patients aged greater than 18 years received an ICD-9 code listed above pertaining to UTI. One hundred and twenty-seven of the 260 patients with UTIs had culture results confirming E. coli as the causative organism. Of these 127 patients, 36 met the criteria for inclusion in our study. Patients were excluded due to pregnancy (12 patients), urosepsis (25 patients), pyelonephritis (18 patients), urinary stones or acute urinary tract instrumentation (24 patients), and lack of access to or incomplete data (12 patients). The majority of our patients were female and in the age range of greater than or equal to 71 years of age (Table 1). In our cohort the average weight was 79 Kg and the average creatinine clearance was 44 ml/min with 12/36 patients having a creatinine clearance of less than 30 ml/min. Patients had a high burden of co-morbidity with most having a Charlton co-morbidity score of 5 or above. Looking at outcomes of the 36 patients who met criteria for study, 34 of them (94%) met the criteria for clinical cure based on information from their follow-up appointments or data from the medical chart during the index hospital stay. Two patients developed recurrence, both with strains of E. coli resistant to either levofloxacin or co-trimoxazole or both. Table 2 lists these patients’ characteristics. Seventy percent of patients were prescribed antibiotics other than cephalexin during their hospital stay compared to 30% who received cephalexin alone. Neither patient with recurrence received cephalexin alone. Most patients had greater than one antimicrobial prescribed for them, with cephalexin being the discharge antibiotic in the majority of cases. The median duration of therapy for cephalexin in patients who had received other antibiotics during the index hospitalization versus cephalexin therapy alone was similar with 7 days versus 5 days respectively. No patient was readmitted within 30

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days for any urinary tract complaint. Looking at resistance patterns of our microbiologic cohort, 20 out of 36 patients, (55%), had an E. coli strain that was resistant to fluoroquinolones, 12 out of 36, (33%), were resistant to co-trimoxazole, and only 2 out of 36, (5%), were resistant to nitrofurantoin. Twelve out of 36, (33%), had E. coli resistant to two of these antibiotics: fluoroquinolones, co-trimoxazole, or nitrofurantoin. Two out 36, (5%), were resistant to all three of those agents. Ten out of 36, (28%) were pan-sensitive E. coli strains (Table 3). One patient reported diarrhea during therapy, but no other adverse events were found, including any incidence of Clostridium difficile disease. Discussion Our retrospective cohort study suggests that oral first generation cephalosporins are an effective and safe treatment strategy for hospitalized patients with E. coli urinary tract infections in the Central Iowa area. Although our local antibiogram has shown remarkable activity of first generation cephalosporins against this organism (>90% susceptibility over the last 5 years), little data existed concerning the clinical effectiveness of this regimen. Although cephalexin is approved by the Food and Drug Administration for “Genitourinary tract infections, including acute prostatitis, caused by Escherichia coli, Proteus mirabilis, and Klebsiella pneumonia”9, the last study published in the United States using this medication for urinary tract infections was published in 1991. In the intervening years since this paper was published surveillance studies have suggested increasing levels of resistance of E. coli to many agents commonly used to treat uncomplicated urinary tract infections including co-trimoxazole and the fluoroquinolones.11 Local and national surveillance programs have not shown such a loss of susceptibility with first generation cephalosporins. Indeed, in vitro results have suggested over 85% of E. coli still susceptible to this class.

However cephalothin (not cephalexin) is the first generation cephalosporin commonly used in mircobroth dilution susceptibility testing to represent all first generation cephalosporins. At least one study has suggested that in vitro susceptibility of E. coli to cephalothin cannot be extrapolated to cephalexin.12 Thus as cephalexin was being used to treat acute UTIs at our institution we felt it was prudent to examine clinical outcomes associated with this regimen. Our patients were representative of patients likely to have resistant E. coli UTIs: They were on average over age 65, and most had multiple comorbidities such as diabetes and hypertension.13 Such patients, when they present with UTIs caused by E. coli resistant to the common antibiotics used for such infections in the United States (e.g. co-trimoxazole, fluoroquinolones) can often present a challenge to clinicians looking for an inexpensive, oral option for treatment. Nitrofurantoin can be used in some cases, but may be less effective (or more toxic) in elders whose renal function is poor.14 In our population with about 1/3 of patients having creatinine clearances of less than 30 ml/min a significant number of patients would be ineligible to use this medication. Thus, cephalexin, if effective against E.coli isolates demonstrating resistance to other oral agents may be an ideal alternative treatment. Our study found a high rate of clinical cure, with no significant adverse effects. Our study has several limitations. Its retrospective nature does not allow for assessment of causality, and, like all such studies, may be subject to potential biases—particularly selection bias—that may influence our findings. Possible errors in coding might have resulted in patients who did not have the disease studied, however many retrospective studies do use this methodology to identify patients. Most of the patients in our cohort were started on one “standard” antibiotic for UTI before being switched

peer review

to cephalexin. The influence and potential interaction of these antibiotic choices on the outcomes we found is unknown and limited are ability to isolate outcomes in patients who received cephalexin alone versus those who received multiple antibiotics. We made the decision to include patients with chronic indwelling catheters which may limit generalizability to other populations. Our sample size is relatively small. However the numbers in our study are close to the numbers of other studies involving cephalexin for UTIs done in the 1980s and 1990s.10,15 Finally this study reflects practices and resistance of our health-system. Such information may not be generalizable to other areas of the country with different pathogen resistance patterns. In conclusion our retrospective study shows that treatment with oral cephalexin is associated with a high clinical cure rate in hospitalized patients with E. coli UTIs and is well tolerated. Prospective, controlled studies could be done to further investigate this association. However, given the unlikely possibility of such studies being done, we suggest that oral cephalexin is a reasonable option in uncomplicated E. coli UTIs resistant to commonly used antibiotics for this disorder.

