North Carolina Pharmacist Spring Journal 2014

North Carolina

Pharmacist Vol. 94, Number 2

Advancing Pharmacy. Improving Health.

Spring 2014

The Changing Role of Pharmacy A look at three different practice settings and how they’re evolving to meet new challenges in healthcare.

Lori Cohn Edwards, PharmD, Clinical Pharmacist Practitioner (left) collaborates with Wynne Elizabeth Woodyear, MD at Cornerstone Health Care. Also featured: Moose Pharmacy and Cherokee Indian Hospital, page 6.

ntion Conve P A C :N he date 8, Raleigh Save t -2 Oct. 26

Official Journal of the North Carolina Association of Pharmacists 109 Church Street • Chapel Hill, NC 27516 800.852.7343 or 919.967.2237 fax 919.968.9430 www.ncpharmacists.org Like us on facebook: https://www.facebook.com/pages/North-Carolina-Associationof-Pharmacists/136657113055347?fref=ts Follow us on Twitter: NC Assoc of Pharm

JOURNAL STAFF

North Carolina

Pharmacist Vol. 94, No. 2

Spring 2014

Inside

EXECUTIVE EDITOR Daniel L. Barbara, Sr., MEd EDITOR/STAFF WRITER Sally J. Slusher, BA

BOARD OF DIRECTORS PRESIDENT Michelle Ames, PharmD PRESIDENT-ELECT Ashley Branham, PharmD PAST PRESIDENT Mary Parker, PharmD TREASURER Dennis Williams, PharmD BOARD MEMBERS Randy Angel, PharmD Andy Bowman, PharmD Paige Brown, PharmD Thomas D’Andrea, BS, MBA Stephen Dedrick, BS, MS Lisa Dinkins, PharmD Leigh Foushee, PharmD Ted Hancock, PharmD Jennie Hewitt, PharmD Debra Kemp, PharmD LeAnne Kennedy, PharmD Kim Nealy, PharmD Becky Szymanski, PharmD STAFF Linda Goswick Sandie Holley Teressa Reavis North Carolina Pharmacist (ISSN 0528-1725) is the official journal of the North Carolina Association of Pharmacists. An electronic version is published quarterly at 109 Church St., Chapel Hill, NC 27516.

The journal is provided to NCAP members through allocation of annual dues. Subscription rate to nonmembers is $40.00 annually. Opinions expressed in North Carolina Pharmacist are not necessarily official positions or policies of the Association. Publication of an advertisement does not represent an endorsement.

Nothing in this publication may be reproduced in any manner, either whole or in part, without specific written permission of the publisher.

• From the Executive Director............................................ 4 • From the President ........................................................ 5 • The Changing Role of Pharmacy: How Three Practices are Meeting New Challenges........ 6 • Chronic Care Practice Forum Meeting Recap................14 • National Report Suggests Medication Adherence in North Carolina Needs Improvement.......................... 16 • NCAP’s Wingate Chapter Strives to Serve the Profession..................................... 18 • New Practitioner Network: So You Didn’t Get Your Dream Job. Now What?.......... 20 NPN Member Spotlight...................................................21 • Award and Election Nominations Sought...................... 24 • Calendar....................................................................... 27 ______________________________________________

Stay In the Loop Connecting with our members is vital to the success of our association. We recently upgraded our database and ask that you take a minute to log on to our website at www.ncpharmacists.org and check your profile information.

If you need assistance please give us a call. We don’t want you to miss out on important information.

North Carolina Pharmacist, Spring 2014 3

From the Executive Director

As of the publication of this Spring edition of the NCAP journal, I have been with the organization for just over three months, and what a journey it has been thus far. Three months is precious little time in terms of the life cycle of an organization such as NCAP, an organization with a rich history and a diverse membership representative of the many different practice settings and roles of pharmacists throughout North Carolina, but the work we have accomplished in this short period of time has been substantial. A number of people, when introducing themselves to me, have remarked that I am “drinking from the proverbial fire hose” of new information at this point. That is an accurate statement with the exception of the word “proverbial.” I would have it no other way and enjoy the challenge of learning from all of you and representing your very broad interests and concerns and those of your patients.

Your Board of Directors and your staff here at NCAP are presently moving in many directions at the same time, focusing the many concerns of North Carolina pharmacy and the many educational programs designed to enhance the knowledge and skills of North Carolina pharmacists and pharmacy staff, as if through a precision lens with the purpose of crafting a succinct and precise public policy representative of North Carolina pharmacy. We endeavor to do this, as it is critical that pharmacy weighs in on (in a hard hitting manner and with unanimity of voice) the issues that directly affect pharmacy in NC. Provider status and the ability of pharmacists to practice at the top of their training and licensure, while being reimbursed for the care that they provide is a national issue, garnering much attention from the various national associations of which NCAP is a state affiliate. In partnering with these organizations and in listening to NC pharmacists, it is clear that NCAP must take a look at the issue of provider status and craft a uniquely North Carolina public policy addressing this issue. This is the topic of a taskforce established by the Board of Directors and headed by President-Elect Branham. It will also be a primary topic of dis4 North Carolina Pharmacist, Spring 2014

cussion at the Pharmacy Leader’s Forum sponsored by the Board of Pharmacy and scheduled for October 3, 2014. Dean Ragan of the new High Point University School of Pharmacy and I will be co-chairing the planning of the agenda for this important summit. It will also be a topic for education at the annual NCAP Convention in October. These are two of the many opportunities that members of NCAP, the faces of pharmacy in North Carolina, will have to weigh in on this issue and to define the shape of it and of the future of pharmacy in North Carolina.

To the end of ensuring that pharmacists have a strong and unified voice in shaping the future of health care in North Carolina and across the country, benefiting both their patients and their practices, it is of the utmost importance that you support and actively participate in your North Carolina Association of Pharmacists. Through concentrated efforts focused on becoming very visible to the pharmacy public, we are turning the corner on NCAP’s recent membership trends, but your continued advocacy with your fellow pharmacists represents the best advertisement for NCAP involvement. The greater the segment of pharmacy represented by NCAP, the greater the credibility of the organization when advocating for a strong public policy benefiting pharmacy and pharmacy patients.

