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Vol 15 No. 3 Summer 2018

Summer 2018

PHARMACY JOURNAL OF NEW ENGLAND

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WHERE DO YOU SEE YOURSELF IN 5 YEARS?

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INSIDE Registration Brochure for the 2018 New England Pharmacists Convention

PAGE 2 The Value of Residencies & Fellowships

PAGE 31 The Power of Networking


Pharmacy

Tomorrow. Imagine That.

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PHARMACY JOURNAL OF NEW ENGLAND Where Do You See Your Career Going? Dear Readers, When you decided to pursue a career in the pharmacy profession, you most likely asked yourself over and over again, “What practice setting do I see myself working in?” From the community chain or independent setting to the hospital setting to the long-term care setting, pharmacists can choose from a variety of career paths. For many pharmacists throughout New England, staying in one practice setting is not the reality today. As umbrella organizations that serve pharmacists in all practice settings, our state associations have seen many of its members change their career paths multiple times—and heard their stories of setbacks and success. That’s why we are excited to share these stories in the summer issue of PJNE, which is all about pharmacy careers as well as the value of residencies and fellowships. At the core of this issue are the results of a job satisfaction survey that PJNE created as a way for pharmacists across the region to share their insight about their own career path, so other pharmacists who are seeking a career change can get all the information they need before deciding where they want to go next. The possibilities are endless, and we hope to be at the forefront of making these career possibilities available to pharmacists. As this issue marks the beginning of an entire journal redesign, we would like to thank all pharmacists, residents and fellows who took the time to answer our questions about their career experiences. We hope their insight will help guide you through that next journey in the pharmacy profession. Sincerely,

Vol 15 No. 3 Pharmacy Journal of New England • Summer 2018

Editors

Lindsay De Santis Margherita R. Giuliano, R.Ph., CAE

Design & Production Kathy Harvey-Ellis

The Pharmacy Journal of New England is owned and published by the Massachusetts Pharmacists Association and the Connecticut Pharmacists Association. Opinions expressed by those of the editorial staff and/or contributors do not necessarily reflect the views or policies of the publisher. Readers are invited to submit their comments and opinions for publication. Letters should be addressed to the Editor and must be signed with a return address. For rates and deadlines, contact the Journal at (860) 563-4619. Pharmacy Journal of New England 35 Cold Spring Road, Suite 121 Rocky Hill, CT 06067-3167 members@ctpharmacists.org

Submitting Articles to the Pharmacy Journal of New England™ The Pharmacy Journal of New England™ is the product of a partnership between the Connecticut Pharmacists Association and the Massachusetts Pharmacists Association. The Journal is a quarterly publication. All submitted articles are subject to peer review. In order to maintain confidentiality, authors’ names are removed during the review process. Article requirements must conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (Ann Intern Med 1982;96 (1part1):766-71). We strongly encourage electronic submissions. PJNE does not assume any responsibility for statements made by authors.

Please submit manuscripts to: PJNE 35 Cold Spring Rd., Suite 121 Rocky Hill, CT 06067 or email to: lcapobianco@ctpharmacists.org

Lindsay De Santis Executive Vice President Massachusetts Pharmacists Association

Contents:

Margherita R. Giuliano, RPh Executive Vice President Connecticut Pharmacists Association

2 01 Residencies 9 What about Fellowships? 15 New England Pharmacists Convention Brochure 23 Feature: Job Satisfaction by the Numbers 33 Health & Wellness: Suicide 35 Study: Innovations in Practice 1


Residencies Total Matches - 2018

50 40 30 20 10

M U C SJ PH M SU C N PH Wo E rc Se M an ste ch r es te r H us so n

U R I A lb PH an S y Bo st on W N E M C

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HOW DOES YOUR SCHOOL MEASURE UP?

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0

Student Match Percentage

100% 75% 50% 25%

UNC Eshelman School of Pharmacy, Chapel Hill NC University of Florida, Gainesville FL University of California, San Francisco CA University of Tennessee, Memphis TN University of Kentucky, Lexington KY

UNC - Chapel Hill 83%

Match Rate

2

W N E M C U P SJ M HS C PH -W UN E S- or M ce an ste ch r es te r H us so n

Rank 1. Rank 2. Rank 3. Rank 4. Rank 5.

U M R C PH Alb I an S Bo y st on

N or th ea st er n U co nn

0%

86

Matches

University of Florida 70% 102 Match Rate

Matches

Rank 21. Rank 29. Rank 38. Rank 40. Rank 62. Rank 85. Rank 102. Rank 109. Rank 119. Rank 126. Rank 128.

Northeastern University, Boston MA University of Connecticut, Storrs CT University of Rhode Island, Kingston RI Albany College of Pharmacy, Albany NY Massachusetts College of Pharmacy and Health Sciences, Boston MA Western New England University, Springfield MA University of St. Joseph School of Pharmacy, Hartford CT University of New England College of Pharmacy, Portland ME Massachusetts College of Pharmacy and Health Sciences, Worcester MA Massachusetts College of Pharmacy and Health Sciences, Manchester NH Husson University School of Pharmacy, Bangor ME


Pharmacy Journal of New England • Summer 2018

2018 Match Statistics 63%

26

National Average Residency Match Rate

National Average Number of Students Matched

Northeastern 70% 48 Match Rate

Matches

USJ 12

57% Match Rate

Matches

UConn 77% 37 Match Rate Matches

UNE 42% 15 Match Rate Matches

URI 71% 35 Match Rate Matches

MCPHS - Worcester 28% 16 Match Rate Matches

MCPHS - Boston 46% 34 Match Rate Matches

MCPHS - Manchester 100% 3 Match Rate Matches

WNE 65% 15

Husson University 56% 5

Match Rate

Match Rate

Matches

Matches

Albany College of Pharmacy 62% 25 Match Rate

Matches

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Residencies

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A Day in the Life of a Pharmacy Resident As residencies become more and more popular, there is increasing pressure on pharmacy students to decide whether or not they want to pursue them. In turn, many questions arise from the students, and they often seek help from those who have completed a residency. Gabriella Salerno, a rising PharmD student at Campbell University in Buies Creek, North Carolina, recently sat down with clinical pharmacist Alexia Sroka to learn more about the value of completing a residency. Alexia is a clinical pharmacist who completed a Pharmacy Practice Residency (PGY-1) at the Greater Lawrence Family Health Center (GLFHC)/MCPHS University. Immediately after her residency, Alexia joined the GLFHC ambulatory clinical pharmacy team. Her area of practice is broad, but includes anticoagulation, latent tuberculosis, and chronic disease state management. She also has experience precepting advanced pharmacy practice interns, pharmacy residents, medical residents, medical and nursing students, and other colleagues at both GLFHC and as an adjunct faculty member at MCPHS University. Alexia received her Doctor of Pharmacy degree from MCPHS University in Worcester, MA. Gabriella: What made you decide to pursue a residency?

You will have to think of the ends and the type of work you enjoy. Gabriella: What apprehensions did you have about applying for a residency? Alexia: I would not say I had apprehensions, but rather logistics to consider. Regardless of your perspective, residency is a time commitment. Like most past and prospective residents, I had to consider my willingness to relocate, goals and interests. Ultimately, I felt that the positive long-term impact the application, interview, and match process would have on me, regardless of the outcome, was worth any fleeting thoughts of reluctance. Gabriella: Would you say your residency helped your career path you’re on now? Alexia: Absolutely. I am fortunate that I get to continue to practice where I did my residency training. I still see some of the same patients I met during my first few months. In addition to congruent patient care, I have been able to participate in the training of other residents now acting as Residency Program Coordinator. Ultimately, residency facilitated a smoother transition as I moved from intern to practicing pharmacist. The variety of experiences I was given across a health center and academia developed my clinical competence and affirmed that the work I was doing was meaningful to me and those around me.

Alexia: Prior to my first advanced pharmacy practice experience, I was not sure what residency training was. After participating in direct patient care activities and working on a publication while on rotation, I felt challenged, yet fulfilled. After determining the ambulatory care arena was where I wanted to focus my interest, I saw residency training as a career entry point. I pursued residency with intentions to apply knowledge to become a proficient clinical pharmacist. For those asking themselves the same question, “Why a residency,” I can say that my experience facilitated the growth I sought. My advice is to recognize that the path to residency is individualized, but knowing your reasons for pursuing one is a necessary point of self-reflection. The same is true once you decide a residency is for you—not all programs will fit your needs and vice versa. Above, from L to R: Gabriella Salerno and Alexia Sroka, BA, PharmD, BCPS stand in front of GLFHC.

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Pharmacy Journal of New England • Summer 2018

Gabriella: What level of independence did you reach with patients while doing your PGY-1 residency?

all skills I got to use and develop throughout my residency and continue to develop as a practicing pharmacist.

Alexia: I felt my professional development was synonymous with the independence I received. In hindsight, I wish I recognized that asking for help, after doing diligent research of course, would not compromise my independence. Independence is a mindset. Drafting assessments and plans on your own is thinking independently. Acting quickly, accurately, and decisively is practicing independently. Those were

Gabriella: What advice do you have for a student pharmacist or practicing pharmacist who is interested in pursuing a PGY-1 residency? Alexia: Seek the advice of others, but stay true to your personal goals and aspirations.

On behalf of all pharmacy students considering a residency, Gabriella (left) would like to thank Alexia Sroka, BA, PharmD, BCPS (right), for her help with this interview and for her great advice!

