- Email: [email protected]
Accurate weathervane for change in the profession
DEPARTMENTS A.K. Kennedy et al. / Journal of the American Pharmacists Association 56 (2016) 355e359
practitioner knowledge and attitude toward these agents, and evaluation of differences in clinical outcomes. Point-of-care testing The second policy focused on expanded roles for pharmacists within point-of-care testing and related clinical services. Similar to the policy focused on biologic drug products, the House was supportive and agreed that these services aligned with visions for team-based care, integration of the Joint Commission of Pharmacy Practitioner’s (JCPP) Pharmacists’ Patient Care Process, and evolving payment models. While not directly referenced in this policy, point-of-care services reflect an excellent opportunity for researchers and practitioners to collaborate to document the influence on clinical outcomes. As traditional payment models are replaced with value-based payment models, all health care professionals, including pharmacists, will be expected to demonstrate the ability to improve health outcomes while reducing costs. High-quality, pharmacy practiceebased research will be essential in achieving the final statement of this policy focused on access, coverage, and payment for these services. Medication optimization services within the patient care process The final policy focused on medication optimization services within the patient care process. Community pharmacies are a powerful vehicle in transforming the patient experience with drug therapy at all steps, from a medication’s initiation to discontinuation. The intent of this policy was to create a framework encompassing the spectrum activities in which pharmacist are engaged while also addressing future needs within the rapidly changing health care system. Changes include the integration of big data, use of predictive analytics, and development of patientcentered approaches and technology platforms that will make research an essential component of health care delivery. The literature consistently demonstrates that pharmacist involvement in patient care improves outcomes, but it is often difficult to aggregate data, make
comparisons, and quantify the effects because of the lack of standardization and variations in patient populations, delivery processes, and endpoints. The development and adoption of the JCPP Pharmacists’ Patient Care Process represented an important first step in addressing these challenges. This policy reflected subsequent needs in defining the larger framework. Although the House and APhA-APRS Delegation clearly supported the intent of the policy, there was significant discussion on the need to provide greater detail for this framework, with specific concerns being raised about confusion that might arise with the introduction of additional terminology and overlap with existing policy. The policy was ultimately referred back to the APhA Board of Trustees so that these concerns could be reviewed and the policy could be developed as appropriate before additional discussion. The Delegation eagerly awaits the revised policy to determine how this framework will provide collaborative opportunities between researchers and clinicians to engaged in pharmacy practiceebased research. New business items In addition to policies proposed by the APhA Policy Committee, the House also adopted new business items related to medication assisted treatment, opioid overdose prevention, oral liquid medications, and substance abuse disorders and education. The delegation was most involved in discussion of a new business item encouraging standardization of generic solid dosage forms and the potential implications; the item was ultimately referred for future consideration. Concluding thoughts and call for academy delegates The APhA House of Delegates provides an essential forum for individuals representing all areas of pharmacy and at all stages of development to discuss topics of common interest. This year in particular, the proposed policies had a clear link to pharmacy research and science. Policy on biologic drug products drew on the knowledge of members of the Basic and Clinical Science Sections and point-ofcare testing services provides future
research opportunities for members of Clinical Science and Economic, Social, and Administrative Sciences Sections. In conclusion, APhA-APRS members interested in serving as a delegate at the 2017 APhA Annual Meeting and Exposition are encouraged to apply at https://fs10.formsite.com/APhA-APPM/ form108/index.html. We look forward to continued discussion on medication optimization services and the newly proposed policies. Adriane N. Irwin, MS, PharmD, BCACP, Clinical Assistant Professor, Oregon State University, Oregon Health and Science University College of Pharmacy, Corvallis, OR
APhA-ASP Accurate weathervane for change in the profession Involvement in the student-led policy development process has long been a core experience of the APhA Academy of Student Pharmacists (APhA-ASP), and the 2015-2016 school year was one of growth, with more than 90% of chapters submitting a resolution to be first considered at the 2015 APhA-ASP Midyear Regional Meetings. This growth signals the role that policy development continues to play in supporting the mission of Bode APhA-ASP, which is to be the collective voice of student pharmacists, to provide opportunities for professional growth, to improve patient care, and to envision and advance the future of pharmacy. Student pharmacists have proved to be an accurate weathervane for the currents of change in pharmacy practice and education, as well as a font of ideas for advancing the profession. Forwardthinking resolutions, such as those calling for medication disposal programs, integrated prescription drug monitoring databases, and transitions-of-care models, have called into focus important changes necessary for the growth of the profession and have served as foundations for policies adopted by the APhA House of Delegates. Now in its 44th year,