Table.1 Demographic Data Characteristic

Numeric (Percentage)

Sex

M: 3 (8.3%), F: 33 (91.7%)

Age

Age < 40 years: 5 (13.8%) Age 41-50 years: 4 (11.1%) Age 51-60 years: 2 (5.6%) Age 61-70 years: 6 (16.7%) Age > 71 years: 19 (52.8%)

Chronic-indwelling catheter

Y: 4 (11.1%) N: 32 (88.9%)

Charlson Co-Morbidity Score

0:1 (2.85%) 6:5 (13.8%) 1:2 (5.6%) 7:2 (5.6%) 2:1 (2.85%) 8:5 (13.8%) 3:3 (8.4%) 9:3 (8.4%) 4:4 (11.1%) 10:5 (13.8%) 5:5 (13.8%)

Creatinine Clearance (by CockcroftGault formula)

Average 44 ml/min Median 45 ml/min (Range 10 ml/min to 105 ml/min)

Table.2 Recurrence Results Recurrence #1

Recurrence #2

Gender

F

F

Age Range

71

38

Charlson Co-Morbidity Score

6

2

Non-cephalosporin concurrent antibiotics (Y/N)

Y (Levofloxacin)

Y (Levofloxacin)

Days of Cephalexin

6

14

Total days of antibiotics

12

14

Initial Culture

R: Ampicillin, R: Ampicillin, Levofloxacin, Levofloxacin Tetracycline, Sulfamethoxazole/ I: Ampicillin/Sulbactam Trimethoprim, Trimethoprim I: Ampicillin/Sulbactam

Repeat Culture

N/A

References

1. Gupta K, Hooton TM, Naber KG, et al. International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52:e103-e120. 2. Khawcharoenporn T, Vasoo S, Ward E, et al. High rates of quinolone resistance among urinary tract infections in the ED. Am J Emerg Med. 2012;30:68-74. 3. Moffett SE, Frazee BW, Stein JC, et al. Antimicrobial resistance in uncomplicated urinary tract infections in 3 California EDs. Am J Emerg Med. 2012;30:942-949. 4. Pallett A, Hand K. Complicated urinary tract infections: practical solutions for the treatment of multiresistant Gram-negative bacteria. J Antimicrob Chemother. 2010;65:325-333. 5. Anon. CLSI. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Third Informational Supplement. CLSI document M100-S23. Wayne, PA: Clinical and Laboratory Standards Institute; 2013. 6. Wang L, Lansing B, Symons K, Flannery EL, Fisch J, Cherian K, et al. Infection rate and colonization with antibiotic-resistant organisms in skilled nursing facility

residents with indwelling devices. Eur J Clin Microbiol Infect Dis. 2012;31:1797-804. 7. Charlson, Mary E.; Pompei, Peter; Ales, Kathy L.; MacKenzie, C.Ronald. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation . J Chronic Dis 1987; 40: 373â&#x20AC;&#x201C;83. 8. Owens RC Jr, Donskey CJ, Gaynes RP, Loo VG, Muto CA. Antimicrobial-associated risk factors for Clostridium difficile infection. Clin Infect Dis. 2008;46 Suppl 1:S19-31. 9. Cephalexin product information. Advancis Pharmaceuticals, Germantown, MD. Accessed via http://dailymed.nlm.nih.gov/dailymed/ lookup.cfm?setid=68fba58a-7748-4581-8432f5286c46d90a, Accessed 5/23/13. 10. Christenson JC, Gooch WM, Herrod JN, Swenson E. Comparative efficacy and safety of cefprozil and cefaclor in the treatment of acute uncomplicated urinary tract infections. J Antimicrob Chemother. 1991 ;28:581-6. 11. Perfetto EM, Keating K, Merchant S, Nichols

R: Ampicillin, Ciprofloxacin, Tetracycline, Levoflaxacin, Trimethoprim I: Ampicillin/Sulbactam, Amoxicillin/ clavulanic acid, Ticarcillin/clavulanic acid BR. Acute uncomplicated UTI and E. coli resistance: implications for first-line empirical antibiotic therapy. J Manag Care Pharm. 2004;10:17-25. 12. Zhang SX, Parisian F, Yau Y, Fuller JD, Poutanen SM, Richardson SE. Narrow-spectrum cephalosporin susceptibility testing of Escherichia coli with the BD Phoenix automated system: questionable utility of cephalothin as a predictor of cephalexin susceptibility. J Clin Microbiol. 2007;45:3762-3. 13. Colodner R, Kometiani I, Chazan B, Raz R. Risk factors for community-acquired urinary tract infection due to quinolone-resistant E. coli. Infection. 2008;36:41-5. 14. Geerts AF, Eppenga WL, Heerdink R, Derijks HJ, Wensing MJ, Egberts TC, De Smet PA. Ineffectiveness and adverse events of nitrofurantoin in women with urinary tract infection and renal impairment in primary care. Eur J Clin Pharmacol. 2013 May 10 PMID: 23660771. Accessed 5/16/13. 15. Ahrens T, Naber KG. Activity of cefroxadine and cephalexin in urinary tract infections: a double-blind comparative study. Infection. 1983;11:25-30.

