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PHARMACIST T H E O F F I C I A L J O U R N A L O F M I C H I G A N P H A R M A C I S T S A S S O C I AT I O N
MPA Annual Convention & Exposition Feb. 26-28, 2016 • Detroit Marriott at the Renaissance Center
Inside 17 Advanced Pharmacy Practice Experience on the Island of Puerto Rico 30 Consultant and Specialty Focus
2016 Jan./Feb./Mar. | Vol. 54, Issue 1
47 App-ealing Apps: New Feature Highlighting Valuable Mobile Apps
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IN THIS ISSUE
Departments
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3 President’s Platform Human Reactions to Changes in Science and Technology
4 CEO Corner We Have a Role in Solving Michigan’s Drug Problem
6 CE Events Calendar Upcoming Continuing Education and Professional Development Opportunities
8 Legislative Update Recent State and Federal Legislative Actions that Could Impact Pharmacy
On the Cover 10
Attend the Premiere Event of the Year for Michigan Pharmacy Professionals!
Membership
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14 Membership New Member Benefit: Student Loan Refinancing Through SoFi
15 Member Voices Members Respond to Questions on MPA Events, Practice Issues and More
17 Student Focus Advanced Pharmacy Practice Experience on the Island of Puerto Rico
20 From the Foundation Michigan Pharmacy Foundation News and Initiatives
22 From the Foundation
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Chronic Obstructive Pulmonary Disease and Asthma Community A.I.M. Project
Practitioners in Action 25 Advocacy Breaking the Ice
Professional Practice & Regulations
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27 Feature MTM: Finding the Program That Fits
30 Consultant and Specialty Focus A Message from CSPM President Sister Phyllis Klonowski, a CE Article on Pharmacogenetics and a Practice Spotlight on Specialty Pharmacy Practice
36 Professional Practice Generic Drug Discount Programs: Implications on Medication Adherence Performance Data
38 Feature
Editor: Larry D. Wagenknecht Associate Editor: Dianne E. Malburg Managing Editor: Leah M. Ball
Could a Changing Legal Landscape Bring New Risks to Pharmacists?
Michigan Pharmacist (ISSN 1081-6089) is the official journal of the Michigan Pharmacists Association, published four times a year at 408 Kalamazoo Plaza, Lansing, MI 48933.
Continuing Education & Professional Development
Phone: (517) 484-1466, Fax: (517) 484-4893 Web site: www.MichiganPharmacists.org, E-mail: MPA@MichiganPharmacists.org Advertising Information: Visit www.MichiganPharmacists.org/news/advertising or contact Bridget Long at (517) 484-1466 or Bridget@MichiganPharmacists.org
42 Continuing Education Geriatric Care Considerations in the Community Pharmacy Setting
45 Leadership Focus Assessments as a Professional Development Tool
47 App-ealing Apps Useful Mobile Apps for Your Personal and Professional Life MichiganPharmacists.org
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All opinions expressed in Michigan Pharmacist are not necessarily official positions or policies of the Association. Publication of an advertisement does not represent an endorsement. Michigan Pharmacist is subject to the standards established by the Association. Michigan Pharmacist is distributed as a regular membership service, paid for through allocation of membership dues. Nonpharmacist subscriptions are $40 annually. Postmaster send address changes to: 408 Kalamazoo Plaza, Lansing, MI 48933. Periodical postage paid at Lansing, Mich. Nothing in this publication may be reproduced in any manner, either in whole or in part, without specific written permission of the publisher. © Michigan Pharmacists Association, 2016
2016 Jan./Feb./Mar. | Vol. 54, Issue 1
PRESIDENT’S PLATFORM
Human Reactions to Changes in Science and Technology By AMY SMENDIK, B.S. Pharm., president, Michigan Pharmacists Association, and pharmacist, Pennock Health Services
“Science fiction can be defined as that branch of literature which deals with the reaction of human beings to changes in science and technology.” – Isaac Asimov, 1975 In 2001: A Space Odyssey, a computer (Hal) is shown taking control of a human system, which results in chaos, as the computer tries to complete the controls of the programmers in a system that is beyond what the programmers could have imagined. In addition, in the novel 1984 by George Orwell, the setting is a world of perpetual war, omnipresent government surveillance and public manipulation, dictated by a political system euphemistically named English Socialism under the control of a privileged Inner Party elite, that persecutes individualism and independent thinking as “thoughtcrime.”1 Today, in pharmacy, I would have Isaac Asimov discuss how we, as scientists, as pharmacists and as human beings, are reacting to changes in technology and advancement in the year
2016. Computers are able to do the jobs of doctors and pharmacists (like Hal); however, despite the utopian attempt to create a perfect world in that film, the actual result was something much less idealistic. Administrators and insurance payers tell us what our profession means and what it is worth (like 1984). But here we are, health professionals with knowledge about how medication therapies can help patients and save money (for the insurance company, the payer and society), but we don’t speak out on our own behalf. We let the doctors tell us that we have nothing to offer, and we believe it. Physicians claim to have the power, yet the laws give pharmacists the separation of power. Imagine a new frontier of health care without a pharmacist included. It would be something like this: • An ATM would dispense medications to patients from prescriptions written by doctors who are miles away.
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• The world would be ruled by patients addicted to medications, learning how to work the system to get the medications they crave. • Pharmaceutical companies would be constantly in search of the financial Holy Grail. It is time for us to fight for ourselves, the pharmacists who are advocating for their patients. Pharmacists have been trusted with the keys to the medicine cabinet. It is time to speak out on our behalf and stand up for the profession of pharmacy. We must take back responsibility for the problems created by those who don’t realize what we bring to the health care system.
References: 1. Wikipedia, Nineteen Eighty-Four, https:// en.wikipedia.org/wiki/Nineteen_EightyFour#cite_note-3, Nov. 23, 2015.
2016 Jan./Feb./Mar. | Vol. 54, Issue 1
CEO CORNER
We Have a Role in Solving Michigan’s Drug Problem By LARRY WAGENKNECHT, pharmacist, and chief executive officer, Michigan Pharmacists Association In June 2015, Michigan Gov. Rick Snyder established the Prescription Drug and Opioid Abuse Task Force to “examine the recent trends, evaluate strategic options and develop a statewide action plan by fall 2015.” Chaired by Lt. Gov. Brian Calley, the Task Force members varied greatly in their professional backgrounds to provide a solid crosssection of input. They represented the Executive Office, the state Legislature, state departments, law enforcement, judges, prosecutors, mental health commissions, pharmacists, doctors, hospitals and insurance companies. In addition to me representing pharmacists, MPA had a second member appointed to the Task Force by Gov. Snyder: Laurie Wesolowicz, representing Blue Cross Blue Shield of Michigan. Over the next several months, the Task Force met nearly weekly to develop consensus around recommendations. A Regulation, Enforcement and Policy Subcommittee chaired by Attorney General Bill Schuette and the Prevention, Treatment and Outcomes Subcommittee chaired by Michigan Department of Health and Human Services Director Nick Lyon spent time dissecting all areas of the drug problem in Michigan. The Task Force also held a public hearing and Subcommittees gathered input from experts involved with the growing problem of prescription drug and opioid abuse in Michigan and across the country. As a pharmacist and a member of the community, I know that substance abuse is a constant challenge for our society. In fact, almost everyone knows someone (a family member, a friend or a friend of a friend) who has been negatively impacted by the pain and hurt caused by substance misuse. What I didn’t realize was how Michigan stacked up against other states and the true extent of the epidemic. The Task Force found that Michigan ranks 10th nationally in per capita
prescription rates of opioid pain relievers and 18th in the nation for all overdose deaths. An even more staggering fact is that in Michigan, the number of drug overdose deaths, a majority of which are caused by prescription drugs, has tripled since 1999.
• Reviewing successful drug take-back programs for possible replication and expansion.
The rise in heroin use is closely related to the prescription drug epidemic. As efforts to address prescription drug abuse increase, addicts often turn to illicit drugs. The fact is that heroin is cheaper to obtain than controlled substance prescriptions. The increased attention paid by law enforcement to combatting this problem as well as the expansion of Drug Courts and the focus on diversion for treatment instead of incarceration, when appropriate, have helped; however, this is not enough action to get the problem under control.
We, as pharmacy professionals, have a real opportunity to provide assistance to patients who may be identified as having a substance abuse problem. It may be as simple as talking with the patient about the frequency of their medication use, talking with their physician about the quantity of medication prescribed or linking them up with a substance abuse counselor in the community.
The recommendations were presented to Gov. Snyder on Oct. 26, 2015. Highlights from the full report, which includes 25 primary recommendations and seven contingent recommendations, include the following: • Updating or replacing the Michigan Automated Prescription System (MAPS) and requiring registration and use of MAPS by those who are prescribing and dispensing prescription drugs. • Increasing licensing sanctions for health professionals who violate proper prescribing and dispensing practices.
• Increasing training for law enforcement in recognizing and dealing with addiction for those officers who do not deal directly with narcotics regularly.
As the state moves forward, we must consider the legitimate needs of patients who require pain medication and recognize that the vast majority of health professionals provide appropriate treatment. The Task Force is cognizant that chronic pain continues to be a serious issue for millions of Americans. Any comprehensive approach to the prescription drug abuse problem and death rate must consider all stakeholders. The MPA Annual Convention & Exposition will be featuring this topic at the Opening Session on Friday, Feb. 26, 2016, from 3-4:30 p.m. in Ambassador Ballrooms 2-3 on Level 3 of the Detroit Marriott. The full Task Force report can be viewed online at www. Michigan.gov/documents/snyder/ Presciption_Drug_and_Opioid_Task_ Force_Report_504140_7.pdf
• Providing easier access to Naloxone to members of the general public. • Requiring additional training for professionals who prescribe controlled substances.
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Task Force members (left to right) Laurie Wesolowicz, MPA member and director of pharmacy services clinical for Blue Cross Blue Shield of Michigan; Brian Calley, Lt. Gov. of Michigan; and Larry Wagenknecht, MPA chief executive officer at the press conference held on Oct. 26 at the Detroit Medical Center Heart Hospital.
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2016 Jan./Feb./Mar. | Vol. 54, Issue 1
EVENTS CALENDAR MPA, local association and national pharmacy organization events as well as health observances are included below. For the most up-to-date information, please visit our online calendar at www.MichiganPharmacists.org/eventscalendar. For continuing education events, please see page 6 of this issue.
JANUARY 2016
FEBRUARY 2016
MARCH 2016
Thursday, Jan. 14
Monday, Feb. 1Monday, Feb. 29
Sunday, March 20Saturday, March 26
American Heart Month United States
National Poison Prevention Week Nationwide
MSHP will hold the first Committee Day of 2016 on Jan. 14. The Society is introducing a new Task Force this year, Antimicrobial Stewardship, to explore collaborative ways in which to minimize the development and emergence of antimicrobial resistance across Michigan, expand infectious diseases-related educational resources and collaborative practices for health-system practitioners in Michigan, and to champion and share successful antimicrobial stewardship practices throughout the state. For more information on MSHP Committees, visit www.MichiganPharmacists.org/mshp.
February is American Heart Month, dedicated to raising awareness of the impact of heart disease and measures that can be taken to prevent it. Heart disease is the No. 1 cause of death for both men and women in the United States. Pharmacists are in a unique position to help in this effort. For more information, please visit www.Heart.org. In addition, visit page 41 for information on new That’s My Pharmacist materials that MPA has made available, including a patient flyer focused on American Heart Month.
National Poison Prevention Week is recognized each year to help prevent poisonings and provide education to the public about unintentional poisonings and accidental exposures in and around the home. Visit www.PoisonPrevention.org for more information and to access materials for any events or presentations that you are planning.
Monday, Feb. 1-Monday, Feb. 29
Monday, Jan. 11-Tuesday, Jan. 12
National Wise Health Care Consumer Month Nationwide
National Nutrition Month Nationwide
Michigan Society of Health-System Pharmacists (MSHP) Committee Day Okemos Conference Center, Okemos
MPA Executive Board Meeting MPA Headquarters, Lansing
Tuesday, March 1Thursday, March 31
Friday, March 4-Monday, March 7 American Pharmacists Association Annual Meeting & Exposition Baltimore, Maryland
Tuesday, Feb. 2
Thursday, Jan. 14
MPA Professional Affairs Committee Meeting MPA Headquarters, Lansing
Tuesday, Jan. 19
Consultant and Specialty Pharmacists of Michigan Board of Directors Meeting MPA Headquarters, Lansing
MSHP Board of Directors Meeting Okemos Conference Center, Okemos Michigan Society of Community Pharmacists Committee and Board of Directors Meetings MPA Headquarters, Lansing
Thursday, Feb. 4
Friday, March 11-Sunday, March 13
Saturday, Feb. 6
Wednesday, March 16Thursday, March 17
NCPA Pharmacy Ownership Workshop Phoenix, Ariz.
NACDS RxIMPACT Day on Capitol Hill Marriott Marquis, Washington, D.C.
National Wear Red Day Nationwide
Wednesday, Jan. 20
Pharmacy Services Inc. (PSI) Board of Directors Meeting Conference Call
Wednesday, March 16
Sunday, Feb. 14
PSI Board of Directors Meeting MPA Headquarters, Lansing
National Donor Day Nationwide
Thursday, Jan. 21
Genesee County Pharmacists Association (GCPA) Executive Board Meeting 501 Bar and Grill, Flint MPA New Practitioner Committee Meeting MPA Headquarters, Lansing
Friday, Jan. 22
Michigan Society of Pharmacy Technicians Executive Committee Meeting Diplomat, Flint
Thursday, March 17
Sunday, Feb. 7-Tuesday, Feb. 9
National Association of Chain Drug Stores (NACDS) Regional Chain Conference Fort Lauderdale, Fla.
Wednesday, Feb. 10Sunday, Feb. 14
National Community Pharmacists Association (NCPA) Multiple Locations Conference Hyatt Coconut Point, Fort Myers, Fla.
MPA Third Party Committee Meeting MPA Headquarters, Lansing
Saturday, March 19-Sunday, March 20
American Society of Consultant Pharmacists Certified Geriatric Pharmacist Exam Preparation and Recertification Spring Boot Camp Crowne Plaza Los Angeles - International Airport
Monday, Jan. 25
Capital Area Pharmacists Association General Meeting and CE Program Sparrow Professional Building, Lansing
Support MPA’s Advertisers
Monday, Jan. 25-Sunday, Jan. 31 National Drug Facts Week Nationwide
Wednesday, Jan. 27
Michigan Pharmacy Foundation Board of Trustees Meeting MPA Headquarters, Lansing
Thursday, March 24
GCPA Executive Board Meeting 501 Bar and Grill, Flint
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2016 Jan./Feb./Mar. | Vol. 54, Issue 1
CE EVENTS CALENDAR 2016 MPA Continuing Education and Professional Development Events
MPA is pleased to offer the following opportunities to earn continuing education credit that meet live, pain, pharmacy law and patient safety requirements.
Friday, Feb. 26-Sunday, Feb. 28
MPA Annual Convention & Exposition Detroit Marriott at the Renaissance Center, Detroit • Target audience: Pharmacists, pharmacy technicians and student pharmacists • Requirements met: Live, law, pain and patient safety • Contact hours: Up to 22 live hours • Registration: Available online at www.MichiganPharmacists.org/eventscalendar/convention16
Saturday, April 9-Sunday, April 10
Northern Michigan Pharmacy Education Seminar Shanty Creek Resorts, Bellaire • Target audience: Pharmacists and pharmacy technicians • Requirements met: Live • Contact hours: Up to eight live hours • Registration: Available online at w.MichiganPharmacists.org/eventscalendar/ nmpe040916
Wednesday, April 27
MPA Pharmacy Law and Policy Symposium Lansing Community College, West Campus, Lansing • Target audience: Pharmacists, pharmacy technicians and student pharmacists • Requirements met: Live and law • Contact hours: Up to six live hours • Registration: Available online at www.MichiganPharmacists.org/eventscalendar/ lawsymp042716
JOIN THE CONVERSATION Use the following hashtags that are specifically designated for the events above in your Tweets, Facebook posts or Instagram photos. Encourage your colleagues to register, or, when you’re at the event, take photos and share them or provide feedback.
MPA Annual Convention & Exposition: #MPAace
Northern Michigan Pharmacy Education Seminar: #MPAnmpe
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MPA Pharmacy Law and Policy Symposium: #MPALawPolicy
2016 Jan./Feb./Mar. | Vol. 54, Issue 1
AT PRESS TIME MPA Members Recognized by ASHP Michigan Society of Health-System Pharmacists (MSHP) and MPA members were recently honored at the American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting in New Orleans. Richard Lucarotti, director of experiential education at the Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences and executive vice president of MSHP, received the Award for Distinguished Leadership for the medication-safety improvements he has spearheaded and for his contributions to the expansion of pharmacy residency training. Read more about his recognition online at www.ASHP.org/menu/AboutUs/ForPress/PressReleases/ PressRelease.aspx?id=889. In addition, the ASHP Foundation honored Suprat Saely Wilson with their New Preceptor Award. She is the pharmacy coordinator, emergency medicine services, and Postgraduate Year 2 emergency medicine pharmacy residency program director for Detroit Receiving Hospital and University Health Center, which is part of the Detroit Medical Center. Find out more about her recognition online at www.ASHPfoundation.org/PR2015PREAAwardees. Lastly, Ryan Bickel, pharmacy manager at Borgess Pipp Hospital, received a Fellow of ASHP designation, which recognizes excellence in pharmacy practice and pharmacists who have distinguished themselves in practice. Read more about ASHP Fellows at www.ASHP.org/ashpfellows. Congratulations to this year’s award winners!
Learn More About the MPA/PSI Executive Fellowship The MPA and PSI Executive Fellowship is a 12-month post-graduate program that will challenge you to look beyond the typical post-graduate training. You will hone your business, leadership and management skills, all while preparing to advance the profession of pharmacy and understand the role of an association. Rotations include orientation, policy and advocacy, communications and publications, membership and marketing, education and event planning, public relations and media, professional practice, executive management and leadership as well as a business project. For more information on the program as well as our past fellows, please visit www. MichiganPharmacists.org/fellowship.
TEDx Talk Highlights the New “Disrupters” in Health Care In October 2015, TEDxFargo published a video titled, The New “Disrupters” in Health Care – Patients and Pharmacists. In this video, Dr. Rajiv Shah, a nephrologist from Minnesota, explains the frequent barriers and issues in health care. His opening remarks focus on the time barriers, access barriers and cultural barriers of the health care team. He discusses how much medicine has changed, and how previously, when a patient was sick, the doctor would go to them. Now, patients spend much of their time while sick waiting to be taken care of. He highlights how impersonal medicine has become and, most importantly, the lack of focus on the patient-centered approach. Much of the video unmasks the problems in health care. MichiganPharmacists.org
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Dr. Shah’s solution is patients and pharmacists. He speaks of the pharmacist as the “Doctor on the Bench” and admits that pharmacists have a knowledge that he will never have. In Dr. Shah’s own words, it is the new team approach that is going to transform health care; the solution no longer is physician centered, but it is the future of health care technology driven by patients and the demand and acknowledgement of pharmacists. Pharmacists, the doctors on the bench, need to be in the game and become a valued member of the health care team that he believes is going to transform medicine in the future. Be a disrupter; share this video (http://www.youtube.com/ watch?v=ajmT93H2RpA&sns=em) with your friends and family. Show the public, patients and doctors that you are ready and willing to be put in the game!
