Table of Contents · 2020. 7. 30. · Developing Level 1 Pharmacy Trainings Level 1 trainings are...

Table of Contents

Section 1: About this Guide ..........................................................................................................................5 Introduction........................................................................................................................................................6 Acknowledgements............................................................................................................................................7 Why train Pharmacists?.....................................................................................................................................8

Section 2: Recommendations for Multi-Level Program Development ...........................................9 AETC Training Levels ....................................................................................................................................10 Developing Level 1 Trainings ........................................................................................................................11 Developing Level 2 Trainings ........................................................................................................................12 Developing Level 3 Trainings ........................................................................................................................13

HIV Clinical/Hospital-based Preceptorships .........................................................................................13 HIV Community Pharmacy-based Preceptorships ................................................................................16 Adapting Existing Preceptorships.............................................................................................................19 Frequently Asked Questions about Level 3 Preceptorships .................................................................21

Developing Level 4 Trainings ........................................................................................................................23

Section 3: Helpful Training Materials.....................................................................................................24 Pharmacists’ Café.............................................................................................................................................25 Needs Assessment Surveys and Program Agendas ....................................................................................26

Section 4: Marketing Strategies ................................................................................................................27 Overview ...........................................................................................................................................................28 How to Identify Pharmacies ..........................................................................................................................28 How to Reach Pharmacists ............................................................................................................................28

Section 5: Continuing Pharmacy Education .........................................................................................30 Definition of Continuing Pharmacy Education ..........................................................................................31 Continuing Education for Pharmacists ........................................................................................................31 Providing Continuing Pharmacy Education ................................................................................................31

Conclusion ......................................................................................................................................................32

References .......................................................................................................................................................32

Table of Contents continued

Abbreviations..................................................................................................................................................33 List of Helpful Resources ...........................................................................................................................34 Appendixes......................................................................................................................................................35

A. Drug Interactions Workshop B. HIV Pharmacology Workshop C. Summary List of Common Training Topics for Pharmacists D. Sample Needs Assessment Survey E. Program Agenda: HIV Clinical Pharmacy Practicum F. Program Agenda: HIV Pharmacy Practicum in the

Community Pharmacy Setting G. Program Agenda: Family-Centered HIV Pharmacy Practicum H. Program Agenda: HIV Update for Pharmacists I. Quick Tips on How to Reach Community Pharmacists J. State Pharmacy Associations

K. Accredited Pharmacy Schools

Developing Regional Approaches to Training Community Pharmacists, 2008

Introduction

The AIDS Education and Training Center’s (AETC) Meeting the Resource Needs of Community Pharmacists Workgroup is pleased to share with the AETC network a resource entitled Developing Regional Approaches to Training Community Pharmacists – An AETC Program Coordinator’s Guide. Based on excerpts of a training guide produced in 2002 by the San Francisco AETC, a Local Performance Site (LPS) of the Pacific AETC, this tool is a collection of HIV pharmacy training recommendations and educational resources. Recommendations presented in this Guide by the workgroup members represent their collective experiences to date with targeted clinical and community-based pharmacists for multi-level HIV programming. The target audience for the Guide includes AETC program coordinators and others involved in developing AETC pharmacy training programs such as HIV-specialty pharmacists and medical directors. The goals of this Guide are to: 1) Outline successful strategies and alternate methods of developing AETC pharmacy programs. 2) Describe marketing tips for training programs. 3) Offer helpful training tips and resources on the development of pharmacy-specific training

programs.

Membership of the Meeting the Resource Needs of Community Pharmacists Workgroup is comprised of AETC pharmacy faculty and program coordinators from diverse settings across the United States who have delivered targeted HIV trainings for pharmacists for a decade. By illustrating proven strategies that have been used for producing effective HIV pharmacist training programs in this Guide, workgroup members hope to encourage all regional AETCs to examine their current methods for delivering pharmacy trainings and utilize this Guide to enhance their current pharmacy training efforts.


Acknowledgements This Guide was developed by members of the Meeting the Resource Needs of Community Pharmacists Workgroup. Authors:

• Kirsten Balano, PharmD; Pacific AETC • Whitney Buckley, PharmD; Mountain Plains AETC • Jean Lee, PharmD; BCPS; Midwest ATEC (MATEC) • Supriya Modey, MPH, MBBS; AETC National Resource Center • David Rosen, MSW, LCSW, C-ASWCM; New York/New Jersey AETC (Workgroup Leader) • Suellyn Sorensen, PharmD, BCPS; Midwest ATEC (MATEC)

Other collaborating members:

• Edward Dillon, R.Ph.; National Community Pharmacists Association (Workgroup Leader) • Cristina Gruta, PharmD; National HIV/AIDS Clinicians' Consultation Center • Blake Max, PharmD; Midwest ATEC (MATEC) • Andrea Norberg, MS, RN; AETC National Resource Center • Trushar Sheth, R.Ph., CCP; Giannotto’s Pharmacy

Guide book Reviewers: • Cristina Gruta, PharmD; National HIV/AIDS Clinicians' Consultation Center • Andrea Norberg, MS, RN; AETC National Resource Center • Jamie Steiger, MPH; AETC National Resource Center

Workgroup Coordinators: • Supriya Modey, MPH, MBBS; AETC National Resource Center (Managing Editor) • Monique Valentine, MSPH ; AETC National Resource Center

Graphic Designer:

• Karen A. Forgash, BA ; AETC National Resource Center


Why Train Pharmacists? The role of a pharmacist in HIV care has evolved over the years. Today, pharmacists are an integral part of the HIV care team and fill an important niche in areas of HIV management such as patient education and identification and prevention of medication errors. Pharmacists and HIV Patients: Optimizing HIV Therapy Pharmacists play a crucial role in educating patients about HIV medications. The introduction of highly active antiretroviral therapy (HAART) in 1990s has added complexity to HIV treatment such as adverse effects and drug-drug interactions (Hardy, 2005). Also, the introduction of new antiretroviral (ARV) drugs in the last few years brought new set of potential pharmacologic problems. It is important for pharmacists to educate patients about possible drug interactions and alleviate any fears or misconceptions that patients might have about side effects or drug interactions. Unresolved patient concerns could lead to poor adherence, which may increase the risk of ARV drug resistance, a serious global treatment problem. Pharmacists should help patients understand HIV therapy goals and help design interventions to enhance adherence, especially for those patients on long term treatment who may experience “pill fatigue”. Ongoing communication with patients also helps foster a trusting relationship between the patient and the pharmacist. Preventing Medication Errors Pharmacists also play an important role in the identification and prevention of medication errors. These errors could be caused by prescriber, patients, or the pharmacy itself. Due to the complex nature of HIV and its co-morbidities, patients are often prescribed medications for other opportunistic infections, which may cause drug-drug or food-drug interactions with HIV medications. Pharmacists should communicate with the prescriber to clarify any medication or dosing changes, or any unclear prescriptions (e.g., similar sounding medications or abbreviations) to help reduce prescription errors. Pharmacists can also help patients prevent medication errors by asking them to repeat dosing instructions. They can help patients get organized with pillboxes, timers, and alarms. With HIV management evolving at a rapid pace, successful training will keep HIV-specialty pharmacists well informed about the latest advancements in HIV care, which in turn will help them excel in their vital role as part of the HIV care team.


Overview Each year, regional AETCs and their Local Performance Sites (LPS) conduct various training programs. AETC Training Levels provide a framework for these training programs. This section includes an overview of these guiding levels and describes how to implement AETC pharmacy-specific training programs for training levels 1-4 in particular. Program coordinators may adapt the information shared in this section based upon their regional or local needs.

AETC Training Levels There are five basic AETC training levels that range from didactic presentations to clinical consultations and programmatic technical assistance. Table 1 provides Pacific AETC’s brief description of the five levels of training.

Table 1: AETC Training Levels

AETC Training Level Description

Participants are often passive learners, with programs varying in length from brief lectures to conferences. Format used:

Level 1: Didactic Presentation

• Panel discussions • Self-instructional

materials

• Journal clubs • Teleconferences • Didactic presentations

Participants may engage in interactive and skills-building activities characterized by active trainee participation.

Level 2: Skills Building Workshops Format used:

• Case discussions • Role play

• Simulated patients • Train the trainer (TOT) • Other skill building activities

Participants may engage in training that includes activities where the trainee is actively involved with clinical care experiences involving patients.

Level 3: Clinical Training

Format used: • Preceptorships

• “Mini-residencies” • Observation of clinical care at

either AETC training site or the trainee’s worksite

Participants may engage in training that includes patient-specific clinical consultation provided to health care professionals.

Level 4: Clinical Consultation

Format used: • Clinical

consultation

• Case-based discussions Level 5: Technical Assistance Technical assistance offered by the Local Performance Site (LPS).

For more specific examples and resources under these training levels, please visit AETC NRC website: www.aidsetc.org


Developing Level 1 Pharmacy Trainings Level 1 trainings are primarily lecture-style trainings where most learners are introduced to the AETC and begin their learning relationship. Successfully engaging participants at this level of training is likely to start a relationship where participants will want to return for more training and engage in more active learning opportunities. These can be stand alone events (i.e., dinner/lunch time lectures) or part of a full-day/multi-day program. Since differences between Level 1 trainings offered to community pharmacists and other healthcare providers (i.e., physicians, physician assistants (PA) and nurses) are few, AETCs/LPSs can use the training skills and tools they have for other healthcare providers and market them for community pharmacists. Common Level 1 training topics for community pharmacists are listed below.

Common Level 1 Training Topics include: • New Antiretroviral Medication Updates • Managing Adverse Reactions to HIV Medications • Pharmacokinetics/Pharmacogenomics and Therapeutic Drug Monitoring • Medication Errors in HIV • Medicare Part D and Access to HIV Medications

Some helpful tips for developing pharmacy-specific Level 1 trainings are as follows: • Invite community pharmacists to programs currently being offered to other professional

disciplines. Having the whole “healthcare team” sit side-by-side can create an interesting learning environment.

