A study on diabetic patients by the University at Buffalo School of Pharmacy and Pharmaceutical Sciences identified cost savings with improvements in a key indicator of glucose control in diabetes patients, the hemoglobin A1C measurement. The A1C provides a three-month average of the amount of excess glucose in the blood. Higher A1Cs indicate that a patient is at higher risk for developing long-term complications associated with diabetes, such as kidney disease or vision problems.

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Published last spring in the Journal of the American Pharmacists Association, the UB study of 50 patients with Type 2 diabetes demonstrated that in just six months clinical pharmacists, in collaboration with primary care providers, were able to significantly reduce patients’ A1C levels.

In the UB study, patients’ A1C levels were reduced by an average of 1.1 percent, from an average of 8.5 percent to 7.4 percent, one year after being enrolled in the program, while also improving the overall metabolic profile.

“Our results show that enhancing the patient’s access to care through collaborative physician-pharmacist relationships can yield lower blood glucose levels, improve the overall metabolic profile and reduce costs to the payer,” says Erin Slazak, PharmD, UB clinical assistant professor of pharmacy practice and board certified pharmacotherapy specialist.

These clinical improvements occurred while monthly costs per patient went down by approximately $212, around $2,500 per year, even though there were nominal increases in the cost of medications prescribed.

The key to success?

“Patients had unlimited access to pharmacists throughout the year,” says Slazak.

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Patients referred to the UB program had been identified by their primary care providers as having difficulty controlling their blood sugar. Slazak notes that it was not uncommon to see patients with glucose levels as high as 400 mg/dl (normal levels are below 100 mg/dl).

The UB pharmacists spent an initial one-hour appointment with each patient, where they worked up detailed health records covering dietary information and all medications and disease conditions, and then reviewed them with each patient.

After that, patients could call or make appointments with pharmacists at will.

“We did extensive education with patients about how to manage their conditions,” says Slazak. “In many cases, we were instrumental in getting them to start insulin. There is a lot of resistance to that, and not just because it’s an injection.”

For patients in the initial stages of administering insulin, she says it was common to be contacted once every few days. The pharmacists then made suggestions to physicians about changes in medications, dosages or lifestyle that might be beneficial to their patients.

That kind of individualized attention is far from the norm for diabetic patients.

“Nationwide, the standard of care is that the primary care provider manages diabetes alone,” says Slazak. “Pharmacists typically do not have direct involvement.”

That is partly because some states, including New York, have not yet approved collaborative practice agreements between physicians and pharmacists. In the Buffalo study, for example, physicians were required to review pharmacists’ recommendations and approve all interventions first. Completion of the review process and approval occurred in only half of the cases, potentially limiting the overall benefit to the patient.

“We know there’s a long-term clinical and economic benefit to pharmacists working directly with patients and we think that can continue to grow,” says Scott V. Monte, PharmD, UB clinical assistant professor of pharmacy practice and director of Diabetes and Cardiovascular Research, CPL Associates, LLC, in Buffalo. “Pharmacists can help achieve better outcomes if given the chance.”

The study was conducted through MedSense™, part of the Pharmacotherapy Research Initiative, a collaborative effort between Lifetime Health Medical Group and UB, to study how pharmacists impact patient care. MedSense™ is one of many program sites that are part of the UB Pharmacotherapy Research Initiative in the School of Pharmacy and Pharmaceutical Sciences, which was established to study how pharmacy medication management can improve the health of patients while cutting costs through patient-centered pharmacotherapy.

In addition to Slazak and Monte, other co-authors on the paper include Nicole Paolini Albanese, PharmD, UB clinical assistant professor; Martin Adelman, PhD, chief information officer at CPL Associates, LLC; Gauri Rao, a student in the UB School of Pharmacy and Pharmaceutical Sciences, and Joseph A. Paladino, PharmD, UB professor of pharmacy and director of outcomes research at CPL Associates, LLC.

The program is jointly funded by Lifetime Health Medical Group and the UB School of Pharmacy and Pharmaceutical Sciences.

Pharmacists Improve Care of Diabetics While Cutting Costs, Research Shows is a post from: Pharmacy in jobs, news, schools

The health-care industry added an additional 29,000 jobs in October, nearly the same amount it grew in September. In total, since the start of the recession, the industry has added 597,000 jobs, according to the BLS.

