May 5, 2020
Casey Tak, PhD, MPH - University of North Carolina Eschelman School of Pharmacy and - Karen Gunning, PharmD, BCPS, BCACP - University of Utah College of Pharmacy - talk with us about hormonal contraception and how pharmacists in community and ambulatory care settings can increase women's access to care.
- A variety of contraceptive methods have been available through pharmacies for decades but many states now permit pharmacists to directly "provide" hormonal contraception without a prescription.
- A state-wide standing order is the most common mechanism for authorizing pharmacists to provide hormonal contraception directly to patients, but state laws and regulations vary.
- The CDC Guidance for Healthcare Providers - US Medical Eligibility Criteria do not require a woman to have a pelvic exam prior to receiving hormonal contraception. The pharmacist needs to ask about and document the patient's medical and medication history, take the patient's blood pressure, and inquire about contraceptive preferences before providing hormonal contraception.
- Some states require pharmacists to refer patients to a primary care provider to receive recommended preventive care, such as pelvic exams, breast exams, and Pap smears. Even when this is not required by state law, it's a best practice to ensure all women are receiving appropriate health maintenance services.
- Insurance coverage for pharmacist-provided hormonal contraception is not universal - many private insurance plans do not cover the cost of hormonal contraception or compensate for the pharmacist's time. However, Medicaid programs often do (varies by state).
- Increasing access to hormonal contraception is good public policy because it can positively impact Medicaid costs by reducing unintended pregnancies, high-risk pregnancies, and infant mortality.
- Student pharmacists can (and have) played an important role in advocating for pharmacist-provided hormonal contraction.
April 16, 2020
Kristin Wiisanen, PharmD - Clinical Professor and Director of the Graduate Program in Precision Medicine at the University of Florida College of Pharmacy - talks with us about using genomics to guide therapeutic decisions.
- Precision medicine and personalized medicine are synonymous terms.
- Pharmacogenomics is a tool to personalize treatment decisions. However, it is not the only tool. Other readily available and routinely collected clinical information has been used to personalize therapy for decades (e.g. blood type, serum creatinine, CV risk score).
- While creating a separate pharmacogenomic service can help ease practitioners into using pharmacogenomic tests, learning how to integrate genetic information as a routine part of clinical decision-making is the ultimate goal.
- Pharmacists have a unique role (and responsibility) to know when and how to use the results of pharmacogenomic tests.
- Teaching students, residents, and fellows to use pharmacogenomic information should be done in an integrated manner - considered alongside other clinical data, not in isolation.
- Several excellent resources now exist that can assist pharmacists and other providers use the results of pharmacogenomic tests including the Pharmacogenomics Knowledge Base (PharmGKB) and the Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines.
March 20, 2020
Lucas Berenbrok, PharmD, BCACP, TTS - Assistant Professor of Pharmacy and Therapeutics at the University of Pittsburgh School of Pharmacy - talks with us about hearing loss and the important role pharmacists can play as OTC hearing aids become available in 2020.
- Most older adults have some degree of hearing loss and it can significantly impact the quality of life
- There are many causes of hearing loss including medications, infections, cerumen, and aging
- A screening exam for hearing impairment is part of the Welcome to Medicare Exam, but hearing aids are not covered by Medicare.
- OTC hearing aids are predicted to be a far more affordable option for patients with mild-to-moderate hearing loss.
- Pharmacists have an important role in assessing patients and referring them to an audiologist for hearing exams.
- Pharmacists can assist patients select an appropriate OTC hearing aid
- To find an audiologist: American Academy of Audiology
February 18, 2020
Cheyenne C. Newsome, PharmD, BCACP and Jessica Conklin, PharmD, BCACP, CDE, AAHIV — passionate advocates for the role of pharmacists in the care of transgender persons — talk with us about the need for patient and provider education and about the benefits and risks of gender-affirming treatment.
- Gender-affirming therapy is highly effective, improving the quality of life in more than 80% of patients.
- Hormonal therapy is the cornerstone of gender-affirming therapy.
- Testosterone is used for masculinization by trans-men. It is traditionally given by intramuscular injection but subcutaneous injections are easier to administered and may have a smoother effect (e.g. lower peak effect).
