1. Pharmacy Practice in the U.S. Part II (Present)
Angela M. Hill, Pharm.D., BCPP

2. Lecture Objectives:
Describe the practice environments that pharmacists utilize.
Review traditional and nontraditional roles of pharmacists.
Discuss collaborative drug therapy management protocols.
Identify multidisciplinary initiatives involving the pharmacist.
Explain the select clinical functions performed by the USF COP PCR faculty.
Explain select credentialing opportunities for pharmacists.

3. Discussion questions
What are services that pharmacists provide in inpatient settings?
What are services that pharmacists provide in outpatient settings?
What is a CDTM?
How does MTM differ from patient counseling?
What credentialing opportunities exists for pharmacists?

4. Where do pharmacists practice?

5. Where do pharmacists practice?
Inpatient
Hospitals
Long-term Care environments
Millitary
Outpatient
Retail pharmacies
Mail order pharmacies
Indian Health Service
Other
Specialty
Radiopharmaceuticals
Home Infusion
Academia
Pharmacy Organizations
Pharmaceutical Industry
Sales
Medical Liaisons
Drug Discovery

6. What do Pharmacists do? Medication distribution
Patient and Healthcare Professional Education
Counseling
Medication Therapy Management
Disease State Management
Medication reviews
Immunizations
Drug Discovery
Clinical Outcomes Research
Policy development
Advocacy
Informatics
Disease Prevention
Medication Safety
Medication Use Evaluations
Compounding
Formulary Management
Health Screenings
Other…..

7. What was the perception of the family or friends that you surveyed about the role of the pharmacist in healthcare?

8. What were the distributive and non-distributive roles of the pharmacists you surveyed?

9. History of MTM
In 2006 Congress passed the Medicare Prescription Drug Improvement and Modernization Act of 2003.
Included a provision for pharmacists and other health care providers to provide MTM to beneficiaries at high risk for medication-related problems.
Recognized the pharmacist value beyond dispensing and established payments for pharmacists to identify and resolve medication related problems.

10. Evidence of Pharmacists’ Value: Diabetes
Outcomes over the initial year:
A1c: 7.9%  7.1%
LDL: mg/dL  mg/dL
Systolic BP: mm Hg  mm Hg
Foot exams: 38%  80%
Eye exam: 46%  82%
Influenza vaccinations: 52%  77%
TOTAL mean health care costs per patient were $ lower than projections for the initial year of enrollment.
95.7% of patients reported being very satisfied or satisfied with the diabetes care provided by their pharmacists
Garrett D, Bluml B. Patient Self- Management Program for Diabetics: First-year clinical, humanistic and economic outcomes.
Study type: Quasi-experimental pre/post cohort study
Sample population: 256 patients with diabetes covered by self insured employers’ health plans
Garrett D, Bluml B. Patient Self-Management Program for Diabetics: First-year clinical, humanistic and economic outcomes. J Am Pharm Assoc. 2005; 45:130-7

11. Evidence of Pharmacists’ Value: Diabetes
Outcomes:
A1c: decreased at all follow ups (> 50% of patients demonstrated improvements)
Lipid levels: > 50% improved
Mean direct medical costs decreased by $1,200  $1,872 per patient per year
Productivity estimated at $18,000 annually
Cranor CW, Bunting BA, Christensen DB. The Asheville Project: long-term clinical and economic outcomes of a community pharmacy diabetes care program.
Study type: Quasi-experimental pre/post cohort study
Sample population: 136 employees having diabetes followed for 5 years
Cranor CW, Bunting BA, Christensen DB. The Asheville Project: long-term clinical and economic outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc. 2003; 43:

12. Evidence of Pharmacists’ Value: Hyperlipidemia
Outcomes over an average of months:
Persistence of medication therapy: 93.6%
Compliance of medication therapy: 90.1%
62.5% of patients reached and maintained their NCEP lipid goal at the end of the project
Bluml B, McKenney J, Cziraky M. Pharmaceutical care services and results in project ImPACT: Hyperlipidemia.
Study type: Observational
Sample population: 397 patients of 26 community-based ambulatory care pharmacies
Bluml B, McKenney J, Cziraky M. Pharmaceutical care services and results in project ImPACT: Hyperlipidemia. J Am Pharm Assoc. 2000; 40:

13. Why now…
The use of prescription medications has increased by 60% over the past decade.
Spending on prescription medications increased from $51 billion dollars to $ billion dollars from 1993 to 2004.
Preventable adverse drug events in ambulatory patients cost $177.4 billion dollars in the year 2000.
The overall goal is to ensure that medications provided by Medicare Part D are used safely and effectively, thereby improving patient outcomes and lowering overall health care costs.

14. Article Reviews
What are non-distributive roles provided by pharmacists?
What roles can pharmacists provide in ACOs?
What roles can pharmacists play in public health?
How are pharmacists valuable as informaticists?
What are steps that cold be used to integrate pharmacist into the interdisciplinary teams?