I look forward to working with you and to hearing from you regarding the various issues important to your practice. I maintain an open door policy, and I mean it when I say that I would be very grateful for the opportunity to meet each and every one of you. I have traveled to many practice sites and have met with many of your colleagues within the last three months.

All invitations to visit your practice site are most welcome and will be met with a resounding yes.

Most sincerely,

Daniel “Dan” Barbara, Sr., M.Ed.

Executive Director

North Carolina Association of Pharmacists 109 Church Street Chapel Hill, NC 27516 phone: 919.967.2237 • fax: 919.968.9430

Greetings NCAP members!

The first quarter of 2014 has been a whirlwind around the NCAP office with plenty of hard work going on behind the scenes.

Provider Status continues to be a forefront issue arising in many of our ongoing discussions, spanning all practice settings. Keeping an eye on this topic on both a national and state level, the amount of activity occurring is exciting and encouraging. Last week my inbox received an email from Jay Campbell with a subject line of “Now this!” sharing the progress made in Wisconsin. On April 16, the Wisconsin Governor signed legislation stating “a pharmacist may perform any patient care service delegated to the pharmacist by a physician” authorizing physician–pharmacist collaboration in any patient care setting. Though only a few simple words, think about the promise offered in that short statement! North Carolina Pharmacists can only hope for the same support gained working hand-in-hand with the Wisconsin Medical Society, allowing unanimous support of the bill by the state legislature.

In order to make strides with Provider Status, involvement of the pharmacists residing in our state is critical to success. Ashley Branham, NCAP President-Elect, has been tasked with the creation of a Provider Status Task Force on a state level. The task force has a call out for volunteers willing to craft NCAP’s position on this topic, and then advance it to the forefront of our lobbying efforts. On a national level, pharmacists are encouraged to support APhA’s provider status efforts through the Pharmacists Provide Care campaign to achieve recognition for pharmacists’ patient care services. Please consider how you can contribute to pharmacy advancement efforts with so many levels of opportunity available for participation.

To highlight other happenings at NCAP: • The Education Committee is deep in planning for October’s Annual Convention. This year’s theme of “Pharmacy’s Modern Role in 2014” fits closely with the current focus of Provider Status.

• Members of the NCAP Board of Directors along with various Practice Forum and Committee Chairs are attending the AENC Legislative Reception in May. This now annual event offers us excellent opportunity for faceto-face time with not only our state legislators, but also other medical associations who can partner with us in advancing pharmacy provider status legislation.

• Our Executive Director Daniel Barbara has wasted no time settling into his new role within NCAP. He has made tremendous strides to network with many of the decision-makers who will impact the progression of pharmacy, in addition to working diligently on our membership. The importance of wide representation amongst pharmacists in North Carolina cannot be emphasized enough.

Sincererly, Michelle Ames, PharmD President Advancing Pharmacy. Improving Health.

North Carolina Pharmacist, Spring 2014 5

The Changing Role of Pharmacy

How three practices are meeting new challenges Compiled by Sally J. Slusher, Editor

The way Americans receive healthcare is rapidly changing, and pharmacy is set to play a vital role in how it evolves. With an aging number of baby boomers, the need to treat chronic conditions that require multiple medications will increase. Millions of people who were formerly uninsured are now receiving insurance through the Affordable Care Act, and primary care doctors are now in short supply. These issues are setting the stage for pharmacists to expand their role as key players in promoting wellness, managing disease and insuring medication compliance through close collaboration with other healthcare professionals.

This is the first in a series of articles 6 North Carolina Pharmacist, Spring 2014

that will focus on “The Changing Role of Pharmacy.� North Carolina Pharmacist is examining various practice settings across the state to learn how pharmacists are adapting to change and mastering new skills and technology to help usher in a new era of healthcare.

In this issue we take a look at a 22-bed Indian Health Services hospital tucked into the mountains of rural North Carolina, a cutting edge collaborative practice in the heart of the Piedmont and a generations-old community pharmacy in Concord. Each setting is different, yet each one offers personal attention and care to every patient and is taking a forward-thinking approach as they prepare for the expanded role of pharmacists and pharmacy technicians.

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A Clinical Pharmacist Practitioner on the cutting edge Lori Cohn Edwards, PharmD, CGP, CPP, FASCP, CIC Consultant Pharmacist, Neil Medical Group Clinical Pharmacist Practitioner, Cornerstone Clinical Pharmacy Services Tell us about your practice. What makes it unique and different from most others?

My practice is actually a combination of two positions: I am a Consultant Pharmacist with Neil Medical Group and

a Clinical Pharmacist Practitioner with Cornerstone Health Care’s Clinical Pharmacy Services Department. It is important to mention both of these because the two practices complement one another.

I have been a Consultant Pharmacist for nearly 20 years. As a consultant in long term care, I see a lot of medication challenges and issues surrounding the care of older patients. As a consultant I am responsible for reviewing and monitoring all aspects of a patient’s medication regimen. This includes medication use, nurse administration of medications, medication dosing, monitoring for efficacy and safety as well as analyzing lab data. These services are provided for all patients, regardless of their clinical complexity and length of stay in long term care.

Additionally I monitor the long term care facility’s compliance with CMS regulations related to medication use and pharmacy services. I serve as a drug information resource to other members of the team and provide education and training to nursing and medical staff. I also provide medication utilization reviews and report quarterly findings to the facility’s administrative staff and medical director.

My patient care responsibilities, clinical oversight and geriatric-based practice translated exceptionally well to my practice at Cornerstone Health Care. In addition to my responsibilities in the anticoagulation clinic, I provide referral based polypharmacy reviews. Most of my referrals come from behavioral medicine, primary care and neurology and sometimes simply by word of mouth. Most of the patients I see are elderly, have multiple providers and several medications and diagnoses. Often, I find the referring provider suspects a medication adverse effect is the cause of a patient’s problem, and not a new ailment or diagnosis. For polypharmacy reviews, patients are seen in an hour-long visit. The process includes making sure that the medications match the diagnoses, that there are no untreated or undertreated diagnoses, medication doses are appropriate given patient specifics, labs are being monitored and, adverse effects are reviewed. As a Certified Intrinsic Coach for health and wellness, I am also discussing, from a more philosophical viewpoint,

what is important to the patient when it comes to their health and medication use.