Oct/Nov/Dec 2013 |

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member section

IPA Member Spotlight on:

Todd Thompson, RPh

By: Jacob Shell, PharmD University of Iowa College of Pharmacy The landscape of Iowa can be summarized as a collection of many small rural communities with a few densely populated cities. This landscape can be problematic when attempting to deliver healthcare to the more rural parts of our state. Todd Thompson and his counterparts at Reliant LTC have a solution with the inception of Victor Drug, Iowa’s first telepharmacy. Why Pharmacy? Todd Thompson’s interest in pharmacy grew out of a family connection. His brother-in-law was working as a pharmacist at St. Luke’s Hospital in Cedar Rapids where Todd was able to shadow his relative and develop his own interest in the profession. He decided to change majors early in his college career, and went on to graduate from the University of Iowa in 1998 with a bachelor’s degree in Pharmacy. Early Career After graduation, Todd took a job as a staff pharmacist with Econo Foods in Muscatine, but unbeknownst to him the store had planned to close just 6 months after he was hired. He then moved across town and took a position with Hy-Vee in Muscatine, where he spent the next 6 years of his career as the pharmacy manager. After leaving Hy-Vee, Todd took a job with Walgreens where he worked 7 on/ 7 off, a schedule that allowed him time to develop ideas for starting his own business. Transition to Ownership With an opportunity to purchase an established pharmacy, Todd decided to leave his job with Walgreen’s and

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take ownership of Remedy Drug in Montezuma, a family-owned pharmacy for more than 100 years. In 2007, Todd and his cousin put their minds together and started Reliant LTC, focusing on the provision of long-term care to a variety of local facilities. In addition to Remedy Drug, Reliant LTC operates 5 other pharmacies and provides services for 24 nursing homes. Today, Todd spends much of his time in a management role, building and strengthening relationships with his business partners. The most rewarding aspect of his current position is the long-term care portion of his business; Todd believes long-term care provides pharmacists with the greatest opportunity to improve patients’ quality of life and impact the lives of their families. Telepharmacy Four years ago, the small town of Victor, IA lost their community pharmacy; one year ago, they got it back in the form of Iowa’s first telepharmacy. Todd Thompson believes that telepharmacy is an improvement over traditional community pharmacies in both safety and accuracy. How can this be? First and foremost, the software that Victor Drug utilizes requires more checking and verifying than most community pharmacies. This software, which was personally developed by Todd’s stepson as an improved version of currentlyavailable programs, also requires consultation on every prescription that is dispensed. In Todd’s opinion, this enables the pharmacist to engage the patient in a more valuable and beneficial consultation, and patients have been very receptive to this interaction. The success of Victor Drug did not come easy, however. Todd and Reliant LTC had to clear numerous legislative hurdles as their proposed telepharmacy was Iowa’s first ever. It took 10 months from the time the Board of Pharmacy

approved the idea until the doors of Victor Drug were opened. Todd wanted to ensure that his pharmacy was utilizing software capable of improving patient safety, not just meeting the status quo. When asked what role he believes telepharmacy will play in Iowa, Todd’s response was very clear: “Telepharmacy is a great tool for small owners to survive on a lower volume of prescriptions.” Community Involvement Aside from his career in pharmacy, Todd is very involved with his community. He is very passionate about his faith and has served as an elder at his church for the past four years. Todd also spends his time coaching basketball and working with young adults in his community. He has always tried to involve young people in his business, and is proud to say that eight of his former employees have graduated from or are currently enrolled in a PharmD program. When he has some time of his own, which is few and far between, Todd enjoys trout fishing and playing golf. Vision for the Future As the practice of pharmacy continues to evolve, Todd believes the practice of pharmacy will become more and more automated. He bases this belief on two realities: prescription reimbursement continues to diminish, and automation allows pharmacies to operate more efficiently. By utilizing technology to their advantage, Todd believes that independent pharmacies can and will stay competitive.

Oct/Nov/Dec 2013 |

29

member section

IPA Member Milestones • Patrick Verdun graduated and received his PharmD from the University of Colorado NonTraditional PharmD (NTPD) in August 2013. He completed his BS in pharmacy from Drake University in 1984. • As a member of the Waverly City Leisure Services Commission, pharmacist Sharon Cashman helped to secure $78,000 from Vision Iowa to build a new community amphitheater in Waverly. Congratulations, Sharon! • Don Letendre, PharmD, Dean of University of Iowa College of Pharmacy was recently elected to the a 4-year term on the ASHP Board of Directors. • Denise Soltis, RPh was recently appointed to Assistant Dean for Community and Global Engagement at Drake University College of Pharmacy and Health Sciences. • Cheryl Clarke, RPh, CHC was recently appointed to Assistant Dean of Clinical Affairs at Drake University College of Pharmacy and Health Sciences. • Lori Schirmer, PharmD, BCPS, BCNSP, of Drake University College of Pharmacy and Health Sciences accepted a position as a Clinical Specialist at Fort Sanders Regional Medical Center in Knoxville, Tennessee. • Congratulations to Robert Nichols, P1, University of Iowa and wife Dr. Bryndee (Boheman) on their recent marriage on September 7th, 2013. • Layla Louise Rosmann was born on July 29th, 2013 to Jon (IDPC) and Amanda Rosmann, PharmD (Walgreens). • Duke Jon Smith was born August 14th to Jess PharmD, MPH (Mercy Family Pharmacy) and Jeff Smith. • Emily Alice Vos was born September 7th to Susan, PharmD, BCPS (University of Iowa College of Pharmacy) and Jeremy Vos. Welcomed home by big sister Claire. Send your member milestones to Lynndi at lkoester@iarx.org for inclusion in the next IPA Journal.

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WELCOME

NEW IPA MEMBERS Thank you for supporting IPA! July 1 - Sept 31: Susan Frey, Villisca Crystal Hopf, Stanton Jeffrey Houseman, Wilton Rebecca Kehoe, Dubuque Wendy Mobley-Bukstein, Clive Merideth Sutton, Sullivan, MO

member section

The mission of the Iowa Pharmacy Association is to promote safe and effective medication use to improve the health of patients by serving the pharmacy profession.