A New Residency Program is Coming Near You! As obtaining a residency has become an extremely competitive process, more available programs are needed to meet the demand. Early last year, the University of Saint Joseph School (USJ) of Pharmacy and Middlesex Hospital Department of Pharmacy teamed up to develop an ASHP-accredited PGY-1 residency program. USJ’s Assistant Professor of Pharmacy Practice & Administration, Lisa DeGennaro, PharmD, CDE, has played a lead role in the development of this new residency

program, which is expected to begin on July 1, 2019. Check out PJNE’s interview with Dr. DeGennaro, who gave us a sneak peak into the program. PJNE: At what point did USJ decide to collaborate with Middlesex Hospital to develop an ASHP-accredited PGY-1 residency program? Explain the need to offer a program like this to pharmacy school graduates. Lisa: The strategic plan of the University of Saint Joseph School of Pharmacy has included the development of postgraduate training opportunities as a key priority. It was important to the School of Pharmacy to focus the efforts of

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residency program development within areas where a current program did not exist. Early last year, the Middlesex Hospital Department of Pharmacy and the USJ School of Pharmacy began a collaboration to develop an ASHP-accredited PGY-1 residency program. Obtaining a residency is an extremely competitive process. There are currently not enough programs available to meet the demand. We are excited to be able to offer a new residency opportunity for pharmacy school graduates. PJNE: Explain some advantages of completing a residency. What job opportunities are available for residents after completion of a residency? Lisa: A residency allows pharmacy school graduates to apply the knowledge learned in the classroom to real-life patients in order to optimize patient care outcomes. Residents develop clinical skills and competence through experience in a variety of pharmacy practice settings. They are mentored by model pharmacy practitioners and gain confidence as a valuable member of the healthcare team. A residency also provides networking opportunities and a helps a resident define which career path or practice area to pursue. In addition, completion of a residency provides a competitive advantage for many employment opportunities. The majority of healthcare systems prefer to hire residency-trained pharmacists for direct patient care roles. PJNE: Describe the process involved with developing this ASHP-accredited program. Lisa: The first step was to define the primary purpose of the residency program. The next step focused on the program design, such as the types and length of learning experiences to be offered. Our collaborative group then worked to associate each learning experience with a set of learning objectives. Identification of preceptors will follow, along with what the preceptor training and continual development plan will look like. Another major focus for us will be the creation of the residency training manual, which includes the specifics of program design, select important policies and responsibilities of the resident. Finally, on to recruitment! PJNE: What will be the structure of this residency 6

program? Lisa: The structure is still being defined, but will include required four-week rotations, a choice of elective rotations, and longitudinal rotations in Drug Information and Pharmacy Service or “staffing.� The resident will be expected to complete a major research project. PJNE: How will this new residency program help residents develop the skills that are needed in order to be successful in their field? Lisa: Through exposure to various clinical situations, diverse patient populations and consistent mentoring and feedback, the resident will gain proficiency in optimizing medication therapy to ensure appropriate outcomes. The resident will further develop and strengthen his or her communication skills with patients and other healthcare providers. Regardless of which area of pharmacy the resident chooses to practice in, these skills will enable the resident to function as an effective member of any healthcare team. PJNE: What advice do you have for students interested in pursuing a residency? Lisa: Stand out from the crowd. Take advantage of opportunities to become involved in professional organizations, leadership activities, research, and/or community service initiatives that may be offered at your school. Begin preparing early for your residency search. Self-reflect on your reasons for pursuing residency training and what qualities make you an ideal candidate. Determine what characteristics you would like to see in a residency program (large versus small program, specialty clinical areas of focus, teaching opportunities, etc.) and begin researching programs. Line up your references well in advance of the deadlines. Finally, make sure to have a well-written cover letter that reflects who you are.


Pharmacy Journal of New England • Summer 2018

Innovation in Residencies Whether they completed a research project in clinical practice or drug therapy, four New England pharmacy residents have submitted their recent work to the summer issue of PJNE. We are excited to showcase the research projects of Tova Berman, a current PGY-1 resident at Hallmark Health System; Nika Bejou, a PGY-2 Infectious Diseases Pharmacy Resident at Yale New Haven Hospital; Jaclyn Kowalski, a PGY1 Pharmacy Resident at St. Francis Hospital and Medical Center; and Morgan Harper, a PGY1 Pharmacy Resident at VA Maine Healthcare System. Check out their abstracts below. Title: Impact of pharmacist driven Heart Failure (HF) in-home counseling on 30-day readmission rates Primary Author: Tova Berman, TBerman@hallmarkhealth. org Additional Authors: Amy Lemieux ALemieux@hallmarkhealth.org, Nicole Clark NClark@hallmarkhealth.org Category: Transitions in Care Objective: This study aims to implement a pharmacist driven intervention specific to HF patients with the goal of reducing readmission rates of this population. Methods: This is a prospective cohort longitudinal study with a historical control group comparing the readmission rates between targeted HF patients who receive intensive HF counseling driven by an individualized action plan and checklist to that of patients who did not. The primary endpoint is the effect of targeted counseling on 30-day readmission rates within a group of HF patients. The intervention began November 13, 2017 and continued through April 2018, with the goal of collecting 100 matched patients. Results: A total of 21 patients were included in the study. 11 patients were female and 9 were male. The mean age was 76 years of age with a range of 65 to 93 years. 2 of the 21 patients were readmitted within 30 days. 1 of the 2 patients died soon after and should be considered when analyzing the results. Conclusion: The study only had one true 30-day readmission. Although power was not met, the results suggest a strong

basis for further research.

Title: Combining rapid diagnostics with pharmacy residentled antimicrobial stewardship to optimize outcomes for bacteremia with methicillin-resistant S. aureus (MRSA-B), methicillin-susceptible S. aureus (MSSA-B), and coagulase-negative Staphylococcus (CoNS) at Yale New Haven Hospital (YNHH) Categories: Antimicrobial Stewardship, Bacteriology Keywords: Stewardship, Staphylococcus aureus, Diagnostics Authors: Nika Bejou, PharmD1, Dayna McManus, PharmD, BCPS AQ-ID1, David Peaper, MD, PhD2,3 and Jeffrey Topal, MD1,4, (1)Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, (2)Yale New Haven Hospital, New Haven, CT, (3)Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, (4)Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT Background: Given the severity of S. aureus bacteremia, prompt initiation of appropriate antibiotics is key. YNHH implemented the CepheidÂŽ Xpert MRSA/SA PCR in an effort to decrease the time needed to identify MRSA-B, MSSA-B, and CoNS. The impact of rapid diagnostics has been limited without stewardship or infectious disease involvement. Our unique notification algorithm utilized our on-call pharmacy residents to allow for 24/7 coverage. The primary objective was time to optimal antibiotic therapy (OAT) before and after implementation of the PCR and algorithm. Secondary outcomes included time to blood culture clearance (BCC), acceptance rate of pharmacist interventions, days of vancomycin therapy avoided, and 30-day mortality. Methods: A retrospective cohort study was conducted in adult inpatients with blood cultures positive for Gram positive cocci in clusters. The pre-implementation, control group (CG) included patients from 4/2017-10/2017 and the post-implementation, intervention group (IG) was from 10/2017-4/2018. Patients < 18 years and polymicrobial bacteremia were excluded. Data collected in addition to primary and secondary outcomes included baseline demographics, allergies and empiric antibiotics. OAT included vancomycin for MRSA-B or 7


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MSSA-B with severe Ƀ-lactam allergy; nafcillin or cefazolin for MSSA-B; and discontinuation of vancomycin for CoNS deemed a contaminant. Results: Of the 544 patients reviewed, 434 met inclusion criteria: 182 in the CG and 252 in the IG with similar baseline characteristics. Mean time to OAT decreased from 10 hours in the CG to 5 hours in the IG (P = 0.006). Time to BCC in the CG and IG cohorts decreased from 100 to 43 hours (P = 0.0001). One day of vancomycin was avoided in patients with MSSA-B and 2 days with CoNS. 30-day mortality decreased from 18% (n = 32) in the CG versus 6% (n = 15) in the IG (P = 0.0001). Finally, 95% (n = 153/161) of pharmacist interventions were accepted. Conclusion: Utilizing the on-call pharmacy resident for notification of rapid diagnostic results for S. aureus bacteremia, we saw a significant decrease in time to OAT, BCC, and 30-day mortality. Our study demonstrates that in the setting of limited stewardship resources, additional members of the health care team can be used to optimize antibiotics in conjunction with rapid diagnostics.

erapeutic INR was lower with pharmacy managed warfarin (22.6% vs 19.4%). The mean length of stay was 11.32 days ± 8.10 days. The mean number of days to therapeutic INR was higher compared to the provider managed warfarin study (5.24 ± 1.61 vs 4.02 ± 1.69). A greater percentage of patients in the pharmacy managed study had an appropriate duration of overlap anticoagulation (90.3% vs 63.7%). No bleeding events occurred for pharmacy managed warfarin patients whereas 15.9% of patients in the provider managed study experienced a bleeding event. Conclusions: Pharmacy managed warfarin improved patient safety by lowering the incidence of supratherapeutic INR and bleeding events and increasing the percentage of patients receiving an appropriate duration of overlap therapy.

Title: Evaluating the Use of Population-Based Management of Direct Oral Anticoagulants (DOACs) Using the DOACulator Dashboard Tool at VA Maine Healthcare System

Title: Evaluation of a Pharmacy to Dose Warfarin Consult Service

Authors: Morgan Harper PharmD, Phillip Gall PharmD, Allison Marshall PharmD, CDE

Authors: Jaclyn Kowalski, Tera R. Falcetti, Andrea Bastiaanse

Purpose: This purpose of this quality improvement (QI) project is to evaluate the use of population-based management of patients taking DOACs using the DOACulator dashboard tool and determine if the integration of this tool into the pharmacist-led anticoagulation clinic (ACC) reduces the amount of time spent monitoring patients taking DOACs while also increasing the amount of interventions identified at VA Maine Healthcare System.

Background: The Joint Commission National Patient Safety Goal 03.05.01 requires hospitals to take measures to reduce the likelihood of patient harm associated with anticoagulant therapy. Objective: To determine if the implementation of a pharmacy to dose warfarin service improves patient safety compared to provider managed anticoagulation with warfarin. Methods: This retrospective chart review evaluated patients who were newly started on warfarin therapy as part of a pharmacy consult. Results were compared to provider managed warfarin which was described in a previous study. The primary outcomes were the percentage of patients with a supratherapeutic INR of 3.6 or higher and length of stay. Results: In total, 580 patients were evaluated for inclusion 8

and exclusion criteria, and 31 patients were included in the final analysis. Compared to the results from the provider managed study, the percentage of patients with a suprath-

Methods: Retrospective and prospective reviews of all ACC follow-up notes in the computerized patient record system (CPRS) for patients prescribed a new DOAC were conducted and then compared surrounding a change in the DOAC monitoring practice to include use of the DOACulator. The retrospective review of all new-start DOAC patients before the change in DOAC monitoring practice occurred indicated that 94 minutes of clinical pharmacy specialist (CPS) time


Pharmacy Journal of New England â&#x20AC;˘ Summer 2018

was being spent monitoring patients taking DOACs to yield one intervention in DOAC therapy. CPS spent an average of 1200 minutes (120 hours) per month monitoring these DOAC patients during the previous DOAC monitoring practice. The prospective review of all new-start DOAC patients in addition to patients monitored using the DOACulator indicated that 35 minutes of CPS time was being spent to yield one intervention in DOAC therapy. CPS spent an average of 2094 minutes (34.9 hours) per month monitoring these DOAC patients with the new DOAC monitoring practice. Conclusion: Population-based management of patients taking DOACs using the DOACulator dashboard tool did not reduce the amount of time that CPSs spent monitoring newstart DOAC patients; however, this can likely be attributed to

clearing the backlog of initial flags in the dashboard and is not likely reflective of future monitoring once the initial flags are cleared. Use of the DOACulator tool in the new ACC DOAC monitoring practice led to an increased amount of interventions made in DOAC therapy and improved efficiency of the ACC clinic. The new practice led to increased patient safety, as patients are continuously monitored through the dashboard tool. It also leads to decreased costs and has resulted in the reallocation of 0.2 full-time employee equivalents CPS from the ACC into another clinical role.