Often times these conversations uncover a hidden issue or impediment to compliance.

Issues like medication cost, high pill burdens, troublesome side effects and improper administration techniques are sometimes uncovered. Re-education and counseling are very helpful to improving their health literacy and understanding of their medications.

Effectively providing this service requires extensive preparation time before the appointment. After the visit, I document my assessment, recommendations and rationale and share the information with the referring provider through our electronic medical record. It is important to note that a polypharmacy review results in recommendations to the patient’s provider(s). Changes to the patient’s medications are made by the provider, usually

at a later appointment. Patients are given talking points to help guide that conversation and empower them in a world of medical speak and confusing information.

They also have electronic access to the plan through the patient portal, should they misplace their paperwork. These tools allow the patient and provider to begin on the same page.

The polypharmacy review process is almost identical to the reviews I provide in the long term care environment. My experience as a consulting pharmacist transitioned into a perfect fit for providing similar services at Cornerstone Health Care. Patients and their caregivers routinely share their delight at this extremely

detailed review and appreciate a discussion focused on their needs.

How do you work and interact with other healthcare providers?

At Neil Medical Group, I interact with nurses, physician assistants, nurse practitioners, and physicians usually via written or secure electronic communication or consults. If they are immediately available or there aren’t time constraints, I may discuss the concern face-to-face.

At Cornerstone, I can communicate with a patient’s provider via phone or secure communications in the electronic medical record. I interact directly with my supervising physicians by walking to their office, which is located in the same suite as my office. My preferred method of communication depends on the situation and degree of urgency.

How has what you do changed since you began practicing pharmacy?

When I first started as a consultant, pharmacy consults at times were ignored! Providers didn’t always realize the value of pharmacy services. Now the regulatory process has changed where the provider MUST respond and in a timely manner given the content of the consult.

Email and electronic medical records have significantly improved timely communications between disciplines.

I have also seen an expansion in the role of pharmacists to more of a clinical focus. Consultants are now writing consults citing evidencebased medicine, best practices for medication administration, following disease management/practice guidelines and instructing staff on proper administration techniques. Consultants are helping with anticoagulation, antibiotics and other medication dosing protocols.

When I was in pharmacy school, it was a dream of mine to fully utilize this highly specialized education. The academic requirements were rigorous with advanced chemistry, disease management and compounding classes. Clinical rotations often involved grand rounds, case studies and clinical projects. Many students went on to do residencies. Finally there are avenues of practice that will allow for much of that knowledge to be utilized if one chooses to do so. Practice sites like Neil Medical Group and Cornerstone are examples. I North Carolina Pharmacist, Spring 2014 7

am very fortunate to have found my niche in pharmacy. I have incredibly supportive managers at Neil Medical Group who serve as mentors in helping me cultivate my practice. Cornerstone Health Care’s management team was receptive to expanding my role based upon my consulting experience. Cornerstone Health Care has embraced the need for comprehensive pharmacy services as we make the transition to an accountable care model. The role of pharmacists within the organization continues to evolve and expand and provides a unique and exciting practice setting.

patient’s understanding of their health and possibly remove the need for a medication, this reduces cost. Many insurance companies presently provide patients with visits to see a dietitian to improve diabetes control through a healthier lifestyle. This is offered in hopes of providing education to the patient that will improve their understanding of diabetes and hopefully decrease medication costs as well as hospitalizations due to diabetic complications.

It seems logical then that seeing a pharmacist would have similar outcomes when it comes to medication regimens. __________________________________

What do you expect pharmacy to look like in 10, 20 years?

I see a very exciting future! I see the pharmacist collaborating with the other providers, each providing insight from their discipline and specialty to provide the best outcome for the patient. I see a fluid and dynamic model of healthcare providers around a patient, each one, including the pharmacist providing enhanced medical care tailored to the patient.

What does provider status mean to you?

To me, attaining provider status is like tying up a loose end. I think anyone would agree that pharmacists are healthcare providers. The difference between being a healthcare provider and having provider status comes down to reimbursement.

Under a fee-for-service model of care, reimbursement for pharmacy services is subject to strict limits. However, in a fee-for-value model, healthcare systems are reimbursed based on patient outcomes.

This setting provides an opportunity for pharmacists to practice in a collaborative role and contribute to patient care without the pressures of the fee-for-service model.

Regardless of the reimbursement structure, it is important that pharmacy services are recognized as a valuable component of patient care.

How will your job change if provider status is attained?

More patients would have access to the pharmacy service I provide. Therefore, my polypharmacy referrals would increase. As access improves, negative outcomes and costs of medication misadventures will decrease. There is plenty of evidence showing the financial benefits of pharmacist consultation in healthcare. By providing counseling that may improve a 8 North Carolina Pharmacist, Spring 2014

How a small, rural hospital is keeping pace

Elizabeth L. Helm, PharmD, BCPS, NCPS CDR USPHS Chief Pharmacist Cherokee Indian Hospital Tell us about your practice. What makes it unique and different from most others?

Our pharmacy is part of the Cherokee Indian Hospital. It is nestled near the southern entrance of the Great Smoky Mountains National Park in Western North Carolina. The pharmacy serves over 14,000 patients of the Eastern Band of Cherokee Indians and fills an average of 1000 scripts per day. Our pharmacy includes 10 pharmacists (from ten different states) and seven pharmacy technicians.

The diversity is something we are very

proud of. We have made several strides within the last two years to improve the lives of our patients. Pharmacists are present on our interdisciplinary teams for inpatient, chronic pain, hypertension, opiate replacement therapy, and healthy heart.

We practice the Patient Centered Medical Home (PCMH) approach to healthcare.

We still counsel EVERY patient on new medications and changes in medication regimens such as changes in dose or directions for use. We have also developed a Pharmacy & Therapeutics Finance Committee with the integration of pharmacy and finance in an effort to manage our formulary both for best efficacy and cost.