• Connect with local professional pharmacist organizations (e.g., state and/or local pharmacy association) that often offer continuing education (CE) opportunities on HIV-specific topics. Solicit important training topics from their representatives.

• Consider offering pharmacist-specific CE credits administered by the Accreditation Council for Pharmacy Education (ACPE). Refer to Sections 4 and 5 for more information on marketing strategies and continuing pharmacy education (CPE).

• Advertise future training opportunities, particularly those that offer skills-building and more in-depth HIV content, i.e., attend higher level AETC trainings.

• Use evaluation forms to rate the training event and solicit future training topics.


Developing Level 2 Pharmacy Trainings Level 2 trainings are interactive learning opportunities such as case discussions and other skills building activities. These are often novel training modalities for community pharmacists, who more often have access to lecture-style learning. Given the complexities and rapidly evolving information in HIV care and treatment, Level 2 trainings provide the opportunity for participants to learn how to research and utilize information to care for their patients. Level 2 trainings can be stand-alone trainings, or part of larger programs. Community pharmacists can be invited to Level 2 training opportunities with other disciplines and this can allow problem-solving opportunities among the “healthcare team”. NOTE: In developing cases for community pharmacists, keep in mind that often they do not have access to laboratory information (i.e., CD4 cell counts, viral load, and genotype). Common Level 2 training topics for community pharmacists are listed below Common Level 2 Training Topics include: • Use of New Antiretroviral Medications • Adherence Counseling • Identifying and Managing Drug-Drug Interactions • Managing HIV Adverse Drug Reactions • Providing Culturally Competent HIV Care • Role of the Community Pharmacist in the HIV Care Team • HIV 101: When to Start Antiretroviral Therapy and What to Start With As mentioned earlier, participants are more actively involved in Level 2 trainings. Interactive, case-based workshops are ideal for Level 2 trainings. Two examples are below: Drug Interactions Workshop: In this workshop, participants are broken into small groups and provided with case scenarios that review antiretroviral drug interactions. Participants are encouraged to discuss the case with their group members, identify various drug interactions, and develop a pharmaceutical care plan. See Appendix A for more information about this workshop and related case scenarios. HIV Pharmacology Workshop: This workshop encourages participants to work in teams to identify the appropriate category for the different antiretroviral medicines (both generic and brand names). See Appendix B for HIV Pharmacology Workshop exercises.


Developing Level 3 Pharmacy Training Level 3 training programs consist of clinical training which requires a certain amount of observational patient-pharmacist contact hours, or preceptorships. There are several methods for designing pharmacy-specific Level 3 preceptorships that will be described step-by-step in this section. They are as follows:

• HIV Clinical/Hospital-based Preceptorships • HIV Community Pharmacy-based Preceptorships • Adapting Existing Preceptorships/Mini-Residencies

HIV Clinic/Hospital-based Preceptorships Most Level 3 pharmacy trainings are clinic/hospital-based preceptorships. Members of the Meeting the Resource Needs of Community Pharmacists Workgroup have recommended the following steps to develop a training program in a HIV clinic or hospital (also shown in Figure 1):

1. Identify a clinic/hospital-based preceptorship site: a) The clinic/hospital should be a facility that treats a significant number of HIV-infected

patients and is staffed by a physician (MD), nurse practitioner (NP), or physician assistant (PA) who is considered to be an expert in HIV care.

b) The clinic/hospital should be a facility that employs a HIV-specialty pharmacist to assist with the medical co-management of HIV-infected patients. This pharmacist may be direct staff of the clinic/hospital or an intern through a pharmacy residency program.

2. Choose a HIV-specialty pharmacist from the clinic/hospital to serve as the primary pharmacy preceptor: Request a meeting with the clinic/hospital’s HIV-specialty pharmacist to discuss their interest in working with your AETC/LPS in building a new HIV clinic/hospital pharmacy preceptorship at their site. During the meeting, several key issues will need to be addressed, including: a) Purpose of the program and key participant learning objectives b) Operational issues such as:

participant attendance, training structure (half-day, full-day, multi-day, etc.), HIPAA concerns, financial compensation for faculty and/or site , required paperwork for ACPE-accreditation, AETC and any clinic/hospital internal

policies regarding external learners on the premises, and delineation of responsibilities and required staff time commitment

3. Get medical administration buy-in: meet with the Clinic/Hospital’s Medical Director If buy-in occurs by the HIV-specialty pharmacist, request a second meeting to be scheduled by the HIV-specialty pharmacist with the clinic/hospital’s Medical Director to discuss the above points. Address any issues the Medical Director may have.

4. Draft the program details The process for program development begins if buy-in occurs by the Medical Director. This process may involve the following steps:


a) Identify a regional ACPE provider. Discuss costs and processes for accrediting the Level 3 preceptorship.

b) Set the program agenda, ensuring that the minimum required patient observational contact is included.

NOTE: Be sure to involve an HIV-specialty pharmacist in determining program details. NOTE: The patient observation component should focus on the role of the HIV-specialty pharmacist in the co-management of patients with the clinician in terms of regimen choices, drug interactions, adherence counseling and side effects management. Other training components (i.e., inclusion of case review, didactic lectures on ARVs, HIV 101, etc.) should evolve from your discussions with the HIV-specialty pharmacist and the Medical Director.

c) Develop an agreement with the clinic/hospital detailing: 1) curriculum payment, 2) management of participant enrollment, 3) policies and HIPAA requirements, and 4) roles and responsibilities. NOTE: Payment methods may vary across AETCs. Also, in some regions, once there is a consensus between the AETC/LPS and the clinic/hospital, a memorandum of agreement is signed.

d) Provide faculty with the learning objectives and request a draft PowerPoint slide presentation for the didactic component. The AETC/LPS program coordinator should review the slides, which will then be reviewed by the ACPE accreditation team.

e) Develop an evaluation tool that includes a set of pre/post test questions and answer key. f) Prepare handout materials including the program agenda, slide sets and any other relevant

materials. g) Pilot test your training by selecting a known HIV pharmacist as your “test subject.” Request any feedback he/she may have. h) Implement the suggested changes and select a second pharmacist who is not an HIV

expert to attend a second pilot training. Be sure to request feedback from the second pharmacist.

i) Submit the curriculum for ACPE accreditation once the necessary changes have been made. j) Design marketing materials for the preceptorship (see Section 4 on Marketing Strategies

for marketing tips).


Figure 1: Summary of Developing HIV Clinic/Hospital-Based Preceptorships

Step 1: Identify a clinic or a hospital

Characteristics of the clinic/hospital: • Treats a number of HIV-infected patients • Employs a HIV-specialty pharmacist

Step 2: Choose a HIV-specialty pharmacist from the clinic/hospital to serve as the primary preceptor

Discussion Points: • Purpose of the program and learning objectives • Operational issues

Step 3: Meet with the Clinic/Hospital’s Medical Administration Discussion Points: • Purpose of the Program • Other operational issues

Step 4: Draft program details This process may involve the following steps: • Identify a regional ACPE provider • Set the program agenda • Develop an agreement with the clinic/hospital regarding operational issues • Provide the faculty with learning objectives • Develop an evaluation tool • Prepare handout materials • Pilot test your training • Submit the curriculum for ACPE accreditation • Market the training program

Common training topics for clinical/hospital-based preceptorships include: • HIV Pharmacotherapy Update and Drug Interactions • Co-Management Approach to HIV Care • HIV Medical Update


HIV Community Pharmacy-based Preceptorships There are several similarities, as well as differences, when developing pharmacy-focused training programs based in a community practice (or retail) pharmacy setting versus one in a clinic/hospital-based setting. To help develop community pharmacy-based training preceptorships, Workgroup members recommended the following steps (also summarized in Figure 2):

1. Identify a community pharmacy preceptorship site with the following characteristics: a) Significant number of ARVs provided to HIV-infected patients b) Staff dedicated to client well-being c) Staff willing to communicate regularly with medical providers d) Staff committed to addressing adherence issues with clients within the community setting e) Separate consultation room is available to engage patients in adherence discussions

2. Meet with the Pharmacy store owner Request a meeting with the Pharmacy owner and/or the primary staff pharmacist to discuss their interest in developing a new HIV pharmacy preceptorship at their community site. During the meeting, several key issues will need to be discussed, including: a) Program’s purpose and key participant learning objectives b) Operational issues such as:

• participant attendance, • training structure (half-day, full-day, multi-day, etc.), • site’s policies and HIPAA concerns (i.e., community pharmacy internal policies regarding

external learners on the premises), • financial compensation for faculty and/or site , and • paperwork for ACPE-accreditation

c) Staff time commitment, including faculty who will receive the training d) Program roles and responsibilities for AETC program coordinator and pharmacy faculty. e) Patient flow on the training date. The community pharmacy will have to ensure enough

HIV-infected patients visit the store on the training date for refills and adherence counseling to provide the learner with the minimum required patient observation contact hours.

3

Develop

HELPFUL TIP: To ensure adequate patient flow in the store on the training date, pharmacies could offer the following incentives: • Pay patients to come in at set intervals • Offer patients store coupons or vouchers if they came in during the training date and

time for their refills

. Develop program details If buy-in occurs by the pharmacy store owner/pharmacist, begin the process for development of the program, similar to what is described under the HIV Clinic/Hospital-based Preceptorship section. The Workgroup members suggest the following steps: a) Identify a regional ACPE provider. Discuss costs and processes for accrediting the

Level 3 preceptorship.

ing Regional Approaches to Training Community Pharmacists, 2008

b) Set the program agenda, ensuring that the minimum required hours of patient observational contact is included.

