Faculty Disclosure. Discussion of off-label and/or Investigational Uses 6/5/2012. Student and New Practitioner Forum Northwest Pharmacy Conference

Transcription

1 Student and New Practitioner Forum Northwest Conference Chris A. Bina, PharmD CAPT, US Public Health Service Director, Program Federal Bureau of Prisons Health Services Division 320 First Street NW Washington, DC Faculty Disclosure The faculty for this program have declared that neither they nor their family members have a relevant financial arrangement or affiliation with any manufacturer of the product(s) or service(s) to be discussed in this continuing education activity. Discussion of off-label and/or Investigational Uses The faculty for this program anticipate discussing the following investigational product(s): None 1

2 ACPE Accreditation Statement The Washington State Association is accredited by the Accreditation Council for Education as a provider of continuing pharmacy education. The Washington State Association designates this educational activity for a maximum of 1.5 contact hours of continuing pharmacy education credit. Each participant should claim only those contact hour units for which he/she actually spent time in the activity. ACPE Number : L04-P&T Objectives Discuss current trends in pharmacy practice. Propose and discuss specific issues and needs pertaining to your practice setting. Update peers on state and federal legislative/regulatory issues pertaining to pharmacy. Discuss strategies to reinforce more patientcentric mission for your profession Insert picture of Atlanta Pharmacist 2

3 Self Assessment Question How many uniformed services are there in the United States? 1. Four 2. Five 3. Six 4. Seven History A Federal Perspective Indian Health Service () Bureau of Prisons (BOP) Veteran s Administration (VA) Department of Defense (DoD) Department of Homeland Security (DHS) Coast Guard (CG) Immigration Customs Enforcement (ICE) St. Elizabeth s Hospital National Institutes of Health (NIH) BOP & PHS History 1930 Congress created the Federal Bureau of Prisons 1930 BOP Director Sanford Bates states, USPHS has taken charge of medical work. Pursuant to Legislation enacted in Seven Penitentiaries & reformatories; Population = 12,398; 50 PHS Staff 1992 Inaugural BOP National P&T Meeting 1993 BOP participates with VA PPV 1994 First standardized pharmacy software 3

4 BOP Timeline BOP Pharmacists 2002 Recruitment Workgroup AKA Chain Gang 2004 HIV Clinical Pharmacist Consultants ONAP, NHAS 2005 Regional Pharmacist Consultants 2006 Scholarship Program 2007 BEMR Rx Full Time Pharmacist Insert funny picture of an inmate, perhaps one from urinalysis talk BOP Timeline Cont Chief, Clinical Services st AAHIVE credentialed 2008 Regional Chief Pharmacist Positions 2009 Central Processing 2009 First BOP Resident 2010 HIV / Hepatitis Program Manager 2011 Chief of Pharmacist Logistics Support 4

5 BOP Timeline Cont Hepatitis Clinical Pharm Consultants student rotations; 28 BOP sites; 32 Schools of Pharmacist FTEs; 6 Vacancies Pharmacists w/ CPAs; 57 protocols 2012 Central Fill??? 2013 Mental Health Pharm Consultants?? 2013 Tuberculosis Pharmacist Consultants? Health Services Overview is not in the middle by accident. 76% of visits 80% of txs Self Assessment Question What term did the Indian Health Service Coin in 1988? 1. Clinical 2. Pharmaceutical Care 3. Medication Management Therapy 4. Pharmacoeconomics 5

6 Indian Health Service Part of the US Public Health Service 561 federalized tribes 600+ health facilities with 46 hospitals and 34 urban clinics across 38 states Comprehensive primary healthcare system Identifiable need and health disparity Large number of ambulatory clinics Innovation and Evolution Edwin M. Allen J. shift begins Holt is the Brands from Program first becomes distribution Planning Practitioner commissioned services. the first to clinical meeting in Program CPO for Rockville teaching officer to be Begins to s assigned to counsel s start physical the Office patients serving as assessment of Indian and use primary and disease Affairs, health care management Department record, not providers in of Interior. Rx form. many Such facilities practice does not exist before this time Standards establishment of the Patient distributes of Practice to provide Clinical Consultation pharmaceutical videos to care to patients. Training academia Coined the Program nationwide. term. (CPTP ) training s in managing chronic disease Innovation and Evolution Program Planning meeting in Rockville s start serving as primary care providers in many facilities begins Practitioner Program teaching s physical assessment and disease management Edwin M. Allen J. Holt is the Brands first becomes commissioned the first CPO for officer to be assigned to the Office of Indian Affairs, Department of Interior. establishment of the Clinical Training Program (CPTP ) training s in managing chronic disease shift from distribution to clinical services. Begins to counsel patients and use health record, not Rx form. Such practice does not exist before this time Standards distributes of Practice to Patient provide Consultation pharmaceutical videos to care to patients. academia Coined the nationwide. term. 6