The Cherokee Indian Hospital, along with the Tribe and the Chief, has increased our community-wide commitment to vigilance in trying to reduce controlled substance abuse and responsibly prescribe to our patients.

Another interesting characteristic about our hospital… since pharmacists are uniquely qualified to create accurate, reproducible results, CDR Jonathan Dando, RPh, USPHS is our billing office manager.

“Who understands better than a pharmacist how to bridge the gap between clinical care and hard numbers? A pharmacist’s training and background allows pharmacists to become excellent system thinkers which will be critical in ACA implementation including accountable care organizations and population health. Pharmacists as providers will be a valuable step in providing high quality accessible care for patients in this new health care arena,” states CDR Dando.

How do you work and interact with other healthcare providers?

At Cherokee Indian Hospital, pharmacists have an unparalleled relationship with ALL other healthcare providers.

This relationship allows both world-class healthcare for our patients through integrated teams, and also a successful management of our formulary. Here we are

Mackensie Sawyer, CPhT, is one of seven technicians at the Cherokee Indian Hospital. All of their technicians are required to become certified within one year. Shown here is part of the newly opened expansion which took the pharmacy from 2,000 to 4,200 square feet.

looked upon as equals and are frequently sought out for our medication expertise.

Fifty percent of our pharmacists are BPScertified!

How has what you do changed since you began practicing pharmacy?

Since I have been practicing lots of things have changed in the world of pharmacy. One of the biggest changes is that there are no more paper charts in my world! This improves patient safety and allows for more efficient chart reviews and drug utilization evaluations. As the clinical pharmacy role continues to evolve, pharmacists have even more responsibility with approved local policies that allow us to adjust medications independently based on our assessments including renal dosing adjustments, pharmacokinetic adjustments, and of course anticoagulation therapy.

In the past 10 years, I have seen a refocus on patient education and compliance and a realization that with these, patient outcomes are improved, and healthcare costs can decrease significantly. Automation including barcoding technology and pharmacy robots now play a significant role in our pharmacy helping

The 22-bed Cherokee Indian Hospital also has nine outlying clinics.

Construction is under way on the mountain top behind the current facility where a new 50-bed hospital is scheduled to open in 2016.

North Carolina Pharmacist, Spring 2014 9

Lt. Chris McKnight, PharmD, utilizes one of the private consulting rooms in the newly renovated pharmacy facility.

to handle increased workload demands while dramatically improving safety and quality and decreasing wait times. It is with the help of automation that we can allow pharmacists out of the pharmacy and into the clinics.

A Cherokee alphabet eye chart.

10 North Carolina Pharmacist, Spring 2014

What do you expect pharmacy to look like in 10, 20 years?

I would expect improved health education on subjects like appropriate home treatment of certain illnesses and issues. Also, more adjustments and assessments made by pharmacists. “Drug decisions� may be made by pharmacists after provider diagnosis but the pharmacist would choose the most appropriate medication. There may be more case management, and pharmacogenomics would have a bigger impact. Hopefully,

there would be fewer drug shortages, and finally, provider status.

What does provider status mean to you?

Provider status means a validation of my education and as a member of the healthcare team. We are already using our expertise to improve healthcare outcomes by increasing accessibility and patient safety. This will ultimately lead to savings for our healthcare system. We should be acknowledged for this!

How will your job change if provider status is attained?

I would expect increased funding and patient access and improved outcomes and safety. There would also be increased responsibility, liability, and increased savings for the healthcare system.

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A community pharmacy that has been evolving for generations Joseph Moose, PharmD Co-proprieter, Moose Drug Concord, NC Ashley Branham, PharmD, BCACP Director of Clinical Services Moose Drug Tell us about your practice. What makes it unique and different from most others?

One-hundred and thirty-one years ago, A.W. Moose established A.W. Moose Drug Company. Four generations later, the business continues to exist as a trusted site for patients seeking personal attention and care. Our pharmacists focus on keeping people healthy, promoting better health and giving people the best treatment options. We are dedicated to providing the highest quality pharmacy service to our patients and strive for each patient’s visit to be even better than expected. The business exists to serve and care for patients and we have dedicated training, resources and commitment to areas of professional service, community service, patient care and educational development.

At Moose Pharmacy we take our commitment of improving patient health to a heightened level by not only offering traditional dispensing services, but also by helping patients find the best management strategies through specialized educational programs. Our pharmacists are trained extensively in medication therapy management to ensure that each patient is on the most cost-effective, appropriate medication regimen. To maintain a high level of accuracy, the pharmacy utilizes dispensing technology in the workflow to ensure the correct dose of medication is dispensed to the appropriate patient.

To further reduce medication errors, all medications are verified through a triple check systematic process. For patients with transportation barriers, we offer free same day delivery directly to a patient’s home. For patients faced with financial struggles affording medications, the pharmacy works with the patient to implement a flexible payment option to assist in timely access to their medications.

The Moose family opened their first pharmacy in 1882 and now have five locations. They offer compounding and a number of educational services including medication therapy management, natural hormone replacement consultations, immunizations, MTM reviews for Medicaid, hospice services, weight loss counseling, blood pressure, smoking cessation, diabetes screening and shoe fitting, OTC medicine education, osteoporosis education, both women’s and men’s health issues and asthma education.

North Carolina Pharmacist, Spring 2014 11

Additionally Moose Pharmacy offers vaccinations, compounding, and diabetes education. These many programs and clinical services demonstrate our commitment to the advancement of independent community pharmacy.

How do you work and interact with other healthcare providers?

Interacting with other healthcare providers is vital to be able to do the best job possible working with our patients.

There are many times when it is necessary to discuss complicated patients and figure out what functions we provide from a community pharmacy standpoint that will help in resolving a patient’s problem. We go to patients’ homes to conduct home visits, we speak with care managers to identify potential barriers for keeping patients adherent to optimal regimens, and we speak to providers to ensure we are supporting the patient-centered care plan. We have stepped outside our silo of pharmacy and we understand that we cannot help patients on our own. It takes a concerted effort among all healthcare providers to keep patients

on effective and appropriate medication regimens as they transition from different healthcare settings.

How has what you do changed since you began practicing pharmacy?

