Crushed by Stressors: Cultivating Healthy Responses

Crushed by Stressors: Cultivating Healthy Responses

January 17, 2022

Cynthia Knapp Dlugosz, BSPharm, NBC-HWC - Solopreneur and Owner of Being in Balance Coaching and Artemis Health Care Communications - and Elizabeth Buckley, PharmD, CDCES - Professor, Department of Pharmacy Practice, Concordia University Wisconsin — talk to us about threats to our well-being and self-care practices.

Key Lessons:

  • We are surrounded by stressors that adversely impact our sense of well-being.
  • The ubiquitous use of technology has increased the demands on our attention.
  • The pillars of well-being based on research from the Center for Healthy Minds at the University of Wisconsin-Madison are: Awareness, Connection, Insight, and Purpose.
  • Much of our dissatisfaction and psychological suffering stems from our desire to push away or change the unpleasantness in our lives.
  • Mindfulness is a state of being where we are attentive in the present moment with receptivity, non-judgment, and compassion with what arises.
  • Meditation and yoga are practices that cultivate our ability to be mindful - our ability to be more attentive, receptive, less judgmental, and compassionate.
  • Gratitude increases our happiness. Those with the least material wealth are often able to recognize and express gratitude for the blessings in their lives but anyone can learn to be more grateful.
  • Health professionals feel acutely stressed today because the environmental demands are beyond their ability to successfully cope due to unpredictability, uncontrollability, and overload.
  • Organizations have a responsibility to implement strategies to address the environmental demands and the underlying causes of stress.

Resources and Books:

Center for Healthy Minds, the University of Wisconsin-Madison

Brown B.  Atlas of the Heart.  Mapping Meaningful Connection and the Language of Human Experience.  New York: Random House, 2021.

Moss J.  The Burnout Epidemic: The Rise of Chronic Stress and How to Fix It.  Boston: Harvard Business Press, 2021

Getting Started with Collaborative Practice Agreements

Getting Started with Collaborative Practice Agreements

July 13, 2021

Charmaine Rochester-Eyeguokan, PharmD, BCACP, CDCES - University of Maryland School of Pharmacy - and Jeffrey Tingen, PharmD, MBA, BCPS, BCACP, CDCES - VCU Health, Department of Family Medicine & Population Health - talk to use about the ins and outs of collaborative practice agreements.

Key Lessons

  • Collaborative practice is governed by state law and regulations; it is important to be familiar with the specific rules for constructing collaborative practice agreements (CPA) in your state.
  • Many states require pharmacists to have specific training and experience in order to enter into a CPA - but some states have relatively few requirements or none at all.
  • CPAs are useful tools to enable greater efficiency by granting the pharmacist greater autonomy to carry out certain patient care functions; however, a CPA is not required to perform many functions that are ordinarily a part of a pharmacist's scope of practice.
  • It's important to have a significant level of rapport and trust with your providers crafting a CPA together.
  • While CPAs are fairly common in ambulatory clinics, they are a potentially useful tool in community pharmacy practice, long-term care facilities, and specialty pharmacy practice.

To learn more about collaborative practice and CPA, check out the Collaborative Practice Resource Page on the website.

Working Remotely - Making Remote Work, Work

Working Remotely - Making Remote Work, Work

April 13, 2021

Christie Nemoto, PharmD, BCACP - Clinical Pharmacy Specialist in The Queen's Health Systems - Queen's Clinically Integrated Physician Network (QCIPN) - talks to us about providing care to patients at a distance and creating an effective work environment at home.

Key Lessons:

  • Health professionals had to learn new skills in order to deliver care to patients and interact with colleagues at a distance over the past year.  Remote work became the new norm during the COVID-19 pandemic.
  • Clinical care models in Hawaii have evolved over the years to support patients at a distance.  Hawaii is an archipelago of islands and access to health care services is enabled by a variety of technologies.
  • Pharmacists play a critical role on the healthcare team, even more so in the digital age.
  • Remote communications with patients are challenging - particularly written patient education sheets and post-visit summaries.
  • Clinicians need to rely on verbal clues (rather than visual clues) to ensure patient understanding.
  • When working from home, it's important to create habits and routines that mimic your work at the office such as dressing professionally, starting and stopping the workday in normal work hours, creating a designated workspace, and setting ground rules with family.
  • Be creative using remote activities to increase bonding and consistent communication between team members.
Pharmacists and Point-of-Care Testing

Pharmacists and Point-of-Care Testing

March 16, 2021

Donald Klepser, Ph.D., MBA - Professor and Associate Dean for Academic Affairs at the University of Nebraska Medical Center College of Pharmacy - and Michael Klepser, Pharm.D. - Professor of Pharmacy Practice at Ferris State University College of Pharmacy - talk to us about the role of point-of-care testing in disease state management and to achieve public health goals.

