PharmacyForward
Expanding the Frontiers of Pharmacy Practice (I)

Expanding the Frontiers of Pharmacy Practice (I)

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.

Key Lessons:

  • 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
Gender Identity & Transgender Care (III)

Gender Identity & Transgender Care (III)

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.

Key Lessons:

  • 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!

Gender Identity & Transgender Care (II)

Gender Identity & Transgender Care (II)

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.

Key Lessons:

  • 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!

Social Determinants of Health and Healthcare Delivery (II)

Social Determinants of Health and Healthcare Delivery (II)

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.

Key Lessons:

  • 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.
Social Determinants of Health and Healthcare Delivery (I)

Social Determinants of Health and Healthcare Delivery (I)

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.

Key Lessons:

  • 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.
Marijuana Use - Medical, Health, and Legal Issues (III)

Marijuana Use - Medical, Health, and Legal Issues (III)

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.

Key Lessons:

  • 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

Credentialing & Privileging (II)

Credentialing & Privileging (II)

April 16, 2019

Julie Groppi, PharmD - National Program Manager, Clinical Pharmacy Practice Policy and Standards, Department of Veteran's Affairs and Todd Nesbit, PharmD, MBA - Director of Pharmacy Patient Care Services, the Johns Hopkins Hospital - discuss the credentialing and privileging of pharmacists.

Key Lessons

  • Credentialing is the process of verifying someone education, training, certifications, and experience. 
  • Privileging is the process of determining an appropriate scope of practice based on the practitioner's credentials and granting authority to carry out specific patient care services/decisions.
  • All health systems should credential the pharmacists they employ.
  • Pharmacists can be privileged to initiate, modify, continue, or discontinue medication therapies as well as order tests and referrals as needed to achieve treatment goals.
  • A pharmacist's privileges may be restricted to specific drugs and disease (e.g. collaboratory drug therapy management agreement) or may be service-specific (e.g. all patients enrolled in or assigned to a specific clinical service unit).
  • The credentials necessary to be privileged to carry out advanced patient care services typically include residency training and board certification.

View and Download the Show Notes!

Credentialing & Privileging (I)

Credentialing & Privileging (I)

March 13, 2019

Joseph Saseen, Pharm.D., BCPS, BCACP, CLS - Professor of Clinical Pharmacy and Family Medicine, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences - discusses the various credentials pharmacists can earn following graduation and licensure.

Key Lessons

  • Credentials include degrees, licensure, post-graduate training, and board certification.
  • Earning a certificate is not synonymous with becoming board certified.
  • Board certification requires candidates to meet specific eligibility criteria and pass a comprehensive examination to validate the breadth and depth of knowledge in the area of specialization.
  • Board certification can give pharmacists a competitive advantage for employment and open doors to new opportunities.
  • Candidates should consider preparing for a board certification exam either through a formal, structured program or forming a study group ... or both.
  • Obtaining advanced credentials is ultimately about improving the quality of care pharmacists provide to patients.

View and Download the Show Notes!

Opioid Overdose Crisis (II)

Opioid Overdose Crisis (II)

December 13, 2018

Suzanne Nesbit, Pharm.D., BCPS - Clinical Pharmacy Specialist in Pain and Palliative Care at the Johns Hopkins Health System - and Lucas Hill, Pharm.D., BCPS, BCACP - Clinical Assistant Professor at the University of Texas at Austin and Director of Operation Naloxone - discuss how to improve patient safety by implementing opioid stewardship and harm-reduction strategies.

Key Lessons

  • Opioid stewardship requires multiple components starting first with a commitment to change and includes opioid prescribing guidelines, provider feedback, and patient education.
  • Discussing the goals of therapy, intended treatment duration, and realistic expectations with patients when opioids are prescribed is critical.
  • Patients at high risk of opioid overdose should receive naloxone and trained how to use it.
  • Naloxone standing orders or collaborative practice agreements can facilitate access.
  • Information from prescription drug monitoring programs can be helpful during the medication review process but providers must recognize their limitations.
  • Pain relief requires a patient-specific approach. Patients with a substance use disorder deserve to have their pain addressed too.

View and Download the ShowNotes!

Pharmacists Patient Care Process (III)

Pharmacists Patient Care Process (III)

October 18, 2018

Kristina Butler, Pharm.D., BCPS, BCACP - Manager of Clinical Pharmacy Specialists in Primary at the Providence Medical Group in Portland, Oregon talks with us about implementing a consistent patient care practice model across multiple sites.

Key Lessons: Implementing a consistent model of care begins with hiring people who have the appropriate training & experience followed by a robust orientation process and supplemented by ongoing peer review; high-quality clinical pharmacy services need to be consistently available; more experienced practitioners may need to reframe their thinking and update their terminology in order to consistently teach learners about the pharmacists patient care process.

Helpful Resources:  Check out the Patient Care Process chapter in Pharmacotherapy: A Pathophysiologic Approach and the Patient Care Process for Delivering Comprehensive Medication Management report.