Pharmacy News

Entries for February 2018

Should We Begin Implementing Preconception Care Counseling Among Women of Childbearing Age, 18 to 45 Years, Within the Community Pharmacy Setting?

By Mollie M. Reidenbach, Pharm.D., pharmacy practice resident, SpartanNash, Byron Center

 

Preconception care is defined as a set of interventions that work toward identifying and modifying biomedical, behavioral and social risks to women’s health or pregnancy outcomes through prevention and management.1,2 It refers to the healthcare a woman or man receives during the years in which they are able to have a child and focuses on taking steps now to protect the health of a baby they might have in the future.3 Many pregnancies have good maternal and fetal outcomes; however, in the U.S., about 30 percent of women experience complications during pregnancy leading to 12 percent of babies being born prematurely, eight percent born with a low birth weight and three percent having major birth defects.2 In addition, pregnancy complications and their aftermath impart a large economic burden with direct and indirect healthcare system costs totaling over one million dollars over the course of that child’s life.2

Several studies show that almost all women who are planning to become pregnant have at least one risk factor that could adversely affect their pregnancy.4 Complications can occur at any stage of pregnancy; however, most birth defects occur within the first three months of pregnancy during fetal organ development.3 Because almost half of all pregnancies in the U.S. are unplanned, women may not be aware of pregnancy until the fetus has moved well into the vulnerable period. This results in an alarming amount of women who are not taking the necessary precautions to prevent complications.3,5 Given this information, timing of prenatal care is key.2 Preconception care should not only target patients who are actively pursuing pregnancy, but also the 62 million women of childbearing age in the U.S. who are capable of becoming pregnant.5,6 Although not all negative occurrences can be avoided, optimizing women’s health and knowledge before conception may help to reduce these risks.5

The Centers for Disease Control and Prevention (CDC) Select Panel on Preconception Care developed 14 proven interventions for preconception care: diabetes, hypothyroidism, maternal phenylketonuria (PKU), oral anticoagulation, antiepileptic medications, isotretinoin use, HIV/AIDs, sexually transmitted infections (STIs), vaccinations, folic acid, smoking cessation, alcohol/drug misuse and obesity.3,7 While much of this can be addressed in the primary care setting, many patients cannot afford routine doctor visits, and providers may find it difficult to address every need within one appointment. Pharmacists can help bridge this gap. In a study by Mager et al., select community pharmacies in Ohio implemented preconception care targeted medication reviews into the pharmacy workflow; the interventions included folic acid supplementation, hepatitis B/MMR vaccination and category D/X medication use.8 The study demonstrated the feasibility of this type of counseling within the community pharmacy setting. With 90 percent of Americans living within a five mile radius of a pharmacy, and medication therapy management (MTM) platforms providing avenues for these types of services to be implemented, pharmacists are in an excellent position to provide those services for their patients.9 Should we begin implementing preconception care-based counseling among women of child-bearing age within the community pharmacy setting? The answer should be a resounding “yes.”

If yes, what are the next steps? Preconception care services are quickly becoming a “hot topic” in healthcare, and the need for these services is well defined. In time, more research and recommendations regarding community pharmacy driven preconception care services will become available. As we begin to learn more about the need for preconception care and how it fits into community pharmacy practice, I leave you with this: where might preconception care services fit within your pharmacy workflow, and how might you implement these types of services to better the health of the patients you serve? 

For more information, visit the CDC’s website: https://www.cdc.gov/preconception/index.html

