Keeping Tabs

KEEPING TABS

UF COP Jacksonville APhA-ASP Volume 2, Issue 2

Table of Contents APhA Annual Recap

2

Embracing my Calling through APhA-ASP

3

Leadership

5

Involving Yourself in Research as a Pharmacy Student

7

Expanding the Role of Prescription Drug Monitoring Programs

9

What Comes After a Cardiac Event?

11

Normalizing Mental Health: Remove the Stigma

13

HPV: Have the Conversation

15

Member Spotlights!

16

Thank You!

17

APhA Annual Recap Our chapter was honored as the national First Place Winner for our OTC Medicine Safety Patient Care Project! Special shout out to Brooke Knapp, Danielle Morgan, and Laura Davis for all of your hard work!

We also received the Division A First Runner-Up award! Huge thank you to all of our officers and members at each campus! Â We wouldn't have achieved these awards without all of your support!

Embracing my Calling through APhA-ASP By: Shannon Stittsworth

During my first Midyear Regional Meeting, I was sitting in the opening session where APhA President at the time Lucy West was giving a speech focused on her presidential theme for the year, “Live your Why.” At the time, I was very impressed by her public speaking skills, but didn’t quite understand what a “why” was. Like many students around the room, I needed some guidance to discover and formulate my why statement. Lucy asked us to write, on a piece of paper, 3 big moments in our lives, moments that stand out as events or choices that ended up making a huge difference in our lives. The 3 things I wrote were: 1.

My parents moving me from Illinois to Florida halfway through high school, 2.

Skydiving, and 3. Choosing to leave the PhD program I was in to pursue pharmacy. She then asked us to find the common link between all three and use that to start thinking about our why. Immediately, I was struck by the commonalities. Each time I was either pushed or jumped out of my comfort zone, something life changing and great happened! This realization allowed me to come up with my why statement which is “to push myself and my fellow student pharmacists out of our comfort zone in order to make a positive impact on those around us.”

Immediately, I made a promise to myself that I was going to continue to push myself out of my comfort zone every chance I got throughout pharmacy school. I could go on for pages about how sticking to that promise opened doors for me that I never could’ve imagined, but instead I want to talk about how it allowed me to find and embrace my calling.

I’ve always known that I want to spend my life doing good for others, especially those less fortunate than me. In fact, I had already submitted my Peace Corps application when I got my admission letter to attend pharmacy school. That’s why I was so drawn to APhA-ASP. I saw all the amazing patient care initiatives and thought it would be the best way for me to give back to my community. My intentions were to get involved in Operation Diabetes and go from there but sticking to that promise I talked about earlier set me on a different path. It was actually at the same MRM I discovered my “why” that I started embracing my calling and made the commitment to run for President-Elect of our APhA-ASP chapter.

From there, I continued pushing myself to get more involved, attending the Summer Leadership Institute, running for Regional Member-at-large at my second MRM and National Member-at-large at APhA Annual 2018. I was fortunate enough to get elected to some amazing positions and ended up losing as well but it was never about holding a certain position that became my calling. I embraced my calling by finding the ability and passion to inspire, motivate and empower those around me to push themselves as well. By learning to coordinate a team of people that worked together to provide more for our community than any of us could do alone. And by working to develop my friends into leaders who would go on to accomplish incredible things.

This year I want to challenge each and every one of you to pursue one thing that scares you. Run for a position that you’re passionate about, ask to host an event even if you’re not the chair, stand up and speak at a large conference in front of strangers, and speak up in a legislative visit. Follow your passions, don’t let anything stop you, and embrace your calling!

Leadership By: Megan Van Fleet

“Leader” has never been a word that I would have used to describe myself.

If you were to have told me my first year of pharmacy school that, by my third year, I would hold 2 leadership positions, one of which involving being in charge of the communications of an entire organization, I would have laughed in your face. As a first-year student, I did not even join an organization, let alone consider running for any officer positions. But by the end of the year, I found myself going to several of the events hosted by APhA-ASP, so I decided to join as a 2PD. Flash forward to the Midyear Regional Meeting (MRM) of 2017, my 2PD year, that was hosted in Orlando, almost too close of an opportunity to pass up. By that point, I had heard about MRM, but still did not really know what it was about. So, with a little courage (and quite a bit of peer pressure) I took the leap and decided to sign up. While there, I can honestly say that I was inspired: meeting so many other student pharmacists and leaders of other chapters, seeing their passion and learning what drives them, watching my own classmates find their voice and speak up for policies and topics that they cared about. Listening to the accomplishments and events hosted by the winning chapter for Operation Immunization, I was struck with an idea to host a new flu shot clinic and even wrote down several ideas, right there in the awards ceremony.