We are working with a variety of players in the healthcare team. In the past, it seemed the pharmacist interacted mostly with the patient and the patient’s prescribing physician. Now it is not uncommon to interact with other members of the care team including the care managers, payers, parish nurses, office nurses, home health, etc. We focus less on the number of prescriptions we fill and more on the total patient and capturing a patient from A-Z. We work more on trying to close the gaps in care that are causing increased cost and suboptimal outcomes.

What do you expect pharmacy to look like in 10, 20 years?

In the next 10 or 20 years, I expect the practice of pharmacy to divide into two segments: those who can provide prescriptions safely, accurately and quickly for the minimal cost, and those who maximize the

Clinical Pharmacist Erin Dalton, PharmD, and pharmacy owner Joe Moose, PharmD work together on adherence packs.

12 North Carolina Pharmacist, Spring 2014

value of the medicines that are being taken through medication optimization.

What does provider status mean to you?

Provider status would mean that we can maximize the multiple touches we have every month with our patients. It also means that we can have a line item justification of our touches and quality metrics and would not rely solely on the implied time saving that we give to those that can currently bill.

How will your job change if provider status is attained?

Our responsibility to ensure patient safety and appropriateness of medication regimens will not change. What will change is that we would have the opportunity to maximize each encounter with patients as an opportunity for education, identification of medication-related problems and work to resolve medicationrelated problems. __________________________________ The changing role of pharmacy is not something we are looking forward to in the future. The changes are happening now as these examples of innovative and collaborative practice settings demonstrate. NCAP is actively reaching out to current member and non-member pharmacists and pharmacy technicians in every corner of the state with an aim to unite, organize, and to both seek and provide support to make sure pharmacy’s new path accommodates all practice settings and allows pharmacists to maximize their skills to benefit patients. Public awareness is critical to our advancement, and it will take a strong and active association (representing all of pharmacy) to help educate the public with regard to the role of pharmacy. As a member of NCAP, there are two very important steps you can take to help shape the future of pharmacy.

First, reach out to your colleagues and invite them to join our association--there is strength in numbers. Second, reach out to your patients and educate them about the role you play in their overall healthcare team. Then, share your story. We’d like to hear what you’re doing to help shape the future of pharmacy. Visit our facebook page https://www.facebook.com/ pages/North-Carolina-Association-ofPharmacists/136657113055347 or email NCAP’s Executive Director, Dan Barbara at daniel@ncpharmacists.org

North Carolina Pharmacist, Spring 2014 13

NCAP Chronic Care Practice Forum Meeting NCAP’s 2014 Chronic Care Practice Forum meeting was held March 19-21 at the Ballantyne Hotel and Lodge in Charlotte, NC where pharmacy professionals from across the state gathered for outstanding speakers, networking and quality CE.

“Thank You” to our Sponsors and Exhibitors - Platinum Sponsors AbbVie Cardinal Health GeriMed Medical Learning Institute, Inc. AbbVie Cardinal Health GeriMed Lilly USA McKesson Corporation 14 North Carolina Pharmacist, Spring 2014

- Exhibitors -

MedCart Works Novartis Pharmaceuticals Sanofi Diabetes Smith and Nephew Smith Drug Company

The Dale Jones Memorial Award for Excellence in Geriatrics was presented to Jena Ivey Burkhart, PharmD, of Chapel Hill, NC. The award is named in honor of the late Dale Jones who was an active and long-time member of NCAP and is bestowed upon a member of the Association who has demonstrated an outstanding commitment to geriatrics and patient care during the course of the year. “It is an honor to receive the Dale Jones Award. I would like to thank NCAP as well as the Chronic Care Practice Forum Awards Committee. Dale Jones was such a wonderful role model, educator, and advocate for the health and well being of older patients. I hope to continue to strive to meet the needs of this special population throughout my career,� said Burkhart.

Burkhart received her Doctor of Pharmacy degree in 2004 from the UNC Eshelman School of Pharmacy where she is a Clinical Assistant Professor. She also serves as a Geriatric Clinical Pharmacist at UNC Hospitals and Clinics.

Dan Barbara, Judy Turnage, Michelle Ames, and Ted Hancock present the Dale Jones Award to recipient Jena Ivey Burkhart.

Kimberly Nealy, PharmD, and Amanda Lynn Perkins, PharmD Candidate, participate in a poster session.

Featured speaker Kelly W. Jones, PharmD. North Carolina Pharmacist, Spring 2014 15

National Report Suggests Medication Adherence in North Carolina Needs Improvement North Carolina Alliance for Healthy Communities Report on North Carolina Statewide Prescription Medication Adherence In the United States alone, prescription medication non-adherence is reported to result in up to 10% of all hospital admissions, 125,000 preventable deaths, and $290 billion in avoidable medical costs each year.

A recent national report on medication adherence in the United States suggested that North Carolina was reported to have a lower than expected medication adherence rate across managed health insurance plans, employer groups and Medicare members.

Medication and treatment non-adherence contributes to many continued health problems including a large number of hospital readmission rates (NEHI Issue Brief Oct.2012). This report provides an analysis of data collected through a larger epidemiologic study called the Behavioral Risk Factors Surveillance Study (BRFSS), run by the Center for Disease Control. This report, entitled “Report on North Carolina Statewide Prescription Medication Adherence” discusses the Behavioral Risk Factors associated with prescription medication adherence of 11,273 North Carolinians. The report can be found here http://www.ncahc.org/ncahc-brfss-adherencereport-2013.html.

Of the adults (aged 18 and over) that responded to the survey, 17 percent self-reported prescription non-adherence within the past year. The reasons for non-adherence varied with many contributing factors including race, gender, age, employment status, type and number of health conditions, perceived health status, and quality of life factors.

Here are just a few specifics revealed in the report: • Non-adherence was highest among individuals with multiple chronic conditions. 39% percent of respondents with three or more co-morbid conditions reported non-adherence with prescription medications over the past 12 months.

• Quality of life factors also strongly influenced medication adherence.

Adherence rates were much lower among respondents reporting poor mental or physical health, low life satisfaction, lack of social support or lack of adequate sleep.

• Health insurance coverage did not impact overall adherence rates; however the reasons for non-adherence varied greatly among the insured verses the uninsured.