APhA Seeking Photos of Immunizing Pharmacists in Action to Honor the Twentyyear Anniversary of Their Certificate Program This year marks the 20th anniversary of the American Pharmacists Association Pharmacy-based Immunization Delivery Certificate Training Program. Since that time, more than 280,000 pharmacists have been trained to administer vaccines, the scope and authority of pharmacists has greatly expanded and pharmacists are recognized as valued members of the immunization neighborhood. APhA is seeking photos of immunizing pharmacists in action that they can use over the anniversary year to highlight pharmacists’ contributions to improving public health. If you have electronic versions of pictures of you or colleagues providing vaccinations/ vaccination services, APhA would appreciate you sending them to MRothholz@APhAnet.org. When you send the picture(s), please indicate in your e-mail the name of the pharmacist(s), practice location and indicate that you have the permission of the patient to submit the photo.
Thank You Members! Although it’s difficult for MPA staff to get to know each and every one of you, we do spend some quality face-to-face time with our membership. I have gotten to know many of you over the seven years I’ve spent working for the Association, so I wanted to say thank you for allowing me to grow professionally and for not only allowing me to get to know you, but for taking the time to get to know me. I have moved onto a new stage of my career in a position with Michigan State University. It’s bittersweet because while I’m excited to transition and be able to work for my alma mater, I’ll miss the great team at MPA and being able to spend time communicating with you - the members. I wish you all the best, and know that the Association will continue to thrive in my absence! - Leah Ball
2016 Jan./Feb./Mar. | Vol. 54, Issue 1
LEGISLATIVE UPDATE
Legislative Update The following provides recent actions in the Michigan Legislature and at the federal level that could impact your practice. Please note that this is the most current information as this issue is going to press. MPA also shares a legislative update document and the legislative tracker that provides an overview of all Michigan Senate and House bills as well as federal bills that could affect pharmacy in MPA E-news. Visit www.MichiganPharmacists.org/advocacy/priorities for the most up-to-date information. State Legislation that Recently Became Law • Epi-pen: Public Act 221, signed by Michigan Gov. Rick Snyder on Dec. 17, 2015, allows providers to prescribe and pharmacists to dispense epinephrine to authorized entities under certain circumstances and limits liability. This legislation becomes effective March 16, 2016. Rep. Lisa Posthumus-Lyons (R-Alto) introduced this legislation on April 24, 2015. • Good Samaritan Law: Public Act 220, signed by Gov. Snyder on Dec. 16, exempts minors from certain possession penalties for seeking medical treatment for drug-use related illness or injury. This bill was introduced by Rep. Al Pscholka (R-Stevensville) earlier this year to address the growing concern of adolescent drug overdoserelated deaths caused by opiates and other prescription drugs.
• Powdered Alcohol: Sen. Rick Jones (R-Grand Ledge) introduced legislation that would ban the sale, use and possession of powdered alcohol. SB 240 was signed by Gov. Snyder on Oct. 28, 2015. It will become effective on Jan. 26, 2016. • Pharmacy Fingerprints: SB 195 was introduced by Sen. Joe Hune (R-Hamburg Township) on March 10, 2015. It removes fingerprint requirements for application of a new pharmacy, manufacturer or wholesale distributor license. This bill was signed by Gov. Snyder on Nov. 3, 2015. It became effective on Dec. 3, 2015.
• Pharmacy Technician Licensure: Public Act 285 of 2014, which requires licensure and certification for pharmacy technicians, was signed by Gov. Snyder on Sept. 30, 2014. Additionally, Gov. Snyder signed into law Public Act 133 of 2015 (Senate Bill [SB] 468) that allows pharmacy technicians to work in multiple retail locations owned by a single entity, extends temporary licenses from 210 days to one year and removes the high school/GED requirements for limited and temporary technician licenses for technicians employed by Dec. 22, 2014. • Compounding Pharmacy Accreditation: Public Act 133 of 2015 (SB 468) went into effect on Sept. 30, 2015, and extends the deadline for pharmacies that provide sterile compounding services to be accredited by a national accrediting organization approved by the Michigan Board of Pharmacy until Sept. 30, 2016. • Maximum Allowable Cost (MAC) Pricing Legislation: Public Act 167 of 2014 is now in effect. Introduced by Sen. Bruce Caswell (R-Hillsdale), the new law includes measures to increase MAC pricing transparency. Medicaid prescription drug plans are now required to have a MAC appeals process to which they respond in writing or electronically in 10 business days. They will have to provide three National Drug Codes and those drugs must be deliverable in the state of Michigan. • Sales Tax and Use Tax: Rep. Lisa Posthumus Lyons (R-Alto) introduced House Bill (HB) 4464 and HB 4465, which would exempt sales tax and use tax
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for those over-the-counter medications sold by a prescription. The bills passed the House and Senate. They were both enrolled by the House on Oct. 22, 2015. They were signed by Gov. Snyder on Nov. 3, 2015.
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State Legislation Recently Introduced • Medication Synchronization: Sen. Margaret O’Brien (R-Portage) introduced Senate Bill (SB) 150 on Feb. 19, 2015. This bill would allow for patients to participate in medication synchronization programs offered by pharmacies and have their copays be prorated for quantities smaller than the typical 30-day supply. Dispensing fees would not be prorated. This bill also mandates that plans cannot deny coverage of the medication should the patient want it to be synchronized. The bill favorably passed out of the Senate on Sept. 17, 2015, (vote 37-0) and has been referred to the House Committee on Insurance. • Biosimilars: HB 4437, introduced by Rep. Ken Yonker (R-Gaines Township), allows pharmacists to substitute interchangeable biosimilars for biologic products. The alternate bill, HB 4812, introduced by Rep. John Bizon (R-Battle Creek), was passed out of the House Health Policy Committee with Substitute S-2 language. The current bill requires prescriber notification within five days of dispensing an interchangeable biologic product. MPA continues to work with the Michigan Association of Health Plans to ensure that the state requirements are not more stringent than the U.S. Food and Drug Administration requirements. • Medical Marijuana Tracking: HB 4827, introduced on Aug. 18, 2015, by Rep. Klint Kesto (R-Commerce Township), would require the Michigan Department of Licensing and Regulatory Affairs to establish and 2016 Jan./Feb./Mar. | Vol. 54, Issue 1
LEGISLATIVE UPDATE utilize a system to track marihuana that is grown, processed, transferred, stored or disposed of under the Medical Marihuana Facilities Licensing Act. The bill passed the House (vote 99-7) on Oct. 7, 2015. • Twelve-month Supply of Birth Control: SB 466, introduced on Sept. 9, 2015, by Sen. Curtis Hertel (D-East Lansing), would require health coverage for the dispensing of a 12-month supply of birth control upon refill of contraceptives. The bill has been referred to the Senate Committee on Insurance.
• Telemedicine: SB 495, introduced on Sept. 16, 2015, by Sen. Rebekah Warren (D-Ann Arbor), would amend the Insurance Code of 1956 to prohibit the requirement of face-to-face contact between patients and health care professionals for services appropriately provided through telemedicine. The amendments also provide an updated definition of telemedicine and several other definitions for clarity. The bill has been referred to the Senate Committee on Insurance.
Federal Legislation and Issues • Provider Status: Reps. Brett Guthrie (R-KY), G.K. Butterfield (D-NC), Todd Young (R-IN) and Ron Kind (D-WI) introduced House Resolution (H.R.) 592, which would amend title XVIII of the Social Security Act to provide for coverage under the Medicare program for pharmacist services. The bill would enable patient access to, and payment for, Medicare Part B services by state-licensed pharmacists in medically-underserved communities. A U.S. Senate companion bill (S. 314) was introduced by Sens. Chuck Grassley (R-IA), Sherrod Brown (D-OH), Robert Casey (D-PA) and Mark Kirk (R-IL). Five of Michigan’s 14 representatives have signed on as cosponsors of H.R. 592 (Reps. Candice Miller, Mike Bishop, Tim Walberg, Daniel Kildee and Debbie Dingell); the bill has a total of 245 cosponsors. Sens. Gary Peters and Debbie Stabenow are two of the 37 total cosponsors of S. 314. • Open Networks in Underserved Areas: Sens. Shelly Moore Capito (R-WV), Joe Manchin (D-WV), Tom Cotton (R-AR) and Sherrod Brown (D-OH) worked together to introduce The Ensuring Seniors Access to Local Pharmacies Act, S. 1190, on May 5, 2015. The legislation allows Medicare beneficiaries in medically underserved areas the opportunity to access lower copays at “any willing pharmacy” that agrees to accept a drug plan’s “preferred pharmacy” terms and conditions. Reps. Morgan Griffith (R-VA) and Peter Welch (D-VT) introduced the companion bill, H.R. 793, earlier this year on Feb. 6, 2015, which was referred to the House Energy and Commerce Committee as well as the House Energy and Commerce Subcommittee on Health. S. 1990 has 10 co-sponsors, and H.R. 793 has 71 co-sponsors including Michigan Reps. Daniel Kildee and Bill Huizenga.
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• MAC Pricing: H.R. 244, introduced on Jan. 9, 2015, by Reps. Doug Collins (R-GA) and David Loebsack (D-IA), would require pharmacy benefit managers to update their MAC lists at least once every seven days and to disclose to pharmacies the resources used to determine that price. This legislation would affect Medicare Part D, Tricare and the federal employee health benefit program plans. • Protected Drug Classes: Sens. Chuck Grassley (R-IA) and Sherrod Brown (D-OH) introduced S. 648 on March 4, 2015, to permanently protect the six classes of medications (antipsychotics, anticonvulsants, antineoplastics, antidepressants, antiretrovirals and immunosuppressants) currently protected under Medicare Part D. • Controlled Substances: The U.S. House of Representatives passed H.R. 471 on April 21, 2015. The bill, titled the Ensuring Patient Access and Effective Drug Enforcement Act of 2015, sponsored by Rep. Tom Marino (R-PA), seeks to clarify key terminology in the Controlled Substances Act to give registrants a better understanding of their responsibilities under the law. This bill will also allow Drug Enforcement Administration-registered companies to submit corrective action plans as well as require a report to Congress to encourage dialogue about stakeholder collaboration to help prevent diversion and abuse. • Medication Therapy Management (MTM): Sens. Pat Roberts (RKS), Jeanne Shaheen (D-NH), Mark Steven Kirk (R-IL) and Sherrod Brown (DOH) introduced S. 776, the Medication Therapy Management Empowerment Act of 2015, on March 18, 2015. The bill would expand Medicare Part D MTM services to include patients with a single chronic disease in the categories of cardiovascular disease, rs olo chronic obstructive pulmonary _c ck o t /s om disease, hyperlipidemia or diabetes. to.c pho
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2016 Jan./Feb./Mar. | Vol. 54, Issue 1
ON THE COVER
ATTEND THE
PREMIERE EVENT OF THE YEAR FOR MICHIGAN PHARMACY PROFESSIONALS!
MPA Annual Convention & Exposition Feb. 26-28, 2016 • Detroit Marriott at the Renaissance Center
By MARY FARRINGTON, CMP, director of continuing education, Michigan Pharmacists Association
ŠiStockphoto.com/seebest
Linda Arrabi, a P2 student pharmacist at Wayne State University (WSU) Eugene Applebaum College of Pharmacy and Health Sciences, and Libin Philip, a P4 student pharmacist at WSU, at the 2015 House of Delegates Session.
Ron Melaragni and John Ochs were among the 50-year members recognized at the 2015 Annual Convention.
Denise Markstrom, Sister Phyllis Klonowski and Carrie Lewis (left to right) served as judges for the 2015 Student Pharmacist Self-care Championship, a General Session that occurs on Saturday afternoon during the Convention.
Members are encouraged to plan now to attend the premier pharmacy event in Michigan: the 2016 Michigan Pharmacists Association (MPA) Annual Convention & Exposition! From Feb. 26-28, pharmacy professionals will gather for the largest state pharmacy association convention in the nation, and you will not want to miss it. Pharmacists, pharmacy technicians, student pharmacists and other industry professionals will have the opportunity to earn live continuing education (CE) credit, network during special events and enjoy attractions in the heart of Detroit. As you anticipate your arrival for the Annual Convention, be prepared to make the most of your weekend by reviewing all this premier event has to offer. MichiganPharmacists.org
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2016 Jan./Feb./Mar. | Vol. 54, Issue 1
ON THE COVER
Student pharmacists enjoying the social on Friday evening of the 2015 Convention. The event provides an opportunity for students from all three Michigan colleges of pharmacy to come together and share stories, network and have fun!
What is the Annual Convention All About? MPA’s Annual Convention & Exposition is a three-day event that occurs annually in February. In 2015, the event attracted nearly 1,300 pharmacists, pharmacy technicians, student pharmacists, pharmaceutical representatives and academia. The following is what you can look forward to this year: • Approximately 50 live CE programs, including the required pain, law and patient safety training pharmacists and pharmacy technicians need for relicensure and certification renewal. • An Exhibit Hall with hundreds of representatives ready to introduce you to a full spectrum of pharmacy products and services to help you advance in your career and improve patient care. • Networking events that allow you to connect with peers, discover best practices, find out how others are growing in the profession and reconnect. • Student-specific programming to meet the demands of student pharmacists preparing for their careers. Pharmacists also have the opportunity to be a part of that process through the Michigan Pharmacy Foundation (MPF) Adopt-A-Student program.
How Do I Register? Register for the Annual Convention online at www. MichiganPharmacists.org/eventscalendar/convention16. Login or create an account and then login to take advantage of your built-in member discounts. If you’re creating a new account, be sure to use your primary e-mail address on file with MPA (where you receive MPA E-news and other members communications). Pre-registration ends at 4:30 p.m. on Feb. 15, so be sure to register early. You may also print out the registration form online and mail in or fax (credit card only) your payment, if you so choose. In addition, you have an opportunity in the registration to adopt a student. Individuals can support the MPF Adopt-a-Student program by making a tax-deductible donation of $100 for one Student MPA member or a $185 donation for two Student MPA members. For Student MPA members, registration for the Convention is free if completed before Feb. 15. Nonmember registrations and any registrations received after Feb. 15 and onsite will incur an additional fee. If you have questions while you are registering for the Annual Convention, please call MPA at (517) 484-1466 and staff will be happy to assist you. MPA will also accept phone registrations. MichiganPharmacists.org
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What Types of Continuing Education Programming Will Be Available? CE programming will begin bright and early at 7:30 a.m. and extend through 4:30 p.m. on Friday and until 6 p.m. on Saturday. Sessions on Sunday run from 8 a.m. to 2 p.m. Careful attention has been given to craft CE programs that not only help pharmacists and pharmacy technicians fulfill their relicensure and recertification requirements, but to also help you grow in your health care setting as a community, consultant, specialty or healthsystem pharmacist, and as a pharmacy technician. Special programming will be brought to you by the Michigan Society of Community Pharmacists (MSCP), Consultant and Specialty Pharmacists of Michigan (CSPM), Michigan Society of Health-System Pharmacists (MSHP), Michigan Society of Pharmacy Technicians (MSPT), Pharmacy Services Inc. (PSI) and the Michigan Pharmacy Political Action Council (PAC). Each day of programming, attendees will be able to earn needed pain, law and patient safety credits. Both the Opening and Keynote Sessions are sure to be memorable! Friday’s Opening Session will focus on prescription drug and opioid abuse issues in Michigan. Lt. Gov. Brian Calley will provide an overview of the Michigan Prescription Drug and Opioid Abuse Task Force findings and recommendations. Rounding out the Opening Session will be discussions on what pharmacists can do to assist patients who have substance abuse problems, and our own Amanda Lick, MPA manager of advocacy, governmental and regulatory affairs, will tell her story related to the issue. The Keynote Session on Saturday will feature technology expert Bill Felkey, who will talk about the digital age of health care. Lucinda Maine from the American Association of Colleges of Pharmacy will join us on Friday to discuss the future of the reforming health care system. Student pharmacists from the colleges of pharmacy at Ferris State University, the University of Michigan and Wayne State University can look forward to specific student programming on Saturday, Feb. 27. For all CE programs, participants will be required to complete evaluation forms and posttests online. Detailed instructions will be given to participants at the Convention. An alternate option will be made to individuals not able to complete the online requirement. A list of all CE programs offered at the Annual Convention will be updated frequently on the MPA Web site. Please visit www.MichiganPharmacists. org/education/convention/schedule for the latest details.