It was there, sitting in a room with over 700 fellow student pharmacists, that I decided to apply to be a chair of Operation Immunization. I was nervous about the possibility of a new leadership position, but knowing that I was going to be on a team comforted me and was another encouraging aspect convincing me to apply.

Then, the day before our chapter’s executive board elections, I received a call from a member of the board and our campus cheerleader (and participation bully), Michael Finnick, informing me that there was no one running for Communications Vice President and asking if I would be willing to step into that role. And I will not lie, I was terrified. How could a I, a shy, scared introvert, be in charge of running the entire chapter social media page, sending emails to the entire campus, and potentially creating a newsletter? How would I be able to overcome the increase pressure and workload of adding, not one, but two new positions? After much debate, and a lot of encouragement, I accepted and the rest is history and I would not have it any other way.

Sometimes all it takes to discover where you are meant to be is a nudge (or shove) in the right direction. If you are hesitant to run for a leadership position, find the courage to take that first step into the unknown. There's an entire organization of student pharmacists who only want you to succeed and will work with your strengths and weaknesses to make that happen. APhA-ASP has allowed me to grow, find more passion in the field of pharmacy, and helped me to turn into the leader that I never thought that I could be.

Involving Yourself in Research as a Pharmacy Student By: Lindsey Little

Getting involved in research as a pharmacy student provides invaluable experiences in developing medical writing skills and opportunities for publication. Involving yourself in research as a student is an important component of your curriculum vitae (CV) and, although it is not required for most programs, it can truly help you stand out from the crowd when it comes time for residency or fellowship applications. From personal experience, I was asked about my research experience on every single one of my residency interviews. These programs want to know if you are capable of handling additional projects to your workload. Research projects are an excellent way to showcase this!

One of the largest hurdles to completing research in pharmacy school is truly that - you are in pharmacy school! Not all students are able to dedicate an entire summer or a large amount of time during the semester to participate in “bench research”, and that is okay! There are many opportunities to participate in all kinds of research or special projects. Finding the perfect fit for your busy life as a student is essential!

Personally, my research experience has included co-authoring a literature review article that was published in a reputable journal and participating as a co-investigator in a quality improvement project with a published eLetter to the Editor regarding our findings.

Additionally, I am currently collecting data for a multi-center retrospective study. These projects were all started because I discussed my professional goals and my desire to add extra projects to my workload with preceptors and mentors early on!

Retrospective chart reviews are one of the most commonly utilized pharmacy residency research projects, as residents are able to collect information, analyze data, and produce a publishable manuscript all within the residency year.

Therefore, involving yourself in this type of study is perhaps the most valuable when it comes to preparing yourself for research as a resident. Data collection allows students to gain familiarity with the electronic health record, practice finding/interpreting laboratory values, and understand patient notes from different disciplines.

It is important to remember that original research is not the only form of research you can do! Composing a literature review will teach you to critically evaluate the quality, and findings, and conclusions of original research empirical studies. Writing a case report or case series will allow you to describe and interpret individual patient cases. For these projects, keep an eye out for interesting patient cases and ask your preceptors if they have any ideas for a literature review or case report.

At the end of the day, the general principle I would like to impart is to diversify your CV with some sort of project prior to ASHP Midyear, if possible. This will provide additional content for your residency applications, conversation topics for your interviews, and most importantly, a better understanding of research!

Expanding the Role of Prescription Drug Monitoring Programs By: Kyle Kirkpatrick and Lauren Ingram

As the United States is currently in the middle of a harrowing opioid crisis, the use of Prescription Drug Monitoring Program (PDMP) data is expanding both on a state and national level to provide pharmacists and providers an increased ability to prevent drug diversion and abuse amongst their patients.

In an effort to address the difficulties associated with inter-state PDMP data sharing, the National Association of Boards of Pharmacy (NABP) has developed PMP Interconnect, a system that encrypts PDMP data and ensures each participating state’s data access rules are being enforced every time a data request is performed. As of January 2018, forty-four states have enrolled in PMP Interconnect and now have the ability to monitor prescriptions across state lines. Unfortunately, Florida has yet to enroll in PMP Interconnect, but with the NABP stating that their mission is not complete until all 50 states are enrolled, we can hope to see our involvement in the future.