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What About Fellowships? Besides residencies, fellowships have also become a popular avenue for pharmacy school graduates to pursue. For Western New England University College of Pharmacy graduates Allison Bisson and Paige Borden, pursuing a fellowship was an opportunity to Allison Bisson set themselves apart upon graduation. Here is what the fellow had to say about the value of their experiences. Allison Bisson is a licensed pharmacist currently working in the pharmaceutical industry. After receiving her Doctor of Pharmacy (PharmD) degree from Western New England University College of Pharmacy, Allison began a two-year

post-doctoral fellowship with Johnson & Johnson on behalf of the Rutgers Pharmaceutical Industry Fellowship (RPIF) program. Upon completion in June 2018, she has accepted a role as a Medical Science Liaison- Immunology/Rheumatology with Janssen Pharmaceuticals Inc. PJNE: At what point did you decide to pursue a fellowship and why? Ally: It wasnâ&#x20AC;&#x2122;t until my P4 year during my APPE rotation with GSK Consumer Health that I decided to pursue a fellowship. During my time at GSK, I had a wonderful preceptor and mentor, an alumnus of the RPIF program, who introduced me to the RPIF program and the many opportunities for pharmacists within the industry. I chose to pursue a fellowship because of the variety of roles pharmacists can have and the fact that the growth potential is truly limitless. PJNE: Take us through a typical day as a fellow. What is the structure of the fellowship program you completed? 9


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Ally: I completed a 2-year fellowship program with Johnson & Johnson Consumer Inc. on behalf of the RPIF program. My position, Global Scientific Engagement, emphasized the functions of medical communication, medical education and training and healthcare professional engagement. During my time as a fellow, I have been able to lead and participate in advisory board development and moderation as well as content development for scientific publications and medical conferences, internal and external training, and discussions with influential thought leaders in a variety of therapeutic areas. My role was heavily project-based, so no two days were the same, which made my time as a fellow fun and interesting! PJNE: What are the advantages of completing a fellowship? What job opportunities are available for fellows after completion of a fellowship? Ally: Completing a fellowship program opens the doors to an array of job opportunities and provides you with a strong network of industry professionals. In general, there are four major areas that provide opportunities for pharmacists, which include research and development, medical affairs, regulatory affairs, and commercial. Within each of those major areas are a multitude of job functions that can be explored. For example, in medical affairs, one can pursue medical information, medical strategy, medical communications, and medical science liaison. PJNE: What top three skills have you gained in your fellowship, and what kind of impact do you feel these skills will make on your success in the pharmacy profession? Ally: During my time as a fellow, I have been able to refine the clinical knowledge and skills from my PharmD training while gaining soft skills that will allow me to excel in the industry. My fellowship training has equipped me with strong critical thinking abilities, relationship development skills, and aptitude for continuous learning. The combination of these skills, coupled with my clinical knowledge, will help to drive impactful patient care on a large scale. PJNE: What advice do you have for students interested in pursuing a fellowship? Ally: The best piece of advice that truly helped me as a 10

student was to take on challenges that seem almost impossible because those experiences afford you the most personal and professional growth. If it scares you, go for it! Paige Borden is a graduate of Western New England University, who completed the Doctor of Pharmacy program in May 2017. She is currently completing a two-year, post-doctoral fellowship at Sanofi in Cardiovascular Medical Affairs through the Rutgers Pharmaceutical Industry Fellowship Program in New Jersey.

Paige Borden

PJNE: At what point did you decide to pursue a fellowship? Paige: I chose to pursue a fellowship after I completed a summer internship with Shire in their Medical Communications department the summer after my P2 year. This opportunity allowed me to gain an understanding for what pharmaceutical industry really is, and how a pharmacist can bring value to the organization. This led me to apply for the industry APPE experiences available during my final year of pharmacy school and solidified my decision to go the slightly non-traditional route of pursuing a fellowship after graduation. PJNE: Take us through a typical day as a fellow. What is the structure of the fellowship program you completed? Paige: I don’t think a “typical day” exists in the pharmaceutical industry. I can have my day planned and a project will come up that involves shifting my priorities and adapting. Although my role is primarily office-based, a lot of travel is required for this position, such as traveling to relevant therapeutic area conferences or attending off-site meetings. My particular fellowship position does not have a rotational component built in. Therefore, the fellow supports all the functions that fall under the Medical Affairs department. This allows for numerous opportunities for the fellow to tailor projects and experiences to their specific interests. PJNE: What are the advantages of completing a fellowship? What job opportunities are available for fel-


Pharmacy Journal of New England • Summer 2018

lows after completion of a fellowship?

Some Residents Also Become Fellows

Paige: One of the advantages of completing a fellowship is that you gain a vast understanding of the pharmaceutical industry throughout your two years. As a fellow, you are fully immersed in your team and company, and therefore, you can understand how and where the pharmaceutical industry impacts the overall healthcare system. Furthermore, you build valuable connections and other key skills to set you up for a successful career. Job opportunities after completing a fellowship will vary based on the individual’s interests. Completing a fellowship allows you to highlight your background and knowledge as a pharmacist and develop the skills needed to be a competitive applicant. PJNE: What top three skills have you gained in your fellowship, and what kind of impact do you feel these skills will make on your success in the pharmacy profession? Paige: The top three skills I feel that I’ve gained or improved upon so far include collaboration, time management and public speaking/presentation skills. Collaboration is crucial to success in the pharmaceutical industry, especially as I support a product in partnership with another pharmaceutical company. Public speaking and clear communication are other assets for a successful career within this industry to effectively share scientific information and communicate across teams. PJNE: What advice do you have for students interested in pursuing a fellowship? Paige: Do your research into the different types of fellowships and positions, as there are numerous programs and companies with unique opportunities. Try to grasp an understanding of what each of them offer and if that ultimately aligns with your career goals. Don’t turn down any projects during your APPEs and practice, practice, practice interviewing. You can’t be too prepared for the midyear interview process. Make sure your CV accurately reflects who you are on paper and ask as many questions as you can to fellows or pharmacists in the industry when you have the opportunities.

Dora Wiskirchen

Just when she thought it was too late, Dora Wiskirchen, PharmD, BCPS, landed a two-year Infectious Diseases Pharmacotherapy Fellowship at the Center for Anti-Infective Research & Development at Hartford Hospital. Check out PJNE’s interview with Dora, who was a PGY-1 resident Greenville Hospital System, University Medical Center in Greenville, SC before she

began her fellowship. Dora Wiskirchen is currently the Pharmacy Coordinator for Antimicrobial Stewardship at Saint Francis Hospital and Medical Center in Hartford, CT. She earned her Doctor of Pharmacy degree from Ohio Northern University. PJNE: At what point did you decide to pursue a fellowship and why? Dora: My interest in infectious diseases came about at the end of pharmacy school, after completing an infectious diseases APPE rotation. Interestingly, infectious diseases were not one of my strengths in pharmacy school, but I figured the rotation would help me to improve my skills in this area. Little did I know that I would develop a passion for the specialty that would set the course for my pharmacy career. Although I knew I wanted to pursue a career in infectious diseases and antimicrobial stewardship throughout my PGY-1 residency, I was late in deciding to pursue fellowships – it was not until the spring of my PGY-1 year. My residency research project involved clinical chart review coupled with benchtop work in the microbiology lab. I enjoyed being able to link the two areas to shed light on a clinical problem we were facing. At the time, I did not know anything about fellowships and had been interviewing for PGY-2 programs. Then I met a fellowship-trained infectious diseases pharmacist during a PGY-2 interview who suggested I look at fellowship programs based on my developing interests in both clinical and basic science research. It was late in the year for applying to fellowship programs, and many had already finished interviews. I feel very fortunate to have landed a position at that 11


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continued

time. PJNE: Take us through a typical day as a fellow. What was the structure of the fellowship program you completed? Dora: There is no typical day in fellowship. Moreover, research, clinical and teaching responsibilities can vary widely between programs. The program that I completed truly required a team-based, all hands-on deck approach for success. There were projects you were responsible for leading, while assisting with other projects that were going on simultaneously. On any given day, you might be designing study protocols, running a benchtop experiment, recruiting and enrolling patients into clinical studies, collecting and processing samples, analyzing data, preparing posters and writing manuscripts, or some combination thereof. It can be hectic at times; staying organized and prioritizing what needs to be done is key. However, the benefit is that you gain experience and exposure to a wide variety of projects. You also learn very quickly how to work as part of a research team. PJNE: What are the advantages of completing a fellowship? What job opportunities are available for fellows after completion of a fellowship? Dora: Research & Clinical Skills. Fellowships immerse you into the world of research and you come out with strong foundational skills in study design, data and statistical analysis, clinical therapeutics, and project management. Mentorship & Networking. You gain a network of support in fellowship from collaborating with other researchers, both internally and externally. After spending two years working closely with experienced researcher and other trainees, fellows often develop lifelong mentors and friends. Job opportunities. Fellowship training equips you with a wide range of skills that are applicable for many different career paths. Some of the unique opportunities for fellowship-trained pharmacists include academia, the pharmaceutical industry, clinical research and management positions. In addition, developing the right mix of skills and building relationships within the field are incredibly beneficial for attaining these types of opportunities. 12

PJNE: What top three skills have you gained in your fellowship, and what kind of impact do you feel these skills will make on your success in the pharmacy profession? Dora: There are too many to pick from! My fellowship director used to tell us that we start fellowship with an empty toolbox, which is quickly filled over the next two years. Some of the most impactful skills for me fall into these three categories: 1. Robust Research Skills. I learned how to design and conduct research projects that have helped solve problems I was encountering in clinical practice. This includes research methods in a wide variety of areas spanning microbiology, in vitro and in vivo studies, pharmacokinetic and pharmacodynamic modeling and clinical outcomes. Having these skills was vital to my success while in academia. More recently, I have also enjoyed using these skills in a slightly different capacity in my current role as an antimicrobial stewardship pharmacist, through helping residents and fellows design their research projects, evaluating the impact of clinical initiatives and serving on our hospitalâ&#x20AC;&#x2122;s IRB. 2. Better Clinical Decision-Making. Having a strong understanding of the research methods commonly utilized in infectious diseases helps me to better evaluate the strengths and weaknesses of the clinical trials and drug literature in this area and to carefully apply it to patient care. This ultimately translates to better clinical decision making for the patients we serve. 3. Project Management Skills. These skills develop over time as one navigates all the opportunities that a fellowship provides. My biggest take-aways were learning how to juggle competing priorities and deadlines, solve problems in an efficient manner, build collaborative relationships with other researchers and health care providers, and manage my time effectively while finding a work-life balance that aligns with my career and personal goals. PJNE: What advice do you have for students interested in pursuing a fellowship? Dora: Many of these are not specific to fellowships and are applicable to pursuing other career paths too:


Pharmacy Journal of New England â&#x20AC;˘ Summer 2018

Spend time exploring your interests. Use your time and available opportunities as a student or resident to figure out what your clinical and/or research interests are. Then seek opportunities to gain additional experiences in those areas. This helps you to expand your skill set and refine your interests prior to committing to a fellowship or career path. Complete a residency first. It will help you develop your clinical skills, broaden your understanding of the healthcare landscape and provide you with the background necessary to determine what research questions are relevant for improving clinical practice. Research different programs. No two fellowship programs are alike. Some are very lab and benchtop research-focused, while others are more clinically oriented. Reach out to program directors as well as current and past fellows to gain additional insight into the program, beyond what may be available on their website. Ultimately, you want to make sure the experiences offered are in line with your goals.

years, I would not have said infectious diseases, research, or academia. Life is a journey and your passions and interests can evolve, or even change with each new experience. Put yourself out there. Try new things, meet new people, and ask for help, even if it is uncomfortable. Itâ&#x20AC;&#x2122;s how you grow as a person and in your profession. You also never know when you might discover an opportunity to help others, learn something new, or develop a relationship. Embrace the spirit of lifelong learning and continual development. Residencies and fellowships are fast-paced and there are numerous commitments on your plate at any given time. However, there is also immense opportunity for personal and professional growth during these years. Utilize each experience to learn and improve something about yourself, not just your research and clinical skills.