• Hispanic women reported higher rates of non-adherence than other gender and ethnicity combinations.

• Black males cited the greatest number of barriers to adherence.

• Elderly adults had the highest adherence rates yet showed concern over side effects was a common reason for their non-adherence.

The following graphic demonstrates that the overall reasons for non-adherence were related to the value the patient respondent received from the product prescribed by their healthcare professional. This data suggests that within North Carolina, healthcare professionals, especially pharmacists have an opportunity to reinforce the value medications provide in the total treatment plan. One could also infer here that talking about potential side effects of the medication can help set a framework for positive outcomes through expectation management. Pharmacists possess a tremendous amount of knowledge that when offered openly can establish the value of the medicine and the role of the pharmacist as a critical player in the patient’s care team.

16 North Carolina Pharmacist, Spring 2014

Conclusions Medication adherence is an important health concern that warrants further evaluation in North Carolina. These factors vary greatly and help point to key demographic and other characteristics that may identify those individuals at greater risk for non-adherence among the population. The report stresses the need for healthcare providers and organizations to work together to better understand and address the barriers to medication and treatment adherence unique to each patient.

About NCAHC The North Carolina Alliance for Healthy Communities (www.ncahc.org) is a non-profit coalition made up of over 30 diverse organizations that collaborate on initiatives related to healthcare quality including medication and treatment adherence. The North Carolina Association of Pharmacists have been a long time member of the organization and NCAP members helped develop, design and contributed to the analysis of this report.

The organization continues its work to understand and address the problem of medication and treatment adherence since 2008.

NCAHC’s goal is to improve medication and treatment adherence by understanding and promoting awareness of this important healthcare issue and to serve as a resource for North Carolina’s healthcare providers, communities and consumers.

Copies of this report are available on the organizations website (http://www.ncahc.org/ncahc-brfss-adherence-report-2013.html) or contacting us via email at info@ncahc.org.

What is the BRFSS? The Behavioral Risk Factor Surveillance System (BRFSS) is a collaborative project of the Centers for Disease Control and Prevention (CDC) and U.S. states and territories. The BRFSS, administered and supported by CDC’s Behavioral Surveillance Branch, is an ongoing data collection program designed to measure behavioral risk factors for the adult population (18 years of age or older) living in households. The BRFSS originally initiated in 1984, with 15 states collecting surveillance data on risk behaviors through monthly telephone interviews. Over time, the number of states participating in the survey increased, so that by 2001, 50 states, the District of Columbia, Puerto Rico, Guam, and the Virgin Islands were participating in the BRFSS. The BRFSS objective is to collect uniform, state specific data on preventive health practices and risk behaviors that are linked to chronic diseases, injuries, and preventable infectious diseases that affect the adult population. Factors assessed by the BRFSS include tobacco use, health care coverage, HIV/AIDS knowledge and prevention, physical activity, and fruit and vegetable consumption. Data are collected from a random sample of adults (one per household) through a telephone survey.

North Carolina Pharmacist, Spring 2014 17

NCAP’s Wingate Chapter Strives to Serve the Profession

By Wingate School of Pharmacy Students Jared Frye, Kyle Hansen, Charleen Gnisci & Whitney Gibson

in “Operation Sandwich” where they prepare over one thousand peanut butter and jelly sandwiches to donate to local homeless residents. Additionally, the chapter works closely with Habitat for Humanity of Union and Mecklenburg counties, volunteering four times throughout the year. Habitat for Humanity takes the students outside of their comfort zones and involves them in the construction of sustainable and energy efficient homes for low income families.

The chapter’s Education Committee is extremely active. This committee focuses its efforts on planning and organizing health outreach events, specifically the

Monroe, NC where they taught seniors about ways to properly dispose of outdated medications. In addition, the chapter supported the educational outreach efforts The Wingate University School of of WUSOP’s Student Senate by particiPharmacy (WUSOP) chapter of the North pating in the semi-annual health fairs.

Carolina Association of Pharmacists is The fall health fair was held in November an organization composed of and led at the Men’s Shelter of Charlotte where by student pharmacists. Its goal is to the NCAP chapter distributed individual promote student leadership, community tissue packages to residents and eduservice, educational outreach, legislative cated them on prevention techniques and advocacy and professional development. self-care measures for colds. The spring Within the chapter, several committees health fair was held in March at the have been established to focus on these Western North Carolina Farmers’ Market efforts. The chapter is comprised of 141 in Asheville, NC. At this event, the new members, including students from both general medication counseling booth was the main campus in unveiled and over Wingate, NC and the 250 pill organizers satellite campus in were distributed to Hendersonville, NC. attendees.

Whether it is through The Professionlocal, state or national alization Committee level efforts, the NCAP works diligently each chapter at WUSOP semester to provide strives to serve the students with inforprofession and student mation on residency development in every preparation, pharpossible capacity. macy career paths, WUSOP’s NCAP and the future of chapter meets monthly pharmacy. This past to discuss upcoming fall, the Professionchapter events and alization Committee emerging opportunities recruited faculty to available for student provide students with pharmacists. Chapter the opportunity to meetings customarparticipate in mock ily provide student interviews tailored development programto students’ profesming led by students, sional interests. For faculty or invited guest Students in Wingate’s NCAP Chapter prepare and donate sandwiches twice each example, if a student semester to local homeless residents. speakers that includes was interested in current topics in pharretail pharmacy, the macy. In April, Daniel Barbara, Executive treatment and prevention of sun-related interview was conducted from the perDirector of NCAP, and Ashley Branham, issues in the spring and influenza in the spective of a community pharmacy hiring President-Elect of NCAP attended and fall. It also promotes proper medicaprocess. In April, this committee also discussed the ever-changing healthcare tion disposal and has recently developed worked with other student organizations system and the emerging roles of pharmacy a community education booth focusing at Wingate to host a local residency panel care in this new landscape. The meeting on general medication counseling such and showcase that included directors and concluded with a brainstorming session to as storage, compliance, and medication current residents from several programs increase the association’s involvement with safety. In October, the Education Comin North Carolina. The panel presented student pharmacists in North Carolina. mittee held an event at a Wingate Univermany perspectives on preparing and apWingate’s NCAP chapter strives for sity football game where they educated plying for residency programs as well as excellence through community service efover 300 people about the importance of considerations during residency training. forts. The Volunteerism Committee suphygiene and vaccinations in flu prevenWingate’s NCAP chapter also has a ports the Urban Ministries of Charlotte tion. They also hosted programming Government Affairs committee which by participating two times each semester at the Ellen Fitzgerald Senior Center in works to keep the chapter updated on 18 North Carolina Pharmacist, Spring 2014

healthcare-related bills.