References:
1.      Preconception care: A guide to optimizing outcomes. ACOG [internet]. 2013 Sept [cited 2017 Sept 2]. Available from: https://www.health.ny.gov/publications/2026/
2.      Proceedings: Kent H, Johnson K, Curtis M, Hood JR, Atrash H. Proceedings of the preconception health and health care clinical, public health, and consumer work group meetings. CDC, National Center on Birth Defects and Developmental Disabilities [internet]. 2006 Jun 27-28 [cited 2017 Sept 1]. Available from: https://www.cdc.gov/preconception/documents/workgroupproceedingsjune06.pdf
3.      Preconception health and healthcare. CDC [internet]. 2017 Feb 13 [cited 2017 Sept 1]. Available from: https://www.cdc.gov/preconception/index.html
4.      Poels M, Van Stel HF, Franx A, Koster MPH. Actively preparing for pregnancy is associated with healthier lifestyle of women during the preconception period. Midwifery [internet]. 2017 Apr 26 [cited 2017 Sept 1]; 228-234. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28478375
5.      The importance of preconception care in the continuum of women’s health care. ACOG [internet]. 2005 Sept [cited 2017 Sept 1]; 313. Available from: https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/The-Importance-of-Preconception-Care-in-the-Continuum-of-Womens-Health-Care
6.      Johnson K, Posner SF, Biermann J, Cordero JF, Atrash HK, Parker CS, Boulet S, Curtis MG. Recommendations to improve preconception health and health care --- United States. A report of the CDC/ATSDR preconception care work group and select panel on preconception care. CDC MMWR [internet]. 2006 Apr 21 [cited 2017 Sept 1]; 55(RR06):1-23. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5506a1.htm
7.      DiPietro N. Preconception care: an overview. US Pharmacist [internet]. 2008 Sept 18 [cited 2017 Sept 1]; 33(9): 34-42. Available from: https://www.uspharmacist.com/article/preconception-care
8.      DiPietro NA, Bright DR, Markus D, Weis L, Hartzell DM, Gartner J. Use of targeted medication reviews to deliver preconception care: a demonstrative project. J Am Pharm Assoc [internet]. 2017 Jan-Feb [cited 2017 Sept 1]; 57(1): 90-94. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27838391
9.      Frederick J. By the numbers: how community pharmacists measure up. DSN [internet]. 2015 Mar 13 [cited 2017 Sept 1]. Available from: http://www.drugstorenews.com/article/numbers-how-community-pharmacists-measure

Posted in: Patient Safety
Curbing the Opioid Epidemic: Proper Opioid Disposal

By Katrina Capapas, Pharm.D., PGY1 pharmacy resident and  Cheryl Genord, R.Ph., pharmacy clinical specialist in pain management, St. Joseph Mercy Hospital, Ann Arbor, MI

 

Prescription drug misuse and abuse continues to be a problem throughout the United States. Particularly, the dramatic increase of prescription opioids since 1999 has resulted in unrestricted availability of unused opioids and has unlocked opportunities for abuse and addiction.1 Per the Centers of Disease Control and Prevention (CD), prescribers wrote 66.5 opioid prescriptions for every 100 Americans in 2016.2 In 2015, the total number of prescribed opioids equated to 640 morphine milliequivalents (MME), which equates to every American being medicated around the clock for three weeks.3 Additionally, Jones et al. evaluated a national survey that identified sources of opioids for non-medical use; the authors found that up to 56 percent of survey responders reported obtaining opioids from a friend or relative for free.4

At the end of 2017, Michigan lawmakers passed new legislation to help curb the opioid epidemic and promote proper prescribing and disposal of opioids.5 The policy includes a provision where a prescriber or health professional must address the patient with the following information before prescribing an opioid:

1.      The dangers of opioid addiction.

2.      How to properly dispose of an opioid.

3.      Diversion of a controlled substance is a felony.

4.      A discussion on the harm of opioid exposure to the fetus for pregnant patients.

In light of the new policy, pharmacists can help patients by providing information on how to remove unwanted or unused opioids to reduce the chance of accidental misuse. Below are ways to dispose of unwanted prescription opioids and other medications:

1.Take-Back Programs: Patients can take old, unused or unwanted medications to an authorized pharmacy for proper disposal. Michigan pharmacy locations are available online here via the Michigan Department of Environmental Quality.5,9 The Michigan Pharmacists Association also holds an annual Medication Disposal Event on the south Capitol lawn in Lansing; the next event will be held on Tuesday, Sept. 11, 2018, from 10:30 am – 1:30 pm.6 Additionally, the Michigan OPEN hosts take-back programs throughout the state.7 The last take-back event in September 2017 collected 17,500 opioid pills from consumers. Visit the website here for updates on the next take-back event.

