PharmacyForward
Expanding the Frontiers of Pharmacy Practice (III)

Expanding the Frontiers of Pharmacy Practice (III)

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.

Key Lessons:

  • 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.
Expanding the Frontiers of Pharmacy Practice (II)

Expanding the Frontiers of Pharmacy Practice (II)

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.

Key Lessons:

  • 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.
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!