Keep an open mind about your career. If you had asked me during pharmacy school about what I would be doing in 10

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2017 Recipients of the “Bowl of Hygeia” Award

Larry Presley Alabama

John McGilvray Alaska

Alan Barreuther Arizona

Sue Frank Arkansas

Pierre Del Prato California

Mary Petruzzi Connecticut

Noel Rosas Delaware

Goar Alvarez Florida

Hewitt Ted Matthews Georgia

Ed Cohen Illinois

Ahmed Abdelmageed Indiana

Tim Becker Iowa

Merlin McFarland Kansas

Melody Ryan Kentucky

Gregory Poret Louisiana

Greg Cameron Maine

Cynthia Boyle Maryland

Anita Young Massachusetts

Dennis Princing Michigan

Denise Frank Minnesota

David French Mississippi

David Farris Missouri

Matthew Bowman Montana

Gary Rihanek Nebraska

Mark Decerbo Nevada

Hubert Hein New Hampshire

Thomas F.X. Bender, Jr. New Jersey

David Lansford New Mexico

John T. McDonald III New York

Steve Caiola North Carolina

Tim Weippert North Dakota

Debra Parker Ohio

Ben Allison Oklahoma

Mercy Chipman Oregon

Jerry Musheno Pennsylvania

Marisa Carrasquillo Puerto Rico

Gary Kishfy Rhode Island

Terry Blackmon South Carolina

Tim Tucker Tennessee

Chris Alvarado Texas

Kurt Price Utah

Pat Resto Virginia

The “Bowl of Hygeia”

In Memoriam: Rob Loe South Dakota Keith Campbell Washington Daneka Lucas Washington DC

Kevin Yingling West Virginia

Thad Schumacher Wisconsin

Joe Steiner Wyoming

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

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Program Agenda General Information The Connecticut Pharmacists Association and the Massachusetts Pharmacists Association invite you pharmacists, student pharmacists, technicians, associate partners - to participate in the 2018 New England Pharmacists Convention at Foxwoods Resort Casino! Foxwoods, located in Mashantucket, CT, features over 35 restaurants serving all kinds of cuisine from contemporary gourmet to classic fare in settings that range from fine dining to casual. In addition to exceptional dining and gaming, enjoy shopping at Foxwoods, where you’ll find top brands like Bvlgari, Chopard, Pandora, Michael Simon, Jared Lang, and Hugo Boss. Our speakers and educational programs will equip you with skills and resources that will empower you to expand your pharmacy practice. We promise exceptional education, social events, and networking. HOTEL RESERVATIONS: A block of rooms has been reserved in the Fox Tower at an amazing rate of $144 per night, and the resort fee for NEPC Attendees is waived. To receive this rate you must reserve your room by Wednesday, August 22. Please be advised that all rates quoted are per room, per night, single or double occupancy. A charge of $25.00 will be added for each guest room over double occupancy. Reserve here: https://book.passkey.com/event/49558073/ owner/46344/home

REGISTRATION: Please go to www.nepharmacists.org to register. Fax form with credit card information to 781-933-1109. Please make all checks payable to the New England Pharmacists Convention. Mail form to NE Convention, c/o MPhA., 500 W. Cummings Park, Suite 3475, Woburn, MA 01801. Please complete all portions of the registration form. Register in advance to avoid a $10 onsite registration fee. Registration Questions: Please contact NEPC at 781-933-1107 or at info@masspharmacists.org Cancellations must be made in writing to NEPC. Registration cancellations received prior to 8/31/18 will be refunded less a $25 processing charge per registrant. Cancellations received after 8/31/18 will not be refunded.

Thursday, September 13, 2018

7:30 a.m. – 8:00 a.m. Certificate Program Registration & Continental Breakfast 8:00 a.m. - 5:00 p.m. Certificate Training Programs •

Pharmacy-Based Cardiovascular Disease Risk Management

Delivering Medication Therapy Management

The Pharmacist and Patient-Centered Diabetes Care

11:00 a.m. – 12:00 p.m. Convention Check In & Registration 1:00 p.m. –2:00 p.m. Understanding Neurodiversity and How Pharmacists Can Better Leverage and Serve Those with Intellectual and Developmental Disabilities (IDD) ACPE: 0106-9999-18-023-L04-P; 0106-9999-18-023-L04-T (0.1 CEUs)

Presented by: Stephan Colgan, Ph.D., Former Senior Director of Pfizer Learning Objectives: 1. Describe neurodiversity and explain why better understanding the neurodivergent community should be important to pharmacists 2. Explain how a few simple accommodations could facilitate better communication and contribute to pharmacists better serving those with intellectual and developmental disabilities (IDD) 3. Describe the positive altruistic and business drivers for employing those with IDD 2:10 p.m.—3:10 p.m. The Pharmacist’s Role in Treating and Managing Migraines ACPE: 0106-9999-18-024-L01-P; 0106-9999-18-024-L01-T (0.1 CEUs)

Presented by: Kevin Chamberlin, Pharm.D. FASCP, Associate Clinical Professor of Pharmacy Practice, University of Connecticut Learning Objectives: 1. Describe the pathophysiology and diagnosis of migraines. 2. Discuss the various medications used for abortive therapy of acute migraines

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The Fox Tower, Foxwoods Resort, September 13 - 14, 2018 3. Discuss medications used for migraine prophylaxis 4. Highlight key counseling points regarding these medications such as dosing/administration, ADEs, and monitoring 5. Explain the treatment of migraines in specific patient populations such as children and pregnant women

8:00 a.m. - 8:15 a.m. Welcome 8:15 a.m. - 9:15 a.m. Keynote Address: Do They Know You Care? ACPE: 0106-9999-18-027-L04-P; 0106-9999-18-027-L04-T (0.1 CEUs)

Presented by: Lucinda Maine, Ph.D., R.Ph., Executive Vice President & CEO, AACP Learning Objectives: 3:20 p.m.—4:20 p.m. 1. Discuss the results of national Panel Discussion: Think Differently, Be consumer research on pharmacists and Innovative: Transform Your Pharmacy their practice Practice Model 2. Describe how the expanded use of ACPE: 0106-9999-18-025-L04-P; technology will impact the profession 0106-9999-18-025-L04-T (0.1 CEUs) Presented by: Jeffrey Bratberg, Pharm.D., 3. Implement public-facing media activities in your local and regional Clinical Professor, University of Rhode Island College of Pharmacy and Felicity channels Holmsted, Pharm.D., BCPS, Chief Pharmacy Officer, Community Care Partner- 9:25 a.m.—10:25 a.m. Community Pharmacists Leveraging ship of Maine Predictive Analytics for the Prevention Learning Objectives: 1. Discuss novel pharmacy practice sce- of Opioid Overdose and Opioid Induced narios that will permit increased scope of Respiratory Depression ACPE: 0106-9999-18-028-L04-P; practice 2. Identify skill sets that these novel prac- 0106-9999-18-028-L04-T (0.1 CEUs) Presented by: Mindy Smith, Vice tice models require to be successful President of Pharmacy Practice 3. Describe the expectation/evidence Innovation, Prescribe Wellness for improved patient outcomes by implementing novel practice models by Learning Objectives: 1. Identify the risk factors for opioid discussing best practices overdose or opioid-induced respiratory depression. 4:30 p.m.—5:30 p.m. Law CE: Federal Public Policy Briefing on 2. Describe the role that community pharmacists can play in educating Issues Impacting Pharmacists patients at risk, including dispensing of ACPE: 0106-9999-18-026-L03-P; naloxone. 0106-9999-18-026-L03-T (0.1 CEUs) Presented by: Scott Brunner, CAE, Senior 3. Describe the role that community pharmacists can play in influencing Vice President, Communications and prescribers, related to resolving State Government Affairs, NCPA medication therapy problems Learning Objectives: 1. Discuss current federal and state legis11:00 a.m.—12:00 p.m. lative/regulatory priorities for Law CE: Cannabis Law: The Past, Present community pharmacy 2. Explain the final 2019 Part D rule and and Future ACPE: 0106-9999-18-029-L03-P; its impact on pharmacy 0106-9999-18-029-L03-T (0.1 CEUs) 3. Discuss the Trump Administration’s goals related to drug pricing, affordabil- Presented by: Al Domeika, R.Ph, Dispensary Manager, Prime Wellness of ity and the nation’s opioid epidemic Connecticut 4. Discuss vertical mergers in the pharmacy space and its implications for com- Learning Objectives: 1. Discuss the history of marijuana munity pharmacy 2. Examine federal laws and recent policy 5. Explore current efforts to regulate changes regarding cannabis pharmacy benefit managers (PBMs) 3. Outline cannabis laws for each New England state Friday, September 14, 2018 4. Explain Connecticut marijuana laws 6:30 a.m. – 8:00 a.m. and how they differ from other parts of Check In, Registration & Continental the country Breakfast 5. Analyze the legality of CBD products

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currently sold on the internet and in stores.