Key Lessons:

  • Point-of-care tests (POCT) can be performed in non-laboratory settings, such as the patient's home or in a community pharmacy, and provide clinical data to make treatment decisions.
  • The sooner test results can be made available, the sooner treatment can be initiated.  This is particularly important for many infectious diseases because the outcome is closely tied to how rapidly the treatment is started.
  • When deployed in community-based pharmacies and clinics, POCTs help increase access to care, particularly in rural and underserved areas.
  • POCT can be used to test for influenza, SARS-CoV-2 (aka COVID-19), Streptococcal pharyngitis (aka strep throat), human immunodeficiency virus (HIV), and other sexually transmitted infections as well as monitor serum lipids, serum electrolytes, and renal function.
  • Under a collaborative practice agreement (CPA), community pharmacists can use the results of POCT to quickly initiate treatment or adjust the doses of medications.
  • POCT empower pharmacists to provide a range of health-related services.
  • Student pharmacists can play a critical role in building our capacity to deploy POCT and provide disease management services in new locations.
  • Key opportunities for the future:
    • PrEP (pre-exposure prophylaxis) to prevent HIV
    • Hepatitis C infection
    • Sexually transmitted infections panel
    • Lead exposure
Pharmacists and Population Health

Pharmacists and Population Health

February 18, 2021

Amanda Schartel, PharmD, BCACP - Clinical Pharmacy Specialist with ChristianaCare CareVio - talks with us about the roles and responsibilities of a population health pharmacist.

Key Lessons:

  • Population health involves holistically evaluating the health needs of a population and bringing together the resources and expertise needed to address those needs.
  • Population health teams often include practitioners that many patients in primary care settings don't ordinarily have access including social workers, respiratory therapists, and clinical pharmacists.
  • Sophisticated data analytics and remote monitoring tools help population health practitioners proactively identify patients who may need additional services or whose health status may be changing.
  • Patient encounters are often conducting using videoconferencing technology and text-messaging can quickly capture patient experience data. 
  • The role and responsibilities of the population health pharmacist often extend beyond what an ambulatory care pharmacist might address.
  • Population health pharmacists often have the authority to adjust medication regimens and order laboratory tests.
  • Residency training and board certification are not required but preferred for those seeking employment as a population health pharmacist. 
  • The key skill sets needed by a population health pharmacist include patient management experience addressing complex medication-related issues as well as a deep knowledge of quality metrics and value-based payment structures.
Pharmacists and Public Health

Pharmacists and Public Health

January 27, 2021

Rear Admiral (RADM) Pamela Schweitzer - retired Chief Professional Officer of Pharmacy for the United States Public Health Service (USPHS) - talks to us about the roles and responsibilities of pharmacists during a public health crisis.  Dr. Schweitzer was responsible for providing leadership and coordination of USPHS pharmacy programs for the Office of the Surgeon General and the Department of Health & Human Services from 2014-2018.

Key Lessons:

  • Pharmacists play a critical role in the USPHS because they have a unique skill set.
  • A pandemic, like COVID-19, requires a coordinated effort between the public and private sectors to address mass vaccination efforts as well as shortages of medications, testing, and personal protective equipment using an incident command structure.
  • USPHS pharmacists are deployed to the hardest-hit zones to provide medical and scientific assistance.  With the COVID-19 pandemic, USPHS officers have been helping set-up community testing and mass-vaccination sites as well as providing input on federal guidance impacting pharmacists and pharmacies.
  • Pharmacists in the USPHS must wear many hats. While formal training is helpful, getting a wide breadth of on-the-job experiences is critical.
  • Be curious. Learn new skills in every position/job. Be flexible and positive. Be comfortable with shifting conditions. Step up, speak up, and volunteer.  Act when you can.  Be a role model.
  • If you'd like to get more involved, consider volunteering with your local Medical Reserve Corps , applying to become a Commissioned Officer in the USPHS or the newly formed USPHS Ready Reserve Corps.
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!

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