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ON THE COVER What Special Events and Convention Highlights Should I Anticipate? Special events and exciting Annual Convention features have been planned throughout the weekend for attendees. Be sure to make time to explore the Exhibit Hall this year. Convention attendees will be able to meet and network with hundreds of professionals and learn about the latest products and services for their businesses and careers in pharmacy. Additional fun activities will occur throughout the weekend in the Exhibit Hall such as massage therapy stations and other entertainment to be announced. The Exhibit Hall hours are Friday from Noon to 2 p.m. and 4:30-6:30 p.m. and on Saturday from 11:30 a.m.-2 p.m. To allow ample time with the exhibitors, CE programs will not occur on Friday and Saturday from Noon to 1:30 p.m. MPF will once again offer the Charity Auction where you can bid on fabulous items or purchase items at the “Buy it Now” price. Additionally, the Foundation will provide breakfast to Convention participants for $10 for three days of coffee and pastries each morning during the Convention. You’ll want to browse the MPA Product Store during the weekend, where you can purchase miscellaneous pharmacy and Association-related items. Visit during posted hours from Thursday evening until Sunday morning. Several MPA practice sections, entities and Committees will be holding special luncheons, meetings and events during the Convention. These events are detailed below. • MPA 50/50 Raffle 50/50 raffle tickets can be purchased in the MPA Product Store and the drawing will be held on Sunday at 12:30 p.m. Participants do not need to be present to win. MPA will donate proceeds to Pharmacy PAC Corporate. • Pharmacy PAC Luncheon The annual Pharmacy PAC Luncheon will be held on Friday from Noon to 1:30 p.m. Current pharmacyand political-related issues will be discussed. The Legislator of the Year, Hank Fuhs Good Government and Good Public Health Policy Awards will be presented. MPA will donate proceeds to Pharmacy PAC Corporate. • MPA Student Social On Friday night from 7-9 p.m., student pharmacists are invited to the MPA Student Social. Attendees will have a chance to network with students from all three Michigan colleges of pharmacy. Student MPA members can attend complimentary. A fee applies to nonmember student pharmacists. • MSPT Pharmacy Tech Connect Reception MSPT will host an informal reception for pharmacy technicians on Friday evening. Watch MPA’s Web site for more details about this event. • Local Association Meeting and Breakfast Local association leaders are invited to attend this informative breakfast meeting. The program will be held on Saturday from 7:30-9 a.m. by invitation only. • MSPT Annual Meeting and Luncheon On Saturday, pharmacy technician members are invited to attend the MSPT Annual Meeting and MichiganPharmacists.org
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Luncheon from Noon-1:30 p.m. The MSPT Technician of the Year Award and Service Award will be presented during this event. • CSPM Annual Meeting and Luncheon On Saturday, consultant and specialty pharmacist members are invited to attend the CSPM Annual Meeting and Luncheon from Noon-1:30 p.m. The CSPM Pharmacist of the Year Award will be presented during this event. • MSCP Annual Meeting and Luncheon On Saturday, community pharmacist members are invited to attend the MSCP Annual Meeting and Luncheon from Noon-1:30 p.m. The MSCP Pharmacist of the Year Award will be presented during this event. • MSHP Student Luncheon Students, join your classmates and future colleagues on Saturday from Noon-1:30 p.m. for a luncheon sponsored by MSHP. • Annual Banquet and Awards Ceremony Please join us Saturday at 6:30 p.m. for a cocktail reception and at 7 p.m. to formally inaugurate 2016 MPA President Amy Smendik. Awards to be presented include the Pharmacist of the Year, American Pharmacists Association Foundation and National Alliance of State Pharmacy Associations Bowl of Hygeia, MPF Fred W. Arnold Public Relations, Outgoing President, Executive Board Service, Upsher-Smith Laboratories, Inc. Excellence in Innovation, PSI Distinguished New Pharmacist Practitioner, Cardinal Health Generation Rx Champions, Executive Board Medal, Hall of Honor, Fellow of Michigan Pharmacists Association and Years of Membership. • MSHP Delegate Caucus Luncheon The MSHP Delegate Caucus breakfast will be held on Sunday from 7:30-9 a.m., by invitation only. • House of Delegates MPA’s 2015 House of Delegates Session will be held on Sunday from 9:30 a.m.-12:30 p.m., and the Local Association Achievement Awards, Distinguished Local Association Achievement Award and the Ernie Koch Striving for Excellence Award will be presented.
How Do I Exhibit at the Convention and What Companies are Exhibiting? The exhibitor prospectus for the Annual Convention is available online at www.MichiganPharmacists. org/education/convention/exhibitors/prospectus. The Exposition provides a forum to meet the pharmacy professionals who purchase the products and secure the services that your organization supplies. The prospectus provides general information about exhibiting, a breakdown of the previous event’s attendees, a map of the Exhibit Hall, rules and regulations and an application to exhibit. If you have any questions regarding exhibiting at the Annual Convention, please contact Elizabeth Adado, MPA education planning assistant, at (517) 377-0225 or Elizabeth@MichiganPharmacists.org. In addition, members can view an up-to-date list of exhibitors who will be displaying at the Convention online at www.MichiganPharmacists.org/education/convention/ exhibitors/map. 2016 Jan./Feb./Mar. | Vol. 54, Issue 1
ON THE COVER
Tentative Convention At-a-Glance Activities and Times Subject to Change
Pharmacy professionals are encouraged to support the Michigan Pharmacy Foundation (MPF) Adopt-a-Student program at the Convention. Provide a student pharmacist (or more than one!) with the opportunity to attend the Annual Banquet and mingle with experienced professionals. Sign up with your Convention registration or write a separate check payable to MPF to receive a tax deduction. Pictured is Patti Smeelink (center) who previously adopted Christina Johnson (left) and Kristin Frye (right), 2014 Pharm.D. graduates from Ferris State University.
How Do I Reserve Hotel Accommodations? Convention participants may make reservations at a special group rate by visiting the Marriott Web site at https://aws.passkey.com/event/13947499/owner/437/ home or by calling Marriott reservations directly at (800) 352-0831 before 5 p.m. on Feb. 4, 2016. Be sure to mention that you are attending the MPA Annual Convention to receive the special rate. The link provided above is also available on our Web site at www.MichiganPharmacists.org/education/convention/hotel.
What Should I Bring With Me? Aside from the colleagues you have invited to attend with you, you may want to have printed off the handouts of the sessions you are interested in so that you can reference them at the Convention. Handouts will be posted at www.MichiganPharmacists.org/education/convention approximately two weeks prior to the event. You may also want to bring some spending money for the MPA 50/50 Raffle, with the proceeds benefitting Pharmacy PAC Corporate, and for the MPF Charity Auction or MPA Product Store. And, don’t forget your business cards for use while networking with pharmacy professionals from all over the state. MPA’s 2016 Annual Convention & Exposition is the event to attend in Michigan! You can look forward to networking with colleagues, learning about new services in the Exhibit Hall, earning up to 20.5 hours of live CE credit and experiencing the excitement of downtown Detroit from Feb. 26-28, 2016.
Join the Conversation Convention attendees can find the latest event information and join the conversation on social media by using and searching for #MPAace. While you’re at the Convention, use this hashtag to share your photos, provide feedback on Convention activities and stay up-to-date on important event details, including possible room changes for sessions or activities. Members are encouraged to follow MPA on social media @MIPharmacists (Twitter, YouTube and Instagram); and like our Facebook page at www.Facebook.com/MichiganPharmacists. MichiganPharmacists.org
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Thursday, Feb. 25 3:30-6 p.m. 4-6:30 p.m. 6-8 p.m. 6-8 p.m. 6-8 p.m. 6-8 p.m. 7-9 p.m. 7-9 p.m.
MPA Executive Board Meeting MSHP Board of Directors Meeting Early Bird Convention Registration MPF Charity Auction Open MPA Product Store Open Mackinac Center Open MPA Executive Board Dinner MSHP Board of Directors Dinner
Friday, Feb. 26 7-8:30 a.m. 7 a.m.-6 p.m. 7 a.m.-6 p.m. 7 a.m.-6 p.m. 7 a.m.-7 p.m. 7:30 a.m.-Noon 9-10:30 a.m. Noon-1:30 p.m. Noon-2 p.m. 1:30-3 p.m. 3-4:30 p.m. 4:30-6 p.m. 6:30-8:30 p.m. 7-8:30 p.m. 7-9 p.m.
MPF Continental Breakfast MPF Charity Auction Open MPF Product Store Open Mackinac Center Open Convention Registration Open Educational Programming General Session Pharmacy PAC Luncheon Exhibit Hall Open Educational Programming Opening Session Exhibit Hall Grand Opening Pharmacy Tech Connect Reception PHP Sponsored 12-step Meeting MPA Student Pharmacist Social
Saturday, Feb. 27 7-8:30 a.m. 7 a.m.-5 p.m. 7 a.m.-5 p.m. 7 a.m.-5 p.m. 7 a.m.-6 p.m. 7:30-9 a.m. 7:30 a.m.-Noon 9-10:30 a.m. 11:30 a.m.-2 p.m. Noon-1:30 p.m. Noon-1:30 p.m. Noon-1:30 p.m. Noon-1:30 p.m. 1:30-6 p.m. 3-4:30 p.m. 6:30-7 p.m. 7-9:30 p.m.
MPF Continental Breakfast MPF Charity Auction Open MPF Product Store Open Mackinac Center Open Convention Registration Open LADC Breakfast Program Educational Programming Keynote Session Exhibit Hall Open CSPM Annual Meeting and Luncheon MSCP Annual Meeting and Luncheon MSHP Student Pharmacist Luncheon MSPT Annual Meeting and Luncheon Educational Programming General Session Pre-banquet Reception Annual Banquet and Awards Ceremony
Sunday, Feb. 28 7-8:30 a.m. 7-9:30 a.m. 7-9:30 a.m. 7 a.m.-2 p.m. 7 a.m.-2 p.m. 7:30-9 a.m. 8-9 a.m. 8 a.m.-2 p.m. 9:30 a.m.-12:30 p.m. 11 a.m.-1 p.m. 11 a.m.-1 p.m. 12:30-2 p.m. 2 p.m.
MPF Continental Breakfast MPF Charity Auction Open MPF Product Store Open Mackinac Center Open Convention Registration Open MSHP Delegate Caucus Breakfast Past President Breakfast Educational Programming House of Delegates Session MPF Charity Auction Winner Pick-up MPA Product Store Open General Session Convention Adjourns
2016 Jan./Feb./Mar. | Vol. 54, Issue 1
MEMBERSHIP New Member Benefit:
Welcome New MPA Members!
Student Loan Refinancing Through SoFi
The number of new MPA members grew by 262 from September through November 2015. For a complete list of pharmacy professionals who recently joined the Association and helped to strengthen the voice of pharmacy in Michigan, visit www.MichiganPharmacists.org/ membership.
Michigan Pharmacists Association (MPA) is proud to announce its partnership with SoFi to offer members a unique solution to help ease their student loan debt burden. Outstanding student loan debt has quadrupled over the past decade, climbing to $1.2 trillion and becoming the largest consumer liability after mortgages. SoFi has emerged as the industry leader in student loan refinancing and has funded more than $5 billion to date with more than 60,000 borrowers.
If you have any questions regarding this new member benefit, please contact MPA Director of Membership Mike Wolf at (517) 377-0231 or Mike@MichiganPharmacists.org.
Pharmacy Technician Students
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The application process is simple and begins with a pre-approval to determine the rates and terms available to you. This should take less than five minutes. Qualifying applicants will see the rates and terms available to them so that they can decide how they would like to proceed. Once you select your repayment term, you simply upload the necessary documents and SoFi does the rest.
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As pharmacists continue to struggle with increasing student debts, MPA is focused on providing unique solutions to help its members tackle these issues. Through a unique partnership with SoFi, MPA members are eligible for a 0.125 percent rate discount by applying through SoFi.com/MPA. On average, pharmacist borrowers who have refinanced with SoFi have saved $21,544. Private and federal student loans can be refinanced and there are no prepayment restrictions, no fees and no catches!
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Members Share Their Feedback on Publications and Communications In the early fall, MPA conducted a Communications and Publications Survey to a sample size of our membership. Below is a summary of the survey results. MPA Web site • More than 70 percent of respondents indicated that the Web site meets their needs very well or extremely well. • The primary reasons that members responding visit the Web site are to read pharmacy news, register for a MPA event and look for an answer to a pharmacy law or regulatory question. Michigan Pharmacist Journal • If given the option, the majority of respondents (71 percent) would not want to receive the journal via e-mail as an electronic publication only • Most respondents want to read more about medication therapy management (62 percent); drug diversion/medication disposal (59 percent); and regulations, compliance and accreditation (53 percent) in the journal. E-mail and Electronic Communications • The majority of respondents (91 percent) are either very satisfied or somewhat satisfied with the amount of e-mails they receive from MPA. • Half of respondents would like to receive e-mails once a week from MPA. Because we only sent the survey to a random sample of our membership, we want to make sure that you too have the opportunity to comment on our communication efforts! Please send your feedback to MPA at MPA@MichiganPharmacists.org.
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2016 Jan./Feb./Mar. | Vol. 54, Issue 1
MEMBER VOICES
MEMBER VOICES Member Voices is a section of the journal designed to highlight member opinions on a variety of subjects, including membership, MPA events, efforts of the Association and more! For this issue of the journal, we asked members the following question and have chosen to highlight the responses shared below.
What is the most important thing that you’ve learned about transitions of care? “One of the most interesting learnings for me has been that even patients with good prescription insurance often have obstacles that result in them not filling their prescriptions after discharge. Typically, discharge prescriptions are written without regard to the patient’s prescription benefit. In many cases, these prescriptions result in prior authorizations or in copayments that are a financial burden for the patient. An effective strategy is for the pharmacy to discuss any financial barriers and to identify and resolve all prior authorizations BEFORE the actual discharge. Once the patient is out of the hospital, it is very difficult for them to resolve these problems and they will often make the decision to not fill a prescription.” –James Stevenson, Pharm.D., FASHP, professor, Department of Clinical Pharmacy, University of Michigan College of Pharmacy, and president, hospital and health services, Visante, Inc.
“I’ve learned that communication is the biggest barrier in transitions of care and that we, as pharmacists, can play a crucial role in facilitating communication between patients and providers. I’ve also learned that listening is a very important part of good communication. My biggest success stories in my practice occurred when I actively listened to what the patients or their families and the providers said.” –Amber Lanae Smith, Pharm.D., BCPS, clinical pharmacy specialist, ambulatory care, Henry Ford Health Systems, and clinical assistant professor, Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences
“I have learned so much about transitions of care, it is hard to focus on just one thing. However, lately, I feel that acute care pharmacists need to understand how important transition of care is in that setting as well as in the ambulatory care area. When we initiate long-term therapies for hospitalized patients, we should evaluate whether or not the patient has access to the therapy at discharge. If they don’t, the patient will never achieve the outcome we want. All pharmacists, regardless of practice site, should choose therapies their patients have access to AND therapies which optimize outcomes.” –Nancy MacDonald, Pharm.D., BCPS, transition of care coordinator, Department of Pharmacy Services, Henry Ford Hospital
Thank you to everyone who contributed! Please review the questions below for our remaining 2016 issues and share your response(s)! Send them to MPA@MichiganPharmacists.org before the deadline specified. • April 2016 (due Feb. 8): What advice would you give to graduating student pharmacists? • July 2016 (due May 9): What MPA activity or event have you enjoyed the most in the past year and why? • October 2016 (due Aug. 8): What is the best thing that you have ever done to celebrate American Pharmacists Month or Michigan Pharmacy Week?
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2016 Jan./Feb./Mar. | Vol. 54, Issue 1
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2016 Jan./Feb./Mar. | Vol. 54, Issue 1
STUDENT FOCUS
My Advanced Pharmacy Practice Experience on the Island of Puerto Rico By ANGELA RONDON-BEGAZO, 2016 Pharm.D. candidate, University of Michigan College of Pharmacy Going to Puerto Rico in September 2015 was a very fulfilling Advanced Pharmacy Practice Experience. Although I was homesick and struggled to adjust to the worst drought in Puerto Rico’s history and the associated water rationing, there were many times when I pictured the rest of my life on the island. I grew to love and appreciate the culture, the food and the landscape. I had the opportunity to work with fantastic pharmacists on the island, develop many wonderful relationships and formally educate high school girls regarding the benefits of vaccines through a presentation at their school. One week of my 5-week rotation encompassed some dancing, many political conversations, lots of food, two days of medication therapy management services at Walgreens pharmacy and two days of ambulatory care at the University of Puerto Rico School of Pharmacy. This experience helped me see that the patient relationship is equally, if not more, important than clinical knowledge. As a student, I am learning the best way to manage a wide range of medical conditions for patients. However, unless I bring my expertise to empower patients to take action, my thoughtful recommendations will go unheard and not be acted upon. In this rotation, I met a patient who trusted my preceptor more than his physician; another patient who did not want to change administration times of a statin before consulting her doctor; and a patient who needed my reassurance to restart his clopidogrel tablet after being hospitalized for a gastrointestinal bleed. All of these and many other encounters have shaped my pharmacy practice philosophy. I am shifting my focus to hone not only my clinical and leadership skills, but also my communication skills. When I first recruited Doña María* over the phone for a comprehensive medication review (CMR), she was hesitant to participate in the program because she said she had trouble reading the medication labels. We offered to visit her at her home because we were not sure if she suffered from vision problems. I interviewed Doña María using my conventional approach when conducting CMRs. Because she spoke very fast Spanish and I had difficulty following the conversation, I asked her to read her medication labels in order to slow down the interaction, unaware that she could not read. My preceptor, Dr. Suzette Velez, stepped in during my interview and demonstrated how to use diagrams and color coding to help Doña María know how to take each medication and why each one was important. That experience left a strong impression. I developed a better appreciation for the need to adjust my communication based on a patient’s health literacy. As a result, I am now more aware of my own predispositions and the effect they have on my patient interactions. In Puerto Rico, community pharmacists are strong community advocates. One evening, I had a long discussion with a Puerto Rican student pharmacist about MichiganPharmacists.org
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Human papillomavirus vaccine presentation to an 8th grade girls class at the Puerto Rican School for Girls (Colegio Puertorriqueño de Niñas) on Sept. 25, 2015.
the homeless population on the island. The conversation took many directions and eventually we landed on the topic of pharmacists dispensing antibiotics without a prescription in smaller independent community pharmacies. While many antimicrobial stewardship pharmacists may be appalled at this practice, it is worth looking at the other side of the argument. Even though Puerto Rico has a governmental health plan, many Boricuas** remain uninsured and access to care may be very limited, especially in some geographical areas. For those who are insured, copays are relatively high compared to the cost of living and it is difficult to obtain an appointment in overbooked primary care clinics. Therefore, many patients elect to visit their trusted community pharmacist over their physician for the one-stop shop convenience and cost-effectiveness. The importance of community pharmacists being knowledgeable about a wide range of health conditions cannot be overstated. It was also surprising to learn about the strict regulations in Puerto Rico related to dispensing of narcotics. For example, all narcotics and Schedule 2 controlled substances have zero refills.1 Narcotics must also be filled within 48 hours of the date the prescription was written. Other controlled substances have a limit of five refills per prescription and must be filled within six months of the date the prescription was written. All controlled substances require a hard copy. An emergency supply of a controlled substance can be dispensed for a 48-hour supply with a verbal order.2 Similarly, the paper copy must reach the pharmacy within 48 hours of dispensing. Faxed prescriptions and verbal orders are not accepted as an original prescription. Prescribers can only send electronic prescriptions for noncontrolled substances. A 120-hour emergency supply of noncontrolled substances can be dispensed with a verbal order, but the paper copy must be turned in within 120 hours of dispensing. Although my head spun many times when I was learning these regulations, taking the 2016 Jan./Feb./Mar. | Vol. 54, Issue 1
STUDENT FOCUS The view from Casa Bavaria in Morovis, Puerto Rico.
“Don José* was my last and most memorable patient while on the island. He was born with spina bifida and encephalopathy, which prevent him from walking. However, one forgets his disabilities when talking to him. He is the most gentle, kind and strong-willed person I have ever met.” time to reflect on the differences in pharmacy law has given me a greater appreciation and better understanding of pharmacy practice. Don José* was my last and most memorable patient while on the island. He was born with spina bifida and encephalopathy, which prevent him from walking. However, one forgets his disabilities when talking to him. He is the most gentle, kind and strong-willed person I have ever met. Even though he requires a motorized wheelchair to ambulate, he is the primary caregiver for his mother who suffers from dementia. And, although he had three hospitalizations in the past six months, he continues to look at the bright side of life and remains engaged in his complex medical needs. His joy for life and appreciation for the service I provided has motivated and empowered me to think beyond the challenges of day-to-day life in order to not only be the best pharmacist I can be, but also a true advocate for my patients. I hope MichiganPharmacists.org
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to continue to integrate my wonderful experiences from the island into my daily practice as a student and future health care provider. *Some names and identifying details have been changed to protect the privacy of individuals. **Boricua: Refers to a person from the Island. Originally from the name of the indigenous Taíno (islanders).