The biggest month-to-month jump came in the category of health care and social assistance, which added approximately 3,400 positions.

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And like in September, there was growth across all health-care sectors, including in hospitals, ambulatory-care settings and in doctors’ offices.

Pharmacy – Looking for a Job? Health Care Is Still a Good Bet is a post from: Pharmacy in jobs, news, schools

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Pharmacy Labs and companies contacts, address, with letter L part 4 – Laboratoires is a post from: Pharmacy in jobs, news, schools

Ambulatory care pharmacy practice, according to the groups’ petition, is a specialty in medication use for preventive and chronic care (see sidebar).

The decision brings to six the number of BPS-recognized specialties: ambulatory care pharmacy, nuclear pharmacy, nutrition support pharmacy, oncology pharmacy, pharmacotherapy, and psychiatric pharmacy.

Another specialty, geriatric pharmacy, is recognized by the Commission for Certification in Geriatric Pharmacy.

If requisite human and financial resources come through, BPS said, the first certification exam for ambulatory care pharmacy practice can be offered in two years.

A chance for recognition. BPS’s decision, said Tim R. Brown, 2009–10 chair of the ASHP Section of Home, Ambulatory, and Chronic Care Practitioners, means that ambulatory care pharmacists “are being recognized in their own right.”

ASHP was one of the groups that submitted the joint petition. The other groups were the American College of Clinical Pharmacy (ACCP) and the American Pharmacists Association.

Brown said a lot of ambulatory care pharmacists have taken BPS’s exam in pharmacotherapy because it led to board certification.

But the content of the certification exam in pharmacotherapy, he said, focuses more on inpatient than ambulatory care issues.

For that reason, Brown, who has practiced 15 years at a family medicine center owned by Akron General Medical Center in Ohio, said he chose not to take the certification exam in pharmacotherapy. He does not deal with oncology, for example, and that topic is part of the pharmacotherapy certification exam.

Jennifer Wood at William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin, took and passed the pharmacotherapy certification exam as soon she became eligible.

Although her background is in ambulatory care—she completed an ambulatory care residency at Middleton in 2007—Wood said she studied and took the exam because “I wanted to be good at what I do.”

That was at a time when, as a new full-fledged staff member, she spent about 50% of her workweek in the inpatient setting and 50% in the clinics. Now, she said, her workload is about 20% inpatient care and 80% ambulatory care.

What she does next with regard to board certification is uncertain.

Wood said she spent a lot of time and effort preparing for the pharmacotherapy certification exam. But now, ambulatory care pharmacy practice at Middleton is expanding. In 2011, she wondered aloud, will she still be predominantly practicing in the clinics? How should she set herself apart from other ambulatory care specialists? How much work would it entail for her to maintain two board certifications?

“I think it’s going to be a hard decision,” Wood said.

Certifications by BPS do not last a lifetime. BPS-certified pharmacists must undergo recertification every seven years.

For pharmacotherapy, according to the 2009 recertification guide, this means achieving a passing score on the 100-item, multiple-choice recertification examination or earning 120 hours of continuing-education credit through ACCP’s Pharmacotherapy Self Assessment Program.

Except for nutrition support pharmacy, there are continuing-education options for recertification in all BPS-recognized specialties.

Sara Milhans works full-time in Middleton’s clinics and, by e-mail, expressed support for the ambulatory care certification exam.

Board certification in ambulatory care pharmacy practice, she explained, would provide a credential specific to her practice interests.

Although she had studied for the pharmacotherapy certification exam, Milhans said she decided not to take it. She had heard rumors that BPS would be considering recognition of ambulatory care pharmacy practice as a specialty. Also, she perceived that the content of the pharmacotherapy certification exam was less relevant to her current practice than if she were an inpatient clinical specialist.

Milhans also said she looks forward to the “quality continuing education opportunities specific to pharmacists” whose focus is ambulatory care.

As is common with many exams, there are groups that sell review information, preparatory courses, and study guides. BPS itself does not provide such materials, but various pharmacy organizations, including ASHP, and a pharmacy college do.

Brown, the longtime family medicine practitioner, said board certification in ambulatory care pharmacy practice may offer an additional benefit: The credential may improve the chances of a pharmacist receiving reimbursement from Medicare and other third-party payers for professional services.