15. Article Reviews: Scan the articles posted in CANVAS
Article Summary: Integration of a Primary Healthcare Pharmacist (Groups 1-3)
Article Summary: From “Retailers” to Healthcare Providers: Transforming the Role of Community Pharmacists in Chronic Disease Management (Groups 4-6)
Article Summary: Pharmacists’ Role in Accountable Care Organizations (Groups 7-9)
Article Summary: Expanding the Role of Pharmacists on the Healthcare Team (Groups 10-12)

16. Article Reviews: Take 15 minutes to scan the articles posted in CANVAS
Article Summary: Is There a Pharmacist in the House? (Groups 13-16)
Article Summary: The Public Health Pharmacists and the Role of the Pharmacy Curriculum: A Call to Action (Groups 17-19)
Article Summary: Faculty Knowledge and Perceptions of Pharmacy Practice and Education at a Traditional Liberal Arts College (All Groups)
Article Summary: Value of Pharmacy Services to the Healthcare System: An Interdisciplinary Assessment (All Groups)

17. Article Reviews
Article Summary: Health Care Reform 2011: Opportunities for Pharmacists (All groups)

18. How do we educate the public about the expanded roles of Pharmacists?
Group Presentations
Teams #1, 2, 4, 6, 7, 9, 10, 11, 12, 13, 15

19. Discussion
What other healthcare disciplines can provide the similar services as pharmacists?
What are non-distributive roles provided by pharmacists?
What roles can pharmacists provide in ACOs?
What roles can pharmacists play in public health?
How are pharmacists valuable as informaticists?
What are steps that could be used to integrate the pharmacist into interdisciplinary teams?

20. Contemporary Healthcare Practice
Affordable Care Act
Fee for Service to Care Coordination
Acute Care to Ambulatory Care Practice
(Transitions of Care)
Patient Centered Medical Home

21. Pharmacy Robots

22. Practice Sites for USF COP PCR Faculty
Outpatient Care
Inpatient Care
USF Carol and Frank Morsani Center
USF B.R.I.D.G.E. Clinic
USF Byrd Alzheimer’s Institute
USF Psychiatry Center
Judeo Christian Center
University Retirement Center
Royal Sun Park
Consulate Healthcare
Florida Medical Clinic
Tampa Family Health Centers
St. Joseph’s North
Bayfront Medical Center
Tampa General Hospital
Florida Hospital
Tampa
Carrolwood

23. MTM: Definition
According to the American Pharmacist Association Medication Therapy Management (MTM) is a partnership between the pharmacist, the patient or their caregiver, and other health professionals that promotes the safe and effective use of medications and helps patients achieve the targeted outcomes from medication therapy.

24. "MTM services have the potential to revolutionize the delivery of health care and the role of pharmacists in this country." - Winnie A. Landis, BPharm.,President American Pharmaceutical Association

25. What MTM is not… What MTM is…
Patient Counseling
Usually brief
Discussion focused on a specific medication, usually the being picked up
Topic: use, directions, adverse effects, and other patient questions
Disease State Management
Focuses on the education and management of a specific disease
MTM
More complex and thorough
Deals with ALL the patient’s medications and disease conditions
Prevent or solve medication issues
Adverse effects, interactions, further complications
Develop interventions to reduce the risk of disease progression

26. Core Elements of Medication Therapy Management
Medication Therapy Review
Personal Medication Record
Medication Action Plan
Interventions
Follow Up/Documentation

27. Patient Centered Medical Home

28. What opportuntities exist with Healthcare Reform for Pharmacists?

29. What Were Some of the Advantages of the Affordable Care Act?
A new $16 billion prevention fund (that has already been raided for other purposes).
A “community transformation grants” program to promote individual and community health and prevent or reduce the incidence of chronic diseases associated with obesity, tobacco use, or mental illness.
A primary care extension program to train primary care providers about evidence-based therapies in preventive medicine, health promotion, chronic disease management, and mental health.

30. The Affordable Care Act: What Can We Expect for Mental Health Services
Preventive Strategies for Psychiatric Services
Alcohol screening
Depression screening for adolescents
Domestic & interpersonal violence screening, tobacco use screening, alcohol & drug use in adolescents
Autism screening
Behavioral screening
Developmental screening

31. What Were Some of the Advantages of the Affordable Care Act?
Guaranteed access to health insurance, regardless of pre-existing conditions.
Coverage for mental health services as part of the basic benefits package in health insurance.
The right of children who develop mental illnesses to remain on parents’ insurance policies until the age of 26.
Beginning in 2014, guaranteed Medicaid and Medicare Part D coverage for benzodiazepines (such as Xanax and Valium), barbiturates, and smoking cessation drugs.

32. What Were Some of the Advantages of the Affordable Care Act?
A mandatory 3-year, 8-state demonstration project to reimburse inpatient and residential treatment facilities for services to adult Medicaid beneficiaries in need of medical assistance to stabilize a psychiatric emergency.
Grants to states to prevent and manage co-morbid chronic conditions in the Medicaid population; grants to organizations to co-locate and integrate health and behavioral health services; and grants to educational institutions for the development or enhancement of behavioral health training programs in the areas of child and adolescent behavioral health.

33. OSF COP Dept. of Pharmacotherapeutics and Clinical Research Faculty
Ambulatory Care
Internal Medicine
Geriatrics
Critical Care
Psychiatry

34. Tampa General

35. Judeo Christian Clinic

36. BRIDGE Clinic

37. Florida Medical Clinic

38. Florida Hospital Tampa

39. Florida Hospital Carrollwood

40. Royal Sun Park

41. University Retirement Village

42. USF BYRD Alzheimer's Institute

43. Moffitt Cancer Center

44. BayFront Medical Center

45. USF College of Public Health

46. Pharmacy +

47. USF Health Morsani Center for Advanced Healthcare

48. USF Health Psychiatry

49. Consulate Care

50. St. Joseph’s North

51. Special Projects

52. Clinical Investigative Research Pharmacy

53. Categories of Credentialing
College and University Degrees
Licensure
Post-graduate training
Residencies
Fellowships
Post-graduate degrees and certificates
Traineeships

54. Discussion Questions?
What are services that pharmacists provide in inpatient settings?
What are services that pharmacists provide in outpatient settings?
What is a CDTM?
How does MTM differ from patient counseling?
What credentialing opportunities exists for pharmacists?

55. What do pharmacists do?
Revise your “Elevator speech” about the role of pharmacists in healthcare.