- Side effects from testosterone are common including body and facial hair growth (you don't get to pick!), deepened voice (irreversible), clitoral enlargement, acne, menstrual irregularities, and weight gain from increased appetite.
- Estradiol (preferred estrogen) is used for feminization by trans-women. In addition, spironolactone is used in high doses for its anti-androgen effects. Side effects are similar to those experienced by cisgender women.
- While trans-men often develop amenorrhea, pregnancy is still possible. Frank discussions about the use of contraception, if sexually active, is important.
- A number of great resources are available to inform drug therapy decision making particularly the Endocrine Society Guidelines.
- Pharmacists can uniquely contribute to optimizing the care of trans-men and -women.
To learn more, view and download the Show Notes!
January 21, 2020
Abby Frye, PharmD, BCACP, Dawn Fuke, PharmD, BCPS, and Justin Bachman, PharmD, BCACP — Clinical Pharmacist Specialists in Primary Care from the Providence Medical Group in Portland, Oregon — talk with us about creating gender-affirming care environments.
- Current estimates suggest that about 1 million adults in Adults in the United States don't identify with the gender assigned to them at birth - but this is likely an underestimate.
- Transgender and gender non-conforming individuals face enormous and persistent stigma within our (and many other) cultures.
- Social stigma is associated with higher rates of anxiety, depression, and substance use disorders.
- Health professionals have a responsibility to take pro-active steps to counteract the discrimination that patients from vulnerable and marginalized populations face.
- Self-awareness and self-examination about communication practices are critical - this includes the information collected on patient intake forms and electronic health records as well as a patient's preferred name and pronoun.
- Insurance coverage for gender-affirming therapies as well as health screening exams for transgender persons are sometimes denied and health professionals may need to advocate for coverage.
- A wide variety of resources are available to health professionals to learn more about the care of transgender and gender non-conforming individuals.
To learn more, view and download the Show Notes!
December 17, 2019
Nicole Avant, PharmD, BCACP - Assistant Professor at the University of Cincinnati and Founder/CEO of Avant Consulting Group - and Tennille McKinney - HIV Educator and Consultant with Avant Consulting Group - talk with us about gender expression/identity, cis-privilege, and transphobia.
- Sex and gender are not synonymous. Sex is based on biology and gender is a social construct. Sex is determined by genes and assigned at birth. Gender is influenced by cultural norms and internal sense of self.
- Transgender persons identify with a gender that is different from the sex that was assigned at birth. Cis-gender persons identify with the gender that is congruent with the sex assigned at birth.
- Some transgender persons, but certainly not all, seek medical and/or surgical gender-affirming treatments to express their gender identity.
- Cis-privilege includes the rights and advantages that cis-gender persons enjoy. This includes respect for one's gender identity and freedom from harassing comments or intrusive questioning.
- Deadnaming is the act of referring to and calling someone by their birth name rather than their chosen name which is congruent with their current identity.
- Transgender persons face social stigma from both the lay public and health professionals. This sigma often results in transgender persons seeking care outside of traditional institutions and relying on self-care.
To learn more, view and download the Show Notes!
October 22, 2019
Lea Eiland, PharmD, BCPS, BCPPS - Clinical Professor and Associate Department Head, Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy — talks to us about the impact of generational differences ... and why these differences influences our patients' communication perferences, beliefs, and expectations.
- Our patients and workforce are more diverse than ever - including their generational experiences that influence their expectations related to work, healthcare delivery, and communication.
- Generational differences are generalizations - so not all people within a generation fit the stereotype and we need to be careful to not make assumptions.
- The generations currrently in the workforce and healthcare delivery systems are Traditionalist, Baby Boomers, Gen-X, Millennials, and Gen-Z/iGeneration.
- Comfort levels with digital technology and communication formats vary by generation. Older generations tend to prefer face-to-face and long-form written communications ... while more recent generations prefer short-form written communications. But everyone can learn to adapt!
- Recent generations prefer short, action-oriented, on-demand learning methods.
- Feedback preferences are also generational. Older generations generally desire less frequent feedback and more recent generations prefer more.
- Learning how to function well as a team requires a shared vision about the goals and valuing the contributions of each person on the team.