To You. To Patients. To The Profession. upcoming priorities

recent achievements

• Expanded pharmacist immunization authority • PBM regulations proposed • Pioneer ACO model incorporating MTM services • New Practice Model pilot project approved • IPA Goes Local hosted in 7 counties • FREE law and patient safety CPE offered to IPA pharmacist members • Increase in Medicaid dispensing fee • TEAM series developed for technician members

• Passage of PBM regulations • Host PPMI (Practice Advancement) workshop • Host inaugural Midwest Pharmacy Expo • Position pharmacists in emerging healthcare models • Partner with Board of Pharmacy: Telepharmacy & Compounding • Pilot tech-check-tech as a New Practice Model

Health care is changing.

Joining IPA is more important than ever. SUPPORT YOUR PROFESSION.

join/renew today!

ONLINE: WWW.IARX.ORG - Click on MEMBERSHIP > JOIN/RENEW

Username (license/member#) MAIL/FAX: Send check or include credit card info with statement Non-deductible portion of dues: 25% (Attributable to Lobbying Expenses)

Iowa Pharmacy Association

8515 Douglas Ave., Suite 16 • Des Moines, IA 50322 • 515.270.0713 • Fax: 515.270.2979 Oct/Nov/Dec 2013 | Website: www.iarx.org • E-mail: ipa@iarx.org

31

technician’s corner

A Winning Combination: Pharmacists & Pharmacy Technicians

W Michelle Garvin CPhT

Wester Drug Wilton, IA

IPA Technician Commentary

here is the future of pharmacy taking us? That is a question most of us in the field have been asking for the past few years. With the ever-changing field of healthcare we have been asking ourselves “Where do we fit in?” The pharmacy profession is very diverse. We work in hospitals, clinics, longterm care, community, and independent settings. We are working to become recognized as providers, separating ourselves from the “product” we dispense, specifically in the community pharmacy setting. As a result it is important we unite and identify the “value” we place on

“As technicians we have an opportunity to evolve with our pharmacist.” ourselves as pharmacists and pharmacy technicians in healthcare. We are trained professionals with the knowledge, skills, and abilities, to help our patients be healthy, manage symptoms, and set life goals. Studies show pharmacists decrease hospitalization rates and the need for repeat clinic visits by improving patient adherence to medication regimens. The importance of the technician in this field is becoming more and more evident. Just as the nurse is to the physician, the technician is to the pharmacist. One cannot provide patient care without the other. As technicians we have an opportunity to evolve with our pharmacist. Our patients rely on us! As pharmacists and technicians, we have an advantage in healthcare that most practitioners don’t; our patients have immediate, direct access to us. When they have questions, concerns, want to talk, or learn ways to improve their health we are readily available for them. Pharmacists

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make recommendations based on patient’s diagnosis that complement the prescriber’s care plan. Together, we can monitor adherence to reduce the need for additional medications. We can help with symptom management and work to determine the “why” as a form of prevention to help the patient reach his or her goals. If we can work together with patients to identify the risks of developing a disease before it actually develops, help the patient to identify his or her goals and implement life-style changes that reduce the risk of developing diseases, then we are focusing on preventative medicine. This helps our patients take responsibility for their health and work to decrease overall healthcare costs.

“So I ask you pharmacists and technicians, how do you value yourself in the profession?” This functional approach to medicine is becoming standard practice. The functional medicine approach focuses on the whole patient, not on the disease as traditional medicine has done in the past. The idea is to identify the cause and aggregators of a disease and focus on minimizing them – not just symptoms. So I ask you pharmacists and technicians, how do you value yourself in the profession? What do you have to offer? How can you justify your position? What is your future? I leave you with this challenge: Utilize the skills you’ve gained from your education. Instead of just treating a disease, step up to the plate and help prevent disease from happening.

technician’s corner

newly ptcb certified iowa technicians April 1, 2013 through June 30, 2013 Please join IPA in congratulating the following pharmacy technicians on becoming PTCB-certified! Mike Aten Jennifer Boudewyns Erica Boyle Alyssa Breitbach Katilin Brown Brenda Bunch Patricia Burrows Samantha Capsopoulos Laura Carpenter Lori Carty Celeste Charchalac Rachel Cook Brittney Davis Sandra DeVries Alicia Diaz Madison Digmann Vanessa Driscoll Andrea Dunn Sadia Embree Carol Evers

Rachel Fetters Bridget Fish Amanda Fortune Scott Foughty Michael Friesenborg Ajith Ganarajah Jaclynn Gard Rachel Gean Sydney Godwin Geraldine Gulbranson Cassondra Hada Aubrey Hansen Debra Hansohn Andrew Hathaway Katie Hayes Melissa Hensley Nathan Hensley Sarah Inman Alanah Johnson Emily Johnson Kimberly Johnson

Talsha Johannsen Stacy Jones Kathy Hatcher James Kay Justin Kilburg Christopher King Matthew Koeser Logan Kubovec Julie Langley Austin Larson Benjamin Legore Iris Le Brianne Lile Sandra Losee Stephanie Maassen Jessica Masker Marcy McCleary Rhonda McGowan Darin Meinen Patricia Merriman Jeremiah Meyer

Monica Mom Choua Moua Kristine Mullen Kally Myers Bonnie Noll Amel Nuhanovic Jeremy Ohrt Emily Olberding Sanny Ong Jana Page Rachel Parry Lindsey Peacock Kelli Pettinger Breeanna Pierce Chaniel Pope Kristie Pope Rebecca Lewis Amanda Rhines Jennifer Ross Nicholas Sagan Katherine Schnoebelen

Danielle Shane Shari Phipps Benjamin Short Kelcee Sams Ashley Stock Der Su Marisa Trautsch Trevor Treglia Seangchan Vanhxay Alma Velasco-Alejos Aaron Vosberg Amanda Walters Christina West Valerie Wisco Brittney Worth Scott Wyman Ashlynn Yant Chee Yang Olivia Kim Yong Samantha Zrust