Some states have made valiant efforts to increase the impact that PDMPs can have on clinical decision-making within their own borders. One example being Ohio, which in 2015 began a statewide initiative to integrate PMP access into Electronic Health Records (EHRs) by providing funding to assist in the integration process. Traditionally, outside internet connection was necessary to access PMP data. This created a barrier for clinicians as it required additional time and effort which ultimately resulted in low utilization. Between the years 2015 and 2017, the Ohio Automated Rx Reporting System (OARRS) had greater than a 400% increase in data requests, showcasing the impact that EHR integration can have in practice.

Wisconsin also made the decision to directly integrate PDMP access into EHRs with the addition of Law Enforcement Alerts. Wisconsin Act 268, which became effective in March 2016, lists 4 specific situations in which law enforcement must submit information to the Wisconsin Prescription Drug Monitoring Program. This additional information allows providers to view a more complete picture of a patient’s opioid history and may lead to more informed decision making. Wisconsin also includes a Prescribing Practice Assessment, which allows prescribers to view how their prescribing trends compare to the rest of the state. Benefits of this feature include making prescribing more consistent and identifying providers that may be abusing their authority.

This additional information allows providers to view a more complete picture of a

As previously mentioned, forty-four states have enrolled in PMP Interconnect with Florida being one of the six that has yet to enroll. In the past several years, Florida has seen a dramatic increase in the number of opioid-related deaths. Florida currently utilizes a statewide prescription drug monitoring program known as E-FORCSE. Gov. Rick Scott recently signed into law House Bill 21, which becomes effective July 2018, limiting opioid prescriptions for acute pain to a three-day supply and even a seven-day supply when deemed medically necessary. HB 21 also requires both prescribers and dispensers to use a statewide database or prescription drug monitoring program, most likely E-FORCSE in this case. While this is a step in the right direction, it is confined to the state of Florida, which limits its usefulness to neighboring states. Joining PMP Interconnect would not only give Florida access to other states’ data, but also share Florida’s data with them benefiting all states enrolled. Although it is apparent that states are making individual strides to counter prescription drug abuse from multiple fronts, a united approach, such as PMP Interconnect, would have a more substantial and longer lasting impact on the opioid crisis we face today.

References 1. CS/CS/HB 21: Controlled Substances. Retrieved April 30, 2018, from https://www.flsenate.gov/Session/Bill/2018/21 2. NABP PMP InterConnect Is the Answer to White House Call for National Interoperability of Prescription Drug Monitoring Programs. (2018, March 22).

Retrieved April 30, 2018, from https://nabp.pharmacy/nabp-pmp-interconnect-is-the-answer-to-white-house-call-for-national-interoperability-ofprescription-drug-monitoring-programs/ 3. NAMSDL. Congressional Briefing - Prescription Drug Monitoring Programs (PDMPs): Critical Decision Support Tools to Respond to the Opioid Crisis - Final Agenda and Presentation (September 8, 2017) Retrieved April 29, 2018, from http://www.namsdl.org/prescription-monitoring-programs.cfm 4. NABP Over Forty States Are Now Members of PMP InterConnect. (2016, August 16). Retrieved April 29, 2018, from https://nabp.pharmacy/over-forty-statesare-now-members-of-pmp-interconnect/ 5. NABP PMP InterConnect FAQs. Retrieved April 30, 2018, from https://nabp.pharmacy/initiatives/pmp-interconnect/faqs/#how-developed

WHAT COMES AFTER A CARDIAC EVENT? B y ;

M a d i s o n

C l a y t o n

Preventative medicine is undoubtedly the preferred way to help our patients maintain healthy cardiovascular health, along with diet and exercise modifications. However, so many of our patients have already experienced a cardiac event and may feel that it is too late for medication and lifestyle interventions to have a significant impact on their cardiovascular health, especially in the later stages of life.

Part of our job as pharmacists is to make sure that our patients understand the value of taking these steps toward a healthier heart at every stage of life. It is important that our patients understand that not only are we working towards helping them live longer and healthier lives, but also ensuring that they have the best possible quality of life by helping them manage medications and side effects and preserving their functionality of daily living.

Now, we can offer our patients even more support by sharing information with them about the Cardiac Rehab program. This 12-week program, established by the American Heart Association, offers patients with heart conditions, or those who have already experienced a cardiac event, a set of exercise and cardiac risk factor educational programs, with the goal of reducing future cardiovascular events.

The program focuses on three components: exercise counseling and training, education for heart healthy living, and counseling to reduce stress. Pharmacists are listed among Cardiac Rehab’s team members, including also doctors, nurses, and friends and family of the patient.

The program keeps the patient at the center of the team and gives them the tools they need to take an active role in achieving their cardiovascular health goals.