NOTE: Patient observation component should focus on the role of the community pharmacist in the co-management of patients with the HIV medical provider. Other training components (i.e., inclusion of case review, didactic lectures on avoiding drug errors, improving communication between community pharmacist and HIV medical provider, etc.) should evolve from your discussions with the pharmacist/store owner. NOTE: Be sure to involve Pharmacy owner/primary staff pharmacist in determining program details.

c) Develop an agreement with the community pharmacy site detailing: 1) training payment, 2) management of participant enrollment, 3) site’s policies and HIPAA concerns, and 4) roles and responsibilities. NOTE: Payment methods may vary across AETCs. Also, in some regions, once there is a consensus between the AETC/LPS and community pharmacy store, a memorandum of agreement is signed.

d) Engage the AETC HIV-specialty pharmacist in discussions with current community pharmacy issues to develop the preceptorship collaboratively. NOTE: It is advisable to pay the AETC faculty and the community owner separately for curriculum development.

e) Provide the curriculum writer(s) with the learning objectives and draft a PowerPoint presentation for the didactic component. The regional AETC or LPS program coordinator should review the slides, which will then be reviewed by the ACPE accreditation team.

f) Develop an evaluation tool which includes a set of pre/post test questions and answer key.

g) Prepare handout materials consisting of the agenda, slide sets and any other relevant materials.

h) Assess the community pharmacist faculty candidate’s ability to represent the AETCs as the main community pharmacy trainer. This assessment should be completed by the AETC HIV-specialty pharmacist.

i) Pilot test your training. Use the AETC HIV-specialty pharmacist as your “test subject” and solicit any feedback he/she may have.

h) Implement the suggested changes and select a community pharmacist (either from the same store or from a busy HIV-specialty pharmacy) to attend the second pilot training. Request feedback from the community pharmacist.

i) Submit the curriculum for ACPE accreditation once the necessary changes have been made.

j) Design marketing materials for the preceptorship (see Section 4 on Marketing Strategies for marketing tips).


Figure 2: Summary of Developing HIV Community Pharmacy-Based Preceptorships

Step 1: Identify a community pharmacy preceptorship site Characteristics of the preceptorship site: • Provides significant number of ARV medications • Holds a strong reputation for its services • Has a separate consultation room for patients

Step 2: Meet with the pharmacy store owner Discussion Points: • Purpose of the program • Operational issues • Staff time commitment and responsibilities • Patient flow on the training date

Step 3: If the pharmacy store owner agrees, draft the program details

This process may involve the following steps: • Identify a regional ACPE provider • Set the program agenda • Come to an agreement with the clinic/hospital regarding operational issues • Provide the faculty with learning objectives • Develop an evaluation tool • Prepare handout materials • Pilot test your training • Submit the curriculum for ACPE accreditation • Market the training program

Common training topics for Community Pharmacy-based preceptorships include:

• Addressing HIV Drug Errors in the Retail Pharmacy Setting • Interactions between Common OTC Products and HIV Medications • Putting Theory into Practice: Medication Counseling with HIV Patients


Adapting Existing Preceptorships/Mini-Residency Although it is ideal to have preceptorship events in the clinic/hospital or in a well-known community pharmacy store, Workgroup members realize that often AETCs/LPSs do not have a HIV-specialty pharmacist in their clinic/hospital or a local community pharmacy capable of conducting pharmacy trainings. In such cases, consider adapting existing medical or nursing preceptorships for community pharmacists. Possible scenarios for adapting preceptorships can be found below.

Scenario 1: For AETCs/LPSs without a HIV-specialty pharmacist working in an HIV clinic or hospital setting in their geographic region

In this situation, consider these options: 1. Collaborate with another AETC/LPS where such a pharmacist position exists. Request a

collaborative partnership so community pharmacists can be referred to this site for training, following the steps outlined in the ‘HIV Clinic/Hospital-based Preceptorships’ section.

2. Connect with an HIV clinic that has existing medical/ nursing preceptorships. Ask

representatives at the site(s) if they are open to having community pharmacists attend an adapted version of the medical/nursing program.

Upon agreement: a) Contact the regional AETC’s primary clinical pharmacy faculty and request a meeting with

the medical preceptorship site’s faculty to: 1) Review and adapt the medical program to meet the identified needs of community pharmacists, as viewed by the medical and pharmacy faculty. 2) Determine training logistics, including ACPE accreditation requirements. 3) Determine faculty composition. Two options are: a) only medical and nursing staff will conduct the trainings (exclude pharmacist co-faculty) or b) an external pharmacy faculty will be allowed to come on-site to co-teach the program with the medical staff.

b) Pilot test the training program, following the steps outlined in the HIV Clinic/Hospital-based

Preceptorships section.


Scenario 2: For AETCs/LPS lacking a suitable community pharmacy in their geographic region

In this situation, consider these options: 1. Contact another AETC/LPS with a community pharmacy in place. Request a collaborative

partnership, enabling community pharmacists to be trained at another AETC/LPS site. Follow the steps outlined in the HIV Community Pharmacy-based Preceptorships section.

NOTE: Make sure the chosen community pharmacy has the following characteristics: a) provides a significant number ARV medications to HIV-infected patients b) is well known for its services, which includes:

• staff’s dedication to client well-being, • willingness to communicate regularly with medical providers and • commitment to addressing adherence issues with clients within the community setting

c) has a separate consultation room to engage patients in adherence discussions

2. Connect with a community pharmacy from another region, which has at least one of the above criteria in place, to discuss the possibility of setting up a capacity-building technical assistance (TA) scenario. In this scenario, the AETC/LPS will help the community pharmacy to establish itself as their HIV training partner.

Upon agreement: a) Contact the regional AETC’s primary clinical pharmacy faculty and request a meeting with the

community pharmacy to: 1) Review the pharmacy’s current capacity to deliver expert HIV 2) Determine if the pharmacy has the capacity to become a suitable HIV training site with

AETC/LPS support 3) Determine pharmacy site’s training needs if technical assistance is warranted 4) Develop and implement a TA workplan focused on a community pharmacy

preceptorship program that has been adapted to the site’s new capacities b) Pilot test the preceptorship as outlined in HIV Community Pharmacy-based Preceptorships section.


Frequently Asked Questions about Level 3 Preceptorships

1. What should I do if the site’s pharmacy does not have a separate consultation room?

If the site’s pharmacy does not have a separate consultation room, perhaps the training can be held at your AETC/LPS, at a nearby HIV clinic, or an HIV/AIDS community-based organization (CBO). Your AETC/LPS might be able to facilitate any required negotiations to enable the collaborative partnership to occur. Transportation of pharmacy customers to the training site would need to be addressed, as well as the comfort level of the site’s identified pharmacist faculty in delivering private adherence counseling sessions to patients.

2. What are my options if there are no HIV-specialty pharmacists in my clinic/hospital?

Ideally, the best option is to have a HIV-specialty pharmacist at the clinic/hospital training site. However, for some AETCs/LPSs, this may not be possible. In such cases, collaborate with another AETC/LPS where such a pharmacist position exists. Another option is to connect with an HIV clinic that has existing medical/ nursing preceptorships that can be adapted for community pharmacists. Please refer to the Adapting Existing Preceptorships section for more detailed information.

3. I need a cross program consultation. Who can I contact in the AETC network?

The following AETC pharmacists can be contacted for cross program consultation:

Name AETC/LPS Contact Information

Orrick, Joanne Florida/Caribbean AETC [email protected] Thompson, Michael Florida/Caribbean AETC [email protected] Lee, Jean Midwest ATEC [email protected] Max, Blake Midwest ATEC [email protected] Miller ,Christopher NY/NJ AETC [email protected] Faragon, John NY/NJ AETC [email protected] DiCenzo, Robert NY/NJ AETC [email protected] Cantenzaro, Linda NY/NJ AETC [email protected] Humberto, Jiminez NY/NJ AETC [email protected] Kanmaz, Jiminez NY/NJ AETC [email protected] Conry, John NY/NJ AETC [email protected] Rosen, David NY/NJ AETC [email protected] Sharma, Roopali NY/NJ AETC (718) 488-1004 Ballard, Craig Pacific AETC [email protected] Balano, Kirsten Pacific AETC [email protected] Bradford, Colwell Pacific AETC [email protected]


4. Can a preceptorship be adapted to address the unique issues involved in the pharmaceutical management of HIV-positive pregnant women and children?

Program Coordinators can design a "Family-Centered" HIV preceptorship for pharmacists who are involved in the on-going management of pregnant women, infants, children and adolescents either in community practice or clinical care settings. The focus of the preceptorship should be on the role of the pharmacist within an HIV family-centered care team and it should be situated in a pediatric HIV clinic where pregnant women and children are routinely being co-managed by a medical provider and an HIV-specialty pharmacist. To help develop a Family-Centered HIV preceptorship program, follow the steps outlined in HIV Clinic/Hospital-based Preceptorships. Please refer to Appendix G for a sample Family-Centered HIV preceptorship program agenda.


Developing Level 4 Pharmacy Trainings Level 4 training programs consist of group case discussions. Real cases, without personal identifiers, are presented by the training participants to the faculty. Discussion follows the presentation. The following is a suggested step-by-step method for designing a pharmacist-specific Level 4 training experience that meets the requirements of the AETC program:

1) Contact various HIV clinics and request the names of two or three pharmacies that their patients commonly go to.

2) Contact each pharmacy and invite their staff for a case discussion program. To generate interest, be sure to mention that the program is free and that expert HIV faculty will be available to their staff. If possible, consider providing dinner and ACPE credits.

NOTE: Initially, the AETC may need to provide the cases for discussion, to give examples of how to use case-based discussion for education.

3) Schedule regular case discussions (i.e., every 2-3 months) with the pharmacy and identify a key pharmacist in the store.