2014 TEAM Topics for Technicians Announced

• IPA and CEI are again partnering to provide pharmacy technicians with 10 hours of continuing pharmacy education in 2014. The CPE articles, TEAM (Technician Education for Association Members), are provided free for all IPA pharmacy technician members. Beginning in January 2014, pharmacy technician members can access the articles on CEI’s website with the access code provided to them. The topics for 2014 include:

• Pharmacy Payment Models and Methods • The Role of the Pharmacy Technician in Obtaining a Medication History • Getting To The Core of CMS Measures • Protecting Patient Privacy • Pour Some Sugar On Me: New Drugs for Type 2 Diabetes Mellitus • Vitamins and Minerals During Pregnancy and Lactation • Pharmacogenomics: Pharmacy’s Role in Personalized Medicine • Hot Topics in Infectious Disease • Ethics for Pharmacy Technicians • Communication and Teamwork – Strategies for Pharmacy Technicians

Oct/Nov/Dec 2013 |

33

college of pharmacy news

New CPHS dean brings passion and innovation

• “I’ve been in pharmacy all my life,” says Wendy Duncan, new dean of the College of Pharmacy and Health Sciences.

Duncan is the daughter of a pharmacist who ultimately became a professor of pharmacy and founding dean of the School of Pharmacy at Memorial in Newfoundland. She was born when her father was working on his master’s degree in pharmacy at the University of Toronto, and was drawn to the profession at a young age. Following in her father’s footsteps, Duncan developed a passion for academia and pharmacy education. Duncan uses problem-based learning methods in her courses, and today is a noted expert in curriculum development. While serving as the vice president of academic affairs and dean of pharmacy at St. Louis College of Pharmacy, Duncan facilitated an academic strategic planning process that resulted in curricular transformation. The new curriculum integrated disciplines to better develop student abilities in communication, critical thinking, and lifelong learning. Duncan was attracted to a similar dedication at Drake. “Drake has an excellent reputation in terms of its innovative approaches,” she says, “which is one of many reasons I’m excited to be here.” Duncan plans to start her Drake journey by learning about the University’s culture and the dreams and aspirations of the faculty and staff.

Kappa Psi Wins Prestigious Awards at National Convention • The Beta Chi chapter of Kappa Psi Pharmaceutical Fraternity at Drake University recently returned from

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a national convention with three prestigious awards. Eight fraternity members attended the Grand Council Convention in St. Pete Beach, Fla., this August where they were recognized for their chapter’s accomplishments. Beta Chi was awarded the Frank H. Eby National Scholarship Tray Award for 2013 as well as two national titles: the Best Collegiate Chapter in the Northern Plain Province and the 5th Best Collegiate Chapter overall. “Looking around the room at the other delegates from the 90 international collegiate chapters of Kappa Psi, I was amazed to see that Beta Chi was ranked number five,” says Natalie Benson, member of Beta Chi. “It put into perspective how much our hard work paid off.”

Phi Delta Chi Receives Recognition at National Awards Banquet • The Phi Delta Chi Pharmacy Fraternity at Drake University received awards for scholarship and overall excellence at the organization’s national meeting in Omaha, NE. More than twenty Drake members attended the banquet at which the chapter was recognized. The chapter completed a series of reports that were graded by Phi Delta Chi’s national officers. As a result, the Drake chapter earned second place in scholarship and fifth best chapter overall. “Our chapter has put in a ton of work trying to come up with new programs and create new ideas,” says Geena Brickson, second year pharmacy student and president of Phi Delta Chi at Drake. “The fact that our work was competitive on a national scale makes us very proud.”

Natalie Schmitz, PH’14, finalist for 2013 Future Pharmacist of the Year • Natalie Schmitz, PH’14,

was one of three finalists in the national Next Generation Pharmacist of the Year - Future Pharmacist of the Year category organized by Parata and Pharmacy

Times. Since the award’s inception four years ago, Drake University has nominated three students, and each has been selected as a finalist. With more than 130 pharmacy schools nationwide, the Drake University College of Pharmacy and Health Sciences has set an impressive track record in this national competition. It’s no surprise Schmitz was selected as a 2013 finalist. With passions for pharmacy, academia, and legislation, Schmitz has created a diverse list of notable Natalie Schmitz accomplishments making her stand out among her peers. As a legislative intern for Iowa State Sen. Jack Hatch, Schmitz was able to advocate for pharmacy in the political arena. She has also been involved in special research and education projects with Drake faculty and the Iowa Pharmacy Association. Her other activities include participating in Drake’s Student Leadership Development series, and being a member of the pharmacy leadership society, Phi Lambda Sigma.

2013-14 New College of Pharmacy and Health Sciences Faculty

• Wendy Duncan, Dean and Professor with tenure, College of Pharmacy and Health Sciences Erin Thatcher Ulrich, Assistant Professor of Social and Administrative Sciences, College of Pharmacy and Health Sciences Eliza Dy, Assistant Professor of Pharmacy Practice, College of Pharmacy and Health Sciences Frank Caligiuri, Assistant Professor of Pharmacy Practice, College of Pharmacy and Health Sciences

college of pharmacy news

A Tribute to TonI

M

ost in the profession recognize Iowa pharmacy as something very special. I would submit that we are like family. We are drawn together in common purpose, we work together for the betterment of all especially those whose lives have been entrusted to our care, and on the occasion when someone passes on, we grieve.