Operation Christmas Child to be distribpharmacy political happenings and Wingate is fortunate to have fourteen uted to children in need. It is estimated encourage advocacy among chapter active members at the satellite campus in that the Hendersonville campus provided members. In March, Heidi Ecker, the Hendersonville who promote the profesover $250 to the charity in its efforts.

National Association of Chain Drug sion of pharmacy in western North CaroThe Hendersonville students also planned Stores (NACDS) Director of Government lina. In the fall semester, the students a community health outreach event at the Affairs & Grassroots Programming, spoke Western North Carolina about grassroots advocacy Multiple Sclerosis Walk and how students can be in Fletcher, NC. In adinvolved at both the state and dition to establishing a national level. Over the past team to walk and raise three years, the chapter has awareness for Multiple also sent several students to Sclerosis, they served as RxIMPACT in Washington, an exhibitor at the event D.C. RxIMPACT, sponsored to provide health informaby NACDS, is an event tion to the public. that hosts pharmacists and student pharmacists from The Wingate NCAP across the US to educate chapter has had a sucmembers of Congress on the cessful year providing importance of pro-pharmacy assistance, education, and awareness to the public policy and the need for quality healthcare reform. The as well as increasing the competence and involvecommittee also organizes efHealth Fair participation is part of the Chapter’s community outreach. ment of its members. forts to attend NCAP’s PharThey plan to grow as a macy Day in the Legislature chapter over the next year and increase in Raleigh, NC every other year. Students in Hendersonville assembled shoeboxes the outreach to the community, state, and are able to meet with their representatives filled with toys, candy, and many esto discuss and support active pharmacy or sential goods, which were donated to profession as a whole. v

North Carolina Pharmacist, Spring 2014 19

New Practitioner Network

So you didn’t get your dream job, now what?

By Holly Causey, PharmD, Kim Nealy, PharmD, & Beth Wilson, PharmD

As new practitioners, so many things lie within us – the past and the future, successes and failures, obstacles and triumphs.

It can be discouraging for new practitioners who may not have landed their dream job following the completion of their training.

Although your current position may not be the one you’d hoped for, it’s in your best interest to treat every job as your dream job.

A mentor once said that you could find your niche in pharmacy based upon your enthusiasm when you wake up every morning. Being a new practitioner has its up and downs. Occasionally your enthusiasm will be challenged and require you to put forth quite a bit of effort.

When work becomes challenging, consider the cliché “when life gives you lemons...” Find a mentor to guide you. Invest yourself in your work and your coworkers – participate in a work culture committee, become a team captain for your work’s 5K race, champion the annual cookout or clothing sale. Additionally, learn to delicately say “no” to additional projects when appropriate. While initially challenging, your mentors, coworkers, and supervisor will help you prioritize.

Obtaining an unexpected job after completing your training may create mixed emotions. Remaining optimistic, humble and eager to learn can result in an enjoyable and productive experi-

ence. In doing this, you will take advantage of all the opportunities available in your current job, be it your dream job or not.

Careful reflection when contemplating change is paramount.

Consider composing a list of your short and long-term career goals. In The 7 Habits of Highly Effective People, Stephen R. Covey recommends drafting a copy of your eulogy to help you envision how you would like your life to look in hindsight. This may also help to refine the concept of your dream job, guiding you on a search for opportunities that will help to achieve these goals. Ultimately, you may decide that this position will not allow you to reach your goals and a career change is necessary.

Making the transition may be difficult, especially for a new practitioner. If you leave soon after starting a position, it may leave employers and colleagues feeling abandoned or let down.

Giving ample time for them to find a replacement, wrapping up all pending projects or assignments, doing all final work with high standards, and even offering to assist with transitioning your replacement into their new position may help them better cope with your departure. If possible, fulfill contract terms. These efforts will go a long way in helping you maintain healthy relationships after you leave the organization. Pharmacy is a small world, so avoid burning bridges when possible. Many mentors recommend a commitment of at least one to two years in your first position before moving on to the next job. However, each situation is unique. If your dream job is incredibly specialized, you may need to seize the moment if an opening becomes available. Maintaining open communication about your professional goals with leaders at your organization may help them understand your future career decisions.

Although your first job out of training may not be what you expect, it will not define the rest of your career. By staying positive and enthusiastic, you can find ways to make it fulfilling and help you grow professionally. While you may not stay in the position for the rest of your career, it will likely give you insight and experience that will be beneficial when you do land that “dream job.” v References:

Covey SR. The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change. New York: Simon & Schuster; 1989, 2004.

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New Practitioner Network Member Spotlight: Stephanie Z. Kujawski, PharmD, BCPS Stephanie Kujawski received her PharmD from the UNC Eshelman School of Pharmacy in 2011 and completed her PGY1 residency training at Mission Hospitals in Asheville, NC in 2012. Upon completion of her residency, she remained with Mission Hospitals where she now serves as Adult Medicine Clinical Faculty and Assistant Professor of Clinical Education with the UNC Eshelman School of Pharmacy.

Mission Hospital is an 800-bed community teaching hospital, which houses 4-PGY1 residencies, a two-year Master of Healthcare Administration residency program, and a PGY2 in Emergency Medicine. In her current role, she is embedded on a general adult medicine floor where she attends daily multidisciplinary rounds, completes antibiotic and anticoagulation dosing consults, and provides discharge education. She is also responsible for coordinating and precepting the introductory and advanced hospital rotations for first and fourth-year students for the UNC Eshelman School of Pharmacy. In 2013, Stephanie was awarded both the Mission Hospitals Pharmacist of the Year and MAHEC Preceptor of the Year for her outstanding clinical and educational practice.