References:
1. Ley Núm. 4 de 1971 Ley de Sustancias Controladas de Puerto Rico, www.LexJuris.com/lexlex/lexotras/lexdroga.htm, Oct. 31, 2015. 2. Ley Núm, 247 de 2004, Ley de Farmacia de Puerto Rico, www.LexJuris.com/ lexlex/leyes2004/lexl2004247.htm, Oct. 31, 2015.
2016 Jan./Feb./Mar. | Vol. 54, Issue 1
BIOS AND MEMORIES
Student Pharmacist Completing a Rotation with MPA Sameh Mousa is a fourth-year student pharmacist from Ferris State University College of Pharmacy. He recently completed a six-week rotation with the Association. Sameh has a bachelor’s degree in supply chain management from Michigan State University. He is an intern for CVS Pharmacy in Wyoming, where he has practiced for a little more than one year. Sameh plans on staying with the company after graduation. He believes in patients taking proactive steps to improving their health and wellness, not only from a medication compliance perspective, but also due to changes in their diet and lifestyle. In addition, Sameh believes a community practice setting is the best place to impact the patients’ outlook on their health. He plans on getting involved with MPA’s advocacy efforts to help pharmacists obtain provider status because he believes that pharmacists have a lot to offer when it comes to patient care.
OBITUARIES Larry R. Kersten Larry Ray Kersten, age 76, passed away on Friday, Oct. 9, 2015, due to the complications of several illnesses. Larry was born June 19, 1939, in Berville to Ralph and Bernice (Stephens) Kersten and graduated from Almont High School in 1957. He was a resident of Oscoda County for more than 30 years and was recently living in Grayling. Larry was active in the Congregation of Jehovah’s Witnesses since March 25, 1973, volunteering much of his time to helping people in the community understand the Bible. He also enjoyed his practice as a pharmacist for 50 years, mostly in Oscoda county and surrounding areas. In lieu of flowers, the family suggests contributions to the Worldwide Work of Jehovah’s Witnesses, 1636 Harwick Pines Road, Grayling, MI, 49738 or the Crawford County Commission on Aging and Senior Services at www.CrawfordCOA.org. Cathy M. Polley Catherine Mary Jelinski “Cathy” Polley, age 56, passed away on Nov. 2, 2015. She was born Aug. 22, 1959, in Wyandotte to Casimir and Mary Jelinski. Cathy’s classmates at Gabriel Richard High School remember her as having a rare combination of being intensely focused on studies, while also reaching out to help and make friends with everyone. After graduating from the University of Michigan, she married the one true love of her life, William (Bill) Polley, on Sept. 4, 1982. Their greatest joy has
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been raising two wonderful children, Kara and Owen. Professionally, Cathy is known for her many initiatives on improving health and wellness. She was appointed by former Michigan Gov. John Engler to serve on the Michigan Board of Pharmacy and she held many key positions in the field of health and wellness, including director of pharmacy for KMart Corporation, vice president of the National Association of Chain Drug Stores and chief policy officer and SVP for the American Pharmacists Association. At the time of her death, Cathy served as the vice president of health and wellness for the Food Marketing Institute (FMI) and as the executive director of the FMI Foundation. After being diagnosed with ovarian cancer in 2010, she focused her attention on helping others with the same disease. In lieu of flowers, donations may be made at www.OvarianCancer.org. Sympathy cards and notes of condolence may be sent to: Bill Polley and Family; Food Marketing Institute; 2345 Crystal Drive, Suite 800; Arlington, VA 22202. Robert L. Stevens Deacon Robert L. Stevens of Portage passed away on July 28, 2015, at Upjohn Community Care Center. Robert was born in Detroit on Aug. 21, 1930, the son of Robert and Constance (Holowasko) Stevens. He was one of the founders and co-owners of Center Medical Supply and three pharmacies: Parchment Pharmacy, Oakwood Plaza Pharmacy and Prescription Center. Robert was a Deacon and member of St. Monica Catholic Church. He was also a veteran of the U.S. Air Force, having served during the Korean Conflict. He graduated from Ferris State University (FSU) School of Pharmacy and was a founding member of the Rho Chi Honor Society of FSU. In addition, he was a member of the Knights of Columbus, Kalamazoo Rotary, Kalamazoo Male Chorus, Board Member of Pretty Lake Camp and St. Vincent DePaul Society. Memorial contributions may be made to the St. Vincent DePaul Society, St. Monica’s Church or Kalamazoo Animal Rescue. Joseph Wolf Joseph Wolf passed away on Sunday, July 5, 2015, at the age of 82 years. A native of Detroit and resident of New Orleans since 1998, Joe was a graduate of Wayne State University School of Pharmacy. He owned multiple pharmacies in Detroit and served as past president of the Metropolitan Detroit Pharmaceutical Association. He was also president-elect of the American Cancer Society of Wayne County. Memorial contributions may be made to the American Cancer Society or the American Heart Association. The family invites you to share your thoughts, fond memories and condolences online at www.LakeLawnMetairie.com.
2016 Jan./Feb./Mar. | Vol. 54, Issue 1
FROM THE FOUNDATION Thanks to more than 40 generous donors contributing more than 150 auction items, the 2015 MPF Charity Auction raised nearly $9,000.
Foundation to Offer Charity Auction, Support for Whaley Children’s Center and More at This Year’s Annual Convention By DIANNE MALBURG, pharmacist, CPIA, chief operations officer, Michigan Pharmacists Association/Pharmacy Services Inc., and executive director, Michigan Pharmacy Foundation
Each year, Michigan Pharmacy Foundation (MPF) hosts a variety of events during the MPA Annual Convention & Exposition, which will be held Feb. 26-28 this year at the Detroit Marriott at the Renaissance Center. MPF will conduct its annual Charity Auction, which is a highlight of the event for many Convention attendees. MPF hosts the Charity Auction to raise funds to support three core initiatives: leadership development activities, student scholarships and grants that encourage practice innovation. Not only can individuals peruse the auction items, but MPF Trustees are also available every morning during the coffee service to visit with Convention participants and provide updates on upcoming MPF activities. It’s a great way to support the Foundation and find out more about how MPF is helping to advance pharmacy and develop current and future leaders in the profession. In addition, the Foundation will be collecting items for the less fortunate to demonstrate pharmacy’s support of a Michigan-based charity. MPF will also be presenting a $2,500 scholarship to three student pharmacists, one from each Michigan college of pharmacy. See the next page for more information about MPF activities that will occur at this year’s Convention. MichiganPharmacists.org
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2016 Jan./Feb./Mar. | Vol. 54, Issue 1
FROM THE FOUNDATION
In 2015, MPF collected 389 pounds of items and $1,075 to support Operation Care Package Michigan (OCPMI)! Pictured (left to right) is JJ Fulgenzi of OCPMI, MPF Event Assistant Cynthia Rowe, MPF Executive Director Dianne Malburg and MPF Chairman Charlie Mollien.
Whaley Children’s Center Mackinac Center, Level 5 • Thursday, Feb. 25, 6-8 p.m. • Friday, Feb. 26, 7 a.m.-6 p.m. • Saturday, Feb. 27, 7 a.m.-3 p.m. This year, the Foundation Board of Trustees voted to support Whaley Children’s Center, located in Flint. The Whaley Foundation was incorporated on Jan. 26, 1924. The mission of Whaley Children’s Center is to provide “… tools to children and families who have experienced trauma to reach their full potential,” with a vision to “… be a source of hope, care, and treatment to Michigan’s abused, neglected, and at-risk children and families.” The Foundation is confident that pharmacy professionals in Michigan will recognize the needs of children in our state and donate generously to this worthwhile cause. In-kind donations of personal care items accepted include shampoo, conditioner, liquid body soap, deodorant, toothpaste, disposable razors, shaving cream, tampons and pads. For additional information on Whaley Children’s Center, please visit www.WhaleyChildren.org/ mission-vision-and-core-values.
Charity Auction Mackinac Center, Level 5 • Thursday, Feb. 25, 6-8 p.m. (Open bidding) • Friday, Feb. 26, 7 a.m.-6 p.m. (Open bidding) • Saturday, Feb. 27, 7 a.m.-5 p.m. (Open bidding) • Sunday, Feb. 28, 7-9:30 a.m. (Open bidding) and 11 a.m.-1 p.m. (Winner pickup) The MPF Charity Auction offers a variety of unique items and experiences for attendees to bid on such as hotel packages, themed baskets, sporting event tickets, autographed memorabilia, jewelry and more. At the time of the journal production, MPF has already received a wide variety of donations, including overnight accommodations at Royal Dearborn Hotel & Convention Center, Evergreen Resort (Cadillac), Hilton Garden Inn (Ann Arbor), Stafford’s Crooked River Lodge (Alanson), The English Inn (Eaton Rapids), Embassy Suites Detroit (Livonia/Novi), Lakeview Hotel & Conference Center (Shanty Creek Resorts) and Ann Arbor Marriott Ypsilanti at Eagle Crest. Also available for bidding is a Somerset Shopper’s Oasis Package from Somerset Inn in Troy, dinner for two provided by Wineguys MichiganPharmacists.org
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Prior to the Student Pharmacist Self-care Championship on Saturday afternoon at the Annual Convention, one student from each Michigan college of pharmacy is presented with a $2,500 scholarship from MPF. Pictured (left to right) are the 2015 recipients: Victor Nguyen from Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences, Emily Belarski from the University of Michigan College of Pharmacy and Lauren Steinhaus from Ferris State University College of Pharmacy.
Restaurant Group, a Michigan Princess Riverboat Gift Certificate, Melissa Lile Photography Gift Certificate, a wide variety of women’s jewelry and fashion accessories, unique art sculptures, and much more! Be sure to visit the Charity Auction at the times listed and bid on your favorite items; or, take advantage of the “Buy It Now” option for all Charity Auction items and take your favorite items with you! In 2015, the Foundation was able to raise more than $9,000. If you’re interested in contributing an auction item for this year’s event, please contact MPF Event Assistant Cynthia Rowe at (517) 377-0222 or Cynthia@ MichiganPharmacyFoundation.org.
MPF Adopt-a-Student Program The Foundation Adopt-a-Student program provides an opportunity for student pharmacists to connect with experienced, practicing pharmacy professionals to network, develop potential long-term mentors and gain valuable advice for their future career. If you are a Student MPA member and you would like to participate in the Adopta-Student program, you must register online at www. MichiganPharmacists.org/eventscalendar/convention16 with your Convention registration or complete a printable registration form (available at the link provided). After you register, please send an e-mail to MPA@ MichiganPharmacists.org and provide the area of practice that you are interested in; a short biography about yourself (one paragraph or 4-5 sentences), including your professional goals and why you chose pharmacy as your career path; and a high-resolution headshot photograph. Please be sure to e-mail this information no later than 4:30 p.m. on Monday, Jan. 25, 2016, which is the registration deadline for students wishing to participate. Pharmacists wishing to adopt a student can register online at www.MichiganPharmacists. org/eventscalendar/convention16 with their Convention registration to support one or more student pharmacists. Or, complete a printable registration form and submit a separate check payable to MPF to receive a tax-deductible receipt. We hope you will support the Foundation during the MPA Annual Convention & Exposition. Be sure to visit the Charity Auction and bid often to get some great items. If you can’t make the Convention but would like to support MPF, visit www.MichiganPharmacists.org/foundation/ contribute to make a tax-deductible donation in any dollar amount meaningful to you. Recurring annual, quarterly and monthly donation options are also available. 2016 Jan./Feb./Mar. | Vol. 54, Issue 1
FROM THE FOUNDATION
Chronic Obstructive Pulmonary Disease and Asthma Community A.I.M. Project By INSAF MOHAMMAD, Pharm.D., Postgraduate Year 1 pharmacy practice resident, Detroit Medical Center Harper University Hospital, and NANCY MACDONALD, Pharm.D., BCPS, transition of care coordinator, Henry Ford Hospital Pharmacists are becoming increasingly involved in the care of patients with pulmonary conditions such as chronic obstructive pulmonary disease (COPD) and asthma. Patients with such diseases are at risk of poor outcomes, including poorer disease-state control, more excessive use of rescue inhalers, increased emergency medical visits and more frequent exacerbations if they do not use appropriate inhaler technique.1 To help combat this problem, Insaf and Nancy applied for a grant offered by Michigan Pharmacy Foundation to initiate a new program at their hospital. Henry Ford Hospital implemented a pharmacist- and student-driven project to optimize inhaler technique for this patient population. The Chronic Obstructive Pulmonary Disease and Asthma Community A.I.M. (Assess, Intervene, Maintain) Project sought to provide a public service to patients in the community who are vulnerable to these poor outcomes if they are not able to appropriately use their inhalers.
Goals of the Project The goal of the A.I.M. Project was to empower COPD and asthma patients by providing them with education to appropriately use their inhalers. The specific goals of the COPD and Asthma Community A.I.M. Project were three-fold: • Assess - Assess patient’s perception of how well they are able to use their inhaler(s) - Objectively assess appropriateness of inhaler technique with a Vitalograph Aerosol Inhalation Monitor • Intervene - Provide patients with education regarding optimal inhaler technique using objective measures from the Vitalograph Aerosol Inhalation Monitor
Project Design and Implementation Three training and education sessions were held at Henry Ford Hospital for all interested pharmacists, pharmacy residents and student pharmacists. These sessions included an overview of the Aerosol Inhalation Monitor and training regarding use of the device. The Community A.I.M. Project was implemented at two Henry Ford Hospital Patient Safety Week events. Henry Ford Hospital also extended the services provided by this project to the community through educational events. In each setting, patients self-reported use of at least one inhaler and were asked about the type of inhaler they used (metered-dose inhaler, dry powder inhaler or other) and their own perception of the appropriateness of their inhaler technique. Using the terms “very well,” “somewhat well” and “not well,” patients were asked to describe how well they believed they accomplished each of the following components of the inhaler technique: • Synchronize canister activation and inhalation • Inhale forcefully enough for mobilization of medication to the lungs
• Maintain - Ensure patients are able to implement and maintain the necessary changes to their inhaler technique by reinforcing the education provided Additionally, a goal of this project was to introduce pharmacists, pharmacy residents and student pharmacists to the Aerosol Inhalation Monitor and provide them with training for potential implementation into patient care.
Vitalograph Aerosol Inhalation Monitor The Aerosol Inhalation Monitor is a training device that allows for the objective assessment of appropriateness of inhaler technique. Using color-coded indicators, the MichiganPharmacists.org
device can be used to simulate a metered-dose inhaler (MDI), a dry powder inhaler (DPI) and a spacer device. The monitor assesses each component of the inhalation process. Indicator lights are used to assess inspiratory acceleration and flow at the start of inspiration. For MDIs, timing of actuation of the canister is also assessed. Additional indicators are used to evaluate inspiratory flow throughout the duration of inspiration, inhalation time within target flow range and breath hold at the end of inhalation. An inhaler technique summary display is also included on the monitor, which is specific to simulation of the MDI, DPI or spacer. The summary display uses color-coded indicators to summarize whether the patient achieved good, suboptimal or failed inhaler technique. The summary display specifies which part specifically contributed to the overall achievement or failure of the technique.2
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• Inhale for an adequate duration of at least three seconds • Hold their breath for at least three seconds at the end of inhalation Following this assessment, pharmacy professionals objectively determined the appropriateness of inhaler technique with the Vitalograph Aerosol Inhalation Monitor. To achieve this, for each patient findings were assessed from the Vitalograph Aerosol Inhalation Monitor regarding each of the following indicators: • Canister activation (for MDI) • Inspiratory flow rate 2016 Jan./Feb./Mar. | Vol. 54, Issue 1
FROM THE FOUNDATION attempts; and only one patient was unable to achieve optimal or sub-optimal technique (after several attempts). Every patient stated that they were satisfied with the inhaler training provided with the Aerosol Inhalation Monitor and education provided by the pharmacist.
Discussion
Clinical pharmacist at Henry Ford Hospital practicing use of the device during a training session.
• Inhale time • Breath hold at the end of inspiration Using the Vitalograph Aerosol Inhalation Monitor colorcoded indicators, the components of inhaler technique reported as failed or sub-optimal were identified, and patients were provided with education to optimize inhaler technique respective to the findings. Patients then used the Aerosol Inhalation Monitor following education. These findings were then compared to the initial results assessed prior to pharmacist education. Patients were then asked about their satisfaction with the inhaler training provided with the Aerosol Inhalation Monitor and also with education provided by the pharmacist.
Outcomes Education was provided to 28 members of the Department of Pharmacy, including pharmacists, pharmacy residents and student pharmacists during the Aerosol Inhalation Monitor training sessions held at Henry Ford Hospital. Overall, 15 patients total from the Safety Week events and community educational events were included in the Community A.I.M. Project. Upon demonstrating his or her inhaler technique prior to any pharmacist’s education with the Aerosol Inhalation Monitor, every patient received a “failed” or “sub-optimal” indicator. After adequate education and coaching from the student pharmacist/pharmacist, 12 patients were able to improve to optimal technique using one to two additional attempts; two patients improved to sub-optimal technique after one to two additional
The Community A.I.M. Project demonstrates the importance of assessing inhaler technique and providing education to patients with COPD and asthma. The outcomes of this project highlight an understated issue among patients who use inhalers, particularly that optimal technique is not being used. Given that every patient included in this project demonstrated sub-optimal inhaler technique at baseline, this highlights the importance of inhaler technique training for this at-risk population. The sheer importance of education regarding inhaler technique provided by a pharmacist is profound considering that nearly every patient improved upon reinforcement of appropriate technique. Therefore, pharmacists and student pharmacists must become more vigilant in identifying patients who use inhalers and providing education to bridge this gap in their care. The Aerosol Inhalation Monitor can be used as a tool to identify patient education needs to optimize the use of the inhaler devices.
Future Directions Due to the high level of patient satisfaction demonstrated during the project, these services will be integrated into the hospital-based ambulatory care clinic at Henry Ford Hospital Detroit. The device will be used in a larger patient population and used to train pulmonary clinic staff. By implementing these services in the clinic, the pharmacist will be able to obtain a better assessment of patients’ initial inhaler technique while also helping to advance the pharmacist’s ambulatory care practice. This project was funded by a grant program supported by Michigan Pharmacy Foundation (MPF), a nonprofit organization that seeks to advance pharmacy through education, practice innovation and research focused on patient care, for the improvement and promotion of public health and public education. MPF provides grant funding for projects that support its mission. For more information, please visit www. MichiganPharmacists.org/foundation/grantsscholarships.
