Pharmacyforward

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 additio

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 w

Nicole Avant, PharmD, BCACP - Assistant Professor at the University of Cincinnati and Founder/CEO of Avant Consulting Group - and Tennille McKinney - HIV Educator and Consultant with Avant Consulting Group - talk with us about gender expression/identity, cis-privilege, and transphobia. Key Lessons: Sex and gender are not synonymous.  Sex is based on biology and gender is a social construct. Sex is determined by genes and assigned at birth. Gender is influenced by cultural norms and internal sense of self. Transgender persons identify with a gender that is different from the sex that was assigned at birth.  Cis-gender persons identify with the gender that is congruent with the sex assigned at birth. Some transgender persons, but certainly not all, seek medical and/or surgical gender-affirming treatments to express their gender identity. Cis-privilege includes the rights and advantages that cis-gender persons enjoy.  This includes respect for one's gender identity and freedom from harassing comments or in

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

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 behavior

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

Laura Borgelt, Pharm.D., BCPS - Professor, Departments of Pharmacy Practice and Family Medicine at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences - talks to us about the recreational use of marijuana and its potential health consequences. Key Lessons: Cannabis (marijuana) use has increased substantially in the past decade.  Young adults are the most likely to report using marijuana in the past year or month but use among older adults (age > 65 years) is growing as well. Its important to ask patients in a non-judgmental, open-ended manner about their cannabis use including the intended purpose(s), frequency of use, and forms used. Numerous cannabis products are available. Inhaling (smoking or vaping) remains the most common method for use.  Edible products are available in a wide variety of food-like delivery systems (e.g. baked goods, candies).  Topical products are more commonly used for medical purposes. The THC concentrations found in cannabis products today are much

Kari Franson, Pharm.D., Ph.D., BCPP - Associate Dean for Professional Education at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences - talks to us about the medical use of marijuana, THC, and CBD. Key Lessons: Cannabis plants have been used for medical, recreational, and industrial purposes for thousands of years. The two active ingredients in cannabis plants include tetrahydrocannabinol (THC) and cannabidiol (CBD) - collectively known as cannabinoids.  They have distinctly different pharmacological properties. Cannabis plants that contain less than 0.3% of THC by dry weight are legally classified as hemp.  Cannabis plants can be cultivated to have more (or less) THC and CBD content. Prescription products containing THC have been available for more than 30 years. A buccal spray containing THC + CBD has been approved (but not in the United States) for the treatment of muscle spasms/stiffness associated with multiple sclerosis.  A purified CBD product was approved by the FDA

Brandon Shank, PharmD, BCOP - Clinical Pharmacy Specialist at the University of Texas MD Anderson Cancer Center - talks to us about credentialing & privileging from a front-line clinician's point of view. Key Lessons: Building rapport and trust with your team is an essential first step from which clinical privileges follow. State laws vary.  Some authorize privileging of pharmacists at the institutional level. Obtaining and maintaining clinical privileges requires additional training ... and paperwork. Pharmacists have a unique understanding of the dosing and available dosage forms of drugs - this brings value to the patient care team. Privileging pharmacists to take on advanced clinical responsibilities can increase team efficiency and effectiveness. View and Download the Show Notes!

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 enro

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. Vie

Carol Ott, Pharm.D., BCPP - Clinical Professor of Pharmacy Practice, Purdue University College of Pharmacy and Residency Program Director for the Eskenazi Health/Purdue University PGY2 Psychiatric Pharmacy Residency Program - discusses how sigma adversely impacts patients with opioid use disorder and how the BoilerwoRx program is helping to address the opioid crises at the community level. Key Lessons Health professionals too often use stigmatizing language when describing patients with a substance use disorder and their behaviors. We need to critically examine our unconscious biases toward patients with substance use disorder. Substance use disorders are most often co-morbid with other mental health conditions. Needle exchange programs are an evidence-based intervention that can reduce harm by preventing the spread of infectious diseases and be an important touchpoint to get people into treatment. There are numerous ways pharmacists can help patients with substance use disorders - approaching them with

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 recogniz

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 View and Download the ShowNotes!

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.