4) Contact the key pharmacist 1-2 weeks prior to your next case discussion to remind them to identify cases for discussion. As the relationship develops, you could invite the HIV clinic(s) providers to attend. This will help foster relationships between clinic and pharmacy.

NOTE: Trainers are encouraged to bring articles and/or guidelines that support the case discussion topics.

Common Level 4 Case Discussion topics include: • HIV regimen changes • Avoiding drug errors • Adherence counseling issues • Over-the-counter (OTC) product interactions with ARVs • How to handle physician communication problems

Please refer to Appendix C for a summary of common topics for all levels of pharmacy trainings.


Pharmacist’s Café When pharmacists gather for trainings, it is often helpful to begin with an ice breaker for the training participants. One example of an icebreaker is the Pharmacist’s Café, which is an open discussion forum to share ideas on issues that matter most to the pharmacists. This format is based on training techniques from a group called The World Café. This group has a website that describes the research and process principles regarding the use of conversations and questions and to utilize the collective intelligence of a group to create shared purpose. This methodology is most effective for getting participants talking and sharing prior to a Level 2 skills-building training.

For more informatin on The World Café, visit: www.theworldcafe.com

Format for Pharmacist’s Café

Tools for how to use this technique can be found on the website above. Below is an example of this technique.

Room Set Up and Preparation:

Learners should be grouped at round tables or other seating structure conducive for conversations. Index cards and pens/pencils should be available to the learners. Poster paper will also be used to summarize themes from the exercise.

The AETC facilitator or faculty should set the tone to be conversational, like those that happen in coffee houses or around the water coolers at work. Here are the steps that follow:

1) Each group should identify a Table Host

2) The Table Host will pose a question and take note of key points shared by the participants

Possible questions are:

• How are pharmacists most helpful to people infected with HIV?

• How are pharmacists helpful to the primary care team that cares for people living with HIV (i.e., physicians, nurses, case managers, etc.)?

• What opportunities are there for pharmacists to be recognized as valued members of every HIV-infected patient’s care team?

• How can we continue these conversations?

3) Other group members should join the conversation and each member should be heard from.

Note: As mentioned above, offer all members some index cards on which they can take notes.

4) After 10 minutes, Table Host will remain and others will travel to another table.


5) Table Host will welcome new guests, summarize ideas from the first group and pose the next question.

6) New members will share their ideas, which will be recorded by the Table Host.

7) Table Host will share the notes with the larger group.

Once the larger group has reconvened, the AETC facilitator or faculty will use the poster paper to summarize comments from the Table Hosts. These posters can be saved during the course of the training. Learners should be encouraged to add any additional comments, themes or drawings to the posters during breaks.

Needs Assessment Surveys Workgroup members have been developing pharmacy training programs for several years. These experienced trainers recommend beginning your program planning with a needs assessment survey to learn the needs of your audience. As a result, this Workgroup also started by creating a needs assessment survey specifically to determine the educational needs of community pharmacists (please see Appendix D). Users are encouraged to adapt the sample needs assessment survey.

Program Agendas A program agenda provides a snapshot of the training event and serves as a marketing point, drawing participants to the event. Responses received from the needs assessment surveys shape the development of a program agenda. To maximize participant attendance, program agendas should include preferred topics and a convenient time, as indicated by the survey respondents. Workgroup members have shared some of their successful training program agendas (see Appendixes E-H). Users are encouraged to adapt and customize the sample program agendas to regional planning and training efforts.

List of agendas in Appendix E-H: a) One-day program:

1) Clinical Pharmacy Practicum Target Audience: clinical pharmacists

2) HIV Pharmacy Practicum in the Community Setting Target Audience: registered community pharmacists

3) Family-Centered HIV Pharmacy Practicum Target Audience: community pharmacists

b) One and one-half day program: 1) HIV Update for Pharmacists

Target Audience: community and clinical pharmacists


Overview There are two important factors that contribute to effective outreach and promotion of pharmacist training programs on HIV:

1. Availability of low-cost continuing pharmaceutical education (CPE) credits for the training program (See the next section on Continuing Education Credit for detailed information on offering CPE credits).

2. Involvement of key stakeholders such as individual pharmacists, community pharmacies, local/state pharmacy associations and consumer groups, when appropriate.

Listed below are tips for outreach, marketing and promotion of pharmacist training activities on HIV. These marketing tips have also been outlined in Appendix I. How to Identify Pharmacies:

• Contact the State Board of Pharmacy or State Pharmacy Association (Appendix J lists the State Pharmacy Associations) for a list of community pharmacies and their address.

• There may be a cost associated with obtaining a list of community pharmacies; however, this may be a worthwhile investment to market the pharmacy programs.

• Perform Internet searches (e.g., based on geographical data and zip codes).

• Ask Medicaid, wholesalers or pharmaceutical representatives where patients fill prescriptions.

• The phone book or the internet may be utilized to identify pharmacy wholesalers or pharmaceutical representatives.

• How to identify specific pharmacies dispensing antiretrovirals:

• Obtain a list from the AIDS Drug Assistance Program (ADAP).

• ADAP also provides data on the number of prescriptions filled by specific pharmacies.

• Contact Ryan White funded medical practices.

• A list of funded programs is available at: http://hab.hrsa.gov/programs/granteecontacts.htm

How to Reach Pharmacists:

• Contact the American Association of Colleges of Pharmacy (AACP) to reach both faculty and pharmacy students. Student organizations may be helpful to identify graduating students. For the list of accredited schools of pharmacy, refer to Appendix K.

• Contact local, state, and /or national pharmacy associations. • Target pharmacists in the local area; contact the state’s professional pharmacy association to

obtain a roster of local chapter affiliates and contacts. These groups may be willing to include the promotional materials with their newsletters and/or promote the HIV training.


• Contact the State Board of Pharmacy for a list of pharmacists and their contact information. Requesting a list of practitioners in specific training areas may require more effort.

• Drawback to using this mailing list: It may include every registered pharmacist in the state and may not segregate community pharmacists from hospital-based pharmacists.

• Target pharmacists participating in regional trainings /conferences.

Visit the American Society of Health-System Pharmacists web site for links to ASHP state affiliate chapters, pharmacy associations and organizations, pharmacy schools,

nontraditional pharmacy programs, pharmacy residency sites, pharmacy technician training programs and other health-related sites: http://www.ashp.org/Import/ABOUTUS/WhoWeAre/StateAffiliates/Resources/OtherASHPResources.aspx


Definition of Continuing Pharmacy Education Accreditation Council for Pharmacy Education’s (ACPE) newly revised definition effective August 1, 2007: Continuing education for the profession of pharmacy is a structured educational activity designed or intended to support the continuing development of pharmacists and/or pharmacy technicians to maintain and enhance their competence. Continuing pharmacy education (CPE) should promote problem-solving and critical thinking and be applicable to the practice of pharmacy. Continuing Education for Pharmacists Pharmacists should develop and maintain proficiency in five core areas:

• Delivering patient-centered care, • Working as part of interdisciplinary teams, • Practicing evidence-based medicine, • Focusing on quality improvement, and • Using information technology

ACPE-accredited providers have to assure that continuing education activities comply with the definition and that activity content is applicable to the practice of pharmacy. To maintain pharmacy licensure, all state boards of pharmacy require pharmacists to participate in accredited or approved continuing education activities. Additionally, an increasing number of state boards of pharmacy require pharmacy technicians to participate in continuing education activities in order to re-register or reapply for their licensure.

ACPE-approved continuing pharmacy education activities: For the complete list of pharmacy education programs offered by ACPE-accredited

providers, visit their website at: http://www.acpe-accredit.org/pharmacists/programs.asp

Providing Continuing Education for Pharmacists To provide CPEs for pharmacists and pharmacy technicians in HIV education, it is helpful to partner with the local or state pharmacy associations. Many of these associations obtain CE credits from ACPE providers or from the State Board of Pharmacy. Sometimes local chapters of state associations are seeking topics, speakers and sponsorship of educational programs for their membership. State pharmacy associations typically have annual or semi-annual conferences/meetings/seminars that are planned at least 6 months in advance. Contact these groups early to discuss adding HIV training for their membership. Also, CE application packets may be obtained from the ACPE providers. At times there may be an early submission deadline (i.e., 45 or 60 days notice).

ACPE providers: For the complete list of ACPE-accredited providers, visit:

http://www.acpe-accredit.org/pharmacists/providers.asp


Conclusion Pharmacists play a significant role in the care and treatment of HIV-infected patients. With rapidly changing information in the field of HIV, successful pharmacy training programs should address these changes as well as the core competencies needed by pharmacists. AETC Training Levels provide the framework for developing training programs for pharmacists and other healthcare providers. As outlined in this Guide, there are several methods for developing pharmacy training programs. Creating a needs assessment survey is an effective starting point. By providing several program development strategies, marketing tips and other helpful resources in one comprehensive document, this Guide can be used as a tool when developing effective AETC pharmacy training programs.