357
DEPARTMENTS A.K. Kennedy et al. / Journal of the American Pharmacists Association 56 (2016) 355e359
the APhA-ASP House of Delegates has again adopted timely and important resolutions for consideration in the association as a whole. This year, the APhA-ASP Resolutions Committee, composed of the 8 regional delegates, considered 81 resolutions that passed at the Midyear Regional Meetings and carefully crafted 4 resolutions. The APhA-ASP House of Delegates debated and passed the following resolutions on Saturday, March 5, 2016, at the APhA2016 Annual Meeting and Exposition in Baltimore, MD. 2016.1: Increasing the security of pharmacies APhA-ASP calls upon all stakeholders to take measures that create an environment that prioritizes the safety and security of patients and pharmacy personnel. These measures include: 1. The development and implementation of strategies and technologies to deter pharmacy robberies, such as time-delayed safes, panic buttons, stock bottle tracking devices, physical pharmacy design, and video surveillance. 2. The development and implementation of relevant procedures and programs to train all personnel on actions to take during a pharmacy robbery. A pharmacy should be a safe haven for patients and the professionals caring for them; however, in the first 5 months of 2015, U.S. law enforcement agencies reported 382 armed pharmacy robberies, putting 2015 on track to break the record of pharmacy robberies in 1 year.1 Multiple technologies exist to help discourage a pharmacy robbery by making it more difficult to commit or harder to escape capture and conviction, and many of the tools enumerated in the resolution have shown positive results when implemented. To foster an environment in which pharmacy personnel feel safe, it is imperative to invest in deterrence strategies and training in robbery response to mitigate risk. Furthermore, as the largest and most inclusive national pharmacy organization, APhA is uniquely poised to address this rising problem.
358
2016.2: Pharmacist administration of injectable medications 1. APhA-ASP supports pharmacists and student pharmacists administering nonvaccine injectables, including but not limited to antipsychotics, longacting contraceptives, and other hormone therapy pursuant to prescription, protocol, or collaborative practice agreement. 2. APhA-ASP supports the development of programs, such as continuing education and certificate training programs, to train pharmacists and student pharmacists to administer nonvaccine injectables properly. 3. APhA-ASP encourages all stakeholders, including but not limited to pharmacies, health systems, and thirdparty payors, to develop a sustainable and financially viable compensation model for pharmacist administration of nonvaccine injectables. Many patients currently prescribed nonvaccine injectable medications are unnecessarily burdened by the lack of accessibility to providers who can administer their medications, increased risks, and additional costs. These barriers can cause poor patient compliance and poor overall patient health because of the patient’s desire to avoid these current obstacles in care. In response to these problems, 21 states have granted pharmacists the authority to administer nonvaccine injectable medications. As pharmacists’ clinical role continues to increase in both community and ambulatory settings, the profession is not only more qualified, but also more adequately positioned than ever before to affect large patient populations positively by administering nonvaccine injectable medications.
2016.3: Establishing immunization requirements 1. APhA-ASP affirms the valuable role of immunizations in protecting the public and strongly recommends that all persons receive immunizations currently recommended by the Centers for Disease Control and Prevention (CDC), except when medically contraindicated. 2. APhA-ASP recommends that all private and public educational or
childcare institutions require enrollees and employees to receive all CDCrecommended immunizations, except when medically contraindicated. 3. APhA-ASP strongly affirms that it is the professional responsibility of all health care personnel to receive CDC-recommended immunizations and supports their employers mandating immunizations as a condition of employment, volunteering, or training, except when medically contraindicated. Immunizations are an important public health tool to prevent the spread of infectious disease. However, amid increasing confusion and misinformation regarding the safety of immunizations, vaccine-preventable diseases are resurging. Unlike most medications, the decision to deny or defer immunizations affects more than the person making the decision. Furthermore, a recent systematic review illustrates the positive correlation between the level of regulation and the immunization rates. The data suggest that adopting more stringent requirements lowers the number of people who choose not to immunize, leading to higher immunization rates and greater protection for the communities.2 In addition, as leaders in health care, pharmacists must take personal responsibility for immunizations. Just as health care professionals protect their patients and themselves through proper hand hygiene, so must we protect our patients and ourselves through immunization. In short, APhA-ASP believes that the health of the public should not be at risk from those whose job it is to preserve it. 2016.4: Increasing patient access to pharmacist-prescribed medications 1. APhA-ASP encourages legislative and regulatory changes that would enable pharmacists, with appropriate training and working as integral members of the health care team, to assess patients and prescribe certain medications, such as those for opioid overdose, contraception, tobacco cessation, and international travel. 2. APhA-ASP encourages the development of sustainable and financially viable compensation models for pharmacist-prescribed medications.