7 Innovation and Evolution Program Planning meeting in Rockville s start serving as primary care providers in many facilities begins Practitioner Program teaching s physical assessment and disease management Edwin M. Allen J. shift Holt is the Brands from first becomes distribution commissioned services. the first to clinical CPO for officer to be Begins to assigned to counsel the Office patients of Indian and use Affairs, health Department record, not of Interior. Rx form. Such practice does not exist before this time establishment of the Clinical Training Program (CPTP ) training s in managing chronic disease Standards of Practice to provide pharmaceutical care to patients. Coined the term. s start serving as primary care providers and disease state managers in many sites. Clinical training begins in Phoenix distributes Patient Consultation videos to academia nationwide. Innovation and Evolution shift from distribution to clinical services. Begins to counsel patients and use health record, not Rx form. Such practice does not exist before this time Program Planning meeting in Rockville s start serving as primary care providers in many facilities begins Practitioner Program teaching s physical assessment and disease management Edwin M. Allen J. Holt is the Brands first becomes commissioned the first CPO for officer to be assigned to the Office of Indian Affairs, Department of Interior. establishment of the Clinical Training Program (CPTP ) training s in managing chronic disease coined the term pharmaceutical care. Standards of Practice to provide pharmaceutical care to patients.. distributes Patient Consultation videos to academia nationwide. Practice In 1996, the scope of pharmacy practice in the was officially broadened in Dr. Michael Trujillo s October 18, 1996 memorandum: Clinical Specialists will be included in the definition of a primary care provider for the purposes of workload reporting, program planning, and reimbursement from all third party payers. An appropriate primary provider code will be assigned to CPS. 7

8 Innovation Business Committee meetings to discuss reimbursem ent for services and contacts HCFA (now CMS) Director of Indian Health Service, RADM Michael Trujillo, signs special memorandum, which codifies Clinical Specialists (CPS) as primary care providers (PCPs) with prescriptive National Clinical Specialist (NCPS) Program Established after business meetings authority. Innovation Business Committee meetings to discuss reimbursem ent for services and contacts HCFA (now CMS) Director of Indian Health Service, RADM Michael Trujillo, signs special memorandum, which codifies Clinical Specialists (CPS) as primary care providers (PCPs) with prescriptive authority. The National Clinical Specialist Credentialin g Committee (NCPSCC) is born out of discussions surrounding decades of expanded practice Leadership meet with HCFA to engage in discussions about reimbursement. Pinnacle Award Innovation Business Committee meetings to discuss reimbursem ent for services and contacts HCFA (now CMS) Director of Indian Health Service, RADM Michael Trujillo, signs special memorandum, which codifies Clinical Specialists (CPS) as primary care providers (PCPs) with prescriptive authority. The National Clinical Specialist Credentialin g Committee (NCPSCC) is born out of discussions surrounding decades of expanded practice - and PHS receives leadership meet completes Roche receives with HCFA to 10-years of D.R.E.A.M. the ASHP discuss national award for Award of pharmacy practice credentialing Excellence and potential for NCPS Nearly 200 through NCPS. for the implementation reimbursement. managed s of a Traineeship in credentialed - First group of CHF clinic Anticoagulation (over 100 s Management currently receive NCPS and active) across NCPS-PP 40 states and 8 credentials. different - receives the disease state APhA Pinnacle areas. Award for contributions to pharmacy profession receives completes Roche receives 10-years of D.R.E.A.M. the ASHP national award for Award of credentialing Excellence NCPS Nearly 200 through NCPS. for the implementation managed s of a Traineeship in credentialed CHF clinic Anticoagulation (over 100 Management currently active) across 40 states and 8 different disease state areas. - and PHS receives leadership meet Roche receives with HCFA to D.R.E.A.M. the ASHP discuss award for Award of pharmacy practice Excellence and potential for NCPS for the implementation reimbursement. managed First Report of a on Traineeship in - First group of CHF clinic Anticoagulation s Management receive NCPS and NCPS-PP credentials. - receives the APhA Pinnacle Award for contributions to pharmacy profession Advanced Practice and Health Reform Submitted to the US Surgeon General CMS Proposal Support from APhA 8