Patients can find local law enforcement agencies participating in the "Big Red Barrel" program to dispose these medications.8 All 29 Michigan State Police posts are collecting scheduled prescription medications every Monday through Friday. To find a law enforcement agency, visit www.Michigan-Open.org/takebackmap/.
 

2. Disposal in Household Trash: if patients are unable to dispose their medications at a participating pharmacy or law enforcement agency, the Food and Drug Administration (FDA) provides four simple steps on how to dispose medications in the trash:11

A. Mix medicines in unpalatable substances such as dirt, kitty litter or used coffee grounds. Do not crush tablets or capsules.
B. Place the mixture in a container such as a sealed plastic bag.
C. Throw the container in your household trash.
D. Scratch out all personal information on the prescription bottle of your empty pill bottle or empty medicine package, then dispose of the container.

 

Deterra® deactivating system

Patients can also dispose of unwanted opioids using the Deterra® deactivating system.12 Deterra® uses a patented activated carbon technology to immediately deactivate opioids and other medications, and is available in different sizes for purchase on the internet or at local pharmacies. The packaging itself is biodegradable and will not significantly contribute to landfills.

 

 

3. Flushing of Medicines: Some medications can pose harmful risks if not disposed of immediately. The FDA recommends certain medications, including opioids, to be flushed down the toilet if a take-back program or other means of disposal is not available to prevent harm to other people (for more information, see the FDA Flush List).13 In light of concerns about medications in the water supply, the FDA released a study that examined ecological and human-health risks.14 Fifteen active ingredients were studied, which included buprenorphine, hydrocodone, hydromorphone, methadone, morphine, oxycodone, and oxymorphone. The study concluded that the medications were not associated with significant risks through ingestion of water or fish.

Pharmacists play an essential role in decreasing the opioid reservoir. Promoting proper opioid use and disposal is among the numerous ways they can educate patients and ultimately act as a line of defense against the opioid epidemic.

References

1. Analysis of Opioid Prescription Practices Finds Areas of Concern. NIH website. https://www.drugabuse.gov/news-events/news-releases/2011/04/analysis-opioid-prescription-practices-finds-areas-concern. Accessed December 18, 2017.
2. Annual Surveillance Report of Drug-related Risks and Outcomes. CDC website. https://www.cdc.gov/drugoverdose/pdf/pubs/2017-cdc-drug-surveillance-report.pdf. Accessed December 18, 2017.
3. Opioid Prescribing. CDC website. https://www.cdc.gov/vitalsigns/opioids/infographic.html#graphic-a. Accessed December 18, 2017.
4. Jones CM, Paulozzi LJ, Mack KA. Sources of Prescription Opioid Pain Relievers by Frequency of Past Year Nonmedical Use. JAMA Intern Med. 2014;174(5):802-803.
5. Medication Disposal. Michigan Pharmacists Association website. http://www.michiganpharmacists.org/medicationdisposal. Accessed December 18, 2017.
5. Senate Bill 0217 (2017). Michigan Legislature website. http://www.legislature.mi.gov/(S(0j3pch3hodgym1moji4sf1gp))/mileg.aspx?page=BillStatus&objectname=2017-SB-0274. Accessed January 14, 2018. 

Posted in: Patient Safety
Keep Calm: You Will Make It Through Pharmacy School

By Sara Kolc, Pharm.D. candidate 2018, Ferris State University College of Pharmacy, Grand Rapids

 

There is often this image of healthcare professionals as “gods and goddesses”; that they are these exceptional people that excel day-to-day in everything they do. They may seem perfect on the outside, but are they really “perfect” on the inside? As you go through pharmacy school, the work never stops. The stress is ongoing, so how do you manage everything going on in school and still have a work, social and family life? It’s not easy, and I think a lot of pharmacy students constantly doubt themselves. If “Jane Doe” can do it, and I can’t, am I really cut out for this? I’m here to tell you that almost every single pharmacy student has felt how you felt, and here’s what I’ve learned to combat those thoughts.