As a student, she joined NCAP because, “I was interested in the exposure to practices offered by NCAP. However, as a clinician, I remain involved because NCAP serves as a voice for pharmacists across the state. It’s important that we have an established avenue not only for networking and exchanging ideas but also for assembling support and advocacy.” To fellow new practitioners, she offers this piece of advice: “Be flexible! Healthcare is rapidly changing, and being willing and able to adapt your responsibilities and focus areas to meet the needs of both the patients and the system is imperative.”

North Carolina Pharmacist, Spring 2014 21

Online Offerings: Pharmacist Refresher Course and QA/Law Course 22 North Carolina Pharmacist, Spring 2014

NCAP has partnered with the Connecticut Pharmacy Association to offer The Pharmacist Refresher Course, an online course designed for pharmacists who wish to return to community pharmacy practice after an absence from practice for three or more years. The course consists of three modules, all of which have been approved for ACPE credits. The first two modules are online and composed of weekly study segments that allow course participants to work at their own pace, on their own time. The third module consists of a threeweek, 90-hour live experience in a community pharmacy. Only those who participate in all three modules will earn a Pharmacist Refresher Course Certificate from Charter Oak State College. Those taking modules One and/or Two for personal enrichment will earn ACPE credits through CPA. This course will give home study law credit to any pharmacist wanting to learn about quality assurance strategies and North Carolina’s pharmacy laws.

The QA/Law Course can be used to prepare for reciprocity into North Carolina, or for those who want an update on Pharmacy Law and Quality Assurance. Students must follow a two-week course schedule. Online discussion boards and instructor monitoring and interaction keep you on track throughout the course.

The course is offered the first two full weeks of every month.

This course is accredited by ACPE for 15 hours of home study law education.

For more information visit www.ncpharmacists.org

North Carolina Pharmacist, Spring 2014 23

Candidates Sought for NCAP Election, Awards Election

Deadline for candidates to enter: June 1, 2014 NCAP Board of Directors NCAP will elect a President-Elect (to serve as President in 2016, 3-year term), a Treasurer (3-year term) and three At-large Board Members (3-year terms). Please send your bio to Mary Parker, Past President of NCAP: mhpandcbp@mac.com Health-System Practice Forum The Practice Forum will elect a ChairElect (3-year term), three Executive Committee members (3-year terms) and one Delegate to ASHP (3-year term). Please send your bio to Becky Szymanski, Chair: becky.szymanski@carolinashealthcare.org Chronic Care Practice Forum The Practice Forum will elect a ChairElect (3-year term) and four Executive Committee members (3-year terms).

Please send your bio to Ted Hancock, Chair: thancock@wilmingtonhealth.com Community Care Practice Forum The Practice Forum will elect a ChairElect (3-year term) and one Executive Committee member (3-year term). Please send bio to Lisa Dinkins, Chair of the Practice Forum (lisa.dinkins@gmail.com).

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Awards

Deadline for Nominations: June 1, 2014 It is a privilege for the North Carolina Association of Pharmacists to recognize excellence within the profession. NCAP will present the following awards at the Convention, October 26-28, 2014 in Raleigh, NC. The Board of Directors invites NCAP members to nominate deserving members for these awards. Nominations must be in writing (see nominations on the website www.ncpharmacists.org or you may request from Linda Goswick).

Submit nominations to the NCAP Awards Committee, c/o Linda Goswick, 109 Church Street, Chapel Hill, NC 27516 (FAX 919-968-9430 or e-mail linda@ ncpharmacists.org). Past nominations must be resubmitted to be considered.

Bowl of Hygeia Award (sponsored by American Pharmacists Association and National Alliance of State Pharmacy Associations): Criteria for this award are: (1) Licensed to practice pharmacy in NC; (2) Has not previously received the Award; (3) Is not currently serving nor has he/ she served within the immediate past two years on its awards committee or as an officer of the Association in other than an ex officio capacity; (4) Has compiled an

outstanding record of community service, which, apart from his/her specific identification as a pharmacist, reflects well on the profession.

Cardinal Health Foundation Rx Champions Award: This award recognizes a pharmacist for his/her work within the pharmacy community to raise awareness of the serious public health problem of prescription drug abuse.

Don Blanton Award: Presented to the pharmacist who has contributed most to the advancement of pharmacy in North Carolina during the past year. This award was established by Charles Blanton in memory of his father, Don Blanton, who served the North Carolina Pharmaceutical Association as President 1957-58.

Excellence in Innovation Award (sponsored by Upsher-Smith Laboratories): Presented to a pharmacist practicing in North Carolina who has demonstrated Innovative Pharmacy Practice resulting in improved patient care.

Distinguished Young Pharmacist Award (sponsored by Pharmacists Mutual Companies): Criteria for this award are: (1) Entry degree in pharmacy received less than 10 years ago (2004 or later graduation date); (2) Licensed to practice pharmacy in NC; (3) Actively practices retail, institutional, managed care or consulting pharmacy; (4) Participates in national pharmacy associations, professional programs, state association activities and/or community service. Please send nominations for this award to Kim Nealy, Chair of the New Practitioner Network (k.nealy@ wingate.edu).

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NCAP CALENDAR 7/17/14 NCAP Board of Directors Meeting, Institute of Pharmacy, Chapel Hill, NC 7/18/14 NCAP Residency Conference, Greensboro, NC 9/18/14 NCAP Board of Directors Meeting, Institute of Pharmacy, Chapel Hill, NC 9/20/14 Student Leadership Conference, Pinehurst, NC 10/26-28/14 NCAP Annual Convention, Raleigh Convention Center, Raleigh, NC 3/34/15 Chronic Care Practice Forum Meeting, Greensboro Sheraton, Greensboro, NC For more information visit www.ncpharmacists.org

e-Prescribing PEER Portal is open for business!

The Pharmacy and Provider e-Prescribing Experience Reporting Portal and instructions on how to report can be found at: https://www.pqc.net/eprescribe

Help us save lives‌ Report eRx problems TODAY! North Carolina Pharmacist, Spring 2014 27

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