Student Programming 10:00 a.m. – 11:00 a.m. Interviewing Techniques, Paul Larochelle Jr., Pharm.D. 11:00 a.m. - 12:15 p.m. Career Path Roundtables: Speak with pharmacists from a variety of practice settings. 12:00 p.m. - 2:00 p.m. Lunch & Exhibit Hall 1:30 p.m.—2:30 p.m. Track 1: Specialty Pharmacy DAAng! So Much Is New in Hepatitis C Virus Treatment—An Update

ACPE: 0106-9999-18-030-L01-P; 0106-9999-18-030-L01-T (0.1 CEUs)

Presented by: Linda Spooner, Pharm.D., Professor of Pharmacy Practice, MCPHS University Learning Objectives: 1. Describe updates in pharmacotherapy of chronic hepatitis C virus (HCV) infection, including characteristics of new direct-acting antivirals (DAAs) 2. Explain updated treatment guidelines for the management of HCV infection 3. Discuss challenges faced with HCV treatment across practice settings, including specialty pharmacy 4. Identify strategies to improve patient adherence to treatment, including methods to enhance communication Track 2: Ambulatory Care Seeing the Forest Through the Trees in COPD: Review, Updates, and New Medications-Oh My! ACPE: 0106-9999-18-031-L01-P; 0106-9999-18-031-L01-T (0.1 CEUs)

Presented by: Jared Ostroff, Pharm.D., Western New England University College of Pharmacy Learning Objectives: 1. Recall the pathophysiology and diagnostic criteria of COPD 2. Summarize the 2018 GOLD guidelines for COPD treatment 3. Compare and contrast current treatment options, including various medication combinations and devices 4. Given a patient case, formulate the


most appropriate plan for a patient with 2. Discuss best practices in managing COPD based on current evidence and access and oral adherence in patients available options receiving specialty medications 3. Describe the importance of measuring clinical outcomes associated with your Track 3: Mental Health Medication-Assisted Therapy for Opioid health system specialty pharmacy Use Disorder: Mobilizing Pharmacists to Combat the Opioid Crisis Track 2: Ambulatory Care ACPE: 0106-9999-18-032-L01-P; 2018: Why Zoster Vaccination Should Be 0106-9999-18-032-L01-T (0.1 CEUs) a Squad Goal Presented by: Rob Picone, R.Ph., Ph.D., ACPE: 0106-9999-18-035-L06-P; Senior Medical Liaison—Rare Metabolic 0106-9999-18-035-L06-T (0.1 CEUs) Diseases, Global Medical Affairs, Alexion Presented by: Stephanie Hernandez, Pharmaceuticals Pharm.D., Woodmans Pharmacy Learning Objectives: Learning Objectives: 1. Explain the pathophysiology 1. Identify the primary risk factors for associated with Opioid Use Disorder shingles, specifically in the geriatric (OUD) as well as its diagnostic criteria population from the DSM-V 2. Discuss the impact of the shingles 2. Discuss the three types of disease burden, diagnosis, treatment medication-assisted therapy (MAT) for and prevention of shingles, including OUD involving antagonist approaches the current vaccine recommendations and review recent comparative efficacy 3. Compare and contrast the Shingrix studies vaccine and the Zostavax vaccine 3. Discuss how pharmacists can be 4. Identify interdisciplinary team involved in increasing access to MAT and strategies focused on increasing health improving outcomes in therapy with literacy and awareness of the shingles communication skills while highlighting vaccine novel practice models Track 4: Pepto-Bowl: Student and Pharmacists Self Care Championship ACPE: 0106-9999-18-033-L04-P; 0106-9999-18-033-L04-T (0.1 CEUs)

Facilitated by: Jeffrey Bratberg, Pharm.D., Clinical Professor, University of Rhode Island College of Pharmacy Learning Objectives: 1. Identify products (and active ingredients) routinely used for safe and effective use in self-care conditions 2. Explain the efficacy, dosage, adverse effects, and administration of nonprescription medicines 3. Counsel on non-pharmacologic measures for the treatment of common care elements 2:40 p.m.—3:40 p.m. Track 1: Specialty Pharmacy Implementation and Integration of a Specialty Pharmacy Model Within a Health System ACPE: 0106-9999-18-034-L04-P; 0106-9999-18-034-L04-T (0.1 CEUs)

Presented by: David Hughes, Pharm.D., Boston Medical Center Learning Objectives: 1. Discuss resources required to build and implement a specialty pharmacy model within a health system

You may attend any track. You do not have to stay in the same room for all 3 sessions. Track 3: Mental Health Post Traumatic Stress Disorder (PTSD): A Pathway to Substance Use Disorders (SUD)? ACPE: 0106-9999-18-039-L04-P; 0106-9999-18-039-L04-T (0.1 CEUs)

Presented by: Joseph Insler, MD, Addiction Psychiatrist, VA Boston Healthcare System Learning Objectives: 1. Explain the etiology, prevalence and diagnostic criteria of PTSD 2. Identify the evidence for the cooccurrence of PTSD and SUD 3. Discuss the behavioral andpharmacological treatment options for PTSD 3:50—4:50 p.m. Track 1: Specialty Pharmacy Biosimilars Are Here: Are You Ready?

0106-9999-18-037-L04-T (0.1 CEUs)

Presented by: Sam Abdelghany, Pharm.D., MHA, BCOP, Clinical Manager, Oncology Pharmacy Services, Yale-New Haven Hospital Learning Objectives: 1. Explain biosimilars and their potential advantages to patients and healthcare 2. Examine federal and state regulatory considerations pertaining to biosimilars 3. Identify challenges and implications of biosimilars to pharmacy practice 4. Discuss pharmacists’ key role in educating patients and other stakeholders about biosimilars Track 2: Ambulatory Care Deprescribing: A New Word in Medication Management

ACPE: 0106-0000-18-038-L04-P; 0106-0000-18-038-L04-T (0.1 CEUs)

Presented by: Katelyn O’Brien, Pharm.D., Boston Medical Center Learning Objectives: 1. Describe the role of the pharmacist in deprescribing 2. Examine a patient’s medication list for potentially inappropriate prescriptions 3. Discuss evidence-based strategies to taper or discontinue unnecessary or unsafe medications Track 3: Mental Health Treatment Resistant Depression— Opportunities for the Pharmacist ACPE: 0106-9999-18-036-L01-P; 0106-9999-18-036-L01-T (0.1 CEUs)

Presented by: Charlie Caley, Pharm.D., BCPP, Clinical Professor and Chair, Department of Pharmacy Practice, Western New England University College of Pharmacy and Health Sciences Learning Objectives: 1. Examine the definitions and prevalence of major depressive disorder and treatment resistant depression (TRD) 2. Describe the process a pharmacist should follow to initially evaluate a patient with TRD 3. Describe the process a pharmacist should follow to monitor a patient with TRD 4. List the interventions that can be used for TRD 5. Given a case, propose an appropriate treatment for a patient with TRD

ACPE: 0106-9999-18-037-L04-P;

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Certificate Programs Pharmacy-Based Cardiovascular Disease Risk Management The goals of the certificate training program are to: • Educate pharmacists on current evidence-based treatment goals and clinical management recommendations for dyslipidemia and hypertension. • Familiarize pharmacists with important concepts related to healthful lifestyle changes that focus on cardiovascular disease prevention. • Introduce techniques and skills for encouraging patient adherence to prescribed therapies. • Ensure pharmacist proficiency in blood pressure measurement technique and point-of-care lipid testing. • Enhance pharmacist experience in applying elements of motivational interviewing with respect to medication adherence and lifestyle modifications. • This ACPE activity does not provide a certification in this topic but rather advanced professional training. The activity is conducted in two parts: a webbased self-study and a live training seminar.

The live seminar will focus on these core areas: • A case-based approach to cardiovascular disease risk assessment and treatment decisions, managing special situations, treating hypertension in a patient with diabetes, and lifestyle modifications and motivational interviewing. • Skills assessments on blood pressure measurement technique and motivational interviewing. Participants will be conducting blood pressure assessments on other participants. • A discussion regarding the role of the pharmacist and existing business models for cardiovascular disease risk management services. Activity Completion Requirements The American Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of CPE. The self-study learning component involves passing the self-study assessment with a grade of 70% or higher and will result in 12 hours (1.2 CEUs) of continuing pharmacy education credit (UAN:

0202-0000-18-106-H01-P; 0202-9999-18-106-H01P). The live seminar component involves attending the full live seminar, successfully demonstrate competency in the utilization and/or evaluation of these devices, and completing the online assessment and evaluation. Successful completion will result in 8 hours (0.8 CEUs) of continuing pharmacy education credit (UAN: 0202-0000-18-107-L01-P; 0202-9999-18-107-L01-P). Please note: APhA is currently redesigning this program. On August 1, participants will receive a new enrollment code. Study materials will be available on September 1. Pharmacy-Based Cardiovascular Disease Risk Management is developed by the American Pharmacists Association. Faculty: Meghan Wilkosz, PharmD, Clinical Pharmacy Specialist at VA Connecticut Healthcare System

Delivering Medication Therapy Management Services Delivering Medication Therapy Management Services is an innovative and interactive certificate training program that explores the pharmacist’s role in providing MTM services to patients. Pharmacists have a tremendous opportunity to receive reimbursement for monitoring and improving medication use in patients with complex medication regimens. This practice-based activity teaches pharmacists the essential skills necessary to become a successful MTM practitioner. The certificate training program will enhance pharmacists’ clinical expertise in evaluating complicated medication regimens, identifying medicationrelated problems, and making recommendations to patients, caregivers, and health care professionals. The certificate training program is conducted in three parts: a self-study activity and pre-seminar

exercise, a live interactive training seminar, and a post-seminar exercise. The goals of the certificate training program are to: • Advance public health and patient care through improved medication use. • Provide training to enhance pharmacists’ ability to effectively provide MTM services. • Motivate increased numbers of pharmacists to establish MTM services. • Communicate benchmark practices for providing MTM services. This entire certificate training program will offer you the opportunity to earn up to 21 hours (2.1 CEUs) of ACPE-accredited continuing pharmacy education credit. Faculty: Susan Holden, Pharm.D., Clinical Pharmacy Specialist , VA Boston Healthcare System, West Roxbury, MA

Successful completion of the self-study component involves passing the self-study assessment with a grade of 70% or higher and will result in 10 contact hours of CPE credit (1.0 CEUs). ACPE UAN: 0202-0000-18-164-H04-P; 0202-9999-18-164-H04-P Successful completion of the live seminar component involves attending the full live seminar and completing the online evaluation and will result in 8 contact hours (0.8 CEUs) of CPE credit. ACPE UAN: 0202-0000-18-165-L04-P; 0202-9999-18-165-L04-P Successful completion of the post-seminar case exercise component involves completing 3 post cases and submitting an online attestation statement of completion and will result in 3 contact hours of CPE credit (0.3 CEUs). ACPE UAN: 0202-0000-18-166-H04-P; 0202-9999-18-166-H04-P

The Pharmacist & Patient-Centered Diabetes Care The Pharmacist and Patient-Centered Diabetes Care Certificate Training Program is an intensive educational experience designed to equip pharmacists with the knowledge, skills, and confidence needed to provide effective, evidence-based diabetes care. Five self-study modules provide comprehensive instruction in current diabetes concepts and standards of care. The live seminar incorporates case studies and hands-on skills training focused on the situations most likely to be encountered—as well as the services most needed—in community and ambulatory care practice settings. Participants will gain experience evaluating and adjusting drug therapy regimens for patients with type 1 and type 2 diabetes, counseling patients about lifestyle interventions, analyzing and interpreting self-monitoring of blood glucose results, and assessing the overall health status of patients to identify needed monitoring and interventions. The goals of the certificate training program are to:

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• Provide comprehensive instruction in current standards of care for patients with diabetes. • Increase pharmacists’ confidence in serving as the drug therapy expert on the diabetes health care team. • Refresh pharmacists’ knowledge of the pathophysiology of diabetes and the acute and long term complications of the disease. • Familiarize pharmacists with important concepts in nutrition, exercise, and weight control that contribute to optimal diabetes care. • Provide training on the use of diabetes-related devices and physical assessments involved with optimal diabetes care. • Describe business opportunities and roles for pharmacists in improving health outcomes for patients with diabetes. This entire certificate training program will offer you the opportunity to earn up to 23 hours (2.3 CEUs) of continuing pharmacy education credit. Successful completion of the self-study component involves passing the self-study

assessment with a grade of 70% or higher and will result in 15 contact hours of CPE credit (1.5 CEUs). ACPE UAN: 0202-0000-18-121-H01-P; 0202-9999-18-121-H01-P Successful completion of the live seminar component involves attending the full live seminar, successfully demonstrate competency in the utilization and/or evaluation of these devices, and completing the online assessment and evaluation. Successful completion of this component will result in 8 contact hours of CPE credit (0.8 CEU). ACPE UAN: 0202-0000-18-122-L01-P; 0202-9999-18-122-L01-P The Pharmacist & Patient-Centered Diabetes Care was developed by the American Pharmacists Association. Faculty: Lisa DeGennaro Pharm D, CDE; Assistant Professor, Department of Pharmacy Practice, University of Saint Joseph School of Pharmacy, West Hartford, CT


Accreditation Statement The Connecticut Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. Attendees can earn up to 11.5 hours (1.15 CEUs) of continuing education credit which includes 2 hours (0.2 CEUs) in pharmacy law. All learning activities are knowledge based unless otherwise noted. Requirements for Credit Program attendees can earn Continuing Pharmacy Education credits for this program by completing an electronic survey following the completion of the activity and inserting the activity specific code and completing the activity learning assessment/evaluation form. Participants have 60 days to complete evaluations. After 60 days from September 14, 2018, no credit will be available for this program. Credits will be electronically transferred to the CPE Monitor System. Statement of Disclosure In accordance with the Accreditation Council for Pharmacy Education (ACPE) Standards for Continuing Pharmacy Education 2009, the Connecticut Pharmacists Association requires that faculty members disclose any relationship (e.g., shareholder, recipient of research grant, consultant or member of an advisory committee) that the faculty may have with commercial companies whose products or services may be mentioned in their presentations. Such disclosure will be made available on the day of the program.

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To Register Online, please visit www.nepharmacists.org

Registration Form

Full Name: _____________________________________________________________________________ Mailing Address: __________________________________________________________________________ City: __________________________________________State: _______ Zip: _____________ Email: _______________________________________Phone: _____________________________________ State Association Member:

CPA

MPhA

MPARX

NHPA

VTPA

WMPha

Practice Setting_______________________________________________________________________________ University/College___________________________________________________(Students Only) Payment Method: Check

Credit Card:

MC

VISA

AMEX

DISCOVER

Credit Card #:_________________________________Security Code#: ________ Expiration Date: __________ Card Holder’s Name:__________________________________________________________________________ Signature:____________________________________________________ Date: _________________________ Please make registration selections below. Member rates apply for members of the CPA, MPhA (MA), NHPA, RIPA, VTPA, and WMPhA, and MPARX. * Full Convention Registration includes CE, Welcome Reception, Friday Breakfast, Lunch, and Breaks & Exhibit hall **Certificate Programs without the CE bundle do not include the Welcome Reception Registration Event

Early Bird through 8/15/18

Registration after 8/15/18

RPh Member Full Convention* $199.00 $229.00 RPh Non-member Full Convention* $249.00 $279.00 RPh Member Thursday CE only (includes Welcome Reception in Exhibit Hall) N/A $119.00 RPh Non-Member Thursday CE only (includes Welcome Reception in Exhibit Hall) N/A $130.00 RPh Member Friday CE only (includes breakfast, lunch & Exhibit Hall) N/A $149.00 RPh Non-Member Friday CE only (includes breakfast, lunch & Exhibit Hall) N/A $189.00 Technician Full Convention N/A $110.00 Technician Thursday Only N/A $35.00 Technician Friday Only N/A $75.00 Student Track & Pepto Bowl (Friday Only) N/A $50.00 Certificate Programs - All Certificate Programs Include Breakfast, Lunch, and a Break RPh Member Pharmacy Based Cardiovascular Disease Risk Management N/A $379.00 RPh Non-Member Pharmacy Based Cardiovascular Disease Risk Management N/A $429.00 RPh Member Delivering Medication Therapy management Services N/A $379.00 RPh Non-Member Delivering Medication Therapy management Services N/A $429.00 RPh Member Patient Centered Diabetes Care N/A $379.00 RPh Non-Member Patient Centered Diabetes Care N/A $429.00 Bundled CE Options - Includes Friday CE, Breakfast, Lunch & Exhibit Hall RPh Member Pharmacy Based Cardiovascular Disease Risk Management & Friday N/A $430.00 CE** RPh Non- Member Pharmacy Based Cardiovascular Disease Risk Management & N/A $525.00 Friday CE** RPh Member Delivering Medication Therapy management Services & Friday CE** N/A $430.00 RPh Non-Member Delivering Medication Therapy management Services & Friday N/A $525.00 CE** RPh Member Patient Centered Diabetes Care & Friday CE** N/A $430.00 RPh Non-Member Patient Centered Diabetes Care & Friday CE** N/A $525.00 Social & Networking Opportunities State Installation & Awards Banquet - Separate Registration Required, Please Confirm Your State Association Connecticut Pharmacists Association (includes welcome reception) N/A $75.00 pp Massachusetts Pharmacists Association (includes welcome reception) N/A $75.00 pp Friday Guest Lunch & Exhibit Hall (no CE) N/A $45.00 Thursday Welcome Reception (included in Full Convention registration and N/A $50.00 Thursday Only CE) TOTAL

Fax form with credit card information to 781-933-1109. Mail form to NEPC, c/o MPhA., 500 W. Cummings Park, Suite 3475, Woburn, MA 01801.

Please Check Your Selection(s)

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Schedule At-a-Glance THURSDAY, SEPTEMBER 13, 2018 7:00 am 8:00 am 8:00 am General Sessions 1:00-2:00pm 2:10-3:10pm 3:20-4:20pm 4:30-5:30pm 5:30 - 6:45 pm 7:00 - 9:00 pm

FRIDAY, SEPTEMBER 14, 2018 6:30-8:00am 8:15-9:15am

Certificate Program Registration Open APhA Certificate Programs Convention Registration Open Understanding Neurodiversity and How Pharmacists Can Better Leverage and Serve Those with Intellectual and Developmental Disabilities (IDD) The Pharmacist's Role in Treating and Managing Migraines Panel Discussion: Think Differently, Be Innovative: Transform Your Pharmacy Practice Model Law CE: Federal Public Policy Briefing on Issues Impacting Pharmacists Welcome Reception in Exhibit Hall State Association Installation & Awards Banquets MPhA Banquet CPA Banquet

Breakfast In Exhibit Hall Keynote Address: Do They Know You Care?

10:25-11:00am 10:00am-12:15pm 11:00am-12:00pm

Community Pharmacists Leveraging Predictive Analytics for the Prevention of Opioid Overdose and Opioid Induced Respiratory Depression AM Break Student Track Law CE: Cannabis Law: The Past, Present and Future

12:00-1:30pm 1:30 - 2:30 pm Track 1: Specialty Pharmacy

Lunch Break in Exhibit Hall Track Sessions I DAAng! So Much Is New in Hepatitis C Virus Treatment--An Update

Track 2: Ambulatory Care

Seeing the Forest Through the Trees in COPD: Review, Updates and New Medications--Oh My

Track 3: Mental Health

Medication-Assisted Therapy for Opioid Use Disorder: Mobilizing Pharmacists to Combat the Opioid Crisis

Track 4 2:40 - 3:40 pm Track 1: Specialty Pharmacy

Pepto-Bowl: Student and Pharmacists Self Care Championship Track Sessions II Implementation and Integration of a Specialty Pharmacy Model Within a Health System

Track 2: Ambulatory Care Track 3: Mental Health 3:50 - 4:50 pm Track 1: Specialty Pharmacy

2018: Why Zoster Vaccination Should Be a Squad Goal Post Traumatic Stress Disorder (PTSD): A Pathway to Substance Use Disorders (SUD)? Track Sessions III Biosimiliars Are Here: Are You Ready?

Track 2: Ambulatory Care

Deprescribing: A New Word in Medication Management

Track 3: Mental Health

Treatment Resistant Depression — Opportunities for the Pharmacist

9:25-10:25am


Feature FEATURE Job Satisfaction By the Numbers By Christopher Merrick, Pharm.D. Candidate 2019, University of Connecticut

We asked, you answered! Do you see yourself on the same pharmacy career path in five years--or are you looking for a change? In June, PJNE designed its first-ever job satisfaction survey to provide pharmacists in the region a snapshot of what other pharmacy professionals had to say about their current practice setting. The survey received over 227 responses from pharmacists across New Englandâ&#x20AC;&#x201D;and across the country! Tennessee, Virginia, New York and Pennsylvania were among the other states that respondents said they currently practice in. Many survey respondents currently have been working full-time in the community chain, community independent or hospital settings for five years or more. Find out how your practice setting 22 responded!


Pharmacy Journal of New England â&#x20AC;¢ Summer 2018

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Pharmacy Journal of New England â&#x20AC;¢ Summer 2018

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Pharmacist Satisfaction But Wait, There's More! Besides hospital and community pharmacists, PJNE also heard from pharmacists in other settings, including long-term care, ambulatory and veterans affairs, to name a few. Here is what these survey respondents had to say about what makes their current career path satisfying or dissatisfying.

A Few Surprising Facts â&#x20AC;˘ When we asked respondents whether they see themselves in the same career path or not five years from now, the overall response was almost evenly split! While 113 pharmacists said they do not see themselves in the same practice setting, 111 said otherwise. â&#x20AC;˘ For most respondents, career advancement in their current position is NOT important. â&#x20AC;˘ While most community chain staff pharmacists chose their work schedule as a top factor that makes their position satisfying, many respondents from this practice setting also said their work schedule was a top factor that make their job dissatisfying.

