PharmacyForward
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.

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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.

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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.

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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.

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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.

Pharmacists Patient Care Process (II)

Pharmacists Patient Care Process (II)

September 12, 2018

Mary Ann Kliethermes, Pharm.D. - Professor and Vice Chair for Ambulatory Care in the Department of Pharmacy Practice at the Midwestern University Chicago College of Pharmacy talks with us about the business case for implementing the pharmacists patient care process.

Key Lessons: Using a reliably consistent process results in reliably consistent outcomes; health information systems require providers to use a consistent method of documentation; pharmacists patient care services will be billed within the existing payment framework and infrastructure; payment for services is contingent on the scope of practice (state pharmacy practice act!), provider status (at state level!), and insurance regulations (state laws!).

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.

Pharmacists Patient Care Process (I)

Pharmacists Patient Care Process (I)

August 14, 2018

Todd Sorensen, Pharm.D. - Professor in the Department of Pharmaceutical Care and Health Systems at the University of Minnesota College of Pharmacy and Executive Director of the Alliance for Integrated Medication Management talks with us about the importance of applying a systematic process of care during every patient encounter.

Key Lessons: All health professions have a similar process of care but each has a different focus and assessment strategy; inconsistencies in the process of care provided by pharmacists has led to inconsistent outcomes in clinical trials; several new resources are available to help pharmacy practitioners deliver the pharmacists patient care process with greater "fidelity."

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.

Digital Health Devices and Apps! (III)

Digital Health Devices and Apps! (III)

July 17, 2018

Cody Clifton, Pharm.D. - Clinical Pharmacist and Special Projects Manager at Moose Pharmacy and Coordinator of Quality Assurance and Best Practices for the Community Pharmacy Enhanced Services Network U.S.A. (CPESN-USA) - talks about the use of mobile devices and apps to remotely monitor patients to improve medication adherence, effectiveness, and safety.

Key Lessons: Numerous devices and apps are available to assist patients with medication adherence; the Spencer device (by Spencer Health Solutions)* provides medication monitoring data and helps connect patients, caregivers, and pharmacists; pharmacists can partner with accountable care organizations (ACOs) to improve outcomes and reduce healthcare cost using mHealth devices and apps.

*Please note that PharmacyForward does not endorse or recommend any products or services.  The Spencer device is one of several potential options that pharmacists and patients may wish to consider when adopting a mHealth solution.

Digital Health Devices and Apps! (II)

Digital Health Devices and Apps! (II)

June 13, 2018

Julie Lauffenburger, Pharm.D., Ph.D. - Assistant Director of the Center for Healthcare Delivery Sciences at the Brigham and Women's Hospital and co-investigator for the MedISAFE-BP study talks to us about the use of smartphone applications to improve medication adherence.

Key Lessons: Improvements in medication adherence don't necessarily lead to improvements in outcomes (e.g. blood pressure control or cardiovascular events) unless patient-monitoring data is shared and used by clinicians to make medication adjustments; smartphone apps should provide nudges to patients in a manner they find most useful; technology should make the medication use process easier, not more difficult.

It’s All About Quality (II)

It’s All About Quality (II)

March 14, 2018

Laura Cranston, R.Ph. - Chief Executive Office of the Pharmacy Quality Alliance (PQA) - talks about the work of PQA and the National Quality Strategy which aims to make care delivery higher quality and more affordable to achieve healthier people and communities. 

Key Lessons:  PQA plays an important role by convening key stakeholders and creating quality measures that are used by the payer community.  Pharmacists and student pharmacists can play an important role in PQA's work.