Message from the Chair, Spring 2017

Dear Colleagues:

On behalf of the leadership team I would like to welcome you to the WSPA ACA! We are honored and thrilled to serve you in establishing more opportunities to connect with colleagues, learn from one another and generate innovations that move the profession of pharmacy forward.

I would like to acknowledge, with special appreciation, the WSPA members who recognized the need for this academy and pursued its development. Thank you also to the WSPA Board of Directors and WSPA Staff for their support in bringing the membership’s vision to fruition.

The ACA was established to address the specific needs of ambulatory care pharmacists who work in a clinic setting. While we experience unique opportunities and challenges, the best solutions often involve collaboration. I encourage you to engage in ACA activities and WSPA’s other academies as we strive to provide safe and effective care to patients across the continuum of care.

To encourage continued growth of ambulatory pharmacy services we look to the future, our learners. Pharmacy students and residents have a strong voice and ability to participate in the ACA. Our goal is to expand exposure of learners to ambulatory care pharmacy and what it can offer as a career path. A special welcome to our student and resident members!

I leave you with a call for your active participation in the ACA as well as a request for your input on what the ACA can do for its members. Feel free to contact your leadership team at any time with ideas or proposals and if you would like to contribute to an upcoming meeting. We are currently seeking input for the upcom-ing spring meeting in Renton, WA on April 28th. Together we can continue to transform pharmacy practice to better serve our patients and communities.

I hope to see you at the ACA meeting in April!

Best Regards,

Andrea Corona

ACA Purpose Statement:

The WSPA Ambulatory Care Academy (ACA) serves leaders, pharmacists, learners and technicians involved in ambulatory clinic direct patient care and practice management. The ACA is committed to providing networking, collaboration and professional development opportunities for its members while prioritizing practice transformation within Washington state.

ACA Webpage: http://wsparx.site-ym.com/?page=Ambulatory

This page has the ACA Policies, important dates, and notes from past meetings.

ACA Ambulatory Care Academy

NEWSLETTER Vol. 1, 2017

Introduction of Ambulatory Care Academy’s Leadership Team

ACA Chair: Andrea R. Corona, PharmD, BCACP, CDE Andrea is the founding Director of a PGY2 Ambulatory Care Residency with Providence Medical Group in Southwest Washington. Dr. Corona also serves as faculty pharmacist for St. Peter Family Medicine medical residency in Olympia, Washington. She received her doctorate of pharmacy from Butler University and completed a specialty residency in ambulatory care and education through Richard L. Roudebush Veterans Affairs Medical Center in Indianapolis, Indiana. Dr. Corona provides inter-professional continuing education programing throughout Washington State and facilitates pharmacotherapy courses for MEDEX Northwest University of Washington Tacoma physician assistant students as well as Pacific Lutheran University nurse practitioner students. Dr. Corona’s clinical practice focuses on chronic disease state management

and population health. She has developed primary care pharmacy services throughout Southwest Washington and chairs the Washington State Pharmacy Association Ambulatory Academy.

ACA Chair-Elect:Amanda Locke, PharmD, BCACP Amanda is a graduate of Purdue University College of Pharmacy. She completed her Post-Graduate Year One residency with Providence Health and Services in Portland, OR and then her Post-Graduate Year Two residency in Healthcare Administration with Virginia Mason Medical Center in Seattle, WA. She has been a member of the Virginia Mason team ever since. Amanda is the ambulatory pharmacy manager for the clinic pharmacy team which supports six departments at eight different locations with clinical pharmacy services. She currently practices with two groups of providers at VM: General Internal Medicine – Downtown Seattle and Physical Medicine & Rehabilitation – Downtown Seattle. As the chair-elect for the WSPA-ACA, Amanda hopes to help facilitate collaboration among all pharmacists providing care in the ambulatory sector

around Washington State. She also hopes to work toward having Washington recognized as a place for innovate care models and a national leader in the ambulatory care pharmacy setting.

ACA Resident: Brittany Kramer, PharmD Brittany Kramer is the resident chair of WSPA Ambulatory Academy and is a current PGY1 at Multicare Tacoma General in an ambulatory care focused program. She recently graduated in 2016 from Oregon State University College of pharmacy and is originally from Oregon. Ambulatory care has always been an area of interest for her and she knew she wanted to pursue this are of pharmacy after graduation. She enjoys interacting with patients and the high level of diversity the field brings. Her goal in being a part of the ambulatory care academy is to heighten the understanding of students and pharmacists as to what ambulatory care is and the various roles pharmacists are already actively participating in the clinics. Besides pharmacy she enjoys being active outdoors in the Pacific Northwest with kayaking, snowshoeing, and hiking.

ACA Student: Katie Mahan Katie is a fourth year pharmacy student at Washington State University College of Pharmacy. She has been involved in ambulatory care throughout pharmacy school. She was the President-Elect followed by President of the American Society of Consultant Pharmacists chapter at WSU where she planned and participated in many medication reviews and other service events. She had two ambulatory rotations during her fourth year at the Community Health Association of Spokane and the Providence Visiting Nurses Association. She pursued the student representative position within the Ambulatory Care Academy with the hope of learning more about the growing ambulatory field of pharmacy and help to evolve the Academy.

Recap from the Fall Ambulatory Care Academy Meeting

WSPA Ambulatory Care Academy recently had its first meeting this past October. Pharmacists, residents, and students in the ambulatory setting had the change to share best practices, advancements in patient care, and were given the opportunity to network with their peers.