Recently, Toni Shea (known as ‘Kruthoff ‘to her College classmates and ‘Nieland’ by most in IPA) passed away after a long and courageous battle with Hodgkins Disease. Toni was among the first pharmacists I visited after my arrival to Iowa. In fact, in the Fall 2008 issue of HawkScripts, our College newsletter, I made special note of my first journey through the Heartland and my stop in Sac City: “The first thing that struck me was the profound sense of caring and responsibility that I witnessed in so many different practice sites [across Iowa]…community pharmacies, ambulatory and family practice clinics, acute care hospitals, and long-term care facilities. In every instance, I witnessed pharmacists’ unwavering commitment to professionalism and high professional ideals. In short, they were always striving to ‘do the right thing for the patient’! Frankly, as a pharmacist, I gushed with pride at what I saw. In several instances, I was introduced to patients being served by the pharmacist I was visiting…in Sac City where an elderly gentleman took me aside to share his very personal story about how the pharmacist there had literally ‘saved his life’!” The pharmacist to whom he was referring was Toni. Toni and I became fast friends…and our bond was especially strong because we had both battled the same disease. Her smile lit up a room, her optimism was infectious, and her patients loved her. She was truly representative of all that is wonderful about our profession. As we like to say to our students, Toni ‘walked the talk’ as she strove to maintain the

high standards of care that have come to be synonymous with this special place known as Iowa.

“Her smile lit up a room, her optimism was infectious, and her patients loved her. She was truly representative of all that is wonderful about our profession.”

Don Letendre, PharmD University of Iowa College of Pharmacy Dean

Toni provided those who knew her many important lessons. Perhaps, none was greater than her determination and desire to fight on. Today, our profession faces many challenges, challenges that at times seem insurmountable…PBMs, reduced profit margins, provider status, ever-increasing resource demands, the love-hate relationship with technology, highly complex and costly drug regimens, regulatory pressures, etc, etc. It is imperative that our family stay strong, that we support each other, and that we continue to exhibit that same level of determination as we have always exhibited as we work together to advance pharmacy in Iowa. I am going to miss Toni. But I know that her spirit lives on. It lives on in every pharmacist who ‘does the right thing for the patient’, who strives for high professional ideals despite the challenges, and who imparts a spirit of optimism and professionalism in the students and residents who will one day be at the forefront of change. That is our tribute to Toni…that is our tribute to the countless pharmacists who went before us. With profound respect and admiration,

Donald E. Letendre Dean and Professor Oct/Nov/Dec 2013 |

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STUDENT SECTION

“Where will Pharmacy take me?” The Real Question to Ask is “Where will I take Pharmacy?” Laura Vollmer

2014 IPA Executive Intern 2016 PharmD Candidate Drake University College of Pharmacy and Health Sciences

R

eimbursement. Surplus of Pharmacy Schools. Telepharmacy. Pharmacy’s Role.

Throughout the summer, these topics were brought to my attention during various meetings and discussions with pharmacists across the state. These topics may seem daunting to any pharmacist; however, The Iowa Pharmacy Association (IPA) always accompanies these issues with a new solution, positive thought or innovative method to determine new opportunities for pharmacists. Above all else, IPA always prides itself in being proactive, and not reactive, in regards to issues facing the pharmacy profession.

“Pharmacy advocacy is an essential aspect of pharmacist’s career.” While being the 2013 Max W. Eggleston Executive Intern, I had the firsthand opportunity to see and understand Iowa’s professional pharmacy association. As a student pharmacist, I constantly strive to learn about our profession whether it be through conversation with a healthcare professional or researching a topic discussion. This internship taught me the importance of advocacy, adaptability in a changing healthcare system and the true meaning of “paying it forward” to create a unified profession. I feel enlightened after taking part in this internship during an exciting time filled with evolving healthcare models. Pharmacy advocacy is an essential aspect of pharmacist’s career. Pharmacists and pharmacy professionals

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continually push the profession forward in order to shape the future. The Iowa Pharmacy Association meets with legislators, lobbyists and pharmacy leaders to engage in conversations regarding new opportunities for pharmacists. IPA works in the field to promote the profession through grassroots advocacy and hosts a legislative day to inform members on pressing issues. I am inspired by passionate, dedicated individuals at the IPA office and Iowa pharmacies that are striving to enhance the opportunities for pharmacy personnel. During my time at IPA, I had the pleasure of working on several different initiatives and met numerous individuals. Currently, IPA is working on a new practice model for community pharmacy settings to allow pharmacists the opportunity to conduct more clinical activities. As a profession, I learned we need to be open to change and try new ideas. For example, this can be implementing a new research project or attending a meeting to be more informed for your patients. As healthcare changes, we need to adapt by creating our own set of standards for years to come.

“Everyone always says Pharmacy is a small world.” “Paying it Forward” is an instrumental aspect to the profession. While at IPA, I was constantly amazed by the willingness of pharmacy professionals to lend a hand or provide a tip to improve my projects. Pharmacists across the state have given me an excellent view of where the profession is headed. It is

STUDENT SECTION

“Ultimately, the experiences I had this summer have influenced me to form a profound love for pharmacy.” exciting to hear from others about their experiences and ideas to improve current practices. Everyone always says “Pharmacy is a small world,” therefore we should always lend out a hand to those we know. We are in this together. Ultimately, the experiences I had this summer have influenced me to form a profound love for pharmacy. I am confident that the future of pharmacy will be positive and provide opportunities for growth. Throughout the summer, I attended numerous

Anthony Pudlo, PharmD, MBA, BCACP, Laura Vollmer and Kate Gainer, PharmD

meetings pertaining to the future of pharmacy, the impact pharmacists have on healthcare, and the value of my state association. As I reflect upon these experiences, I realized we all have an obligation to continuously promote the profession and make

a path where there is none. During my time at IPA, I had the privilege of working with pharmacists across the state and IPA, and I know that they are always asking the question “Where will I take Pharmacy?” not “Where will pharmacy take me?”