References 1. Giraud, V., Roche, N., Misuse of Corticosteroid Metered-dose Inhaler is Associated with Decreased Asthma Stability, European Respiratory Journal, 2002, Vol. 19, pp. 246-251. 2. Vitalograph Aerosol Inhalation Monitor User Training Manual, Vitalograph, 2013.
MPF Approves Grant Project for 2016 Focused on Improving Patient Care Over more than 20 years, the Foundation has awarded in excess of $250,000 in grant funding for projects that advance the profession. Each year, the MPF Board of Trustees reviews applications requesting financial support and selects projects that advance the profession of pharmacy. After reviewing grant submissions for 2016, the Foundation Board of Trustees voted to award a grant to the project entitled “Patient Self-monitoring and Empowerment Project,” submitted by Insaf Mohammad, Postgraduate Year 1 pharmacy practice resident at Detroit Medical Center – Harper University Hospital. The goals of the project are for pharmacists to educate patients regarding disease-state management, self-monitoring and medication adherence; to empower patients to control chronic conditions such as heart failure, hypertension and diabetes by providing them with necessary tools; and to ensure patients are engaged in the process by employing post-discharge follow-up and communication. Congratulations Insaf on receiving a second grant to support a worthy project! MichiganPharmacists.org
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2016 Jan./Feb./Mar. | Vol. 54, Issue 1
MEMBERSHIP
Meet the 2016
MPA EXECUTIVE BOARD Elections for the 2016 MPA Executive Board were held last October, and the new president-elect and Board members took ofямБce Jan. 1, 2016. Installation ceremonies will be held at the Annual Banquet on Saturday evening of the MPA Annual Convention & Exposition, CHAIR Feb. 26-28 at the Detroit Marriott at the JENNIFER HAGERMAN Renaissance Center. Linden
PRESIDENT
PRESIDENT-ELECT
AMY SMENDIK
JIM LILE
Middleville
Midland
S E C RE TARY/ C EO
TR EASUR ER
SPEAKER OF THE HOUSE
VICE SPEAKER OF THE HOUSE
LARRY WAGENKNECHT
JONATHAN GRICE
PAUL WALKER
MIKE CROWE
Haslett
Newaygo
Detroit
Grand Blanc
GHADA ABDALLAH
DAVID BACH
JESSICA BESSNER
STEPHANIE KLEPSER
Grosse Pointe
West Bloomfield
Hubbell
Kalamazoo
SISTER PHYLLIS KLONOWSKI Saginaw
CHRIS MAKSYM
MARGARET MALOVRH
CHARLES MOLLIEN
VICTOR NGUYEN
Dexter
Okemos
Wyoming
Southfield
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2016 Jan./Feb./Mar. | Vol. 54, Issue 1
ADVOCACY
Student members of the Wayne State University chapter of the American Pharmacists Association – Academy of Student Pharmacists write letters to U.S. Congressman Fred Upton. Photo courtesy of Linda Arrabi, 2018 Pharm.D. candidate, Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences
BREAKING the ICE
By PANG HANG, 2017 Pharm.D. candidate, Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences, and pharmacy intern, CVS Pharmacy
Writing a letter to someone for the first time can be intimidating. It’s especially difficult when you are writing to someone who has power and authority to affect something you care about. I still have a hard time getting a letter or an e-mail started; however, the more I do it, the easier it gets. Knowing that, I wanted to make it easier for those who’ve never done it to help them get started.
• Let them know that short and sweet is good. One page is doable.
Legislators ask for examples and stories of how bills affect their constituents. As constituents, your experiences are important to legislators and they want to hear from you. Let’s assume that someone has already said what you want to say. Your personalized letter lets the lawmaker know that the issue affects more than one individual. It helps them understand and know that the experience is shared. If you don’t let your story be known, it’ll be assumed that it never happened, or that the issues you experience only happened to other pharmacy advocates who have acted on them and shared their story.
Ben August, a 2019 Pharm.D. candidate at Wayne State University, who was writing a letter for the first time, shared his experience: “It was a good experience advocating for our profession and writing the letter was extremely easy, taking less than 10 minutes, but it could make a huge difference. I would definitely do it again.”
I am one of the few student pharmacists who regularly write to our legislators. I likely have less experience in a pharmacy than many of my colleagues. I know they have much to contribute to advocating for the profession and our patients. Therefore, I decided to help other students feel more comfortable with writing letters to their lawmakers. The following are key ways to ease individuals through the process: • Write letters as a group. I announced a date on Facebook to have them collected so we could send them all together. • Provide a template. MPA Manager of Advocacy, Governmental and Regulatory Affairs Amanda Lick provided one in an e-mail for all Pharmacy Advocacy Response Team members. • Suggest how to individualize the letter and include a personal story. For example, the writers changed the font and format to their liking and shared a personal experience in the template. MichiganPharmacists.org
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• Provide the name of the person to address the letter to. For example, we wrote letters to U.S. Congressman Fred Upton because I know that he had asked for stories on how the lack of pharmacist provider status has affected people.
I’m certain our individual letters had a greater impact than one letter with many signatures and I also plan to do this again and encourage others to as well. Join us in writing a letter to your lawmaker. Support provider status or other state and federal initiatives by visiting the Advocacy Action Center on the MPA Web site at www.MichiganPharmacists.org/ advocacycenter. Support your profession today!
Contact Your Legislators with a few Simple Clicks! MPA recently launched the Advocacy Action Center on our Web site. Access information and take action on a variety of issues that matter most to you, your patients and your practice. Several issues are ready for you to take action on now! Each issue page includes details on the legislation for you to review before you reach out to your elected official such as MPA’s position and talking points. The center also features individualized legislator contact information for members in the Advocacy User Profile, allowing you to make a phone call in addition to e-mailing and/or printing a letter. We will continue to update the center with issues that are currently moving through Congress and the state legislature. Get engaged and make your voice heard today! Visit www. MichiganPharmacists.org/advocacycenter to get started. 2016 Jan./Feb./Mar. | Vol. 54, Issue 1
MPA IN ACTION Stewart Presents MPF Leadership Academy Project at Statewide Substance Abuse Conference
Brittany Stewart, a clinical assistant professor at the Wayne State University (WSU) Eugene Applebaum College of Pharmacy and Health Sciences, recently presented a workshop entitled “The Truth about the Truth Fairy” at the 16th Annual Substance Use/Co-occurring Disorder Conference in Grand Rapids on Sept. 21, 2015. This session highlighted her project work completed for the Michigan Pharmacy Foundation Leadership Academy. Presenting before hundreds of substance abuse professionals from around Michigan, Brittany shared community intervention experiences that were created by the WSU Generation Rx student chapter under her leadership and co-sponsored by the Love Detroit Prevention Coalition.
MPA Member Collins Recognized as Compounding Pharmacist of the Year by PCCA
The Professional Compounding Centers of America (PCCA) recently named MPA member Mike Collins their Compounding Pharmacist of the Year. Mike has been practicing the art of compounding for more than 30 years. He opened Healthway Pharmacy in 1985 when he purchased a pharmacy in St. Charles. Mike saw the need to formulate medications for people and their pets and added a compounding laboratory to the facility. The practice grew dramatically and, in 1994, he built a new state-of-the-art compounding laboratory that also offered nutritional supplements, homeopathic remedies and herbal products. To accommodate a growing base of prescribers and patients, Mike opened a second compounding-only pharmacy in 2001 in Saginaw. Healthway Pharmacy was Accredited by the Pharmacy Compounding Accreditation Board in 2007. Congratulations Mike! For more information on his accomplishments, please see a press release from PCCA online at www.BusinessWire.com/news/home/20151109005545/ en/PCCA-Names-Mike-Collins-RPh-FIACP-FACA.
Michigan Pharmacists Answer a Call to Action from State Sen. Knollenberg
(R-Troy) of the 13th District. The annual Tribute to Seniors Health and Vendor Fair at the Royal Oak Farmer’s Market is a special health event that offers flu vaccines, health screenings, entertainment, vendor booths and prizes. This long-standing event attracted more than 400 seniors in 2014. Walgreens provided pharmacist volunteers and flu shots for this event, and it was a huge success. Most importantly, seniors were taken care of and Michigan pharmacists showed their lawmaker just how important they are in delivering health care to patients.
During the Society of Infectious Diseases (ID) Pharmacists Annual Meeting in the fall, Nicholas Torney (far left), a Postgraduate Year 2 ID resident at Munson Medical Center, took first place in an ID Jeopardy competition!
PGY2 Resident Torney Earns First Place in Infectious Diseases Jeopardy at SIDP Annual Meeting
Nicholas Torney, a Postgraduate Year 2 infectious diseases (ID) resident at Munson Medical Center, was recently selected to participate in a Jeopardy-style competition at the Society of Infectious Diseases Pharmacists Annual Meeting in San Diego. At the end of the meeting, after a long day of programming, individuals who indicated their interest in participating were chosen, including Nicholas and two other residents. Just as in Jeopardy, contestants answered in the form of a question, with categories focusing on ID-related topics. He did so well that when it came to the final Jeopardy question, he didn’t have to wager anything, as he was far ahead of the other contestants. Nicholas took first place in ID Jeopardy and was congratulated by many attendees at the reception following adjournment of the Annual Meeting. Congratulations Nicholas!
On Oct. 5, 2015, Michigan pharmacists and Walgreens met a call to action from State Sen. Marty Knollenberg
Sen. Marty Knollenberg (R-Troy) hosted the annual Tribute to Seniors Health and Vendor Fair in Royal Oak on Oct. 5. Michigan pharmacists volunteered and provided flu shots, demonstrating the value of their role in health care delivery.
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2016 Jan./Feb./Mar. | Vol. 54, Issue 1
FEATURE
Medication Therapy Management Services:
Finding the Program that Fits By ROSEANNE PAGLIA, Pharm.D., clinical specialist, St. John Retail Pharmacy; PETER LEWYCKYJ, R.Ph., medication therapy management (MTM) pharmacist, St. John Retail Pharmacy; HEIDI SCHMID, Pharm.D., MTM pharmacist, St. John Retail Pharmacy; and JOHN MOHLER, R.Ph., pharmacy manager, St. John Retail Pharmacy; Traditionally, medication therapy management (MTM) is defined as a distinct service or group of services that optimize therapeutic outcomes for individual patients.1 MTM services are independent of, but can occur in conjunction with, the provision of a medication product.1 The goal is to improve collaboration among health care professionals and help patients achieve improved knowledge and understanding of their medications and medical conditions. MTM programs can and do differ across organizations and pharmacies. Previously published studies vary in program designs, goals and objectives, but all strive to improve patient outcomes.2-4 Finding the right program that fits a pharmacy can be challenging. The St. John Retail Pharmacies began this journey four years ago when we were called to address an unmet need in our organization.
Who We Are The St. John Retail Pharmacies are part of St. John Providence (SJP), which is a member of Ascension Health. Ascension Health is the largest Catholic, nonprofit health system in the United States. SJP is one of six ministries located within the state of Michigan. SJP includes four hospitals located on six campuses, a substance-abuse recovery center, several outpatient medical centers, surgery centers and physician offices. There are 19 St. John Retail Pharmacies within SJP. The pharmacies are located on hospital campuses, within St. John Providence medical office buildings, and, in one instance, in partnership with a community mental health agency. The St. John Pharmacies are in a unique position to closely integrate with various disciplines within SJP and help achieve the goals of the organization.
Where We Started In early 2011, as part of SJP’s overall hospital readmission strategy, representatives from the St. John Retail Pharmacies were invited to participate on a multidisciplinary
team to share ideas and develop strategies to reduce readmissions. Specifically, the group was charged with designing, developing and supporting programs intended to safely transition patients from the inpatient to the outpatient settings. The St. John Pharmacies welcomed the opportunity, as medication-related problems were considered a contributing factor to readmissions. One of the first MTM programs developed was in partnership with St. John Providence’s home care agency. One contingent MTM pharmacist, based out of the St. John Long-term Care Pharmacy, was dedicated to this project. As pharmacy resources were limited, the service was designed as a pilot program with specific goals and a focused target patient population. Patients discharged from a St. John inpatient facility, who were also receiving St. John Home Care services, were targeted for intervention. St. John Home Care nurses screened and identified adult patients most likely to benefit from the services of a clinical pharmacist. Based on the nurse’s assessment, patients with complex medication needs were offered the opportunity to speak with a pharmacist to discuss their medication regimens. Patients who were agreeable to this service were contacted by phone by the MTM pharmacist. Medications were reviewed, questions were answered and problems were addressed. Pharmacists documented and reviewed findings and therapeutic recommendations with physicians, and home care nurses helped verify that accepted recommendations are implemented in the home. Readmissions were tracked for patients who were readmitted to a St. John inpatient facility (see Table 1). Over the first two years of the program, representatives from the St. John Pharmacies and the MTM pharmacist worked diligently to establish synergistic working relationships with St. John Home Care’s nurses and nursing supervisors. Meetings were arranged to educate home care nurses regarding the availability and benefit of a pharmacist. The MTM pharmacist referral process was discussed and the characteristics of patients likely to benefit from MTM services were reviewed. Although it is not a
Table 1. St John Retail Pharmacy: Home Care MTM Summary May 2011-September 2013 Diagnosis Heart Failure = 248 Chronic Obstructive Pulmonary Disease = 38 Atrial Fibrillation = 13 Cardiomyopathy = 6 Coronary Artery Disease = 24 Pneumonia = 7
Number of Patients MTM Completion 30-day Readmission Agreeable to MTM Services Rate Rate (MTM)* 205 82.7% 6.8% 23 9 2 20 4
60.5% 69.2% 33.3% 83.3% 14.3%
*Excludes two patients who were readmitted for planned procedures.
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13.0% 0.0% 0.0% 0.0% 0.0%
30-day Readmission Rate (non-MTM)** 38.6% 24.0% 25.0% 25.0% 50.0% 0.0%
**Excludes nine patients who were readmitted prior to MTM consultation.
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FEATURE specific criterion for referral, heart failure was a diagnosis in 73.8 percent of the cases referred for MTM services. Patients with other conditions were also referred, but those volumes were much lower in number (see Table 1).
Program Expansion
Table 2. St. John Retail Pharmacy: CCTP Program Summary April 2014-April 2015 Total Referrals
As enthusiasm for MTM services grew, the St. John Pharmacies were invited to collaborate in other healthsystem initiatives. Two similar programs, each with the goal of improving transitions of care and reducing readmissions, were launched. Based on our experience with the St. John Home Care MTM program, a second MTM pharmacist position was justified. Both MTM pharmacists became integrated into the Advanced Care Coordination Program (ACCP) and the Community Care Transition Program (CCTP) teams. The ACCP targeted heart failure and chronic obstructive pulmonary disease (COPD) patients discharged from St. John Macomb Hospital. Nurses enrolled patients in the program. Patients were followed for a minimum of two months via weekly telephone calls. Pharmacists offered a one-time telephonic medication review and MTM counseling session. The nurses and the pharmacists worked together to reinforce, educate and assist patients in reaching therapeutic goals. The CCTP was established at St. John Macomb Hospital and St. John Hospital and Medical Center and was supported by a Centers for Medicare and Medicaid Services (CMS) grant. The main goal of the CCTP was to reduce 30-day readmission rates for patients with heart failure, acute myocardial infarction and pneumonia. Readmission rates were chosen as a program metric since these rates were already tracked by our health system. Also, reducing readmission rates were part of the overall strategy to improve patient experience, improve quality performance and optimize payment for acute care services. A readmission reduction strategy was specifically important to offset the payment adjustments implemented by Medicare’s Readmission Reduction Program. Eligible patients were identified and enrolled in the program before discharge by a Health Navigator, who sent a referral to a health coach/social worker for a one-time home visit and to the pharmacist for a one-time telephonic MTM review. Pharmacists ensured patients had needed prescriptions, clarified dose changes, corrected medication errors and provided adherence education. Pertinent information that benefited the patient was exchanged between the pharmacist and health coach. In both programs, all patient interactions with the pharmacist were recorded in an electronic roster. Referral completion rates, pharmacist interventions and 30-day readmission rates were calculated monthly and cumulatively. Data was collected over 13- and 18-month periods for the CCTP and ACCP programs, respectively. MTM completion, intervention and readmission rates are outlined in Tables 2 and 3, respectively. The types of MTM interventions were noted and categorized for each patient (see Table 4). Each of these intervention categories was assigned a code to facilitate ease of tracking. The intensity of the interventions ranged from minor to significant and was often variable among patients. Some patients required basic counseling and reassurance regarding their medication instructions, where other patients needed a MichiganPharmacists.org
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1,045
MTM Completion Rate 69.3%
MTM Overall Intervention Rate 45.1%
Overall 30-day Readmission Rate 14.4% MTM Patients Non-MTM Patients 11.2% 19.3%
Table 3. St. John Retail Pharmacy: ACCP Program Summary April 2014-September 2015 Total Referrals 605
MTM Completion Rate 80.5%
MTM Overall Intervention Rate 51.9%
Overall 30-day Readmission Rate 12.9% MTM Patients Non-MTM Patients 11.9% 16.9%
Table 4. MTM Intervention Categories MTM Code MTM Category Description Drug dose discrepancy identified from discharge A medication list B Patient without medication C Patient not taking medication D Drug side effect E Drug interaction F Duplicate drug therapy Pharmacist advised patient to follow-up with G prescriber H Prescriber call required I Over-the-counter drug recommendation Physician appointment and/or transportation J scheduling assistance K Patient education regarding drug therapy Pharmacist called patient’s pharmacy to assist L with prescription Pharmacist updated program partners on patient M issue
secondary intervention by their prescriber. In all cases, the pharmacist managed the situation and documented the outcomes of the intervention.
Conclusions and Discussion The St. John Retail Pharmacies implemented MTM services with the support of our health system. We were fortunate to have the opportunity to work with multidisciplinary teams and embed MTM pharmacists into comprehensive transitions of care programs. The reduction in readmission rates are a result of concerted efforts on the parts of health care providers and patients. It is believed that patients who are willing to work with pharmacists to 2016 Jan./Feb./Mar. | Vol. 54, Issue 1
FEATURE
“As health care embraces a multidisciplinary team approach to chronic disease management, integrating pharmacists into these new health care delivery systems has been proposed as a best practice model.”5 improve their medication experiences are also likely to adhere to other recommendations (i.e., nutrition) that will improve their outcomes. Additional benefits that were not tracked but appreciated were improved chronic disease management and patient care satisfaction. Also, interventions that target high-risk medications in elderly patients were not specifically evaluated in any of our programs; however, there is interest in including this type of evaluation in future projects. As health care embraces a multidisciplinary team approach to chronic disease management, integrating pharmacists into these new health care delivery systems has been proposed as a best practice model.5 Pharmacists are called upon to expand their roles and share their unique skills to fulfill this need. The importance of medication adherence has specifically been identified as a key element for chronic disease management. Patients will gain the most benefit from their medications if they understand why they are needed and how they should take them.5 When medication adherence is not achieved in patients, poor health outcomes, increased service utilization, increased health care costs and increased patient costs can be expected.6 In summary, with growing evidence that medication adherence and drug therapy management play a pivotal
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role in patient outcomes, recognition of the pharmacists’ contribution and its effect on patient outcomes will continue to grow. As value for service becomes a focal point of health plans, the necessity of MTM programs is clearly demonstrated. The St. John Retail Pharmacy experience has been rewarding and continues to evolve. The more experience we gain on our MTM journey, the more we realize that there is more to discover.