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Pharmacy Journal of New England • Summer 2018

Making the Career Switch From the community setting to the medical marijuana setting When Connecticut became the first state to require the employment of pharmacists under its medical marijuana program, pharmacist Dave Slomski knew an interesting opportunity would come his way. Check out PJNE’s interview with Dave about his journey to becoming a dispensary manager at The Healing Corner in Bristol, Conn. Dave is an active member of the CPA who enjoys giving back through his role on the Connecticut Pharmacists Foundation Board of Directors. PJNE: Explain how you landed your role as dispensary manager at The Healing Corner. At what point did you realize that the medical marijuana setting was the best career pathway for you? Dave: Connecticut actually legalized medical marijuana while I was in pharmacy school, and I was surprised to hear that CT would be the first state to require pharmacists to facilitate the dispensing of medical marijuana. I thought that this would be a very interesting opportunity for pharmacists. I knew that I would want to find out more about it and vowed to keep my ears open for any opportunities to get involved in this industry. When I completed an APPE rotation at the Connecticut Pharmacists Association (CPA), the state awarded producer and dispensary facility licenses, and I found out that one of the six licensed dispensary facilities would be opening right here in Bristol. I had the chance to attend a stakeholders meeting with various members of DCP, along with owners of producers and dispensary facilities (several of whom are pharmacists that I already knew). A little further down the road, one of these [dispensary] owners contacted the CPA, asking if the organization knew any pharmacists who were interested in becoming involved in the medical marijuana program, and they referred my name. The rest is history! PJNE: Take us through a typical day at The Healing Corner. What do you enjoy the most about your job? Dave: As a dispensary pharmacist, one of my most important

Dave Slomski

roles is sitting down with patients and helping them to pick out what type of medical marijuana formulation will help them with the symptoms that they are looking for relief from. This involves finding out what their qualifying condition is, what specific symptoms that they are looking for relief from, and what their level of experience and discretion is. It is so rewarding to make a recommendation to a patient, and to hear them tell you how well it worked for them the next time that they come in! The thing that I enjoy the most about my job is that there is no “typical day” at The Healing Corner! Even now that we are almost four years into CT’s medical marijuana program, the industry is still constantly evolving. We have 20 to 30 new products that are made available to us every week, and it is fascinating to look back and see that when we opened, only three different products were available, and over the past four years, several thousand have been made available to dispense to patients. PJNE: At what point in your career did you decide to pursue a Masters Degree in Biomolecular Science, and how has this degree played a role in your current position? Dave: I actually earned my Masters Degree in Biomolecular Science before starting Pharmacy School. As I was completing my Bachelors Degree in Biomolecular Science, I became very passionate about it, and decided to pursue my Masters Degree. During school, I worked as a pharmacy technician, and through the advice of several pharmacists I worked for, I decided to look into going to pharmacy school. I found this degree to be extremely helpful in getting through pharmacy 27


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school, especially the accelerated program at the University of Saint Joseph (USJ). Additionally, having the background in biomolecular science continues to help me to this day, particularly when researching how the different cannabinoids and other molecules in the cannabis plant interact with receptors in the body, exerting various therapeutic effects. PJNE: Aside from the medical marijuana setting, you have 10 years of experience working in the community pharmacy setting. What skills did you gain through that experience, and how did those skills prepare you for your success in your current role? Dave: I have 10 years of experience in the community setting, starting as a cashier, then progressing through the ranks of pharmacy technician, intern, and eventually a pharmacist. I think the biggest skill that I was able to hone during that time was being able to communicate effectively. I sit down with patients on a daily basis to talk with them about the symptoms that they are looking for relief from and to make product recommendations. Without that retail experience, I don’t think that it would go as smoothly as it does for me. PJNE: What kinds of setbacks, if any, have you experienced in making the career switch from the community setting to the medical marijuana setting, and how did you overcome those setbacks? Dave: My only concern was the potential unknown of getting involved in a brand new industry, especially as a newly licensed pharmacist. I had invested a lot of time and energy into my previous employer, and it was a difficult decision to make to leave and try something completely new. However, I in no way regret this decision, because each and every day is so rewarding. PJNE: What advice do you have for pharmacy students who may be considering the medical marijuana setting as a possible career pathway? What kinds of opportunities are available to them in this setting? Dave: Treat every rotation like a job interview! Pharmacy school is unique in that you have the opportunity to try out six to 10 different jobs for four to six weeks at a time during your last year. Taking these opportunities seriously is critical, as the pharmacy community is very small. You never know when you will be interviewing with a former preceptor or 28

professor for a job, so it is very important to always put your best face forward during every interaction. If I did not take my rotations seriously, I wouldn’t be where I am today.

From the hospital setting to academia For Dr. Lisa DeGennaro, teaching has always been a part of her role as a pharmacist. A former PGY1 pharmacy resident at Saint Francis Hospital and Medical Center, Lisa teaches at the University of Saint Joseph School of Pharmacy in Connecticut, where she enjoys supporting the development of future pharmacists. Throughout Lisa DeGennaro her career, Lisa has worked in the hospital setting and achieved credentials along the way, including the Certified Diabetes Educator credential. Lisa also brings her teaching outside the classroom, as she has served as a speaker for CPA’s continuing education programs. In September, Lisa will facilitate the APhA certificate program, “The Pharmacist and Patient-Centered Diabetes Care,” during the 2018 New England Pharmacists Convention at Foxwoods. Check out PJNE’s interview with Lisa to learn more about her journey to teaching. PJNE: After completing an ASHP-Accredited PGY1 Pharmacy Practice Residency at Saint Francis Hospital and Medical Center, you joined the department of pharmacy there. What skills did you acquire as a resident that helped you transition to the pharmacy team? Lisa: As a resident, I gained experience working with different patient populations and was exposed to various clinical situations. I was challenged every day to use critical thinking and problem-solving skills to prioritize aspects of patient care. In addition, my involvement in areas like medication safety and pharmacy operations fostered a greater understanding and appreciation for all aspects of the medication use process. The residency helped strengthen my communication skills, as I gained proficiency in written communication, formal oral presentations and direct communication


Pharmacy Journal of New England â&#x20AC;˘ Summer 2018

with other members of the healthcare team. Balancing direct patient care responsibilities and multiple long-term projects developed my time management and efficiency. These acquired skills helped to build my confidence and competence and allowed for a successful transition to the inpatient pharmacy team. PJNE: At what point in your career did you begin to work for the Ambulatory Clinic system affiliated with the hospital? Lisa: After working for two years as an inpatient pharmacist, the opportunity became available to move to a pharmacist position in the Ambulatory Clinic system. The Ambulatory Pharmacist worked collaboratively with the medical providers in the clinic to provide education and management for various chronic disease states. I had spent four weeks in the clinic on rotation during my residency and loved the chance to interact directly with patients in this setting. PJNE: In 2006, you achieved a Certified Diabetes Educator credential, and have maintained practice interests in diabetes care since then. What inspired you to achieve this credential? Lisa: During my time in the ambulatory clinic, the majority of the patient referrals I received were for diabetes education and assistance with management. The treatment of diabetes is complex, and a multidisciplinary approach is best. Many patients lack knowledge regarding the various medications used for treatment and other important self-care behaviors that can reduce the risk of long term complications. I began to realize the positive impact a pharmacist could have on this population of patients. I was dedicated to continuing to provide care at the highest level, so I pursued the Certified Diabetes Educator (CDE) credential. This credential confirms my commitment to life-long learning in this clinical area. PJNE: How did your experience as an Ambulatory Care Pharmacist benefit you in your next role as Clinical Manager and Residency Program Director for the department? Lisa: Working directly with patients and other healthcare professionals in the Ambulatory Clinic further developed my communication and problem-solving skills. I gained knowledge and experience in the care of patients throughout various care transitions, having now worked in both the

inpatient and outpatient setting. This experience allowed me to better promote the safe, effective, and efficient use of medications in my role as Clinical Manager. I do not feel that any of the positions I have held would have been possible without the valuable experience I gained from my residency. The chance to give back to the residency program as a Residency Program Director was important to me. PJNE: Why did you pursue a career as an Assistant Professor of Pharmacy Practice and Administration at USJ, and what do you enjoy the most about this job? Lisa: I have always loved to teach. Whether it was fellow healthcare professionals or patients, teaching was an important aspect of my job. As a clinical manager I had the opportunity to precept APPE students during their clinical rotations. When the opportunity became available to transition to academia and teach full time, it seemed like the right fit. The most enjoyable aspect of this job is the interaction with students and the chance to support their development. I also enjoy the fact that I get to utilize the skills I have learned along the way nearly every day. I continue to be involved in direct patient care activities and now I can bring these experiences into the classroom to use as teaching tools. PJNE: Looking back on your career, what setbacks or challenges did you encounter throughout the various positions you held, especially when transitioning from the hospital setting to the academia setting? How did you overcome these challenges? Lisa: Determining which learning opportunities worked best in the classroom was challenging at first. I had become accustomed to certain teaching styles that had worked for me in the past, but these styles did not always work well in the academic setting. Through a trial of various learning techniques, feedback from fellow colleagues, and continual review of the scholarship of teaching and learning, I was able to develop new and innovative ways to deliver material. PJNE: What advice do you have for any pharmacists who are looking to transition to a new setting in the pharmacy profession? Lisa: Realize that the skills pharmacists possess are not unique to only one practice setting. Skills in communication, time management, critical thinking, and teaching are 29


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desired in most areas of pharmacy practice. Look for ways to continue to develop your skills or diversify yourself such as through specialty certifications, involvement in pharmacy organizations or by becoming a preceptor to students. Dr. Lisa DeGennaro earned her Doctor of Pharmacy degree from the University of Connecticut. She completed an ASHPAccredited PGY1 Pharmacy Practice Residency at Saint Francis Hospital and Medical Center in Hartford, Connecticut. After residency, Dr. DeGennaro joined the department of pharmacy at Saint Francis. While at Saint Francis she held various positions such as Ambulatory Care Pharmacist,

The Power of Networking By Nicole Asal, Pharm.D., BCPS When I first moved to Rhode Island, I was too busy getting settled into my new job as a Clinical Assistant Professor at the University of Rhode Island to investigate professional development and networking opportunities. It wasn’t until a then colleague, now friend and mentor, encouraged me to join the Rhode Island Pharmacists Association (RIPA). I was overwhelmed with setting up my practice site at the Providence Veterans Hospital, precepting several students on rotation and getting to know my new surroundings. I didn’t think I had time for anything else. My involvement started out slowly; several options of activities were available to participate in. I had opportunities that matched my interests and workload capabilities. I was paired with another Executive Board member who had previously held many roles within the organization to work on the communications and events committees. This was a great way to use my existing skill set, so I didn’t feel overstretched. By attending monthly meetings, I was able to passively learn about each person in the room, their practice and their experiences in pharmacy. As the years passed, I noticed that more and more friends and acquaintances from pharmacy school were reaching out to ask for advice on how to get into a certain line of pharmacy or if I knew anyone within a certain organization because they were interested in a job. State pharmacy associations offer a range of benefits, including, but not limited to: continuing education, profes30