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iowa residents section

2013-2014 Iowa Pharmacy Residents Spotlight • Iowa is

well known as a state that provides for progressive pharmacy practice. This can be attributed to many things. Not only are Iowa pharmacists trained to advance the profession during the graduate school training, but Iowa pharmacists have the opportunity to become leaders in our profession through the multiple post-graduate residency training programs. Iowa is home to 10 residency programs that offer the experience to work with a wide range of patients, but also give pharmacists the ability and nurturing to grown personally and professionally. This year, Iowa welcomed 36 pharmacy residents from around the country. There were 32 postgraduate year one (PGY1) residents and 4 post-graduate two year (PGY2) residents. IPA hosted the 2013 Annual Resident’s Meeting at the Marriott in Coralville in October. This event provides all residents the opportunity to meet and network with one another along with IPA officers and staff. Roundtable sessions provided engaging conversations about pharmacy practice issues. This article spotlights all 36 residents, including their type of residency, practice site and location, and other interesting facts about these new practitioners.

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Elizabeth Acevedo Creighton University ‘13 Allen Memorial Hospital, Waterloo PGY-1 Residency project: Review and implementation of clinical practice guidelines for antimicrobial prophylaxis in surgery Elizabeth Amelon University of Iowa ‘12 University of Iowa Hospitals & Clinics, Iowa City PGY-2 in Pediatrics Why did you choose your residency? It was well-established, teaching institution with a large residency class, flexibility in rotation selection, and the opportunity to obtain a teaching certificate. Kari Angwin University of Findlay VA Health Care System, Iowa City PGY-1 Advice when considering a residency: Don’t overthink the choice - there is no better time than now to pursue a residency. A residency lasts for one year, yet it provides a magnitude of clinical insight and experiences that can significantly impact your future career path. Be positive!

Daniel Barone Midwestern University—Chicago ‘13 Mercy Medical Center, Mason City PGY-1 Why did you choose your residency? One-on-one training with each rotation with emphasis on feedback and continuous improvement, and flexibility to meet my needs and interests. Andrea Bennett University of Iowa ‘13 University of Iowa Hospitals & Clinics, Iowa City PGY-1 Why did you choose your residency? Location at a comprehensive academic medical center next to a College of Pharmacy, opportunity to complete a rotation in emergency department and five different ICUs. Chris Brabeck Drake University ‘13 Iowa Methodist Medical Center, Des Moines PGY-1 Advice when considering a residency: Have a polished and well-written CV. Involve your references early in your planning. Do your research prior to your interviews. Be prepared for your interviews.

Adam Baird Drake University ‘13 University of Iowa Hospitals & Clinics, Iowa City PGY-1

Katie Brower Drake University ‘13 Iowa Methodist Medical Center, Des Moines PGY-1

Residency project: Evaluation of a standardized order protocol in the ICU for treatment of diabetic ketoacidosis.

Residency project: Evaluation of nitroglycerin paste as a treatment for acute hypertension.

iowa resident’s section

Kate Campbell Husson University ‘13 VA Health Care System, Des Moines PGY-1 Residency project: Review adherence to guidelines for atypical antipsychotic medications as augmentation of depression Megan Ford University of MissouriKansas City ‘13 Hy-Vee Drug Store, Iowa City PGY-1 Community Practice Advice when considering a residency: Be 100% committed to spending one year in a very intense learning environment. If it is something that you can commit to, then do it!

Administration

Courtney Gent University of Iowa ‘12 University of Iowa Hospitals & Clinics, Iowa City PGY-2 in Health System

Why did you choose your residency? UIHC is a nationally recognized academic medical center with excellent pharmacists with significant experiences to provide great learning opportunities in pharmacy administration. Tonya Gross South Dakota State ‘13 Mercy Medical Center, Mason City PGY-1 Thoughts on residency so far: With not much hospital experience in school, I’ve been very surprised at the ease of transition into the hospital setting for me. The staff made the transition very smooth.

Alex Hoopes Drake University ‘13 OutcomesMTM, West Des Moines PGY-1 Thoughts on residency so far: My residency has greatly surpassed my expectations. I have been able to work on grant proposals, exhibit at national conferences, and work directly with rotation students. Courtney Hugie University of Utah ‘13 VA Health Care System, Iowa City PGY-1 Advice on Midyear: I narrowed down my search before Midyear, so I wasn’t overwhelmed. Make an Excel spreadsheet to list pros, cons, and questions of each program. Tony Huynh University of Iowa ‘13 University of Iowa Hospitals & Clinics, Iowa City PGY-1 Why did you choose your residency? Ample opportunities to work on multidisciplinary teams both in inpatient and outpatient settings; and be involved in the care of a wide variety of patients and medical conditions. Diana Karkow University of Iowa ‘13 University of Iowa Hospitals & Clinics, Iowa City PGY-1 Thoughts on residency so far: It’s fast-paced and requires lots of hard work, but I’m learning a lot.

Rawand Khasawneh Jordan University of Science and Technology ‘09 University of Iowa Hospitals & Clinics, Iowa City PGY-2 in Critical Care

Why did you choose your residency? The availability of prominent pharmacy leaders/preceptors in different fields, flexibility of the residency program, and patient population I will be dealing with. Ashley Kral University of Iowa ‘13 University of Iowa Hospitals & Clinics, Iowa City PGY-1 Residency project: Comparison of outcomes status post external ventricular drain antibiotic prophylaxis Tamara Lallier Drake University ‘13 NE IA Medical Education Facility & Waverly Health Center, Waterloo/ Waverly PGY-1 Why did you choose your residency? This site has a research department that participates in major clinical studies. I will be prepared to take on research project and all of its components required when I leave this program. Wendy Lantaff University of Colorado-Denver ‘13 Towncrest Pharmacy, Iowa City PGY-1 Community Practice Thoughts on residency so far: I feel I’m getting the experience I wanted since I spend the majority of my day with clinical activities in a community