References Accreditation Council for Pharmacy Education. Accreditation Standards for Continuing Pharmacy Education. Retrieved on June 09, 2008 from http://www.acpe-accredit.org/pdf/CPE_Standards_Final_092107.pdf Accreditation Council for Pharmacy Education. Revised ACPE Definition of Continuing Education for the Profession of Pharmacy. Retrieved on June 09, 2008 from http://www.acpe-accredit.org/pdf/CE_Definition_Pharmacy_Final_CoverMemo2007.pdf AIDS Education and Training Centers, National Resource Center. AETC Training Principles. Retrieved on August 04, 2008 from http://www.aidsetc.org/aidsetc?page=tr-29-00 Hardy, Helene (2005). Adherence to antiretroviral therapy: the emerging role of HIV pharmacotherapy specialists. Journal of Pharmacy Practice,18(4)247-263. New York State Department of Health. Pharmacists: partners in health care for HIV-infected patients. New York (NY): New York State Department of Health; 2006 Jan. 28. Retrieved on August 03, 2008 from http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=10974&nbr=5754


Abbreviations

The following abbreviations have been used in this Guide: AETC AIDS Education and Training Centers ACPE Accreditation Council for Pharmacy Education ADAP AIDS Drugs Assistance Program ARV Antiretroviral CBO Community-Based Organization CE Continuing Education CPE Continuing Pharmacy Education HIPAA Health Insurance Portability and Accountability Act LPS Local Performance Site NP Nurse Practitioner OTC Over The Counter PA Physician’s Assistant TA Technical Assistance


List of Helpful Resources

• AIDS Education and Training Center (AETC) Web link: www.aidsetc.org

• Academy of Managed Care Pharmacy (AMCP) Web link: www.amcp.org

• Accreditation Council for Pharmacy Education (ACPE) Web link: http://www.acpe-accredit.org

• American Association of Colleges of Pharmacy (AACP) Web link: www.aacp.org

• American College of Apothecaries Web link: www.americancollegeofapothecaries.com

• American College of Clinical Pharmacy (ACCP) Web link: http://www.accp.com

• American Pharmacists Association (APhA) Web link: http://www.pharmacist.com

• American Society of Consultant Pharmacists (ASCP) Web link: http://www.ascp.com

• American Society of Health-System Pharmacists (ASHP) Web link: http://www.ashp.org

• National Association of Boards of Pharmacy (NABP) Web link: http://www.nabp.net

• National Community Pharmacists Association (NCPA) Web link: http://www.ncpanet.org

• National Alliance of State Pharmacy Associations (NASPA) Web link: http://www.ncspae.org/

• National HIV/AIDS Clinicians’ Consultation Center (NCCC) Web link: http://www.nccc.ucsf.edu/


APPENDIX A: ANTIRETROVIRAL DRUG INTERACTIONS WORKSHOP

OBJECTIVE: To review HIV antiretroviral and related opportunistic infection medication drug interactions. GOALS: During this session, pharmacists will be able to:

1) Review a patient’s drug profile and identify potential drug interactions. 2) List the expected outcome/consequences of the interaction. 3) Formulate a counseling strategy and pharmaceutical care plan for handling the drug

interaction INSTRUCTIONS: The following activity uses case scenarios to review antiretroviral drug interactions. You are a pharmacist performing a dispensing shift at your local community or hospital outpatient pharmacy. You will be broken up into small groups and provided with easel paper and markers. Please read your case and then discuss with your group. References on drug interactions will be provided. On your paper, create a chart with the following headings:

1. Drug Interaction 2. Expected Outcome of Drug Interaction 3. Pharmaceutical Care Plan 4. Patient Counseling Points Complete the chart with the pertinent fields from your case. At the end of the allotted time, we will review your findings and care plans in the larger group. There are seven cases that have been provided in this workshop.


ARV Drug Interactions Workshop: CASE 1

Dr’s Office 12345 Medication Lane San Francisco, CA 94143 (415) 911-4111 Patient’s Name ___Homer Simpson_______________________________________ Date: ___________6/20/08_______________________________________ Rx: Clarithromycin 500mg PO BID #60, 5 refills Ethambutol 400mg PO QD #90, 5 refills Rifabutin 300mg, PO QD #30, 5 refills Methadone 10mg PO BID #120, 0 refills Signature:_____________Dr. Doe__________________________________________ Conversation at the pharmacy counter: “Hi! I’m here to refill my prescriptions. I think there are 7 of them. I also have these new ones (hands you the prescription) from Dr. Doe.” When you ask him how he has been lately he says… “I’ve been doing just ‘ok’. Dr. Doe keeps giving me all these medications. My back has been killing me – more than it has been in a long time. Especially over the last month. Maybe I should ask Dr. Payne if I can try a new medicine.”


ARV Drug Interactions Workshop: CASE 1 (cont’d) Patient Homer J. Simpson Address 128 Donut Lane, Gender Male Insurance Cover-all insurance PATIENT PROFILE Drug Name COMBIVIR 300mg/150mg TABS Orignal Rx 3/18/08 Sig Take one tablet by mouth twice daily Last Filled 5/20/08 Quantity 60 Physician Dr. Doe Refills left 3 Drug Name INVIRASE 500mg TABS Original Rx 3/18/08 Sig Take two tablets by mouth twice

daily Last Filled 5/20/08

Quantity 120 Physician Dr. Doe Refills left 3 Drug Name NORVIR 100mg TABS Original Rx 3/18/08 Sig Take 1 capsule by mouth twice daily Last Filled 5/20/08 Quantity 60 Physician Dr. Doe Refills left 3 Drug Name Buspirone 15mg TABS Original Rx 2/20/08 Sig Take 1 tablet by mouth daily Last Filled 5/20/08 Quantity 30 Physician Dr. Psych Refills left 2 Drug Name Methadone 10mg TABS Original Rx 5/20/08 Sig Take 2 tablets by mouth twice daily Last Filled 5/20/08 Quantity 120 Physician Dr. Payne Refills left 0 Drug Name Stavudine 30mg TABS Original Rx 5/20/08 Sig Take 1 capsule by mouth twice daily Last Filled 5/20/08 Quantity 60 Physician Dr. Newhouse Refills left 4 Drug Name EPIVIR 150mg TABS Original Rx 5/20/08 Sig Take 1 tablet by mouth twice daily Last Filled 5/20/08 Quantity 60 Physician Dr. Newhouse Refills left 4 Drug Name Digoxin 0.125mg TABS Original Rx 3/20/08 Sig Take 1 tablet by mouth twice daily Last Filled 5/20/08 Quantity 60 Physician Dr. Hart Refills left 5



Dr’s Office 12345 Medication Lane San Francisco, CA 94143 (415) 911-4111 Patient’s Name ___Marge Simpson_______________________________________ Date: ___________6/20/08_______________________________________ Rx: Rifampin 300mg ii PO daily #60, 5 refills Isoniazid 300mg PO daily #30, 5 refills Pyrazinamide 500mg ii PO daily #60, 1 refill Ethambutol 400mg iii PO QD #90, 1 refills Epivir HBV 100mg PO daily, #30, 5 refills Signature:_____________Dr. I. Diseases_____________________________________ Conversation at the pharmacy counter: “I can’t believe I got TB and hepatitis from my trip to Asia! Here are my prescriptions. I think I also need refills on my other meds too.


ARV Drug Interactions Workshop: CASE 2 (cont’d) Patient Marge Simpson Address 128 Donut Lane, Gender Female Insurance Lotsa insurance PATIENT PROFILE Drug Name COMBIVIR 300mg/150mg TABS Orignal Rx 2/18/08 Sig Take one tablet by mouth twice daily Last Filled 5/20/08 Quantity 60 Physician Dr. Doe Refills left 1 Drug Name KALETRA 200/50mg TABS Original Rx 2/18/08 Sig Take two tablets by mouth twice


Quantity 120 Physician Dr. Doe Refills left 1 Drug Name ADVAIR DISCUS 100/50mg Original Rx 1/18/08 Sig 1 inhalation twice daily Last Filled 5/20/08 Quantity 1 Physician Dr. General Refills left 0 Drug Name Phenytoin 300 CAPS Original Rx 1/20/08 Sig Take 1 capsule by mouth daily Last Filled 5/20/08 Quantity 30 Physician Dr. General Refills left 1 Drug Name CRESTOR 5mg TABS Original Rx 5/20/08 Sig Take 1 tablets by mouth daily Last Filled 5/20/08 Quantity 30 Physician Dr. General Refills left 2



Dr’s Office 12345 Medication Lane San Francisco, CA 94143 (415) 911-4111 Patient’s Name ___Moe Beers_______________________________________ Date: ___________6/20/08_______________________________________ Rx: Migranal nasal spray 4mg/mL: Instill 1 spray in each nostril. Repeat in 15 min. Signature:_____________Dr. General_____________________________________ Conversation at the pharmacy counter: “Ugh. I thought I was supposed to be starting to feel better now! That’s the whole reason I agreed to starting antivirals is to give me more energy. But I’m feeling awful! I’ve got this terrible headache, and my body and muscles really ache! I hope this migraine medicine does the trick. I never thought I had migraines before, but maybe it will at least get rid of my headache. Maybe some of these supplements will help too.” Brings to the counter for purchase: a pack of gum, cigarettes a bottle of SAM-E and St. John’s Wort.


ARV Drug Interactions Workshop: CASE 3 (cont’d) Patient Moe Beers Address 911 Drinking Lane, Gender Male Insurance Kindasorta insurance PATIENT PROFILE Drug Name EPZICOM 300mg/600mg TABS Orignal Rx 5/01/08 Sig Take one tablet by mouth daily Last Filled 5/01/08 Quantity 30 Physician Dr. Infectious Refills left 0 Drug Name EPZICOM 300mg/600mg TABS Orignal Rx 6/01/08 Sig Take one tablet by mouth daily Last Filled 6/01/08 Quantity 30 Physician Dr. Internal Refills left 5 Drug Name LEXIVA 700mg TABS Original Rx 5/01/08 Sig Take one tablet by mouth twice daily Last Filled 5/01/08 Quantity 60 Physician Dr. Infectious Refills left 0 Drug Name Famciclovir 500mg TABS Original Rx 6/01/08 Sig Take one tablet by mouth twice daily Last Filled 6/01/08 Quantity 60 Physician Dr. Internal Refills left 5 Drug Name Simvastatin 40mg TABS Original Rx 6/01/08 Sig Take one tablet at bedtime Last Filled 6/01/08 Quantity 30 Physician Dr. General Refills left 5 Drug Name WELLBUTRIN XL 300 TABS Original Rx 1/20/08 Sig Take 1 tablet by mouth daily Last Filled 6/01/08 Quantity 30 Physician Dr. General Refills left 1



Dr’s Office 12345 Medication Lane San Francisco, CA 94143 (415) 911-4111 Patient’s Name ___Lisa Simpson_______________________________________ Date: ___________6/20/08_______________________________________ Rx: Mevacor 10mg po at bedtime #30; 5 refills Signature:_____________Dr. Cardio_____________________________________ Conversation at the pharmacy counter: “Sigh. Isn’t San Francisco so grey in the summer? And now Dr. Cardio says I might have clogged arteries! It just figures that I have a broken heart. I thought I was doing so well, starting my meds and all. But I’ve been feeling so blah lately and I don’t have any energy. Do I have to wait long for this prescription? I just want to go home, go back to bed, and stay there forever.”