References: 1. Bluml, B.M., Definition of Medication Therapy Management: Development of Profession-wide Consensus, Journal of the American Pharmacists Association, 2005, Vol. 45, pp. 566-72. 2. Gillespie, U., A Comprehensive Pharmacist Intervention to Reduce Morbidity in Patients 80 years or Older: A Randomized Controlled Trial, May 11, 2009, Archives of Internal Medicine, Vol. 169, No. 9, p. 894. 3. Al-Ghamdi, S.A., The Outcome of Pharmacist Counseling at the Time of Hospital Discharge: An Observational Nonrandomized Study, Annals of Saudi Medicine, Vol. 32, No. 5, p. 492. 4. Bellone, J.M., Postdischarge Interventions by Pharmacists and Impact on Hospital Readmission Rates, May 2012, Journal of the American Pharmacists Association, Vol. 52, No. 3, p. 358. 5. European Pharmacists Forum, The Role of Pharmacy in Supporting the Public’s Health, www.EuropeanPharmacistsForum.com/epf-white-paper, Nov. 4, 2015. 6. PubMed Central, Adherence and Health Care Costs, www.ncbi.nlm.nih.gov/ pmc/articles/PMC3934668, Nov. 4, 2015.
2016 Jan./Feb./Mar. | Vol. 54, Issue 1
CONSULTANT AND SPECIALTY FOCUS
A Voice and Presence for Pioneer Pharmacy Leaders in Specialty Practice By SISTER PHYLLIS KLONOWSKI, B.S. Pharm., pharmacist, HealthFirst Pharmacy, and president, Consultant and Specialty Pharmacists of Michigan
As the president of the Consultant and Specialty Pharmacists of Michigan (CSPM), I would like to remind you of our new name and provide you with some history on our practice section. Previously the Consultant Pharmacists Society of Michigan, our section underwent a name change at the end of 2014 in response to the surfacing of many unique practice areas over the years. While the name change may appear to be subtle, it is significant. As a member of MPA for more than 40 years, I have come across many pharmacists who have chosen to serve the growing population of elderly patients. As they aged, those patients served had to take an increasing number of maintenance medications. They also needed someone to explain, advocate and assist as they came to embrace the reality of medication that let them both live longer and engage with family and friends in activities that were not imaginable when they were young. The number of pharmacists whose practice focused on the elderly continued to grow. Their unique contribution in monitoring for interactions and complications specific to the elderly was noted. From within the pharmacy profession, momentum grew to acknowledge the service as a specialty. In 1993, MPA formerly recognized this specialty group and the Consultant Pharmacists Society of Michigan was formed. By this action, MPA gave both voice and presence to these pioneer pharmacy leaders. CPSM was designed to represent primarily consultant pharmacists serving in nursing homes, who provided chart reviews and other services to geriatric patients; however, the
Society has grown over the years to include a wide variety of specialty practice areas beyond consultant pharmacy. This includes home infusion, nuclear pharmacy, managed care, long-term care dispensing and consulting, compounding, physician practices, academia, medical homes and specialty pharmacy. The majority of Society members voting in the fall of 2014 selected the name Consultant and Specialty Pharmacists of Michigan, or CSPM. The Board of Directors of the Society had been considering a name change for some time, and this new name better encompasses all of the areas represented by this practice section of MPA. The last 40 years since I joined the Association have been marked by the use of pharmaceuticals in unique medical settings and for specialty groups of patients. A partial listing of these sites and patient groups include the following: • Nuclear laboratories, where radiopharmaceuticals are used to diagnose and treat patients; • Transplant centers where special consideration to dosing and interactions are critical for patient survival and support of life functions in vital organs; • Neonate and pediatric intensive care units, where some of our most vulnerable are able to survive and gain footing for a long life; • Long-term care and assisted living residences, where vibrant activity engages the young and elderly; • Mental health facilities, where psycho-pharmaceuticals that have transformed living for
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many from bare existence, often from an institutional setting to independent living; and • In-home IV medications, including antibiotics and nutrition CSPM seeks to acknowledge and give an opportunity to those who may want to put a focus on addressing some of the clinical aspects of practice outside the physical boundaries of a hospital or the dispensing capabilities of a community pharmacy, including those listed above. For the good and welfare is a designated time during meetings of MPA Boards, Committees and Task Forces where any member present can bring up a recognition, an issue of interest or concern, or another topic that may be of importance to those in attendance. Each of us has a professional responsibility to provide excellent care and fulfill our duties for each patient we serve. We also have a responsibility to each other. This requires us to observe, to share and to assist. Our patients are of primary importance. Medical care, especially medication, is not static. What is requested, what is available, how it can be provided, and how it can be used safely and effectively is of concern for each of us individually and collectively. May we own and use our voice to speak, our will to act and our spirit to rejoice as those we serve can claim and sustain strength and health. Beyond the time designated during these meetings, I encourage each and every member to always share their ideas, feedback and stories. We look forward to seeing you as well as hearing and learning from you.
2016 Jan./Feb./Mar. | Vol. 54, Issue 1
CONTINUING EDUCATION
The Pharmacist’s Role in Personalized Medicine: A Review of Pharmacogenetics By REBECCA TOMICH, Pharm.D., CGP, consultant director, In Touch Pharmaceuticals; and JOE BROWN, B.S. Pharm., senior executive consultant, In Touch Pharmaceuticals, and president, JKB Solutions Inc.
Background
Target Audience
This continuing education activity was designed specifically for pharmacists.
Disclosure Statement
Rebecca Tomich received an honorarium from Boehringer Ingelheim for serving as a speaker; however, she has agreed to present information in an unbiased manner. Joe Brown does not have any conflicts of interest, or financial relationships with a commercial interest, related to the activity.
Learning Objectives
At the end of this activity, participants should be able to: • explain basic pharmacogenomic and pharmacogenetic concepts. • explain how genetic variation in proteins, including drug transporters and drug metabolizing enzymes, affect drug metabolism and drug response. • discuss the availability of evidence-based guidelines and utilize them for the selection of drug therapy. • review the cost, cost-effectiveness and reimbursement by insurers relevant to pharmacogenomics tests and test interpretation for patients. • recall the process of acquiring genetic material, completing the necessary paperwork and interpreting the pharmacogenetic testing results.
Medications demonstrate effectiveness in clinical studies, yet they may be less effective in a particular patient, resulting in failure to reach desired treatment goals. Medications can also cause adverse drug events (ADEs), which are unintended effects, or injuries to the patient. While most often inconvenient or uncomfortable, ADEs can be extremely dangerous. Adverse drug events contributed to an estimated 13.5 million outpatient visits between 2005 and 2007.1,2 The elderly are at an increased risk due to decreased physiologic function, comorbid disease states and an increased number of medications. The decreased physiologic function results in increased drug exposure (decreased renal and hepatic function). There were an estimated 100,000 emergency department visits related to ADEs among Americans 65 and older, resulting in hospital admissions between 2007 and 2009.3
References: 1. Sarkar, U., Lopez, A., Maselli, J.H., Gonzales, R., Adverse Drug Events in U.S. Adult Ambulatory Medical Care, Health Services Research, 2011, 46, pp. 1517-1533. 2. Preventable Adverse Drug Reactions: A Focus on Drug Interactions, www.FDA.gov/Drugs/DevelopmentApprovalProcess/DevelopmentResources/ DrugInteractionsLabeling/ucm110632.htm, Oct. 10, 2015. 3. Budnitz, D.S., Lovegrove, M.C., Shehab, N., Richards, C.L., Emergency Hospitalizations for Adverse Drug Events in Older Americans, New England Journal of Medicine, 2011, 365, pp. 2002-2012.
IMPORTANT INFORMATION REGARDING CONTINUING EDUCATION CREDIT Due to the length of this continuing education article MPA has posted the complete article online. Upon completion of this activity, participants must complete an evaluation and posttest with a passing score of 70 percent on the MPA Web site at www.MichiganPharmacists.org/education/online. A failed test may be retaken only once without additional cost. There are no refunds for failed tests. If all requirements are met, participants will receive pharmacy continuing education (PCE) credit through CPE Monitor, a national, collaborative effort by ACPE and the National Association of Boards of Pharmacy (NABP) that went into effect on Jan. 1, 2013, to provide an electronic system for pharmacists and pharmacy technicians to track their completed PCE credits. MPA, as an ACPEaccredited provider, is required to report pharmacist and pharmacy technician PCE credit using this tracking system. Pharmacist and pharmacy technician participants must provide their NABP e-Profile identification number and date of birth (in MMDD format) when they register for a CPE activity or complete activity evaluations. It will be the responsibility of the participant to provide the correct information (i.e., e-Profile identification number and date of birth in MMDD format). If this information is not correctly provided, NABP and ACPE prohibit MPA from issuing CPE credit. Online access to their inventory of completed credits will allow pharmacists and pharmacy technicians to easily monitor their compliance with CPE requirements and print statements of credit. Therefore, MPA will not provide printed statements of credit to pharmacists and pharmacy technicians. Partial credit will not be awarded. If you have yet to sign up for CPE Monitor, go to MyCPEMonitor.net. Please note that this activity is only accredited for pharmacists due to the topic discussed; therefore, pharmacy technician credit does not apply. For more home study activity options for pharmacists and pharmacy technicians, please visit www.MichiganPharmacists.org/education/online.
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Michigan Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. Universal Activity #0112-0000-15-009-H01-P. Initial Release Date: 1/5/16; Expiration Date: 1/5/19; 1.0 contact hour
2016 Jan./Feb./Mar. | Vol. 54, Issue 1
PRACTICE SPOTLIGHT
Specialty Pharmacy Practice By CONNOR LUCZAK, 2016 Pharm.D. candidate, University of Michigan College of Pharmacy
What is specialty pharmacy practice? Specialty pharmacy defies easy categorization, but it is typified by three primary characteristics: high complexity, high touch and high costs. Specialty pharmacy deals with diseases that can present with significant clinical complications and involve treatments that require extensive drug monitoring and supportive care, interventions which often entail significant expense. It was very much a niche market at its inception, but it has since become an area of burgeoning growth. Some of the diseases most closely associated with specialty pharmacy include cancers that can be treated with oral chemotherapy, HIV, hepatitis C, multiple sclerosis, rheumatoid arthritis and organ transplantation. In practice, specialty pharmacy operates in a manner reminiscent of a community pharmacy, but with some important special considerations and additional functions. These medications are associated with some of the most stringent prior authorization programs that health insurers have devised. The best specialty pharmacies help patients and physicians to obtain approval for these prior authorization requests. The costs associated with these medications are often an unbearable burden for certain patients and specialty pharmacy staff members help to find forms of financial support for these patients. Finally, in the realm of specialty pharmacy, medication counseling by a pharmacist does not end when patients receive their prescriptions. Pharmacists in this setting offer significant clinical support to patients, call them on a regular basis to assess and relieve drug side effects, communicate key findings to prescribers and ensure that patients have an uninterrupted supply of medication. In addition, more and more specialty pharmacies are gravitating toward formal accreditation. Specialty pharmacies that seek accreditation must adhere to rigorous standards in record keeping, clinical monitoring, and patient care and communication. These efforts, while considerable, are well worth it. It allows specialty pharmacies to obtain a broader variety of medications and operate at the forefront of patient care.
What is the role of a specialty pharmacist? Specialty pharmacists need to be acquainted with the newest medications approved to treat a multitude of complex disease states. Oftentimes, these medications employ novel mechanisms of action and have special considerations for storage and administration. A specialty pharmacist must be well informed of these new therapeutic developments and have a clear understanding of their implications for patient care. In addition to ensuring safe and accurate drug dispensing, specialty pharmacists also offer extensive medication counseling to all patients under their care. Specialty pharmacists communicate with their patients on a regular basis, most often through phone calls, to ensure their therapy is well tolerated and adheres to the latest treatment guidelines. They offer strategies to mitigate drug side effects when appropriate MichiganPharmacists.org
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and talk with physicians to optimize treatment options. Continuity of care is especially important for patients who need specialty medications. A typical patient may be someone undergoing several cycles of chemotherapy or a 12-week treatment for hepatitis C, or even lifelong HIV suppression. Specialty pharmacists follow their patients through all these different phases and settings, constructing a cohesive treatment narrative along the way. A single pharmacist will be responsible for the care of multiple patients, so the information they note must be both informative and concise. As drug manufacturers release more and more specialty medications, specialty pharmacists work to ensure these new therapies are used both judiciously and effectively, with a focus on patient-centered outcomes.
How can you prepare for a career as a specialty pharmacist? There is no formal pathway to becoming a specialty pharmacist; however, since the field deals exclusively with emerging and unique therapies, one must have impeccable clinical knowledge. Current and upcoming specialty medications are predominantly associated with the treatment of cancers, HIV, hepatitis C and multiple sclerosis, alongside other autoimmune conditions. It is important to have some past experience with these areas of practice. This can be obtained either through prior direct work with these conditions or via Postgraduate Year 1 and Postgraduate Year 2 training programs. Many of the drug distribution tasks associated with specialty pharmacy are also similar to community practice, so having familiarity with the best workflows present in the retail setting can also be of great help to a specialty pharmacist. Finally, obtaining coverage for these medications is often associated with many stipulations, so it is important to have some working knowledge of how to navigate prior authorization programs and third-party payer reimbursement. While the patient contact is extensive, much of it is via phone. It is imperative to have good communication skills such as avoiding complex medical jargon and making extra effort to ensure patient understanding. Specialty medications are often indicated for frightening and distressing diagnoses. A specialty pharmacist is often the most accessible member of a patient’s care team and, as such, is often the first person to be asked questions regarding therapy. Pharmacists who wish to work in specialty pharmacy should practice their ability to provide both empathic reassurance and knowledgeable expertise to the patients they serve.
What is in the future for specialty pharmacy practice? Several converging trends will help to ensure that specialty pharmacy remains an area of importance and significant growth for the foreseeable future. Many of the largest pharmaceutical manufacturers in the world are directing their research and development toward producing 2016 Jan./Feb./Mar. | Vol. 54, Issue 1
PRACTICE SPOTLIGHT medications that will qualify as specialty drugs. Greater than 40 percent of drugs currently in development will be considered specialty medications. Specialty pharmacy also holds both promise and peril for health insurers and other managed care organizations. Emerging medications offer the means to combat previously intractable diseases, but they also are often associated with considerable costs. Specialty pharmacy can help to optimize these
interventions, offering not only a means of access to these medications, but also clinical services that encourage medication adherence, offer side effect management and promote communication between the patient, physician and pharmacy. As more and more medications of increasing complexity become available, specialty pharmacy can help to ensure that the correct product is given to the right patient for the best possible outcome.
MEMBER PROFILE : STEPHANIE DUNSEITH PHARM.D., CLINICAL PHARMACIST SPECIALIST, ST. JOHN SPECIALTY PHARMACY How long have you practiced as a specialty pharmacist and where do you practice? What interested you about this practice area? I have been a specialty pharmacist for the past two years. I practice at St. John Specialty Pharmacy, which is part of the St. John Providence/Ascension network of hospitals, ambulatory centers and other health services. My background was initially focused on a clinical inpatient setting. I completed two years of post-graduate pharmacy residency training at the University of Chicago Medicine program, with my second year focusing on oncology. I became interested in specialty pharmacy because it is an exciting and rapidly growing area of pharmacy. I also appreciate the opportunity to work with patients on a long-term basis, rather than just brief interactions during their hospital stay.
How would you describe your typical work day? Most of my day is spent communicating with patients and their caregivers. I call new patients for an initial in-depth counseling session prior to their first fill of a specialty medication. I typically discuss what patients can expect from new medication, answer their questions and confirm the start date associated with their therapy. After this initial contact, I then call patients approximately every two to four weeks to see how they are tolerating their medication or encountering any barriers. Some common issues which can emerge include concerns or problems associated with drug adherence, side effects associated with therapy and potential drug interactions. As a pharmacist, I can help the patient manage a number of these issues. However, there are issues that need the prescriber’s direction. All of these issues are communicated back to the physician’s office. This type of system promotes clear lines of communication and helps to establish a sense of partnership in care between patients, physicians and our pharmacy. Some of my other frequent activities include verifying prescriptions, managing projects designed to improve patients’ clinical outcomes, chairing a Committee focused on improving patient safety and continuous quality improvement of specialty pharmacy care.
How has your role as a specialty pharmacist evolved during your career? When I began practicing with St. John Specialty Pharmacy, I focused primarily on developing a strong patient management program. With that implemented, I now focus more on quality improvement projects, chart audits and accreditation standards. By examining what we do and how we do it, we can identify process improvements that help the pharmacy improve and optimize the services offered. I am also responsible for educating other pharmacists and team members on the process improvements and problem-solving the everyday issues that arise during the course of the day.
What advice would you give to new pharmacists beginning their careers in specialty pharmacy? Pharmacists who desire to practice in this field should have excellent communication skills and be capable of talking clearly and concisely to both patients and prescribers on a level they understand. Specialty pharmacy also requires a keen attention to detail. It is helpful to have an understanding of ongoing coordination of care between pharmacists, patients and prescribers, and familiarity with third-party payer utilization rules, reimbursement and patient financial assistance options. Specialty pharmacy is a field that is growing rapidly!
“I became interested in specialty pharmacy because it is an exciting and rapidly growing area of pharmacy. I also appreciate the opportunity to work with patients on a long-term basis, rather than just brief interactions during their hospital stay.”
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FEATURE
Self-improvement and the Importance of Continuous Growth By SARAH BARDEN, M.B.A., executive fellow, Michigan Pharmacists Association and Pharmacy Services Inc. This past spring, as I was finishing up my final year of pharmacy school and my clinical rotations, I felt like I had a neon sign flashing above my head that said, “Ask me about my post-graduate plans.” Friends, family, mentors and even well-intentioned, barely-made acquaintances were happy to comply. The conversations, however, were remarkably similar. They went something like this.
and his writings on self-improvement reinforced my decision. He discusses the following eight principles for self-improvement: 1. Choose a life of growth 2. Start growing today 3. Focus on self-development, not self-fulfillment 4. Never stay satisfied with current accomplishments
[Them] So, what are you going to do after graduation?
5. Be a continual learner
[Me]
6. Develop a plan for growth
I am going to do a one-year executive fellowship at Michigan Pharmacists Association.