9 Self Assessment Question How many pharmacy schools are currently, or a candidate to become ACPE accredited? Profession Trends Personnel Pharmacists Schools & Students Technicians / PTCB Primary Care Opportunities A call to all entrepreneurs! Pharmacists & Schools pharmacy schools accredited pharmacy schools Tennessee 2006 one pharmacy school 2012 six pharmacy schools Pharmacists ,000 s ,000 s ,000 s 9

10 Profession Trends External Factors Aging of America Personalized Medicine Shortage of physicians and midlevel providers Pharmacist Opportunities!! Legislation CMS Final Rule Published May 16, 2012 We have broadened the concept of medical staff and have allowed hospitals the flexibility to include other practitioners as eligible candidates for the medical staff to allow other practitioners (e.g. APRNs, PAs, s) to perform all functions within their scope of practice. CMS Unfortunately, does not include ambulatory care, YET! Source: 42 CFR Parts 482 and 485, HRSA / NHSC National Health Service Corps (NHSC) State Loan Repayment Program (SLRP) State Program funded under ACA Pharmacists finally eligible!! Student advocacy efforts effective! Still work to do. Source: Drug Topics, "Pharmacists included in student loan repayment program," articledetail.jsp?id=

11 Today s Practice Bina s Breakdown Administrative Policy, Accreditations, Contracts, P&T, QA Operational / Work flow Prescription Processing Prescription Fulfillment Distribution / Inventory Management Clinical Disease State Management Medication Management Health Prevention Creating a Patient Centric Mission Putting it all together Can be overwhelming Manageable Initiatives Organizational Chart Interchangeable parts All s are clinical Health Systems Community Pharmacies Independent and Chain Manage Expectations! Strategy: Teams Building medical homes for patients with chronic conditions: Robb Malone, PharmD, CPP, CDE, pioneered centered care at UNC. Source: Today, March

12 Rememberable Quote We are spreading the idea of what we think the country s new health care system is going to be: coordinated teams working at the top of their licenses, using data and information technology to support care delivery, and working with patients to achieve high quality, efficient care. - Robb Malone, PharmD, CPP, CDE Self Assessment Question What an essential skill for success that is always needed, but rarely taught? 1. Physical Assessment 2. Keyboarding 3. Diplomacy 4. Success How to make it happen the equation for success DOCS Diplomacy + Outcomes + Collaboration + Skill = Success 12

13 Diplomacy Most essential skill, but rarely taught Diplomacy to succeed Manage your Supervisor Co-workers and Patients Core Values & Integrity Three F s Diplomacy & Communication Packaging is everything Communication is underrated Your best asset is you Control the controllable Civility Diplomacy & Integrity Nearly all men can stand adversity, but if you want to test a man's character, give him power. - Abraham Lincoln Power, authority, access, knowledge, intelligence 13

14 Integrity In looking for people to hire, you look for three qualities: integrity, intelligence, and energy. And if they don't have the first, the other two will kill you. Warren Buffet Outcomes With authority comes accountability Objective impact is needed Types of outcomes in pharmacy practice Multiple perspectives / needs Match outcomes with local barriers Follow Up and/or Follow Through! Collaboration Leadership / Team Building The Five Dysfunctions of a Team, A Leadership Fable Patrick Lencioni Constantly applied gentle pressure Diplomacy builds the foundation, collaboration sustains it. More than one right answer Blue Ocean Strategy TM 14

15 Collaboration cont. Identify the collaborators Find the comfort zone Benefits: Improved communication Misperceptions laid to rest Competence demonstrated Tangible outcomes Common barriers overcome The essence of inter-professional practice My Motto It Takes a Team to Raise and Outcome Skills / Knowledge Beyond the known skills and knowledge (testing, licensure, residency, etc) Assessment and clinical reasoning Interprofessional interaction Competence Learn and teach practice innovation Appropriate attitude is a skill We don t know what we don t know 15

16 Skills / Knowledge Never demand respect, only command it. Learn something from everyone...and learn something every day. Knowledge is a lifelong endeavor Concepts Items to add to tolk See list in notes Lessons Learned A Personal Account First Chief Position First Chief Position at Medical Center First refused prescription Move to Central Office Enjoy the journey of your career Find a balance 16

17 All war represents a failure of diplomacy. - Tony Benn The diplomat remembers the MDs birthday, but not their age. Interprofessional practice needs diplomacy - not just for the pharmacy profession, but from every professional - to make it work. TEAM Team First Hard Work Recognition Success Self Assessment What is this? Tattoo Gun 17

18 Career Aim high in your career, but remain humble in your heart. Anonymous Remember what Counts 18

19 THANK YOU!! Questions? 19