ARV Drug Interactions Workshop: CASE 4 (cont’d) Patient Lisa Simpson Address 8220 Jazzy Lane Gender Female Insurance Smartypants Insurance PATIENT PROFILE Drug Name EPZICOM 300mg/600mg TABS Orignal Rx 2/01/08 Sig Take one tablet by mouth daily Last Filled 6/01/08 Quantity 30 Physician Dr. Viral Refills left 2 Drug Name PREZISTA 600mg TABS Original Rx 2/01/08 Sig Take one tablet by mouth twice daily Last Filled 6/01/08 Quantity 60 Physician Dr. Viral Refills left 2 Drug Name NORVIR 100mg CAPS Original Rx 2/01/08 Sig Take one capsule by mouth twice


Quantity 60 Physician Dr. Viral Refills left 2 Drug Name ISENTRESS 400mg TABS Original Rx 2/01/08 Sig Take one tablet by mouth twice daily Last Filled 6/01/08 Quantity 60 Physician Dr. Viral Refills left 2 Drug Name Lorazepam 1mg TABS Original Rx 4/20/08 Sig Take ½ - 1 tablet by mouth at

bedtime as needed for sleep Last Filled 6/01/08

Quantity 30 Physician Dr. Psyche Refills left 1 Drug Name Paroxetine 20mg TABS Original Rx 12/20/08 Sig Take 1 tablet by mouth daily Last Filled 6/01/08 Quantity 30 Physician Dr. Psyche Refills left 6 Drug Name ORTHO CYCLEN 7/7/7 TABS Original Rx 12/20/08 Sig Take 1 tablet by mouth daily Last Filled 6/01/08 Quantity 84 Physician Dr. Baby Refills left 1 Drug Name Vitamin C 500mg TABS Original Rx 12/20/08 Sig Take 1 tablet by mouth daily Last Filled 6/01/08 Quantity 30 Physician Dr. Baby Refills left 1


ARV Drug Interactions Workshop: CASE 5 Dr’s Office 12345 Medication Lane San Francisco, CA 94143 (415) 911-4111 Patient’s Name ___Sideshow Bob_______________________________________ Date: ___________6/20/08_______________________________________ Rx: Viagra 100mg Sig: Take ½ - 1 tablet 30 minutes prior to sex. #30 0 Refills Signature:_____________Dr. Internal_____________________________________ Conversation at the pharmacy counter: “I am just loving life! I need this prescription and refills on my Reyataz and Truvada, please.”


ARV Drug Interactions Workshop: CASE 5 (cont’d) Patient Sideshow Bob Address 1092 Bigtop Lane Gender Male Insurance CircusCircus Insurance PATIENT PROFILE Drug Name TRUVADA 300mg/200mg TABS Orignal Rx 1/01/08 Sig Take one tablet by mouth daily Last Filled 3/01/08 Quantity 30 Physician Dr. NT Viral Refills left 2 Drug Name Didanosine 400mg CAPS Original Rx 1/01/08 Sig Take one capsule by mouth daily Last Filled 3/01/08 Quantity 30 Physician Dr. NT Viral Refills left 2 Drug Name NORVIR 100mg CAPS Original Rx 1/01/08 Sig Take one capsule by mouth daily Last Filled 3/01/08 Quantity 30 Physician Dr. NT Viral Refills left 2 Drug Name REYATAZ 300mg CAPS Original Rx 1/01/08 Sig Take one capsule by mouth daily Last Filled 3/01/08 Quantity 30 Physician Dr. NT Viral Refills left 2 Drug Name COMBIVENT INH Original Rx 1/20/08 Sig 2 inhalations four times daily Last Filled 2/01/08 Quantity 1 Physician Dr. Internal Refills left 3 Drug Name Albuterol MDI Original Rx 1/20/08 Sig 1-2 inhalations every 4-6 hours as

needed for shortness of breath Last Filled 6/01/08

Quantity 1 Physician Dr. Internal Refills left 0 Drug Name Esomeprazole 40mg CAPS Original Rx 4/01/08 Sig Take 1 capsule by mouth daily Last Filled 6/01/08 Quantity 30 Physician Dr. Internal Refills left 3 Drug Name CARDIZEM CD 120mg CAPS Original Rx 4/01/08 Sig Take one capsule by mouth daily Last Filled 6/01/08 Quantity 30 Physician Dr. Internal Refills left 1


ARV Drug Interactions Workshop: CASE 6 Dr’s Office 12345 Medication Lane San Francisco, CA 94143 (415) 911-4111 Patient’s Name ___ Guy Comicbook _______________________________________ Date: ___________6/20/08_______________________________________ Rx: Loratidine 10mg i PO QD #30 5 refills Sudafed 30mg i PO QID PRN #100 0 refills Signature:_____________Dr. House_____________________________________ Conversation at the pharmacy counter: “I need refills on my Septra. I’m already behind by a week. My doctor said it’s going to prevent me from getting sick – I don’t want to get that sick again. Here, I’ll buy this can of grapefruit juice to wash my meds down with. And, by the way, I know it’s a little early, but can I also pick up my other meds? Not the methadone – I know I need a special prescription for that one. I have an appointment coming up with Dr. Payne and Dr. Specialist on June 30th.”


ARV Drug Interactions Workshop: CASE 6 (cont’d) Patient Guy Comicbook Address 28346 Fantasy Island Street Gender Male Insurance Trekkie Insurance PATIENT PROFILE Drug Name TRUVADA 300mg/200mg TABS Orignal Rx 5/30/08 Sig Take one tablet by mouth daily Last Filled 5/30/08 Quantity 30 Physician Dr. Specialist Refills left 3 Drug Name VIRAMUNE 200mg TABS Original Rx 5/30/08 Sig Take one tablet by mouth daily x 21

days then increase to one tablet twice daily

Last Filled 5/30/08

Quantity 60 Physician Dr. Specialist Refills left 3 Drug Name Methadone 10mg TABS Original Rx 5/30/08 Sig Take 3 tablets orally three times daily Last Filled 5/30/08 Quantity 270 Physician Dr. Payne Refills left 0 Drug Name BACTRIM DS 800/160mg TABS Original Rx 5/26/08 Sig Take 2 tablets by mouth three times


Quantity 126 Physician Dr. Specialist Refills left 0 Drug Name Azithromycin 600 mg TABS Original Rx 5/30/08 Sig Take two tablets by mouth once weekly Last Filled 5/30/08 Quantity 8 Physician Dr. Specialist Refills left 3 Drug Name VFEND 200 mg TABS Original Rx 5/26/08 Sig Take one tablets by mouth twice daily Last Filled 5/26/08 Quantity 60 Physician Dr. Specialist Refills left 2


ARV Drug Interactions Workshop: CASE 7 Dr’s Office 12345 Medication Lane San Francisco, CA 94143 (415) 911-4111 Patient’s Name ___ Joe Crabapple_______________________________________ Date: ___________6/20/08_______________________________________ Rx: Atripla i po at bedtime, #30 5 refills Selzentry 300mg i po twice daily #30 Signature:_____________Dr. Virology_____________________________________ Conversation at the pharmacy counter: “Time to start these meds, huh? I guess things could be worse – I’m feeling pretty good, so I think I’m up to it.”


ARV Drug Interactions Workshop: CASE 7 (cont’d) Patient Joe Crabapple Address 6253 Schoolhouse Street Gender Male Insurance University Insurance PATIENT PROFILE Drug Name Risperdal 1mg TABS Orignal Rx 2/30/08 Sig Take one tablet by mouth twice daily Last Filled 5/30/08 Quantity 60 Physician Dr. Hed Case Refills left 1 Drug Name Doxycycline 100mg CAPS Original Rx 3/30/08 Sig Take one capsule by mouth twice

daily until gone Last Filled 3/30/08

Quantity 20 Physician Dr. General Refills left 0 Drug Name Itraconazole 200mg CAPS Original Rx 3/30/08 Sig Take one capsule by mouth daily x

12 weeks for toenails Last Filled 5/30/08

Quantity 30 Physician Dr. General Refills left 0 Drug Name CIALIS 10mg TABS Original Rx 3/30/08 Sig Take one tablet by mouth 30

minutes prior to sex Last Filled 3/30/08

Quantity 30 Physician Dr. General Refills left 0 Drug Name Atorvastatin 20 mg TABS Original Rx 3/30/08 Sig Take one tablet by mouth at bedtime Last Filled 5/30/08 Quantity 30 Physician Dr. Hearty Refills left 3 Drug Name Lorazepam 1mg TABS Original Rx 4/20/08 Sig Take ½ - 1 tablet by mouth at

bedtime as needed for sleep Last Filled 6/01/08

Quantity 30 Physician Dr. Hed Case Refills left 1


Appendix B: HIV Pharmacology Workshop Exercise

Exercise: Have posters around the room with the topic in the title section. Each table then has colored cards (approximately 10) with names of antiretroviral medicines (generic and brand names). The cards then need to be placed on the appropriate poster. If place near top of poster, the group is “Sure” the medicine belongs to that poster. Can place the card near the bottom of poster if “less sure” it belongs there. If brand name is already on the poster, do not also place the generic name there (and visa-versa). Groups can discuss with each other and use the references available in their packet (ARV tables from DHHS guidelines, ARV drug information sheet with pictures).