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iowa residents section

setting. I wish I had budgeted more for moving and licensing expenses though. Jacqueline Lee University of Iowa ‘13 University of Iowa Hospitals & Clinics, Iowa City PGY-1 Advice on Midyear: Attend as a P3 and P4 student if possible. It was good practice to go as a P3 and crucial to attend as a P4. Generate at least 3 questions for each program of interest in showcase. Alex Martin University of Wisconsin ‘13 Shepley Pharmacy, Mt. Vernon PGY-1 Community Practice Patient care programs at your site: Disease state education including diabetes program, immunizations, MTM, health coaching through worksite wellness screenings Lauren McCaulley Drake University ‘13 Mercy Medical Center, Des Moines PGY-1 Thoughts on residency so far: Don’t be afraid to say “I don’t know” and ask questions, you won’t be discredited and you will learn a lot more that way. Alex Middendorf Drake University ‘13 CarePro Pharmacy/A Avenue Pharmacy, North Liberty/Cedar Rapids PGY-1 Community Practice Residency project: Development of modules to foster health coaching

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techniques in rotation students to improve quality of patient care Linley Mild West Virginia University ‘13 VA Health Care System, Des Moines PGY-1 Why did you choose your residency? The biggest criteria when choosing a program, especially when it came to ranking choices, is “Would I be happy here?” and I knew I would be happy with this program. Tim Peterson University of Minnesota-Duluth ‘13 University of Iowa Hospitals & Clinics, Iowa City PGY-1 Residency project: Impact of pharmacists on adherence to ACLS guidelines during in-hospital cardiac arrests Kevin Roeder University of Iowa ‘12 University of Iowa Hospitals & Clinics, Iowa City PGY-2 in Ambulatory Care

compounding, CPAP supplies, pink wardrobe, DME, wellness screenings, immunizations Kerry Schueler University of Iowa ‘13 University of Iowa Hospitals & Clinics, Iowa City PGY-1 Why did you choose your residency? Very progressive pharmacy practice settings with excellent opportunities to gain clinical experience in any field you desire Jordan Schultz University of Iowa ‘13 University of Iowa Hospitals & Clinics, Iowa City PGY-1 Advice when considering a residency: You should pick the residency program that will help you to accomplish your own personal goals. Critically thinking about what you ultimately like to achieve will help you more easily make your choice. Anna Sciegienka University of Iowa ‘13 VA Health Care System, Iowa City PGY-1

Advice when considering a residency: Keep an open mind. Prepare yourself as if you will do further training in whatever field you pursue. Get heavy involved in at least one student organization during pharmacy school.

Residency project: Effects on serum bicarbonate levels associated with topiramate use and how it relates to monitoring, adverse effects, and topiramate discontinuation.

Janis Rood University of Michigan ‘13 Osterhaus Pharmacy, Maquoketa PGY-1 Community Practice

Rachel Smith University of Iowa ‘13 Mercy Family Pharmacy, Dubuque PGY-1 Community Practice

Patient care programs at your site: diabetic shoes, MTM, OTC consultation,

Residency project: Effects of pharmacist intervention on 30-day

readmission rates and length of time to see a PCP after discharge for patients of a 340B facility Emily Stensrud Creighton University ‘13 VA Health System, Iowa City PGY-1 Residency project: Impact of a Pharmacist-Managed Inpatient Anticoagulation Monitoring Service in a VA Healthcare System

Greg Tallman Drake University ‘13 Mercy Medical Center, Des Moines PGY-1 Thoughts on residency so far: I get to work with inspiring people that provide great support and guidance. I look forward to each day because I’ll be challenged to be a better pharmacist than I was at the beginning of the day. Ryan Thurm University of Iowa ‘13 University of Iowa Hospitals & Clinics, Iowa City PGY-1

Teaching elements of your program: Opportunity to teach in the Clinical Professional Skills course and Pharmacy Practice Labs, precept IPPE/APPE students, and didactic lectures in the Non-prescription Pharmacotherapy course Adam Wilcox University of Iowa ‘13 Allen Memorial Hospital, Waterloo PGY-1 Why did you choose your residency? Extremely flexible and willing to tailor the program to what I want to get out of the residency experience.

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last laugh

need a relief pharmacist? Contact Joseph thompson

“Joseph in Relief” Joseph Thompson, RPh 9616 Quail Ridge Urbandale, IA 50322

CALL 1.888.278.0846 515.278.0846

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Place your ad/classified ad with us. All ads, contracts, payments, reproduction material and all other related communication should be addressed to Lynndi at lkoester@iarx.org or call the IPA office at 515.270.0713 for more information.

2013-2014 Calendar of Events November 2013 3 IPRN Group Support Meeting - Des Moines Fellowship Church 6 IPA Board of Trustees Meeting, IPA Headquarters 7 IPA-F Board of Directors Meeting, IPA Headquarters 12 2/2/2 Virtual Engagement Series 13 Log-in To Learn e-journal Club 20-22 ASCP Annual Meeting and Exhibition - Seattle, WA December 2013 1 IPRN Group Support Meeting - Des Moines Fellowship Church 8-12 ASHP Midyear Meeting - Orlando, FL 10 2/2/2 Virtual Engagement Series January 2014 8 Log-in To Learn e-journal Club 14 2/2/2 Virtual Engagement Series

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February 2014 7 Immunization Administration Training - Altoona 7 Together. Providing Quality Care to Patients in Pain - Altoona, IA 7-9 Midwest Pharmacy Educational Expo - Prairie Meadows Events and Conference Center - Altoona 11 2/2/2 Virtual Engagement Series 12 Log-in To Learn e-journal Club 19 IPA Board of Trustees Meeting, IPA Headquarters 20 Legislative Day and Capitol Screenings March 2014 3-4 ASHP Ambulatory Care Conference & Summit - Dallas, TX 11 2/2/2 Virtual Engagement Series 12 Log-in To Learn e-journal Club 28-29 NASPA Spring Meeting - Orlando, FL 28-31 APhA Annual Meeting & Exposition - Orlando, FL

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