[Them] How much does that pay? [Me]
8. Find a way to apply what you learn
Not as much as a typical pharmacist, but it’s an incredible learning opportunity.
[Them] Didn’t you just spend four years learning? Don’t you have student loans to repay? [Me]
Yes and yes.
[Them] But why do you need more education? [Me]
7. Pay the price
Because I believe certain experiences such as those offered through the MPA/Pharmacy Services Inc. Executive Fellowship are invaluable. Think about the MasterCard commercials. The benefits of learning from mentors, making career connections, and seeing first-hand how associations support, educate and advocate for pharmacy professionals are priceless. My pharmacy career is going to last for at least another 30 years. How can I not sacrifice a little money for one year to obtain so many other benefits?
After explaining it this way, most people understood, or at least respected, my decision. Self-improvement is a continuous process that requires sacrifice at times. For me, the long-term benefits for my professional development far outweighed the short-term pain related to cash flow. Part of the MPA fellowship is a longitudinal rotation on executive management and leadership. As one of the learning tools for this rotation, we are reading and discussing principles from John C. Maxwell’s 101 Collection. Maxwell is an internationally recognized authority on leadership,
From these principles, a few concepts resonated with me. First, self-improvement is a choice that happens intentionally. Creating a plan, following the plan, reflecting on the outcomes and modifying the plan are all important, active steps in growth. Growth does not happen to us but is something we actively pursue. Secondly, self-development differs from self-fulfillment. Self-fulfillment is about feeling good, but self-development is about continually striving to be better than you were before. Growth is not always comfortable and does not always make us feel good. The benefits of becoming a better pharmacist, employee, friend, listener and leader are worth the moments of discomfort. Third, it is important to acknowledge accomplishments, but it is even more important to identify the next set of goals and keep pushing forward. Stagnation is dangerous, and the best way to avoid it is to keep working the plan for growth. Michigan Pharmacy Foundation offers the year-long Health Professional Leadership Academy (HPLA) specifically designed to help health care professionals meet personal and professional leadership goals. I am fortunate to be part of the fourth class of this program. What began as an initiative to help young pharmacists develop and improve leadership skills has transformed into a program open to all health care practitioners in all stages of their careers. The developers of HPLA apply Maxwell’s principles of self-improvement to continually grow and adapt the program itself to ensure it is meeting the needs of the health care landscape. I am excited to continue my learning at MPA through the fellowship and HPLA. I highly encourage others to seek out opportunities that will help you meet your goals, regardless of how uncomfortable they are in the moment.
“The benefits of becoming a better pharmacist, employee, friend, listener and leader are worth the moments of discomfort.” MichiganPharmacists.org
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PATIENT SAFETY
MEMBER RESOURCE SPOTLIGHT:
PERTUSSIS BOOKMARK www.MichiganPharmacists.org/resources/immunizations
Michigan can tout high rankings on many annual lists, but readers may not be aware that our state ranks among the highest in incidence/number of cases of whooping cough (pertussis). In fact, according to data from the Centers for Disease Control and Prevention, Michigan faced 1,272 incidences of whooping cough in 2014. In collaboration with the Franny Strong Foundation, MPA created a printable resource for pharmacists to utilize that promotes recommendations from the Advisory Committee on Immunization Practices for pertussis vaccination. Provisions recommend the pertussis vaccine for all pregnant women, regardless of whether or not they’ve received it in the past. Visit the Immunizations page and click on “Pertussis Vaccine Awareness” to access this resource. It’s the size of a bookmark, so it can easily be printed off and used in prescription bags or placed on your pharmacy counter for patients to grab!
“According to data from the Centers for Disease Control and Prevention, Michigan faced 1,272 incidences of whooping cough in 2014.”
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PROFESSIONAL PRACTICE ©iStockphoto.com/AlexanderNovikov
Generic Drug Discount Programs: Implications on Medication Adherence Performance Data By ALEXANDRA TUNGOL LIN, Pharm.D., clinical manager, health outcomes and pharmacy care management, clinical drug evaluation and policy, Blue Cross Blue Shield of Michigan Pharmacy Services Clinical
Since 2006, several retail pharmacies have offered a 30-day supply of select medications for as low as $4 or, in some cases, for free. Patients without prescription drug coverage can use this program to obtain their medications. However, patients with drug coverage who use this program often do not use their insurance card. They pay cash for the prescription and the pharmacy does not submit the claim for reimbursement. As a result, insurance pharmacy claim records show that patients are not taking their medications as prescribed. For pharmacies that offer discounted prices to everyone (membership fee not required), transactions for these discounted generics should be submitted through the insurance, as required by pharmacy network contracts. Using the insurance card offers patients many benefits, including the following: • Lowest available prices for drugs: At many pharmacies, patients may still get generic medications for cholesterol, diabetes, blood pressure and other conditions for the “cash” price (or free) when they use their insurance card.
• Review of each drug claim for several safety factors: This includes drug interactions, inappropriate dosages and duplicate medications by the pharmacy claim system. • Care management programs: Patients are targeted based on their pharmacy and medical claims history. • Transactions that count: These transactions apply toward patients’ deductibles and out-ofpocket maximums. Health plans track performance on medication adherence of the following drug classes using pharmacy claims data: noninsulin diabetes medications, renin angiotensin system antagonists and statins. This is because the Centers for Medicare and Medicaid Services uses medication adherence of these drug classes for their Medicare Part D Star Ratings and the new quality rating system for health care plans on the health insurance marketplace. As health plans and pharmacy benefit managers consider alternative pharmacy network designs, pharmacy claims data is used to evaluate pharmacies’
performance and inclusion in these programs. Prescribers also use claims data. They identify patients who do not use their insurance cards when getting medications based on the claims processing data on file with health plans. Prescribers may notify health plans, who may consequently ask pharmacies to reprocess transactions through the patients’ insurance cards.
What You Can Do: • Submit claims for all medications, including the free or low-cost medications on your pharmacy’s generic drug discount programs (for example, $4 for a 30-day supply, or free statin or diabetes medications). • Submit claims electronically. • Use the National Council for Prescription Drug Programs field 426-DQ (U&C Charge) when you submit claims for discounted medications offered by your pharmacy. • Complete all claims accurately and include the prescribing physician information.
For pharmacies that offer discounted prices to everyone (membership fee not required), transactions for these discounted generics should be submitted through the insurance, as required by pharmacy network contracts. MichiganPharmacists.org
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FEATURE
Could a Changing Legal Landscape Bring New Risks to Pharmacists? By JEFFREY BURTKA, Rogers & Associates, P.C., Attorneys and Counselors Despite the potential licensing and criminal ramifications of prescribing controlled substances to drug addicts, pharmacists in Michigan traditionally have not had to worry about civil lawsuits from drug seekers who commit criminal offenses to obtain narcotics. However, a recent West Virginia case should raise concerns about potential civil liability for pharmacists who prescribe narcotics to drug addicts. In Tug Valley Pharmacy, LLC v. All Plaintiffs Below In Mingo County,1 the plaintiffs obtained prescriptions for controlled substances from medical providers and filled them at the defendant pharmacies. The plaintiffs sued the medical providers and pharmacies for causing their addiction to controlled substances. The plaintiffs alleged that the pharmacies acted in concert with the medical providers as pill mills and “refilled the controlled substances too early, refilled them for excessive periods of time, filled contraindicated controlled substances and filled ‘synergistic’ controlled substances which would provide an enhancing effect to the drugs.” Despite these allegations, the plaintiffs were also at fault. Most of the plaintiffs admitted that they were addicted to narcotics before visiting the medical providers, and all of the plaintiffs admitted to illegal activities such as the criminal possession
and receipt of pain medications, criminally acquiring narcotics through fraud, doctor shopping and using higher dosages than prescribed. Before the case went to trial, the pharmacies argued that the court should apply the wrongful conduct rule and dismiss the case. The trial court asked the West Virginia Supreme Court of Appeals to determine whether it should apply the wrongful conduct rule. The court held that West Virginia does not recognize the wrongful conduct rule and allowed the patients to bring suit against the pharmacies, even though the plaintiffs’ own illegal activity contributed to their addiction. Instead, the court held that the principles of comparative negligence should be applied.
The Wrongful Conduct Rule The wrongful conduct rule prevents a plaintiff who is injured by another person’s negligence from bringing a case to trial if his or her own illegal action was a cause of the injuries. It is not recognized in every state, but Michigan courts traditionally have applied the wrongful conduct rule to bar plaintiffs like the ones in Tug Valley Pharmacy from bringing lawsuits. In Orzel by Orzel v. Scott Drug Co.,2 the Supreme Court of Michigan defined the wrongful conduct rule, stating: “A person cannot maintain an action if, in order to establish his cause of action, he must rely, in whole or in part, on an illegal or immoral act or transaction to which he is a party.”
Comparative Negligence Under comparative negligence, a judge or jury determines the amount of damages a plaintiff suffered as well as each party’s percentage of fault. For example, if a court finds
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FEATURE that a plaintiff suffered $100,000 in damages and that the defendant is 75 percent at fault while the plaintiff is 25 percent at fault, it will award the plaintiff $75,000 in damages. This system prevents a plaintiff from being awarded for the portion of his or her injuries that result from his or her own negligent actions. Most states use some form of comparative negligence. In Michigan, a plaintiff can recover economic damages even if he or she is more than 50 percent at fault. However, courts have applied the wrongful conduct rule as an exception to Michigan’s comparative negligence system.
The Orzel case In Orzel, the plaintiff alleged that the defendant pharmacy caused his permanent injuries by negligently filling prescriptions for Desoxyn® without asking for identification or ensuring that enough time had passed since filling his last prescription. The plaintiff admitted that he was addicted to Desoxyn® before visiting the pharmacy and that he was also illegally obtaining Desoxyn® from other sources. Instead of applying comparative negligence principles, the court held that the wrongful conduct rule applied and that the plaintiff’s criminal activity barred his claim. The court explained that not all bad conduct will bar a plaintiff from bringing a lawsuit in Michigan courts. For a court to apply the wrongful conduct rule, a plaintiff must have violated a criminal statute, not just a safety statute (such as a traffic law). Also, the plaintiff’s illegal conduct must be an actual cause of the injuries. For example, if a plaintiff was using illegal drugs and was a passenger in a vehicle involved in an accident, the fact that he was high was not a cause of the accident. Even though he was engaging in criminal activity, he would not be barred from suing because being high as a passenger could not have caused the accident.
What Does the Future Hold? For now, the Michigan case law still favors the wrongful conduct rule, so pharmacists likely will be safe from a civil lawsuit for negligently providing controlled substances to drug seekers. Shifting public policy and the possibility of a legal challenge to Orzel could convince the Michigan Court of Appeals or Supreme Court to eliminate the wrongful conduct rule. The most common rationale courts use to support the wrongful conduct rule is a public policy argument that plaintiffs should not profit from their own illegal conduct. But the court in Tug Valley Pharmacy dismissed this rationale:
With higher scrutiny from Lansing regarding overdoses from prescription painkillers,3 pharmacists should be concerned that Michigan courts eventually might agree with the West Virginia Supreme Court of Appeals and reject the wrongful conduct rule. Furthermore, a Michigan statute, MCL 600.2958, enacted seven months after Orzel could be read to specifically prohibit Michigan courts from applying the wrongful conduct rule. The statute states that, “in an action based on tort or another legal theory seeking damages for personal injury, property damage or wrongful death, a plaintiff’s contributory fault does not bar that plaintiff’s recovery of damages.”4 Despite this language, the Court of Appeals of Michigan has continued to apply the wrongful conduct rule, but two decisions have called the continued use of the rule into question. In Stolicker v. Kohl’s Dept. Stores, Inc., the Court of Appeals of Michigan ruled that the wrongful conduct rule barred a plaintiff from suing Kohl’s for injuries suffered during an attempted shoplifting.5 In her dissent, Judge Gleicher argued that the wrongful conduct rule was revoked by the Michigan Legislature: “But in language that could not be more straightforward, our Legislature has declared that ‘a plaintiff’s contributory fault does not bar that plaintiff’s recovery of damages.’ This contributory negligence framework supersedes the common-law wrongful-conduct rule.” More troublesome for pharmacists is a federal court case from October 2015. In Chorazyczewski v. Costco Wholesale Corp.,6 the Sixth Circuit Court of Appeals found that the trial court did not properly apply the wrongful conduct rule. Although the court did not specifically hold that the wrongful conduct rule is superseded by MCL 600.2958, it noted that “it is an open question whether the wrongful conduct rule remains in force” because the Michigan Supreme Court has not ruled on the issue of whether the wrongful conduct rule still applied after the passage of MCL 600.2958. Until the Michigan Supreme Court unequivocally rules that MCL 600.2958 does not nullify the wrongful conduct rule, pharmacists should understand that their protection from liability for negligently prescribing drugs to addicts might be short lived. Pharmacists also must be cognizant that cases like Orzel protect them only from criminal drug seekers, not addicts who obtain narcotics through legal means. The best way to avoid civil liability (and potential criminal liability or administrative sanctions) is to follow the duty to dispense controlled substances in good faith under the Michigan Public Health Code.7
References: First, the suggestion that the absence of such a rule allows a plaintiff to “profit” from his wrongdoing is misguided; if a plaintiff is injured as the result of someone’s negligence, merely obtaining compensation for his loss does not constitute “profit.” Secondly, the idea that precluding personal injury suits by those who engage in criminal conduct serves as a deterrent to such conduct lacks credulity.
1. Tug Valley Pharmacy, LLC v. All Plaintiffs Below In Mingo County, 235 W.Va. 283, 773 S.E.2d 627, 2015. 2. Orzel by Orzel v. Scott Drug Co., 449 Mich. 550, 537 N.W.2d 208, 1995. 3. Burns, G., Gov. Rick Snyder: It’s Time to Address Michigan’s Pain Pill Problem, MLive, Oct. 26, 2015, Dickson, J.D., Heinlein, G., Calley: Fight Overdoses with Tighter Drug Monitoring, The Detroit News, Oct. 26, 2015 4. MCL 600.2958 5. Stolicker v. Kohl’s Dept. Stores, Inc., 2012 WL 676391, 2012. 6. Chorazyczewski v. Costco Wholesale Corp., 2015 WL 5780995, 2015. 7. MCL 333.7333; MCL 333.17751.
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2016 Jan./Feb./Mar. | Vol. 54, Issue 1
Don’t Overlook the
©iStockphoto.com/Jirsak
COVER YOUR ASSETS
Little Things By RON DEVERS, CIC, CPIA, manager, PSI Insurance Agency
As the calendar turns to a 2016, we find ourselves immersed in another winter. What plans do we have to make for the New Year and season to be prepared? Sometimes the greatest damage is caused by the little things that get overlooked. If you vacation to warmer climates during the winter or have rental or vacant properties, who do you have checking on the home regularly to avoid an unexpected and unnoticed claim? Water pipes can burst, particularly if there is a power outage, causing untold damage to property. If your stay away is extended, have you properly winterized your home, draining the pipes and making sure it is adequately insulated? Having someone check on the property on a regular basis will serve as a deterrent for vandalism as well because they will see that someone is regularly there. Ice dams can cause a great deal of damage to your home as well. Checking for proper insulation and ventilation will help the roof to properly melt ice and snow and avoid buildup of ice along the eaves. Not only will this provide protection to the roof and eaves, but it will prevent water from leaking into the attic and
ultimately into the dwelling. Often, undetected water leaks can cause more damage to walls, ceiling, carpeting and personal property by the time they are noticed. In addition, be sure to inspect your plumbing to make sure it is properly protected from the elements. Do you need to put heat tape or more insulation in particular areas of you home? Hopefully inspecting these areas before the weather turns bad will prevent any unexpected claims and damage. Beyond your property exposure, an annual review of your liability coverage would be a good action to take at the beginning of each year. What limits do you carry for medical payments to others? If you are found negligent, what limits of liability do you carry to pay judgments against you? Finally, who handles your life insurance? When was the last time you had your life and disability policies reviewed by an insurance professional? What do you want your policies to do for you and your family? Contact PSI Insurance Agency at (517) 484-1468 or Agency@PSIinsurance.net for help in these and other areas of your insurance program.
“Sometimes the greatest damage is caused by the little things that get overlooked.” MichiganPharmacists.org
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2016 Jan./Feb./Mar. | Vol. 54, Issue 1
THAT’S MY PHARMACIST
Campaign to Encompass Monthly Health Observances By AMANDA LICK, M.A., manager of advocacy, governmental and regulatory affairs, Michigan Pharmacists Association
In 2015, MPA launched the new and improved That’s My Pharmacist campaign. Materials were redesigned with the overall goal of improving quality and effectiveness. Last year’s campaign focused on these main points: • Redesign messages based on theory, considering source credibility • Consider audience literacy and health literacy. Pharmacies all across Michigan were engaged in the 2015 campaign. Those who participated were asked to complete a survey. Table 1 compares results of the followup surveys conducted for the 2014 and 2015 campaigns. Based on member feedback, we will making the That’s My Pharmacist Campaign a year-round campaign. Each month will focus on a specific health observance. MPA will provide a flyer for pharmacies to print off and display or make available to patients that is specific to the featured health observance for that month. Here is a list of the topics covered in the first quarter of 2016:
Table 1. Comparison of Survey Results for 2014 and 2015 Campaigns Number of participating pharmacies Respondent pharmacies that utilized medication cards Pharmacies that stated the campaign met or exceeded their expectations Pharmacies that would like to receive materials in the future
2014
2015
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37
JANUARY National Birth Defect Prevention Month
71 percent
77 percent
FEBRUARY American Heart Month
80 percent
100 percent
86 percent
100 percent
MichiganPharmacists.org
MARCH National Kidney Month Visit www.ThatsMyPharmacist.com to access a flyer for each of the observances above. Print off the flyer and share the key information included with your patients! The details included in these resources will help your patients further understand the importance of utilizing their pharmacist as a vital member of their personal health care team.
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2016 Jan./Feb./Mar. | Vol. 54, Issue 1
CONTINUING EDUCATION
Geriatric Care Considerations in the Community Pharmacy Setting By KATIE WENSTROM, Pharm.D., staff/clinical pharmacist, Meijer, and residency coordinator, Meijer/Pfizer/Ferris State University (FSU); TODD KENNEDY, Pharm.D., and BRIAN PALMER, 2016 Pharm.D. candidate, FSU College of Pharmacy ©iStockphoto.com/LiseGagne
Target Audience
This continuing education activity was designed specifically for pharmacists.
Disclosure Statement
The authors do not have any conflicts of interest, or financial relationships with a commercial interest, related to the activity.
Learning Objectives
At the end of this activity, participants should be able to: • identify three physiologic changes that occur in the elderly population. • review a patient’s medication list based on the Beers list criteria. • define polypharmacy and its implications in the community pharmacy setting.