• Co-formulated (combination) Products (>1 medicine in one pill) • Once daily dosing FDA approved • Avoid in Pregnancy (or avoid component if co-formulated) • Renal Dose Adjustments Recommended (or component if co-formlated) • Significant interactions with Proton-Pump Inhibitors • Should be taken on Empty Stomach • Rash and/or Allergic Reaction is Common & suggests special education • Activity against Hepatitis B (or component if co-formulated) • FDA approved after January 2005 • Must Be Dispensed with Ritonavir

1. Co-formulated (combination) Products (>1 medicine in one pill)

• Combivir (zidovudine/lamivudine) • Trizivir

(abacavir/zidovudine/lamivudine) • Truvada (tenofovir/emtricitabine)

• Kaletra (lopinavir/ritonavir) • Atripla

(efavirenz/tenofovir/emtricatabine) • Epzicom (abacavir/lamivudine)

Teaching Points:

• Some patients prefer lower bottle burden than pill burden. • Can affect co-pays (decrease cost). • Can increase confusion about names. • Need to recall individual components to educate/consider interactions and side-

effect issues. 2. Once daily dosing FDA approved

• Atripla (efavirenz/tenofovir/emtricitabine)

• Epzicom (abacavir/lamivudine) • Lamivudine (Epivir) • Viread (tenofovir) • Efavirenz (Sustiva)

• Atazanavir/ritonavir (Reyataz/Norvir) • Emtricitabine (Emtriva) • Tenofovir/emtricitabine (Truvada) • Didanosine (Videx)


Naïve patients: • Kaletra (lopinavir/ritonavir) • Fosamprenavir/ritonavir (Lexiva/Norvir) • Reyataz (atazanavir)

Teaching Points:

• Can effectively combine once daily dosing of antiretrovirals. • Some ARV are used once daily, but not FDA-approved (not on this list, would be

added to chart during exercise). • Some once daily regimens are FDA-approved for use in ARV naïve pts, but not

ARV experienced. • Review pharmacokinetic issues:

Boosting of ritonavir – what does that really mean? “Forgivability” of regimens – what is the significance of missing a dose in a

once a day regimen vs. twice a day regimen? • Adherence rates differ between once daily vs. twice daily vs. three times daily

regimens. (In all chronic disease conditions, including HTN & DM) 3. Avoid in Pregnancy (or avoid component if co-formulated)

• Efavirenz (Sustiva) • Viracept (nelfinavir) • Stavudine/didanosine (Zerit/Videx) • Atripla (efavirenz/tenofovir/emtricitabine)

Teaching Points:

• Efavirenz isteratogenic– especially if used early in pregnancy (Pregnancy Category D) • Women desiring pregnancy, and/or not using effective birth control, should avoid

efavirenz. • Stavudine and didanosine is on this list due to increased risk of pancreatitis and lactic

acidosis when used in pregnancy. • Pharmacokinetics of ARV can be affected by pregnancy, leading to some dosing

adjustments or increased side-effects. • Can use most of our ARV during pregnancy

4. Renal Dose Adjustments Recommended (or component if co-formulated)

• Viread (tenofovir) • Lamivudine (Epivir) • Truvada (tenofovir/emtricitabine) • Zidovudine (Retrovir) • Combivir (zidovudine/lamivudine) • Videx (didanosine)

• Emtricitabine (Emtriva) • Stavudine (Zerit) • Trizivir

(abacavir/lamivudine/zidovudine) • Epzicom (abacavir/lamivudine)

• Atripla (efavirenz/tenofovir/emtricitabine)


Teaching Points: • No Protease Inhibitors on this list • Dose adjustment due to renal dysfunction is different that having medications cause renal

dysfunction. • Tenofovir is only one on this list that is associated with causing renal dysfunction. • Coformulated products often need to be separated for appropriate dose adjustment. • Often medication errors are found when the dose is not adjusted for renal dysfunction.

• Especially after renal function improves, if the dose is not adjusted accordingly, this could lead to subtherapeutic concentrations and resistance.

• Atazanavir should not be administered to treatment experienced patients on hemodialysis and treatment naïve patients need to be on boosted atazanavir. No adjustments required for patients not on hemodialysis.

5. Significant interactions with Proton-Pump Inhibitors (PPIs)

• Atazanavir (Reyataz) • Atazanavir/ritonavir (Reyataz/Norvir)

Teaching Points: • Atazanavir requires an acidic environment for absorption and PPIs will decrease

absorption, even with boosted atazanavir. • A good drug history important, including over-the-counter medications, due to

availability of PPIs and H-2 antagonists OTC • See FDA-approved package insert for atazanavir for updated recommended dosing

for treatment experienced and treatment naïve patients receiving PPIs or H2 antagonists.

6. Should be taken on Empty Stomach

• Videx (didanosine) • Efavirenz (Sustiva) • Indinavir (Crixivan) • Atripla (efavirenz/tenofovir/emtricitabine)

Teaching Points:

• Indinavir (rarely given anymore) was given Q 8 hrs on empty stomach for adequate absorption, – until started using with boosted RTV.

• Didanosine, even in enteric-coated formulation, still has an empty stomach requirement, unless dosed with tenofovir. When given with tenofovir, the dose is reduced to 250mg once daily and maybe given with food.

• Need to double check auxiliary labels from pharmacy, as they do not always take into account co-administered meds.

• The reason efavirenz is recommended on empty stomach is to avoid INCREASED absorption, which would lead to increased possible side-effects, not decreased efficacy. So if patients can tolerate taking with food and improves adherence, the patient can do so.


7. Rash and/or Allergic Reaction is Common & suggests special education • Abacavir (Ziagen) • Epzicom (abacavir/lamivudine) • Trizivir (abacavir/zidovudine/lamivudine) • Nevirapine (viramune)

Teaching Points:

• HLA-B*5701 test is available which could help predict patients likely to have abacavir hypersensitivity (ABC-HSR) reaction.

• Discuss warning card dispensed with abacavir and abacavir-containing products. Patients should actually be advised NOT to stop their medications on their own. May often suggest for patients who have symptoms reported on the card to continue medication for several days to determine if truly ABC-HSR or just early side-effects from the new ARV regimen.

• Early symptoms of ABC-HSR are not fatal. Restarting after stopping has had some life-threatening reactions.

• Nevirapine dose should be once daily for first 2 weeks, then every 12 hours to reduce incidence of rash.

• If a nevirapine rash develops without other symptoms (flu-like, abdominal pain), may be able to continue the medication. Rash often resolves within several days to weeks.

• Severe rash and hepatitis is seen more often when nevirapine is used in men with CD4 > 400 and women with CD4 > 250. Should monitor Liver Function Tests (LFTs) every 2 weeks for first 8 weeks in all patients started on nevirapine.

• Many other ARV can also cause rash, but do not necessarily need special education: Etravirine Fosamprenavir Efavirenz Darunavir Tipranavir Nelfinavir


8. Activity against Hepatitis B (or component if co-formulated) • Tenofovir (Viread) • Lamivudine (Epivir) • Emtricitabine (Emtriva) • Truvada (tenofovir/emtricitabine) • Atripla (efavirenz/tenofovir/emtricitabine) • Trizivir (abacavir/lamivudine/zidovudine) • Epzicom (abacavir/lamivudine)

Teaching Points:

• Tenofovir, lamivudine and emtriciatabine which are available in several co-formulated products, have activity against both HIV and Hepatitis B virus.

• When treating co-infected individuals, both infections need to be treated concomitantly. (i.e., don’t treat one without treating the other).

• There is a warning not to stop these medications suddenly as a Hepatitis B flare up may occur.

9. FDA approved after January 2005

• Atripla (efavirenz/tenofovir/emtricitabine) • Raltegravir (Isentress) • Darunavir (Prezista) • Maraviroc (Selzentry) • Tipranavir (Aptivus) • Etravirine (Intelence)

Teaching Points:

• Some of the medications that are newly approved are actually just new formulations of old medicines (i.e., Atripla).

• Some are new medicines in current classes of antiretrovirals (i.e., darunavir and tipranavir are new protease inhibitors). Data suggests activity against PI resistant virus, especially for darunavir.

• Like-sounding medications adds to the confusion of names (Intelence vs Isentress). • Most recently, there has been an approval for medicines that are novel targets against

HIV, such as CCR5 receptor antagonist and integrase inhibitor. 10. Must Be Dispensed with Ritonavir

• Darunavir (Prezista) • Tipranavir (Aptivus)

Other Protease Inhibitors often boosted, but NOT ALWAYS:

• Atazanavir (Reyataz) • Fosamprenavir (Lexiva) • Saquinavir (Invirase) • Indinavir (Crixivan)


Already Co-formulated with ritonavir, therefore does not need extra dispensing:

• Lopinavir (coformulated as Kaletra) Teaching Points:

• Many Protease Inhibitors are used in combination with ritonavir, but many have FDA-approved dosing without ritonavir.

• The two above are the only protease inhibitors that have no approved dosing without ritonavir

• Efficacy of boosted protease inhibitors and “forgivability” is improved compared to unboosted protease inhibitors.

• BID dosing of ritonavir can make for dispensing errors, as two or more bottles of 100mg ritonavir are given to the patient.


