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.
- 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
December 14, 2021
Bruce Berger, Ph.D. - Berger Consulting LLC and Professor Emeritus, Auburn University - and Col. John D. Grabenstein, R.Ph., Ph.D. - Vaccine Dynamics SP - talk with us about treatment hesitancy, its root causes, and how health professionals can engage patients in treatment decisions more effectively.
- Treatment and vaccine hesitancy is often grounded in inadequate information, changing information (leading to doubt), personal beliefs, misinformation, distrust (of the health care professional's motivations), and (sometimes) apathy.
- Actively soliciting and listening to a patient's concerns is the key to understanding the sources of doubt and hesitancy.
- Confrontation and dismissing a patient's understanding will cause "face loss" and lead to more resistance, not less.
- Monologues about "the facts" are not helpful. It is important to ask permission and then gently offer new information for the patient to consider.
- The patient is always driving the bus and all treatment decisions rest with them. The goal should be to become a trusted advisor who's always on the patient's side.
- It may take some patients several months (or even years) to arrive at a decision to start a new treatment or receive a vaccine.
- Our words can alienate a patient and sever a relationship. This is perhaps the worst possible outcome because it prevents us from having a positive influence in the future.
Want to learn more about motivational interviewing and vaccinations? Be sure to check out these resources:
Immunization Action Coalition (www.immunize.org)
ComMIt - Comprehensive Motivational Interviewing (MI) Training
eLearning MI Training for Health Professionals - Purdue University
Berger B. Using Care and Compassion to Respond to Vaccine Hesitancy.
August 17, 2021
Special Host Kristin Janke, PhD - Senior Associate to the Dean and Professor, University of Minnesota College of Pharmacy - and Special Guests Jessica L. Johnson, PharmD, BCPS - Associate Professor, William Carey School of Pharmacy - and Karen Kopacek, BPharm, MS - Associate Dean and Associate Professor, University of Wisconsin School of Pharmacy - talk with us about professional identity formation, how our identities are formed, and why they are important.
- Our identities shape our sense of self ... which influence our values, beliefs, and actions
- All of us have multiple identities ... including a professional identity
- Professionalism and professional identity are related but distinct concepts
- Students and residents may feel uncomfortable or experience identity conflicts as they form their professional identity — assimilating the values and norms of the profession
- Our professional identities are developed through interactions with colleagues and mentors
- A strong professional identity can help counterbalance work stressors and negative emotions that lead to burnout
For more information about professional identity formation, read the Report of the 2020-2021 AACP Student Affairs Committee: A Pathway to Professional Identity Formation
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.
- 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 iForumRx.org website.
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.
- 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.
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.
- 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
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.
- 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.
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.
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!