Complicated, lengthy, expensive process. It has been 13 years since BPS recognized a new specialty.

Terry L. Schwinghammer, the 2009 chair of the certification agency, called the process “complicated, lengthy, and expensive” and said that this is necessary in order to have credentials that are “high quality, psychometrically sound, and legally defensible.”

According to the BPS website, the recognition process starts with a person or group of persons petitioning the certification agency to recognize a specific area of pharmacy practice as a specialty. The petition must be accompanied by a $7500 filing fee.

But BPS “jump-started” the process for ambulatory care pharmacy practice because pharmacy groups had mixed opinions on whether it was a specialty, Schwinghammer said.

BPS, he said, conducted the requisite “role delineation study,” which establishes that an area of specialization is based on specialized knowledge and functions.

ASHP, ACCP, and the American Pharmacists Association then used the role delineation study in the groups’ joint 96-page petition and 886 pages of appendixes to BPS.

Each of those pharmacy groups has an organized subgroup of members who practice in the ambulatory care setting.

David R. Witmer, vice president of member services at ASHP, said members of the ambulatory care subgroup had increasingly expressed interest in having their practice recognized as a specialty.

Also, he said, ASHP has a growing interest in the development of appropriate credentials, such as board certification, to support the expansion of pharmacists’ roles in patient care.

BPS said it will now work with the three pharmacy groups to establish a specialty council on ambulatory care pharmacy. Other necessary tasks include defining the details of the certification process for the new specialty and preparing content for the certification exam.

Ambulatory Care Becomes Certifiable Specialty Practice is a post from: Pharmacy in jobs, news, schools

• Kuwait Pharmacy Information Center, Kuwait

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• Martin’s Pharmacy Page, Belleville General Hospital, Belleville , ON, Canada
• Martindale’s The Reference Desk
• Medical pharmacology, Prairie Village,KS, USA
• MedicationAdvisor, Timothy McNamara, MD MedicationAdvisor.com 5312 Pawnee Lane Fairway KS 66205
• Medicial Matrix
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• MedicusLinks, Medical Link Directory for Global and Japanese Medical Sites
• Medline Plus, US National Library of Medicine and National Institutes of Health
• Medline via Infotrieve
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Database for pharmaceutical data and links on the web letters I, K, L and M is a post from: Pharmacy in jobs, news, schools

These capital improvements now allow us to provide cGMP contract packaging services for select potent pharmaceutical compounds such as enzymes, antibiotics, antifolates, antimetabolites and some hormones,? said Tony Fenno, Chief Operating Officer. Compass Pharma investments continue to position the company as a responsive contract pharmaceutical packaging partner for sophisticated, high-demand contract packaging services for the pharmaceutical industry.?

In February 2009, Compass Pharma added Micro and Nanofill packaging capabilities to its growing list of cGMP contract packaging capabilities. Micro and Nanofill technologies allow filling small volumes (less than one gram) of powders into blister packaging, vials or pouches.

The capital improvements for ISO-Class 8 certification comprise a fully integrated production suite where the primary packaging area has negative differential air pressure relative to surrounding gowning and secondary packaging areas. High-Efficiency Particulate Air (HEPA) filters are deployed in the primary packaging area.

Manufacturing Automation Corporation of Princeton, NJ assisted Compass Pharma with the engineering/design and validation of the ISO Class 8 area. Whitehouse Analytical Laboratories, Inc. (Whitehouse, NJ) has been retained to provide Compass Pharma with ongoing analytical services.

About Compass Pharma Services

Compass Pharma Services, LLC is an independently owned and operated contract packaging company located in Clifton, NJ. Originally founded as General Packaging Services in 1949, Compass today operates a fully-equipped cGMP-certified contract packaging facility on a two-shift-per-day schedule for packaging solid dose preparations, liquids and powders into virtually all packaging forms including blister packaging, pouches, bottles and cans. Customers include pharmaceutical, nutraceutical, virtual pharma and manufacturers of over-the-counter (OTC) products.

SPS Group, Inc.
David S. Brooks, 973-255-1105

Source: Compass Pharma Services, LLC

Contract Pharmaceutical Packaging Company Offers ISO Class 8 Capabilities for Potent Compounds is a post from: Pharmacy in jobs, news, schools