           

The program at Ferris State University (FSU) is designed so pharmacy students spend P1-P2 years on campus in Big Rapids and then move to Grand Rapids for P3 year. I did all my undergraduate studies at FSU, so I had been in Big Rapids for five years prior to moving to Grand Rapids. Moving three hours from metro-Detroit to a small town in west Michigan away from all my friends and family was a big transition for me. Despite hating it my freshman year, I began to love the atmosphere and the people I met. I developed relationships with friends and faculty, and I felt like I belonged. When I moved to Grand Rapids and began P3 year, I felt like my life flipped upside down. I didn’t have all the friends and faculty right there with me anymore. I had new faculty that I didn’t know, and all of my classmates were scattered throughout the big city of Grand Rapids instead of all together in little ol’ Big Rapids.

 

P3 year I felt alone, scared and depressed. I felt this wave of anxiety any time I walked into school. I wasn’t eating right, sleeping, and most certainly, not focusing. Those are the three key things students need to have under control to be successful in school. One day, it came to me that I needed to do something to change how I was feeling. I loved pharmacy and what I was doing. I wanted to continue and be successful. I sought out counseling, and it really helped me change my ways of thinking about life. I also found exercise really helped my mood and overall sleep. I’m no gym-fanatic by any means, but when I went, it made me feel good and boosted my self-esteem. You may experience this in pharmacy school, and I want you to know that it is okay! Every healthcare professional that’s come before you has felt this at some point in their career. Although patients may think we are immortal superheroes, at the end of the day, we are human beings that have feelings too.

 

Every individual is different, remember that. Like we all know, some medications will work for some, and some will not work for others. Likewise, how one person deals with stress in pharmacy school may not work for another. Be open to exploring new things to help keep your mental health at peace. You have to believe that there is a reason you are here, in this profession, and stick with it. There are times you will struggle or fail, but you must accept it and continue moving forward. Everything happens for a reason, and I can guarantee there will be some benefit to your struggles. It is so easy to let everything going on around you overwhelm and take over your life. You must remember to take care of yourself! Pharmacy school is purposefully not easy because, as a pharmacist, some of the decisions you will make could be life or death to a patient. You should not take that lightly. That license is a privilege and now is your time to prove yourself and earn it. At times when you are struggling, remember that when it’s all said and done, and you’re a licensed pharmacist, that you’ve gone through experiences that make you worthy to care for the people in the world.

Posted in: Member News
If Not You, Then Who?

By John Clark, Pharm.D., M.S, BCPS, FASHP, MSHP president-elect, associate chief of pharmacy, Michigan Medicine and clinical associate professor, University of Michigan College of Pharmacy, Ann Arbor

Collectively, we as a pharmacy profession (pharmacists and pharmacy technicians) are practicing at a time of amazing opportunity. Our legislative leaders may soon pass a bill that grants pharmacists provider status. Many thousands of hours of advocacy have led to this point. As we contemplate our role as a pharmacist provider, we must ask ourselves one question: What are we doing right now to be prepared for recognition as providers?

As pharmacists, we can prepare ourselves by working with our systems to participate in medical leadership delegated prescribing in health-systems and using the Michigan Collaborative Practice Agreements to participate in direct provision of care. As you think about what that might be, consider the mundane (IV to PO switching), to the complex (therapeutic anticoagulation). How will you know what patients need from pharmacy at your organization? Open a dialogue with physicians, nurses, patients, dieticians, respiratory therapists and the therapy areas. Where are current gaps in patient care that pharmacists or their extenders can help address?

How do we find pharmacist time to provide such services? Just look around. We have many highly trained pharmacy technicians in the State who can take ownership of the medication distribution process. Pharmacist final checks are required; however, think of the whole process before the pharmacist check as being owned by pharmacy technicians. Our pharmacists’ paths to roles as providers are as close as our pharmacy technicians we train and empower.

Released in 2017, information collected by the Centers for Disease Control and Prevention (CDC) on collaborative practice agreements can be found here.