Patients of all ages are eligible for this program if they have either one or more of the following conditions: coronary artery disease, angina, or heart failure; or have had the following procedure or surgery: coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI) including coronary angioplasty (balloon or angioplasty), stenting, valve replacement, pacemaker, or implantable cardioverter defibrillator (ICD); or have had a heart attack.

Patients also need to be referred by a physician to be eligible for the program.

Interestingly, even though women are more likely to gain benefits from the program, they are less likely to be referred to Cardiac Rehab than men. Make sure your patients are aware of this option and empower them to ask their physicians for a referral if one is not offered to them.

Reimbursement for the program is provided by Medicare and most other insurances for the conditions or procedures listed above. Coverage for patients with heart failure is limited to patients with compromised ejection fraction (HFrEF), which covers about 50% of heart failure patients.

There is still a lot of life left for patients after a cardiovascular event, and Cardiac Rehab is a tool to help guide our patients toward improving their heart health and quality of life, no matter their age. Add this to your list of resources to offer your heart patients who struggle with managing their medications, lifestyle modifications, and stress associated with cardiovascular disease.

Reference 1. AHA. “Cardiac Rehab: Your Roadmap to Recovery.” American Heart Association, www.heart.org/HEARTORG/Conditions/More/CardiacRehab/CardiacRehab_UCM_002079_SubHomePage.jsp

Normalizing Mental Health: Remove the Stigma By: Hailey Rutledge What is the Mental Health Stigma?

subjective quality of life, and low self-

Mental health includes our emotional,

esteem. Self-stigma in particular has been

psychological, and social well-being, and it

associated with lower employment success

affects how we think, feel, and act.

and increased social isolation (2).

Maintaining mental health is important during every stage of life, and throughout

Why Does the Stigma Remain?

your life you may experience changes in your

As previously stated, this a complex and

thinking, mood, or behavior. These changes

multifaceted issue. One glaringly obvious

can be attributed to many factors, such as

factor is the lack of public education

biological changes or life experiences (1).

surrounding mental health. Mental health

Mental health and illnesses have

awareness and wellness is rarely ever taught

become hot topics in recent years, and while

in public schools and large scale public

there have been countless strides in treating

education is equally sparse. This, along with

mental illnesses and maintaining mental

the historically negative perception of

health, the stigma remains. People who live

people who suffer from mental health

with mental illness are often ostracized and

problems, has led to lingering fears and

not treated with the compassion that is

suspicions of mental health (4).

shown to those who suffer from physical

Another important factor is the way

ailments. In turn people who try to prioritize

mental health is portrayed in the media.

their mental health and wellness are often

They often perpetuate stereotypes of people

seen as “weak” or “overly sensitive”(2).

who suffer from mental health problems, so

The stigma surrounding mental health

their role cannot be understated (4). All of

is a complex multifaceted issue with several

the above factors have shaped the way we as

negative overarching consequences. Stigma

a society talk about mental health, which is

and discrimination can impede access to

another contributing factor in and of itself.

care at institutional, community, and

Words like “crazy” or “nuts” used to describe

individual levels (3). Social effects of the

people with mental health issue has only

stigma include poor social support, poorer

perpetuated the stigma.

How Do We Eliminate the Stigma?

It is important for the public and even

The National Alliance on Mental Illness

for health care providers to acknowledge

(NAMI) lists 9 ways to fight the mental health

that mental health is an important part of

stigma (5):

overall health. Removing the stigma

1. Talk openly about mental health

surrounding mental health is a crucial first

2. Educate yourself and others

step to achieving this goal. While it may not

3. Be conscious of language

be possible to entirely eliminate the stigma,

4. Encourage equality between physical

individual efforts to educate, listen, and

and mental illness

show compassion will make a significant

5. Show compassion for those with

impact and provide help for those who are

mental illness

victims of stigmatization.

6. Choose empowerment over shame 7. Be honest about treatment 8. Let the media know when they’re being stigmatizing 9. Don’t harbor self-stigma

References 1. U.S. Department of Health & Human Services, 200 Independence Avenue, S.W. Washington, D.C. 20201 https://www.mentalhealth.gov/basics/what-is-mental-health. Last updated 08/29/17 2. Livingston JD1, Boyd JE. 2010 Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis. Soc Sci Med. 71(12):2150-61.doi: 10.1016/j.socscimed.2010.09.030.