September 24, 2019
Magaly Rodriguez de Bittner, PharmD, BCPS, CDE - Professor and Associate Dean for Clinical Services and Practice Transformation, University of Maryland School of Pharmacy - talks to us about the impact of culture on behaviors and health outcomes ... and why healthcare practitioners need to develop cultural awareness and move toward cultural proficiency to achieve optimal outcomes for the patients they serve.
- Culture is the characteristics, knowledge, and beliefs of a group of people including their shared language, religious/spiritual beliefs, habits, and values. Culture impact beliefs about diseases, medications, and healthcare.
- Many patients are reluctant to tell healthcare providers about their culturally-related health behaviors for fear of being judged or may believe such information is irrelevant.
- Behaviors and beliefs, regardless of source, can impact health outcomes and can augment, detract, or have no impact on the recommended treatment plan.
- Openly discussing beliefs and behaviors is critical. Supporting patient decisions based on their beliefs builds trust.
- Communicating in the patient's preferred language is mandated by law. Use trained interpreters. Have written materials available in the patient's preferred language.
- Cultural awareness and moving toward cultural proficiency makes good business sense as you are better able to understand the needs of your patients.
August 15, 2019
William J Stilling, BS Pharm, JD - Founding Partner, Stilling & Harrison, PLLC and Clinical Associate Professor, Department of Pharmacy Practice at the University of Utah College of Pharmacy - talks to us about some of the legal issues related to the medical and recreational use of marijuana.
- Marijuana (in its raw form) is a schedule I substance under Federal Law. However, the US Congress has prohited the Department of Justice from using its funds to enforce Federal law superceding State laws related to marijuana.
- Medical marijuana is typically legal to use under State laws only in specific "use cases" or "qualifying conditions." Physicians and other prescribers can't legally prescribe marijuana because it would violate their DEA issued license but may "recommend" or "authorize" the use of marijuana.
- Healthcare instutitions need to consider the use of marijuana for therapeutic purposes by their patients and develop clear policies and procedures on how marijuana use will be accommodated in their facility.
- Pharmacists and pharmacies are subject to oversight by the board of pharmacy and most state boards require pharmacists to abide by Federal laws. Thus, pharmacists who use marijuana, even for "legal" therapeutic purposes, may be subject to sanctions and lose their license to practice.
- Employers may terminate a pharmacist or health professional for marijuana use because it is a violation of Federal law.
- The FDA is unlikely to approve marijuana (in its raw form) for medical indications because it can not be easily studied or standardized.
- The legal status of marijuana in the years to come will be significantly impacted by political and economic forces.
View and Download the Show Notes
July 18, 2019
Laura Borgelt, Pharm.D., BCPS - Professor, Departments of Pharmacy Practice and Family Medicine at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences - talks to us about the recreational use of marijuana and its potential health consequences.
- Cannabis (marijuana) use has increased substantially in the past decade. Young adults are the most likely to report using marijuana in the past year or month but use among older adults (age > 65 years) is growing as well.
- Its important to ask patients in a non-judgmental, open-ended manner about their cannabis use including the intended purpose(s), frequency of use, and forms used.
- Numerous cannabis products are available. Inhaling (smoking or vaping) remains the most common method for use. Edible products are available in a wide variety of food-like delivery systems (e.g. baked goods, candies). Topical products are more commonly used for medical purposes.
- The THC concentrations found in cannabis products today are much higher than years ago. This has resulted in higher rates of unintentional overdoses leading to paranoia and psychotic symptoms. Overdosing is most common with edible products due their delayed absorption.
- There are several short-term and long-term health consequences related to marijuana use. Regular cannabis use can lead to neurocognitive effects including impaired memory. Cannabis use is more likely to have a detrimental impact for adolescents and young adults. Cannabis use during pregnancy also appears to have detrimental neurocognitive effects on children.
- There are several potential drug-drug interactions with THC and medications metabolized through CPY2C9 and CPY3A4 as well as receptor interactions.
- Pharmacists have an important public health role by screening for cannabis use, educating patients about the potential risks associated with marijuana use, and identifying potential drug-drug interactions.
View and Download the Show Notes