Residency Program Director and Clinical Manager. Dr. DeGennaro achieved her Certified Diabetes Educator (CDE) credential in 2006 and her Board Certified Pharmacotherapy Specialist (BCPS) credential in 2013. She joined the University of Saint Joseph School of Pharmacy in 2013 and maintains research and practice interests in diabetes care and interprofessional education. Her clinical practice site is located at The Hospital of Central Connecticut Outpatient Medical Clinic in New Britain, CT.

sional development, legislative representation, school/college of pharmacy connections and informational updates about the profession. Perhaps one of the most overlooked benefits of becoming involved with your state pharmacy association is networking opportunities. As a non-native Rhode Islander who moved here for work, getting involved in my state association was paramount in helping me make professional (and social) connections in a state where most pharmacists grew up and/or went to pharmacy school in “Rhody.” Here is how involvement in your state pharmacy association can help you network: • Increases your confidence: As a student or new practitioner, making the leap into your individual career can be daunting. While rotations and post-graduate training help expand your professional skillset, nothing can really prepare you for that first leap into independence. Similarly, if you are changing jobs after being in your current position for some time, getting back out into the field can be daunting. As you meet new members within the organization, you can practice your communication skills in a variety of professional (and social) settings. While this may be intimidating at first, like anything else, practice makes perfect. The more you build this skill set, the easier it will become to confidently talk about your career, your professional interests and yourself in a meaningful way. The more confident you become in this role, the more approachable you will be and the more seriously you will be taken. • Builds meaningful relationships: This is likely the first thing


Pharmacy Journal of New England • Summer 2018

that comes to mind when you hear “networking.” You probably think of an awkward cocktail party or networking hour where you are expected to roam around the room and, well, network. Becoming involved with your state association offers more dynamic and less intimidating ways to build new professional and social relationships. When you work with other pharmacists (and/or technicians or students) towards a common goal (i.e. planning a social event for your association, putting together a continuing education program, summarizing proposed legislation for your members), the connections you build are more organic and you get to know each other better. Additionally, as different members offer their opinions and insights on issues, you gain a deeper understanding of their experiences and roles within their organizations. • Improves your industry knowledge: When you are part of an organization that aims to unite and advocate for pharmacists in your state, you stay “in the know” about issues surrounding the profession. You have the opportunity to interact

with people from many areas of pharmacy and learn about what is going on in each practice area. Just because you do not hear about an issue in your practice, does not mean others aren’t navigating new and/or challenging territory. You can engage and interact with pharmacists from other areas who can share their advice or experience on a particular issue. The more you know, the better you can advocate for yourself and your profession. By being better prepared to share your experiences, building your professional relationships and increasing your professional knowledge, you will be in a better position to network your way to a new job or other new opportunities. If you have not already, join your state pharmacy association and see what the future holds! Dr. Asal is a Clinical Associate Professor at the University of Rhode Island College of Pharmacy and President of the Rhode Island Pharmacists Association.

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With the recent deaths of fashion designer Kate Spade and culinary star Anthony Bourdain, public health officials have raised more awareness about the rising suicide rates in the U.S. According to the Centers for Disease Control and Prevention (CDC), suicide rates increased by 25% nationwide between 1999 and 2016. In 25 states, suicide rates increased by more than 30%, reported the CDC. New England was not alone in these statistics. Here is a snapshot of where suicide rates currently stand in Connecticut, Massachusetts, Rhode Island, Maine, New Hampshire and Vermont. Besides mental health conditions, many socioeconomic conditions also play a role in rising suicide rates. Relationship problems made the top of the list, as reported by the CDCâ&#x20AC;&#x2122;s National Violent Death Reporting System. Click here for more details.

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5 WAYS PHARMACISTS CAN HELP PREVENT SUICIDE 1

IDENTIFY AT-RISK PATIENTS

2

MONITOR MEDICATION USE AND MENTAL HEALTH

3

COLLABORATE WITH THE HEALTH CARE TEAM

4

REFER PATIENTS TO SUICIDE PREVENTION RESOURCES

5

BE ENCOURAGING AND EMPATHETIC

SOURCE: PHARMACY TIMES

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Study Innovations in Practice

efficacious alternative to long-acting insulins glargine and detemir.

Several professionals from both the pharmacy and medical practice collaborated on a retrospective study on patients who had to switch from Lantus insulin to NPH insulin. Check out the study below.

Introduction

Title Can We Switch from Insulin Glargine/Insulin Detemir to Insulin NPH In a Real-World Outpatient Setting?

Authors Morgan Reynolds PharmD, CDE1; Pia Clive PharmD, BCPS2; Mohamed Nounou PhD1; Michael Thompson MD2

Affiliations University of St. Joseph 1 UMass Memorial Medical Center 2

Corresponding Author: Morgan Reynolds, PharmD, CDE

Abstract

Research Design and Methods

OBJECTIVE: The purpose of this study is to evaluate the safety and effectiveness implications of switching from insulin glargine/insulin detemir to insulin NPH.

A retrospective medical record review was conducted for patients who were previously prescribed insulin glargine or insulin detemir and were then switched to insulin NPH between January 1, 2013 and December 31, 2016. Patients that were included were those over 18 years of age with documented type 1 or type 2 diabetes mellitus, received a minimum of six months of therapy with long-acting basal insulin (insulin glargine or detemir) immediately followed by a minimum of six months of insulin NPH therapy. Pre- versus post-switch analyses were conducted for hemoglobin A1C (HbA1C) values and for blood glucose values collected from self-monitoring (SMBG) device uploads. Patient records included in the HbA1C analysis required at least one HbA1C reading within the year leading up to the switch and one

METHODS: A retrospective medical record review was conducted of patients who were previously prescribed insulin glargine or insulin detemir and were then switched to insulin NPH. The primary efficacy endpoints were the change in average HbA1C and self-monitoring of blood glucose (SMBG) values before versus after the switch. Safety analysis was conducted by comparing the rates of hypoglycemic episodes. RESULTS: A total of 56 patient records were identified as having met inclusion criteria for HbA1C and 30 for SMBG analysis. There was a statistically significant improvement in HbA1C and SMBG values in the NPH group and a higher overall rate of hypoglycemia in NPH group (not statistically significant). CONCLUSIONS: Insulin NPH appears to be a safe and 34

Long-acting insulin analogues such as insulin detemir and glargine have largely replaced use of intermediate-acting insulin NPH due to their convenient once-daily dosing and pharmacokinetic profile. However, insulin NPH remains significantly less expensive and is often chosen over long acting insulins for patients in whom compliance is highly dependent on cost. To assist in putting the cost of these types of insulin in perspective, a 10ml vial of insulin glargine is on average 10 times the cost of insulin NPH. Regarding clinical efficacy, the two regimens have proven comparable, and in some cases, glargine was shown to be superior in controlled clinical trial settings1,2 and current guidelines and standards of practice for the management of diabetes mellitus do not favor one regimen over another3. Considering that cost alone drives a frequent clinical scenario of patients switching insulins, it begs the question: how does this switch affect the patientâ&#x20AC;&#x2122;s diabetes clinical outcomes from both an efficacy and safety standpoint in a real-world setting?

reading taken between 30 days to one year after the switch. Pre/post SMBG analysis was conducted for the six months pre-switch versus the six months post-switch; records included required a minimum of five readings in each period. Patients were excluded from either analysis (HbA1C or SMBG)


Pharmacy Journal of New England â&#x20AC;˘ Summer 2018

if their records lacked data necessary for that analysis, records failing to meet criteria for one analysis were not automatically excluded from the other. Records of patients under the age of 18 and those of other vulnerable populations including prisoners, pregnant women, and adults unable to consent were excluded entirely. A total of 56 patient records were identified as having met inclusion criteria for HbA1C and 30 for SMBG analysis. The primary efficacy endpoints were the change in average HbA1C and SMBG values before versus after the switch. Safety analysis was conducted by comparing the rates of hypoglycemic episodes (defined as one or more SMBG reading of 70 mg/dL or less within a two-hour period) within the SMBG data for pre- versus post-switch periods. Statistical analyses of safety and efficacy endpoints was conducted using ChiSquare test (Two sided, CI (Confidence Interval) of 95%) and Two-way ANOVA with Sidakâ&#x20AC;&#x2122;s multiple comparisons test (CI of 95%).

Results HbA1C was found to be significantly less following the switch with average A1C being 9.3% versus 8.4% (P<0.0001) during long acting insulin and insulin NPH periods, respectively. Average SMBG readings were also significantly lower postswitch at 182.3 mg/dL versus 157.8 mg/dL (p<0.0001) during long acting insulin and insulin NPH periods, respectively). Subgroup analysis of SMBG data showed that this difference was significant across all times of day except early nighttime (12-2 am) and was most significant among readings taken during late night to early morning hours. Of note, there was statistically significantly more patients with a SMBG of <180mg/dL in the insulin NPH group (P<0.0001). Finally, in regards to safety, there was a higher overall rate of hypoglycemia (<70mg/dL) among SMBG readings during the NPH period, which was not found to be statistically significant

(P<0.2485) however in the subgroup of patients with a SMGB <50mg/dL there was statistically significantly less occurrences in the insulin NPH group (P<0.01).

Conclusion Based on the study findings, insulin NPH appears to be a safe and efficacious alternative to newer analogue long-acting insulin. In our study we saw lower sugars in the overnight hours for patients on insulin NPH. The potential increased risk of hypoglycemia, particularly in early morning hours, remains one of the leading deterrents for providers who might otherwise consider prescribing insulin NPH. It is interesting that in our study severe hypoglycemia (<50mg/dL) was actually lower in the insulin NPH group. It should be noted that since our study was not powered to detect a significant difference in hypoglycemia between the two treatments, a larger study would be required to either confirm or refute this finding. The improvement in A1c observed in this study may have simply been due to ongoing efforts to improve glycemic control but it is possible that cost of therapy was a primary driver of poor glycemic control and that improved control resulted from increased patient compliance due reduced cost of therapy . Limitations of this study include its small sample size and the fact it is a retrospective chart review, however we were surprised to find that following a switch to insulin NPH, patients had better A1C control, improved SMBG readings, and less severe hypoglycemia.

References 1. Zdarska DJ, Kvapil M, Rusavy Z. et al. Comparison of glucose variability assessed by a continuous glucose-monitoring system in patiets with type 2 diabetes mellitus switched from NPH insulin to insulin glargine; the COBIN2 study. Wein Klin Wochenschr. 2014 Apr; 126(7-8):228-37. 2. Frier BM, Russell-Jones D. Heise T. A comparison of insulin detemir and neutral protamine Hagedron (isophane) insulin in the treatment of diabetes; a systematic review. Diabetes Obest Metab. 2013 Nov; 15(11);978-86. 3. American diabetes association standards of medical Care in diabetes. Diabetes Care. 2018; 41(1); 1-150.

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PJNE Summer 2018