PharmacyForward

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.

Jeffrey Bratberg, Pharm.D., BCPS - Professor of Pharmacy Practice at the University of Rhode Island talks with us about the opioid overdose crisis - it's causes and potential solutions. Key Lessons The causes of the opioid overdose crisis are multifactorial but rooted in hopeless and despair Illicitly obtained synthetic opioids are very potent and the leading cause of opioid overdose deaths today Opioid use disorder is a brain disease and all patients deserve compassionate care The response to the opioid overdose crisis (to date) has been anemic due to societal stigma and unconscious bias Supply-side solutions (e.g. prescription drug monitoring programs) to the problem may seem helpful but have unintended consequences Naloxone should be widely available and all health professionals should carry it

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.

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.

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.

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.

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.

Timothy Aungst, Pharm.D. - Associate Professor at the MCPHS University in Worcester, Massachusetts and the author of The Digital Apothecary blog talks to us about the current digital health landscape. Key Lessons:  Stand alone mobile health devices and apps have limited value; patient-specific data can inform diagnosis and treatment decisions; aggregated data from 1000's of users can help direct public health efforts; and pharmacists can and should play a bigger role in mHealth/digital health.

Rosemary Duncan, Pharm.D., BCPS - Medication Safety Officer - and Jacob Smith, Pharm.D. - Assistant Director of Medication Safety and Quality at The Johns Hopkins Hospital talk about measuring quality in hospital settings and how quality metrics are used for accreditation and value-based payments. Key Lessons:  Measuring quality is difficult and event rates are not an adequate metric of medication safety; pharmacists can help improve HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores by providing patient and provider education; quality in healthcare is advanced by implementing high-reliability systems and processes by interprofessional teams.

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.  

Troy Trygstad, Pharm.D., MBA, Ph.D. - Executive Director of CPESN-USA, a network of pharmacies that provides a portfolio of medication optimization and patient care services - talks about the "quality movement" and how it's impacting the practice of pharmacy in community and ambulatory care settings. Key Lessons:  Create supports to help patients to optimally use medications; follow-up is critical; fully engage staff and student pharmacists to deliver care.

Dr. Jean-Venable "Kelly" Goode from the Virginia Commonwealth University (VCU) talks about relationship building in the community setting.  Dr. Goode is Past-President of the American Pharmacists Association (APhA) and helped develop several innovative community-based pharmacy practices during her career. She serves as the residency program director for the highly regarded VCU Community-based Residency Program. Key Lessons:  understand the needs first, make time to meet providers in their space, consider practice model changes, and always follow through.

Sara J. White - former Director of Pharmacy at Stanford Hospitals and Clinics - talks about relationship building in hospitals and health systems.  Ms. White is a Past-President of the American Society of Health-System Pharmacists (ASHP) and a Scholar-in-Residence with the ASHP Foundation in 2004. Key Lessons:  know the distinction between interactions and relationships, connect with people - not just communicate, and be visible.

Dr. Hae Mi Choe from the University of Michigan College of Pharmacy talks about relationship building in ambulatory care environments.  Dr. Choe is Director of Pharmacy Innovations and Partnerships for the U-M Medical Group and lead the development of innovative pharmacy services at 14 U-M affiliated hospitals and health centers. Key Lessons:  align your goals with institutional goals, tell your patient's success story, be visible, and be persistent.