3. Henderson, C., Evans-Lacko, S., & Thornicroft,G. (2013). Mental Illness Stigma, Help Seeking, and Public Health Programs. American Journal of Public Health, 103(5), 777–780. http://doi.org/10.2105/AJPH.2012.301056 4. Davey, G C.L. (2013) Mental Health & Stigma Mental health symptoms are still viewed as threatening and uncomfortable. Psychology Today. https://www.psychologytoday.com/us/blog/why-we-worry/201308/mental-health-stigma 5. Greenstein, L. (2017) 9 Ways To Fight Mental Health Stigma. National Alliance on Mental Illness.https://www.nami.org/blogs/nami blog/october-2017/9-ways-to-fight-mental-health-stigma 6. Chau, Huong. “Coping with the Stigma of Mental Illness.” Hello Doktor, Hello Health Group, 20 Mar. 2017. https://hellodoktor.com/health centre/mental-health-center/coping-stigma-mental-illness/

HPV: Have the Conversation BY: ISHANI PATEL, JEREMY OBORDO, AND MARIAH BIGAUD

Human Papillomavirus, or HPV, is a group of 150 related viruses. Each virus is given a number, which is its HPV type. This set of viruses can cause serious health effects including genital warts and even cancer. For men, it can cause penile cancer. In women, it can cause cervical, vulvar, and vaginal cancer. In addition to these types of cancer, it can lead to cancer of the mouth/throat and anus/rectum in both men and women. HPV is transmitted through intimate skin-to-skin contact. Fortunately, there is a vaccine available that can prevent infection of the HPV types that most commonly cause cancer.

The HPV vaccine is a safe and effective tool for reducing both HPV infections and HPV-associated cancers. The vaccine is a 2-shot series (3-shot series for those with weakened immune systems) given at least 6 months apart that can be started as early as 9 years old. The CDC, Advisory Committee on Immunization Practices, and Pediatric Pharmacy Advocacy Group all recommend its use in patients age 11-26. Despite this recommendation, only 60% of teens age 13-17 received one or more doses of the vaccine in 2016 (far below Healthy People 2020’s goal of 80%). Of those who receive the first dose, many do not complete the series. Due to age at which the vaccine is recommended, parents may be reluctant to have the necessary conversation with their children about the child’s sexual activity. Parents may view getting their children vaccinated as permission to engage in sexual behavior. Thus, we are seeing a lower percentage of vaccinated teens.

As a pharmacist, it is our duty to help patients make the best choices for their health through a shared decision making model. This means gathering evidence that supports healthy, favorable outcomes for the patients, while also incorporating the patient’s preferences and values. The CDC offers many resources and aids that help with giving parents information on HPV vaccination. The CDC recommends improving parental education by taking action in the following three ways: 1) Sending a letter home to parents when their child turns 10 to inform them of the vaccines that their child will need at their next visit, 2) Sharing one of the factsheets provided by the CDC website about HPV vaccine for parents who want more information, 3) Understanding that parents may have questions about vaccine and only need to be reassured that it is safe, effective, and long lasting. HPV is an easily preventable disease that will help prevent possible cancers as the disease progresses. Helping parents make informed decisions about their children’s HPV vaccination will help reach Healthy People 2020’s goal of an 80% vaccinated teen population.

References: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5341536/ https://www.cdc.gov/hpv/parents/whatishpv.html https://www.cdc.gov/hpv/hcp/vacc-coverage.html

Member Spotlights!

Ms. COP 2018

Region 3 Spotlights This year, Jeremy served as the APhA Annual Meeting Coordinator for all 4 campuses. During the Meeting, he kept students on trach, attended all required sessions and displayed a high level of professionalism throughout. Even though the conference is over, Jeremy is looking for ways to help future coordinators by creating a guide. As the incoming Membership VP, we can't wait to see where Jeremy's enthusiasm and infectious personality take him in APhA-ASP!

Emilie Collongette

Member of the Year

Alex is an outstanding student member of the UF COP Jacksonville APhA-ASP Chapter. At Legislative Days in Tallahassee, his enthusiasm for pharmacy policy was evident in every meeting he attended. Not only was he extremely engaged throughout the weekend, but he is now determined to continue advocating back home by officering to help set up local visits, tracking the bills, and keeping other students up-to-date and continuing to stay passionate about policy. Great job, Alex!

Officer of the Year

THANK YOU! Editor and Designer Jennifer Parmar Designer Ishani Patel Writers Shannon Stittsworth Megan Van Fleet Lindsey Little Kyle Kirkpatrick Lauren Ingram Madison Clayton Hailey Rutledge Ishani Patel Jeremy Obordo Mariah Bigaud

From the Keeping Tabs team and your leaders of UF COP Jacksonville APhA-ASP, thank you for another amazing semester! We hope you have a great summer and we'll see you again in August!Â