These resources and data can allow us today to prepare for advanced roles. The advanced roles needed are as diverse as the patients we treat. Our initiative, drive and ability to innovate are the only rate limiting steps to pharmacy advancement.

Today, as we consider future provider status, take steps now to prepare yourself and your health-system for pharmacists as providers. The Michigan Society of Health-System Pharmacists needs you as individual practitioners to embrace the role of direct patient care providers and share your learning with each other. The power of collaboration is strong. In the spirit of President McDonald’s theme for the year, “Demonstrating our Value”, let’s develop progressive pharmacy services our patients need and deserve.

As you think carefully around the development and implementation of clinical services, please be prepared to answer the question, “If not you, then who?” Let’s seize the opportunity that sits before us!

Posted in: Member News
Membership Reflections and Anticipation

By Gillian Leung, Pharm.D. candidate 2019, University of Michigan College of Pharmacy, Ann Arbor, MPA/MSHP Membership Committee

 
2018 Membership Committee: (left to right; back to front) Hope Broxterman, Peggy De Voest, Alex Proux, Stephanie Klepser, Susan Melendy, Neha Desai, Kali VanLangen, Chadi Abbas, Gillian Leung, Jillian DiClemente, Emily Blum and Andrew Johnson

 

Happy 2018 from your Membership Committee! The New Year is commonly known as a symbol of innovation, change and resolution. Have you made plans for the New Year? For the Membership Committee, our goal remains the same – to evaluate member benefits and offerings and work to increase the value of your membership. We aim to make the Michigan Society of Health-System Pharmacists (MSHP) and Michigan Pharmacists Association (MPA) the professional home where members grow personally and professionally so our profession can prosper and advance. The Committee is scheduled to meet twice a year on the MSHP Committee Days in January and May. Every January, members of the MSHP/MPA Membership Committee get inducted and reappointed. We were excited to reconnect with familiar faces and meeting new additions to the Membership "pharmily." The Committee reflected on old businesses and achievements, and also engaged in productive discussions to work toward a goal to serve our members better. We are excited to continue serving you this year!

Is there anything you may be excited to see or experience in 2018? One of the most highly-anticipated events every year is the MPA Annual Convention & Exposition (ACE). The MPA ACE is a meeting for all pharmacists, pharmacy technicians, student pharmacists and other pharmacy profssionals in the state of Michigan. It offers over 40 continuing education (CE) opportunities and over 20 hours of live CE to keep pharmacy practitioners current with the latest information about the profession. No matter your interest and field of practice, it is guaranteed you will find something beneficial. In order to make information more readily available and CE sessions more interactive this year, a mobile-friendly Lecture Panda system and the EventMobi mobile app will be launched at the meeting. Aside from the educational component, the convention provides an invaluable environment for pharmacy practitioners to reconnect with old contacts and build relationships with new faces.

The MPA ACE is scheduled for Feb. 23-25, 2018, at the Detroit Marriot at the Renaissance Center. Online registration to attend the convention is now closed, but onsite registration is still available! Bring your friends and colleagues for a truly remarkable weekend.

One of the annual charges for the Committee is to plan the annual MSHP Student Pharmacist Luncheon and program at the MPA ACE. The goal of the luncheon is to provide student pharmacists with an opportunity to network with pharmacist leaders as well as fellow student pharmacists from across the state. This year, in order to facilitate ice-breaking and encourage conversations, the Committee has proposed the incorporation of a pharmacy-related Heads Up style game at the tables. The roundtable discussion guide has also been revised to make the experience more enlightening for students and more stress-free for the pharmacist table leads. Giveaways such as white-coat clipboards and gift cards will also be available. It is highly encouraged that student pharmacists seize the opportunity to learn and network at the luncheon. We are looking forward to seeing you at the convention.

As announced by MSHP President, Nancy McDonald, the MSHP theme of the year is “Demonstrating Our Value.” The Membership Committee strives to continue evaluating member benefits and increasing the value of your membership so MSHP and MPA can exemplify this theme to help you and every Michigan pharmacy practitioner demonstrate their value.

Posted in: Member News
Page 1 of 2First   Previous   [1]  2  Next   Last