DEPARTMENTS A.K. Kennedy et al. / Journal of the American Pharmacists Association 56 (2016) 355e359
The current shortage of primary care providers contributes to the ongoing issue of access to important primary care services, including medications. The comprehensive training that pharmacists receive through school curriculum and continuing education prepares pharmacists to supervise the use of some medications safely and effectively, such as those for opioid reversal, contraception, tobacco cessation, and international travel. Pharmacists are knowledgeable, accessible, yet underused health care professionals positioned to fill gaps in care and to meet patients’ medical needs.
Looking forward
References
APhA-ASP adopted resolutions are more than words on paper. Just as each of these resolutions began as the idea of student pharmacists, they will be acted upon by student pharmacists and implemented with the help of the APhAASP Policy Standing Committee. Student pharmacists stand ready for the challenges of advocacy that lie ahead to have these and other resolutions put into practice. Until then, see you in San Francisco!
1. Barker A. Top 20 states for pharmacy robberies; July 21, 2015. Available at: http://www.pharmacytimes. com/contributor/alex-barker-pharmd/2015/07/ top-20-states-for-pharmacy-robberies. Accessed January 6, 2016. 2. Bradford WD, Mandich A. Some state vaccination laws contribute to greater exemption rates and disease outbreaks in the United States. Health Aff. 2015;34(8):1383e1390.
Lauren E. Bode, PharmD, 2015-2016 APhA-ASP Speaker of the House, 2016-2018 Combined PGY1/ PGY2 Pharmacotherapy Resident, UNC Medical Center, Chapel Hill, NC
359
practitioner knowledge and attitude toward these agents, and evaluation of differences in clinical outcomes. Point-of-care testing The second policy focused on expanded roles for pharmacists within point-of-care testing and related clinical services. Similar to the policy focused on biologic drug products, the House was supportive and agreed that these services aligned with visions for team-based care, integration of the Joint Commission of Pharmacy Practitioner’s (JCPP) Pharmacists’ Patient Care Process, and evolving payment models. While not directly referenced in this policy, point-of-care services reflect an excellent opportunity for researchers and practitioners to collaborate to document the influence on clinical outcomes. As traditional payment models are replaced with value-based payment models, all health care professionals, including pharmacists, will be expected to demonstrate the ability to improve health outcomes while reducing costs. High-quality, pharmacy practiceebased research will be essential in achieving the final statement of this policy focused on access, coverage, and payment for these services. Medication optimization services within the patient care process The final policy focused on medication optimization services within the patient care process. Community pharmacies are a powerful vehicle in transforming the patient experience with drug therapy at all steps, from a medication’s initiation to discontinuation. The intent of this policy was to create a framework encompassing the spectrum activities in which pharmacist are engaged while also addressing future needs within the rapidly changing health care system. Changes include the integration of big data, use of predictive analytics, and development of patientcentered approaches and technology platforms that will make research an essential component of health care delivery. The literature consistently demonstrates that pharmacist involvement in patient care improves outcomes, but it is often difficult to aggregate data, make
comparisons, and quantify the effects because of the lack of standardization and variations in patient populations, delivery processes, and endpoints. The development and adoption of the JCPP Pharmacists’ Patient Care Process represented an important first step in addressing these challenges. This policy reflected subsequent needs in defining the larger framework. Although the House and APhA-APRS Delegation clearly supported the intent of the policy, there was significant discussion on the need to provide greater detail for this framework, with specific concerns being raised about confusion that might arise with the introduction of additional terminology and overlap with existing policy. The policy was ultimately referred back to the APhA Board of Trustees so that these concerns could be reviewed and the policy could be developed as appropriate before additional discussion. The Delegation eagerly awaits the revised policy to determine how this framework will provide collaborative opportunities between researchers and clinicians to engaged in pharmacy practiceebased