As the population of the United States continues to grow, it is predicted that by 2030 more than 20 percent of the nation’s population will be comprised of people aged 65 or older (compared to 13 percent in 2010 and 9.8 percent in 1970).1,2 The life expectancy for elderly patients has increased over the years as well. At a patient’s 65th birthday, the median remaining life expectancy is 15-20 years.3 Due to many age and disease-related conditions, elderly patients are in need of special consideration when being treated with prescription and over-the-counter (OTC) medications. Age-related physiologic and pharmacokinetic changes can affect both a medication’s effectiveness and potential to cause adverse events, and certain prescription and OTC medications can cause or exacerbate adverse events in the elderly. Elderly patients tend to have more comorbid conditions, leading to an increased number of medications taken. This also increases the risk of adverse events due to duplication in therapy or unnecessary therapy. Due to the frequency and caliber of patient interactions available in the community pharmacy setting, community pharmacists have the ability to play an important and unique role in ensuring that their geriatric patients are being treated appropriately and impacting their overall quality of life.
References: Important Information Regarding Continuing Education Credit Due to the length of this continuing education article MPA has posted the complete article online. Upon completion of this activity, participants must complete an evaluation and posttest with a passing score of 70 percent on the MPA Web site at www.MichiganPharmacists.org/education/online. A failed test may be retaken only once without additional cost. There are no refunds for failed tests. If all requirements are met, participants will receive pharmacy continuing education (PCE) credit through CPE Monitor, a national, collaborative effort by ACPE and the National Association of Boards of Pharmacy (NABP) that went into effect on Jan. 1, 2013, to provide an electronic system for pharmacists and pharmacy technicians to track their completed PCE credits. MPA, as an ACPE-accredited provider, is required to report pharmacist and pharmacy technician PCE credit using this tracking system. Pharmacist and pharmacy technician participants must provide their NABP e-Profile identification number and date of birth (in MMDD format) when they register for a CPE activity or complete activity evaluations. It will be the responsibility of the participant to provide the correct information (i.e., e-Profile identification number and date of birth in MMDD format). If this information is not correctly provided, NABP and ACPE prohibit MPA from issuing CPE credit. Online access to their inventory of completed credits will allow pharmacists and pharmacy technicians to easily monitor their compliance with CPE requirements and print statements of credit. Therefore, MPA will not provide printed statements of credit to pharmacists and pharmacy technicians. Partial credit will not be awarded.
1. Ortman, J., Velkoff, V., Hogan, H., An Aging Nation: The Older Population in the United States, May 2014, https://www.Census.gov/ prod/2014pubs/p25-1140.pdf. 2. Mangoni, A., Jackson, S., Age-related Changes in Pharmacokinetics and Pharmacodynamics: Basic Principles and Practical Applications, British Journal of Clinical Pharmacology, 2003, Vol. 57, No. 2, pp. 6-14, www.NCBI.NLM.NIH.gov/pmc/ articles/PMC1884408/pdf/bcp0057-0006.pdf. 3. U.S. Department of Health & Human Services, Administration on Aging: The Older Population, 2014, www.AOA.gov/aging_statistics/Profile/2014/3.aspx
If you have yet to sign up for CPE Monitor, go to MyCPEMonitor.net. Please note that this activity is only accredited for pharmacists due to the topic discussed; therefore, Michigan Pharmacists Association is accredited by the pharmacy technician credit does not apply. For Accreditation Council for Pharmacy Education as a more home study activity options for pharmacists provider of continuing pharmacy education. Universal and pharmacy technicians, please visit www. Activity #0112-0000-15-008-H01-P. Initial Release MichiganPharmacists.org/education/online. Date: 1/5/16; Expiration Date: 1/5/19; 1.0 contact hour
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2016 Jan./Feb./Mar. | Vol. 54, Issue 1
Annual Meeting Honors Health-System Pharmacy Leaders and Highlights Unique Practice Topics The Michigan Society of Health-System Pharmacists (MSHP) held its Annual Meeting on Nov. 6 at the Somerset Inn in Troy. A variety of programming was offered, including a Keynote Session on the emerging role of pharmacists in transitions of care and support for their involvement. Other unique sessions focused on communicable disease outbreaks, game-changing publications in cardiology, infectious disease and critical care; building relationships in health care; antipsychotic medication use in transitions of care; and barriers of technician licensure. Beyond the traditional tracks, the event also offered programming for those who are interested in implementing a Postgraduate Year 1 or Postgraduate Year 2 residency program at their facility. Several student pharmacists also participated in a Clinical Skills Competition, a closed session during which they created a written pharmacist’s care plan. Congratulations to the winning team, Jake Chaffee and Emma Holmi from Ferris State University College of Pharmacy, and thank you to the other student participants: Kayla Popova and Allison Schepers from the University of Michigan and Alex Chaben and Alison Lobkovich from Wayne State University. In addition, residents, preceptors and residency directors were invited to attend a breakfast meeting where the topic of research projects, including study design, statistics, and data collection and analysis, were discussed. A Town Hall Meeting was held following the Keynote, where annual awards were presented, outgoing MSHP Board members and Committee chairs and co-chairs were honored, and incoming Board members were officially sworn into office. The following individuals were honored with MSHP awards. Visit www.MichiganPharmacists.org/ news and click on ‘MPA Press Releases’ in the right sidebar for more information on each of the award winners. Pharmacist of the Year – Mark Lutz: Mark was selected by the American Society of Health-System Pharmacists to serve on a four-member Steering Committee for the multifaceted quality improvement initiative, “Strategies for Ensuring the Safe Use of Insulin Pens in the Hospital.” He assisted in developing tools, conducting webinars and mentoring hospitals nationwide, and Mark continues to participate with ASHP in additional insulin pen safety initiatives. Joseph A. Oddis Leadership Award – David Bach: David has been active in MSHP and MPA since joining the Society in the 1980s. He currently represents healthsystem pharmacists on the MPA Executive Board and is a past president of MSHP, MichiganPharmacists.org
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Southeastern Michigan Society of Health-System Pharmacists and Wayne County Pharmacists Association. By providing time off and financial support, when possible, David has encouraged his staff to get involved in pharmacy organizations. President’s Award – Margo Farber: Margo was recognized for her dedication to advancing pharmacy practice, collaborating with other health care providers to improve patient outcomes, and serving as a mentor and preceptor for student pharmacists and residents. She inspires others with her ability to bring together various health care professionals, including physicians, nurses, pharmacists and pharmacy technicians, to work toward improving patient outcomes. Professional Practice Award – University of Michigan Health System Antimicrobial Stewardship Team: The team was recognized for piloting a program reviewing all positive blood cultures. Real-time pages were received following each gram-stain, organism identification and susceptibility over a three-month period. For patients deemed to have true bacteremia, the team reported significant improvements in time to appropriate therapy, which resulted in decreases in mortality, intensive care unit length of stay and recurrent bacteremia. An Exhibit Hall was also available for attendees to network with colleagues and vendors representing various companies. MSHP held an exhibitor challenge again this year, allowing any attendees who visited at least 10 exhibitors and had the representative at the booth sign their card to be entered into a drawing for various prizes. Arthur Sugarman was the winner of the grand prize, a Kindle Fire HD6. Other prizes were awarded to Kaitlin Baisden, Lauren Wolf, Sara Brown, Mary Kirbitz and Nan Kratovil. In addition, those who referred colleagues to attend the Annual Meeting were entered into a prize drawing. The winners were Hana Alaway, referred by Michelle Dehoorne-Smith. Lastly, new this year was the reverse exhibitor program, where registered exhibitor representatives had the opportunity to have one-on-one discussions with key pharmacy decision makers about their products and company information. Congratulations to all award and contest winners, and thank you to everyone who attended this year’s event! Photos are available on the MPA Web site at www.MichiganPharmacists.org/photos.
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Attend Upcoming Live Continuing Education Events in April! MPA currently has registration open for two live continuing education (CE) events in April 2016! Read more about these events below and visit the Web site links provided for the most up-to-date information and to register online to attend. Northern Michigan Pharmacy Education Seminar April 9-10, 2016 Shanty Creek Resorts, Bellaire Held each spring, the Northern Michigan Pharmacy Education Seminar provides pharmacists and pharmacy technicians with up-to-date information on medications, legislation affecting pharmacies, and other specialized topics. There is also an exhibit hall with designated hours during the seminar, allowing attendees the chance to network with pharmacy professionals. Online registration is available until 4:30 p.m. on Monday, April 4. Visit www. MichiganPharmacists.org/eventscalendar/nmpe040916 to register online. MPA Pharmacy Law and Policy Symposium April 27, 2016 Lansing Community College, West Campus, Lansing The MPA Pharmacy Law and Policy Symposium is intended to provide pharmacists, pharmacy technicians and student pharmacists with information on important legislative and regulatory changes that impact their profession. In the past, presentations have included Drug Enforcement Administration drug trends and diversion efforts, legislative priorities in Michigan, administrative rules and Michigan Medicaid priorities. In 2015, this event attracted a record attendance of 175 pharmacy professionals! Online registration is available until 4:30 p.m. on Wednesday, April 20. Visit www.MichiganPharmacists. org/eventscalendar/lawsymp042716 to register online.
Join the Conversation Use the following hashtags that are specifically designated for the events above in your Tweets, Facebook posts or Instagram photos. Encourage your colleagues to register, or, when you’re at the event, take photos and share them or provide feedback. Northern Michigan Pharmacy Education Seminar: #MPAnmpe MPA Pharmacy Law and Policy Symposium: #MPALawPolicy MichiganPharmacists.org
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2016 Jan./Feb./Mar. | Vol. 54, Issue 1
Assessments as a Professional Development Tool By ERIC ROATH, Pharm.D., director of professional practice, Michigan Pharmacists Association
One of the more popular components of the Michigan Pharmacy Foundation (MPF) Health Professional Leadership Academy (HPLA) is the use of various assessments as tools for professional growth. Academy participants complete the assessments, and then use the findings to develop an understanding of how personalities, leadership styles and tendencies effect the way they interact with those around them. Using this information, participants are better equipped to deal with the day-to-day challenges that all professionals face. Here are five assessments that you or your colleagues may find helpful in the pursuit of professional development:
DiSC Assessment This assessment tool groups personality traits into four broad categories: Dominance, Influence, Steadiness and Conscientiousness. Different iterations of the assessment may classify groups of certain traits slightly different; however, in general, the assessment evaluates individuals on two continuums: task oriented versus people oriented, and assertive (outgoing) versus passive (reserved). Many employers utilize the DiSC as a tool in hiring candidates with the thought that certain personalities may lend better to a given position. Proper application of the assessment teaches individuals how to deal with other personality types and how to be mindful of their own tendencies, particularly when under stress.
Myers-Briggs Type Indicator This assessment utilizes a questionnaire, much like the DiSC assessment, to group individuals into certain categories based on four distinct dichotomies that work together to form one’s personality and temperament. The dichotomies are Extraversion/Introversion, Sensing/ Intuition, Thinking/Feeling and Judging/Perceiving. This four-temperament model of personality is one of the more popular assessments, but critics of the assessment state that certain aspects of the test have shown weak validity, and that societal stereotypes and biases to factors such as gender may play too strong of a role in the determination of the testing results.
Social and Emotional Intelligence Although many people may loosely recognize the phrase “social/emotional intelligence,” relatively few have taken assessments to see how their “EQ” (as opposed to their “IQ”) has developed. An assessment by the Institute for Social +Emotional Intelligence (ISEI) utilizes a four-quadrant model for social/emotional intelligence. The assessment gauges self-awareness, self-management, awareness of others and relationship management. This assessment stands out, as it is less about grouping people into “styles,” but rather it focuses on key skill sets and personality characteristics that are essential to leadership MichiganPharmacists.org
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and cooperation in the workplace, including empathy, integrity, stress management, communication, interpersonal effectiveness, collaboration and conflict management.
Clifton Strengths Finder This assessment, which gained popularity following the publication of the 2001 book Strengths Finder by Marcus Buckingham and Donald Clifton, uses an Internet-based self-assessment to rate an individual’s proficiency in each of 34 distinct patterns. The application of this assessment is to encourage individuals to pursue their strengths, rather than accommodate for their weaknesses. Most of the criticism of this assessment comes from recognition that an individual’s weaknesses can be just as impactful as their strengths, with some critics noting that some strengths, when out of control, can actually become weaknesses.
Situational Leadership Situational leadership theory operates with the understanding that there is no single “best” style of leadership, but rather different situations lend better to different leadership styles. Four leadership styles identified by this model include “Telling,” “Selling,” “Participating” and “Delegating.” The application and effectiveness of a leader is affected by other variables such as maturity (of both the leader and of the group being led) and group competence and commitment. Utilizing a variety of these assessments can offer a leader, or group of leaders, a multi-layered, valuable perspective on their own tendencies in terms of how they deal with others. These tools are not without drawbacks, some of which have been noted in the description of each test. Perhaps the most significant weakness of assessments in general is that most of them are self-reported and, therefore, highly culpable to personal bias and heavily reliant on a strong sense of self awareness. One should also be wary of the tendency to label certain outcomes from each assessment as “good” or “bad,” but should instead look for positives and negatives associated with all outcomes. Remember, the assessments are not pass/fail, but rather they serve as a source of insight when used appropriately. 2016 Jan./Feb./Mar. | Vol. 54, Issue 1
©iStockphoto.com/SrdjanPav
LEADERSHIP FOCUS
FROM THE FOUNDATION
2015-2016 MPF Health Professional Leadership Academy The 2015-2016 class of the Michigan Pharmacy Foundation (MPF) Health Professional Leadership Academy began their year-long journey on Oct. 3, 2015, at the Michigan Pharmacists Association Headquarters in Lansing. This year’s class marks the first year that the program has been expanded to encompass a variety of health care professions beyond pharmacy. Meet the new class members below!
LAUREN ANDERSON
SARAH BARDEN
LINDSEY CLARK
TERRY GOTTSCHALL
Pharmacist, Walmart Pharmacy
Executive Fellow, Michigan Pharmacists Association and Pharmacy Services Inc.
Clinical Pharmacist, University of Michigan Health System
Anticoagulation Pharmacist, Henry Ford Hospital
MICHELLE IZOR
CARISSA JACOBS
BENJAMIN KORMAN
RETA MOURAD
Clinical Care Coordinator, Kroger Pharmacy
Postgraduate Year 1 Resident, Spectrum Health
Postgraduate Year 1 Resident, Diplomat Pharmacy
Clinical Pharmacist, Self-employed
KATHLEEN ROLLINGER
KRISTEN SCHAEFFLER
PATRICE SHOOK
ZACHARY SMITH
Physician, Beaumont Health System
Staff Pharmacist, University of Michigan Health System
Compliance Officer, Pharmacy Solutions
Clinical Pharmacist, Critical Care, Henry Ford Health System
ERIC SZYDLOWSKI
SARAH THOMAS
JASON THOMPSON
JASON WILLIAMSON
Executive Fellow, Michigan Pharmacists Association and Pharmacy Services Inc.
Postgraduate Year 1 Resident, Diplomat Specialty Pharmacy
Physician Assistant, Spectrum Health
Clinical Pharmacist, Genesys Regional Medical Center
CONGRATULATIONS TO THE 2014-2015 CLASS! Congratulations to graduates of the 2014-2015 MPF Leadership Academy! The class held their final workshop and received certificates honoring their graduation from the year-long program on Oct. 2, 2015. Pictured are: Back row (left to right) - Kimberly Moon, Jacob Holler, David Bright, Paul Miron, Thomas Bostwick and Hope Broxterman; Middle row (left to right) - Thanh Ta, Emily Brown, Mathew Jones, Jamie Tharp, Jon Rys, Nabeel Qureshi and Kanika Kapoor; Front row (left to right) - Amanda Moulton, Brittany Stewart, Sara Ogrin, Alexandra Lin and Ashley Builta. MichiganPharmacists.org
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2016 Jan./Feb./Mar. | Vol. 54, Issue 1
APP-EALING APPS ©iStockphoto.com/Logorilla
App-ealing Apps A little more than one-half of the American population owns a smart phone. Reliance on mobile applications has become common practice for both professional and personal use. Below are two highlighted applications: one that you may find useful in your role as a pharmacist, and one that you can share with patients or use yourself if you find it of interest!
PROFESSIONAL
PERSONAL
Epocrates
Any.do
The gold standard for mobile drug references, Epocrates is available at multiple price points to fit every budget. Review drug prescribing and safety information for thousands of brand, generic and over-the-counter medications. Drug information includes:
Any.do allows you to seamless organize everyday tasks, capture big projects and share lists with the people around you. Any.do seamlessly syncs between your mobile, desktop, web and tablet so you, and everyone around you, can access it from anywhere. Make every day a success with the following Any.do features:
• Adult and pediatric dosing for Food and Drug Administration (FDA)-approved and off-label indications • Black box warnings, contraindications, adverse reactions and drug interactions • Safety/monitoring, including pregnancy risk categories, location safety ratings, monitoring parameters and similar drug names
• Clean and smart design that keeps you focused on your goals for the day. • Collaborate with colleagues, friends, and spouses to get things done together. • Update grocery lists, chores and ‘Honey Do’ lists in realtime with your spouse and family. • Attach video, audio, photo and Dropbox files to any task. • Set recurring tasks for regularly scheduled to-dos.
• Pharmacology, including metabolism, excretion, subclass and mechanism of action
• Access all of your lists at home, at the office or on the go. Your Any.do stays perfectly synced across all your devices.
• Manufacturer, Drug Enforcement Administration/FDA status and approximate retail price
• Intuitive drag and drop, swipe to complete and shake to remove features help you organize and complete tasks faster. • Use voice entry to speak your tasks into a list, or type with the powerful auto-suggest feature.
The free version features drug information, an interaction check, pill ID functionality, a formulary, athenaText (secure text messaging designed for health care providers) and tables. In-app purchases offer you the opportunity to add essentials ($159.99), which are additional tools, or upgrade to Epocrates Plus for $174.99 per year. Epocrates Plus features additional information such as clinical practice guidelines, disease states, alternative medicine, ICD and CPT codes, infectious disease treatment and labs.
Any.do is free to download on your compatible device. You can upgrade to a pro subscription for $2.99 per month or $26.99 per year (regular price is $4.99 per month or $49.99 per year; the pricing indicated is a special launch price available for a limited time only). The premium version provides unlimited sharing and collaboration; 100 MB per file upload vs. the 1.5 MB offered by the free version; unlimited Any.do moments vs. the five moments per month offered by the free version; and multiple themes to personalize your app.
Compatibility: Web browser; iOS 7.0 or later for iPhone, iPad and iPod touch; and Android devices
Compatibility: Web browser; MAC computer; Google Chrome app; iOS 8.0 or later for iPhone, iPad and iPod touch; and Android devices
Web site: http://www.epocrates.com
Web site: http://www.any.do
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2016 Jan./Feb./Mar. | Vol. 54, Issue 1