The main focus was determining what the new Ambulatory Care Academy can do for its members and what the members would like the Academy to support them on. Many topics were discussed at the various breakout sessions. Those included were:

Clinic time management

Integration of pharmacy services across the continuum of care

Collecting data to support staffing

ROI and RVUs as productivity measures

Credentialing and privileging

Competency and proficiency

Student and resident involvement

Training and retooling pharmacists

These sessions include a best practice demonstration followed by collaborative discussion to learn what other facilities are doing to heighten ambulatory practice in their area.

As the Ambulatory Care Academy will hold these meetings bi-annually, please contact any of the leadership team members, or Jenny Arnold, with ideas for discussion or to volunteer to present a best practice.

Practice Spotlight Article—CHAS Health

CHAS Health is a non-profit federally qualified health center providing high-quality medical, dental, pharmacy, and behavioral health services to families and individuals of all ages regardless of ability to pay. With 12 locations throughout Eastern Washington and North Idaho, the mission is to improve the overall health of the communities served by expanding access to quality health and wellness services. Currently, services are provided to over 65,000 patients which continues to grow in order to meet the need of the communities.

Within these services, pharmacy staff are integrated into specialty care teams that work with patients to meet their health care needs in the areas of tobacco cessation, diabetes, hepatitis C, rheumatology, human immunodeficiency virus, high risk cardiovascular and anticoagulation management, high risk geriatric prescribing management, naloxone and emergency contraception prescribing. They are also embedded into the system reviewing all medication renewal requests and authorizations via a collaborative drug therapy agreement. When pharmacists participate on a care team they train to become the expert in that specialty to allow them to be the most efficient resource for the care team and the system. They meet with patients col-laboratively with other members of the care team and or on an individual basis. (continued on the next page)

CHAS Health is proud of being able to incorporate pharmacy staff into patient care in this way, which allows for higher complexity quality management of patients who have multiple comorbid conditions as well as socioeconomic factors that can be barriers to care.

For other entities who are looking to integrate pharmacy staff into their clinical services for patient care it is critical to have top leadership engagement and provider champions. Use of the Quality improvement model (Plan Do Study Act-PDSA) is also key.

http://patientsafetyed.duhs.duke.edu/module_a/methods/pdsa.html This model allows for gradual improvement changes to be tested on a small scale and quick adaptations to be made as needed until implementation is achieved.

To highlight just one example of the patient impact that these care teams provide, a 78 year old woman was referred to CHAS Diabetes Educational Services with a pharmacist. At her first visit, she had an A1C of 12.1%; the diabetes educator thoroughly discussed the medications, blood sugar values, diet, and exercise. In a period of just over a year, she was seen by the diabetes educator a total of 10 times. Prior to being seen by the diabetes educator, the patient was on 100 Units of Levemir, 14-30 Units of Humalog three times a day, as well as 10mg glipizide twice daily. She frequently skipped lunch and often snacked at bedtime. Due to self-management skills developed through the course of her therapy with the Diabetes Educator, the patient gradually began to eat three times a day, cook fresh meals, and eliminate bedtime snacking. The patient also began to increase her activity intentionally by walking around the house and eventually incorporated “Sit and Be Fit” videos four times per week. As these factors improved and impacted her blood sugars, the pharmacist was able to tailor the patient’s medications to accommodate her improving disease state.

Due to insignificant results, Levemir was switched to Lantus which also worked out to be more economical for the patient to sustain. The patient’s dose of Lantus decreased and she was introduced to the ER formulation of metformin due to adverse side effects to the regular formulation. By the time the patient had her fourth visit with the diabetes educator, glipizide was decreased to 5mg twice daily. The patient was also taken off metformin due to renal decline, which was being moni-tored closely by the pharmacist. Shortly after, her renal function improved and metformin was reintroduced. Through self-management of diet and exercise, the pa-tient was steadily able to decrease her A1C. By the 10th visit it had decreased to 8.8%. For more in depth care, the pharmacist was able to get the patient in contact with Priori-ty Footwear to be fitted for diabetic shoes. The pharmacist also encouraged her to work on self-management of sleep hygiene and acquiring an annual eye exam. The patient is extremely pleased with her progress and continues to follow up with the educator to have continuous management.

Contact at CHAS: Heather McNamee, Pharmacy Director (HMcnamee@chas.org)

The ASHP Ambulatory Self-Assessment – why you want to complete it!

Every ambulatory clinic in Washington should consider completing the ASHP Ambulatory Care Self-Assessment tool. All questions within the assessment tool were created from the recommendations from the 2014 ASHP Ambulatory Summit in which recommendations by an expert panel were discussed and agreed upon. Once complete, it can help identify opportunities for growth and improvement within your practice. If your organization has pharmacist services in multiple departments, this may be a good way to perform a gap analysis on the different groups.

In order to complete the assessment, you can access it through www.amcareassessment.org. An individual on your team will need to create an account and complete the assessment. Once done, you will be given an action list with identified opportunities and literature references to assist in learnings on how to take action. We strongly recommend reviewing the action plan and implementing actions for improvement within your own team, as well as with leaders at your organization.

Important Upcoming Dates:

April 28 --- Ambulatory Care Academy Biannual Meeting; Valley Medical Center, Renton, WA

May 1 --- Resident and student representatives are appointed and begin a 14 month term

June 1-4 --- Northwest Pharmacy Convention in Coeur d'Alene, ID where the Ambulatory Care Academy will hold a forum (exact time to be determined)

October 6 --- Ambulatory Care Academy Biannual Meeting (exact time and location to be determined, to be held in Central or Eastern Washington)

November 10-11 --- WSPA Annual Meeting at Great Wolf Lodge in Grand Mound, WA

December --- Incoming Chair Elect selected via academy membership vote for a three year term