research. New business items In addition to policies proposed by the APhA Policy Committee, the House also adopted new business items related to medication assisted treatment, opioid overdose prevention, oral liquid medications, and substance abuse disorders and education. The delegation was most involved in discussion of a new business item encouraging standardization of generic solid dosage forms and the potential implications; the item was ultimately referred for future consideration. Concluding thoughts and call for academy delegates The APhA House of Delegates provides an essential forum for individuals representing all areas of pharmacy and at all stages of development to discuss topics of common interest. This year in particular, the proposed policies had a clear link to pharmacy research and science. Policy on biologic drug products drew on the knowledge of members of the Basic and Clinical Science Sections and point-ofcare testing services provides future
research opportunities for members of Clinical Science and Economic, Social, and Administrative Sciences Sections. In conclusion, APhA-APRS members interested in serving as a delegate at the 2017 APhA Annual Meeting and Exposition are encouraged to apply at https://fs10.formsite.com/APhA-APPM/ form108/index.html. We look forward to continued discussion on medication optimization services and the newly proposed policies. Adriane N. Irwin, MS, PharmD, BCACP, Clinical Assistant Professor, Oregon State University, Oregon Health and Science University College of Pharmacy, Corvallis, OR
APhA-ASP Accurate weathervane for change in the profession Involvement in the student-led policy development process has long been a core experience of the APhA Academy of Student Pharmacists (APhA-ASP), and the 2015-2016 school year was one of growth, with more than 90% of chapters submitting a resolution to be first considered at the 2015 APhA-ASP Midyear Regional Meetings. This growth signals the role that policy development continues to play in supporting the mission of Bode APhA-ASP, which is to be the collective voice of student pharmacists, to provide opportunities for professional growth, to improve patient care, and to envision and advance the future of pharmacy. Student pharmacists have proved to be an accurate weathervane for the currents of change in pharmacy practice and education, as well as a font of ideas for advancing the profession. Forwardthinking resolutions, such as those calling for medication disposal programs, integrated prescription drug monitoring databases, and transitions-of-care models, have called into focus important changes necessary for the growth of the profession and have served as foundations for policies adopted by the APhA House of Delegates. Now in its 44th year,
357
DEPARTMENTS A.K. Kennedy et al. / Journal of the American Pharmacists Association 56 (2016) 355e359
the APhA-ASP House of Delegates has again adopted timely and important resolutions for consideration in the association as a whole. This year, the APhA-ASP Resolutions Committee, composed of the 8 regional delegates, considered 81 resolutions that passed at the Midyear Regional Meetings and carefully crafted 4 resolutions. The APhA-ASP House of Delegates debated and passed the following resolutions on Saturday, March 5, 2016, at the APhA2016 Annual Meeting and Exposition in Baltimore, MD. 2016.1: Increasing the security of pharmacies APhA-ASP calls upon all stakeholders to take measures that create an environment that prioritizes the safety and security of patients and pharmacy personnel. These measures include: 1. The development and implementation of strategies and technologies to deter pharmacy robberies, such as time-delayed safes, panic buttons, stock bottle tracking devices, physical pharmacy design, and video surveillance. 2. The development and implementation of relevant procedures and programs to train all personnel on actions to take during a pharmacy robbery. A pharmacy should be a safe haven for patients and the professionals caring for them; however, in the first 5 months of 2015, U.S. law enforcement agencies reported 382 armed pharmacy robberies, putting 2015 on track to break the record of pharmacy robberies in 1 year.1 Multiple technologies exist to help discourage a pharmacy robbery by making it more difficult to commit or harder to escape capture and conviction, and many of the tools enumerated in the resolution have shown positive results when implemented. To foster an environment in which pharmacy personnel feel safe, it is imperative to invest in deterrence strategies and training in robbery response to mitigate risk. Furthermore, as the largest and most inclusive national pharmacy organization, APhA is uniquely poised to address this rising problem.
358
2016.2: Pharmacist administration of injectable medications 1. APhA-ASP supports pharmacists and student pharmacists administering nonvaccine injectables, including but not limited to antipsychotics, longacting contraceptives, and other hormone therapy pursuant to prescription, protocol, or collaborative practice agreement. 2. APhA-ASP supports the development of programs, such as continuing education and certificate training programs, to train pharmacists and student pharmacists to administer nonvaccine injectables properly. 3. APhA-ASP encourages all stakeholders, including but not limited to pharmacies, health systems, and thirdparty payors, to develop a sustainable and financially viable compensation model for pharmacist administration of nonvaccine injectables. Many patients currently prescribed nonvaccine injectable medications are unnecessarily burdened by the lack of accessibility to providers who can administer their medications, increased risks, and additional costs. These barriers can cause poor patient compliance and poor overall patient health because of the patient’s desire to avoid these current obstacles in care. In response to these problems, 21 states have granted pharmacists the authority to administer nonvaccine injectable medications. As pharmacists’ clinical role continues to increase in both community and ambulatory settings, the profession is not only more qualified, but also more adequately positioned than ever before to affect large patient populations positively by administering nonvaccine injectable medications.
2016.3: Establishing immunization requirements 1. APhA-ASP affirms the valuable role of immunizations in protecting the public and strongly recommends that all persons receive immunizations currently recommended by the Centers for Disease Control and Prevention (CDC), except when medically contraindicated. 2. APhA-ASP recommends that all private and public educational or
childcare institutions require enrollees and employees to receive all CDCrecommended immunizations, except when medically contraindicated. 3. APhA-ASP strongly affirms that it is the professional responsibility of all health care personnel to receive CDC-recommended immunizations and supports their employers mandating immunizations as a condition of employment, volunteering, or training, except when medically contraindicated. Immunizations are an important public health tool to prevent the spread of infectious disease. However, amid increasing confusion and misinformation regarding the safety of immunizations, vaccine-preventable diseases are resurging. Unlike most medications, the decision to deny or defer immunizations affects more than the person making the decision. Furthermore, a recent systematic review illustrates the positive correlation between the level of regulation and the immunization rates. The data suggest that adopting more stringent requirements lowers the number of people who choose not to immunize, leading to higher immunization rates and greater protection for the communities.2 In addition, as leaders in health care, pharmacists must take personal responsibility for immunizations. Just as health care professionals protect their patients and themselves through proper hand hygiene, so must we protect our patients and ourselves through immunization. In short, APhA-ASP believes that the health of the public should not be at risk from those whose job it is to preserve it. 2016.4: Increasing patient access to pharmacist-prescribed medications 1. APhA-ASP encourages legislative and regulatory changes that would enable pharmacists, with appropriate training and working as integral members of the health care team, to assess patients and prescribe certain medications, such as those for opioid overdose, contraception, tobacco cessation, and international travel. 2. APhA-ASP encourages the development of sustainable and financially viable compensation models for pharmacist-prescribed medications.
DEPARTMENTS A.K. Kennedy et al. / Journal of the American Pharmacists Association 56 (2016) 355e359
The current shortage of primary care providers contributes to the ongoing issue of access to important primary care services, including medications. The comprehensive training that pharmacists receive through school curriculum and continuing education prepares pharmacists to supervise the use of some medications safely and effectively, such as those for opioid reversal, contraception, tobacco cessation, and international travel. Pharmacists are knowledgeable, accessible, yet underused health care professionals positioned to fill gaps in care and to meet patients’ medical needs.
Looking forward
References
APhA-ASP adopted resolutions are more than words on paper. Just as each of these resolutions began as the idea of student pharmacists, they will be acted upon by student pharmacists and implemented with the help of the APhAASP Policy Standing Committee. Student pharmacists stand ready for the challenges of advocacy that lie ahead to have these and other resolutions put into practice. Until then, see you in San Francisco!
1. Barker A. Top 20 states for pharmacy robberies; July 21, 2015. Available at: http://www.pharmacytimes. com/contributor/alex-barker-pharmd/2015/07/ top-20-states-for-pharmacy-robberies. Accessed January 6, 2016. 2. Bradford WD, Mandich A. Some state vaccination laws contribute to greater exemption rates and disease outbreaks in the United States. Health Aff. 2015;34(8):1383e1390.
Lauren E. Bode, PharmD, 2015-2016 APhA-ASP Speaker of the House, 2016-2018 Combined PGY1/ PGY2 Pharmacotherapy Resident, UNC Medical Center, Chapel Hill, NC
359