Appendix C: List of Common Training Topics for Pharmacists

Level 1 • New Antiretroviral Medication Updates • Managing Adverse Reactions to HIV Medications • Pharmacokinetics/Pharmacogenomics and Therapeutic Drug Monitoring • Medication Errors in HIV • Medicare Part D and access to HIV Medications

Level 2 • Use of New Antiretroviral Medications • Adherence Counseling • Identifying and Managing Drug-Drug Interactions • Managing and Counseling HIV Adverse Drug Reactions • Providing Culturally Competent HIV Care • Role of the Community Pharmacist in the HIV Care Team • HIV 101: When to Start Antiretroviral Therapy and What to Start With

Level 3 For clinic/hospital-based preceptorships: • HIV Pharmacotherapy Update and Drug Interactions • Co-Management Approach to HIV Care • HIV Medical Update

For community pharmacy-based preceptorships: • Addressing HIV Drug Errors in the Retail Pharmacy Setting • Interactions between Common OTC Products and HIV Medications • Putting Theory into Practice: Medication Counseling with HIV Patients

Level 4 • HIV regimen changes • Avoiding drug errors • Adherence counseling issues • Over-the-counter (OTC) product interactions with ARVs • How to handle physician communication problems


Appendix D: Needs Assessment Survey for Community Pharmacists and Pharmacy Staff

Purpose: The AIDS Education and Training Centers (AETCs) are a network of 11 regional centers that conduct targeted, multi-disciplinary education and training programs for healthcare providers treating persons with HIV/AIDS. The AETC within your region is interested in learning more about the educational needs of community pharmacists and pharmacy staff related to HIV/AIDS care and treatment. This needs assessment survey will be used to help the AETCs identify topics of interest and the best ways to meet your educational needs. Your responses will be kept confidential. State: ____________________ Zip Code: _________________ 1. Are you familiar with your regional AIDS Education and Training Center? Yes No 2. Please indicate what type of pharmacy you work for (check all that apply):

O Independent O Part of a small chain O Part of a large chain

O Mail order O HIV Specialty Pharmacy O Located in hospital/clinic

3. Please indicate your primary functional role.

O Pharmacy Manager/Director O Registered Pharmacist

O Pharmacy Technician O Pharmacy/Store Clerk

4. On average, how many HIV/AIDS-related prescriptions do you fill monthly? O 0-10 O 10-50 O 50-100

O 100-200 O >200 O Not applicable/don’t dispense

5. Please rate your knowledge/skills and desire for additional training in the following areas.

Novice/ Somewhat Expert I would like additional Beginner Knowledgeable training in this area Antiretrovirals and Drugs for Prevention and Treatment of Opportunistic Infections O O O O Yes O No Complications of ARVs O O O O Yes O No Pharmacy-specific educational resources O O O O Yes O No HIV Medication Assistance Programs O O O O Yes O No HIV Prevention/Pharmacist’s Role O O O O Yes O No Managing side affects of HIV medications O O O O Yes O No Pediatric Drug Formulations O O O O Yes O No Prescribing Errors O O O O Yes O No Prescription Reimbursements O O O O Yes O No Relevant HIV drug interactions O O O O Yes O No


Review of adult ARV treatment guidelines O O O O Yes O No Treatment Updates and Drugs in Development O O O O Yes O No Updates on HIV Resistance O O O O Yes O No Other (specify):__________________________ 6. Please rate the following information dissemination and training formats according to your preference.

Really Neutral Dislike Prefer O O O Conferences or Seminars

O O O CD-ROM programs

O O O Interactive online studies

O O O Preceptorships

O O O Printed materials (brochures, journals, newsletters, pocket guides, etc)

O O O Video/Audio Teleconferences

O O O Web courses (live) O O O Other (specify):__________________________

7. Please indicate how much time your staff can devote to receiving HIV/AIDS education (check all that apply).

Training days per month: O ½ day O 1 day O 2 days O 3 days O >3 days

Hours per training session: O 1 hr. O 2 hrs. O 4 hrs. O 8 hrs. O >8 hrs.

8. What barriers exist for you and your staff in attending/obtaining training and education? (Check all that apply)

O Time O Travel O Cost O Staff Coverage

O Language O Limited Computer Technology O Patient/Client Scheduling O Other (specify):______________________

9. What resources do you utilize most frequently when you are faced with an unfamiliar HIV/AIDS prescription dose?

(Check all that apply)

O Computer automatically flags and provides a reference resource O Look-up in a paper reference manual O Contact colleagues outside of your pharmacy O Ask colleague in your pharmacy

O Online drug information resource O DHHS Updated Treatment Guidelines O National or Regional AETC Warmline/Hotline O Other (specify):_______________________

10. What barriers do you and your staff encounter in providing adequate or optimal consultation to HIV patients/clients?

(Check all that apply)

O Lack of time to interact with clients O Not in my job description O No reimbursement/fee paid to pharmacist for these efforts O Inadequate staffing

O Inadequate private/semi-private space O Staff do not have knowledge of HIV drug information O Patient/client not receptive O Language barriers O Lack of internet access O Other (specify): ______________________


11. Do you provide the following to patients: Verification of prescription drug coverage eligibility Yes No Assistance in applying for or updating prescription drug coverage eligibility Yes No Counseling on formulary options for non-covered medications Yes No Working with prescribers to develop alternate treatment options Yes No Assist and coordinate manufacturer drug assistance programs for patients without coverage Yes No Provision of emergency prescriptions at no charge Yes No

12. Does your pharmacy have mechanisms in place for patients to receive HIV medications that are not covered or not

affordable based on their insurance plan? Yes No

If yes, please describe: ______________________________________________________________________

13. The provision of culturally competent care by health professionals has been recognized by the Surgeon General as

an important component of effective health management of HIV patients. How does your pharmacy / staff deliver culturally competent care within the scope of pharmacy practice? (Check all that apply)

Provide written materials and signage in the clients’ preferred language Provide services that are client centered (compatible with clients' cultural beliefs and practices) Promote diverse staff and leadership that are representative of the demographic characteristics of the service

area in your organization Conduct a needs-assessment to plan for culturally and linguistically appropriate services within your

organization None of the above Other, please specify: ______________________________

14. The AETC’s mission is to target “Big 6” populations (pharmacists, physicians, physician assistants, nurses, nurse

practitioners, dentists).

Have you ever attended an AETC training? Yes No

If yes, was it useful in your care of patients? Yes No

AIDS Education and Training Centers

Thank you for your time and interest in completing this needs assessment survey.

Return this survey to: _____________________


Appendix E: HIV Clinical Pharmacy Practicum (Program Agenda)

Tuesdays

7:30am – 1:45pm Hackensack Univ. Medical Ctr

Hackensack, NJ

Tuesdays 7:30am – 1:45pm

Jersey Shore Univ. Medical Ctr Neptune, NJ

Wednesdays 7:15am – 1:30pm

St. Michael’s Medical Ctr Newark, NJ

Purpose: The program offers registered pharmacists an opportunity to directly observe how HIV patients receive both assessment and HIV clinical treatment by a multi-disciplinary management team of doctors, clinical pharmacists and nurses in an out-patient clinical care setting.

Objectives:

Upon completion of this program, participants should be able to: • Identify pertinent drug-drug interactions observed with highly active antiretroviral therapy

(HAART). • List management strategies for dealing with adverse effects of HAART. • Interpret and understand ART resistance testing and its impact on selection of a HAART

regimen. • Determine how to approach therapeutic dilemmas, e.g. unavailability of medications,

incorrect drug doses, etc. • Recognize the role of a pharmacist in a multi-disciplinary approach to the management of

HIV patients. • Understand a wide array of challenging issues in the lives of various patients living with

HIV infection

Agenda 15 minutes Registration and Pre-Test Completion

60 minutes Lecture: HIV Pharmacotherapy Update and Drug Interactions

200 minutes Patient Care Observation: Co-Management Approach to HIV Care

40 minutes Lecture: HIV Medical Update

15 minutes Post-Test Completion and Evaluation



Appendix F: HIV Pharmacy Practicum in the Community Pharmacy Setting (Program Agenda)

08HX1I

2007-2008

Purpose: This customized one-on-one training is designed to educate registered pharmacists on community pharmacy issues relevant to the management of HIV-positive patients in the community through a combination of didactic lectures and patient observation at a community pharmacy.

Objectives: Upon completion of this program, participants should be able to:

• Identify potential over-the-counter product interactions observed with highly active antiretroviral therapy (HAART) and other common HIV prescription medications.

• Manage potential HIV drug errors which may adversely affect patient care • Foster patient-provider relationships which enhance HIV medication adherence • Incorporate learned theories into effective HIV community pharmacy practice

Agenda: This program is 5.5 hours in length and is individually arranged for dates and times at each

participating retail pharmacy site

15 min Registration and Pre-Test Completion

60 min Addressing HIV Drug Errors in the Community Pharmacy Setting

60 min Interactions between Common OTC Products and HIV Medications

180 min Putting Theory into Practice: Medication Counseling with HIV Patients

15 min Post-Test Completion and Evaluation

Purpose This program is designed to offer registered pharmacists an opportunity to directly observe the multidisciplinary management of pregnant women, infants, children, and adolescents with HIV. The focus will be on the critical role of the community pharmacist in the co-management of these patients with their HIV family-centered care team at a Ryan White Part D-funded pediatric clinic. Learning Objectives Upon completion of the program the pharmacist should be able to:

Discuss the appropriate use of antiretroviral therapy (ART) by HIV-positive pregnant women and their newborn infants to prevent perinatal transmission of HIV.

Discuss the approved indications for initiating ART in infants, children, and adolescents with HIV infection, along with the preferred ART regimens in each age group.

Discuss the prevention and treatment of opportunistic infections commonly associated with HIV infection in pediatric patients, including Candidiasis, Pneumocystis jeroveci pneumonia, Mycobacterium avium complex.

Understand the age-appropriate dose and dosing requirements, along with the adverse effects and drug interactions commonly associated with the antiretroviral medications approved for pediatric use.

Understand the importance of antiretroviral drug adherence and the factors that affect adherence, including family and school dynamics, patient and caregiver education, dosage form and palatability, and regimen complexity.

Agenda 8:30 AM - 9:00 AM Registration and Pre-Test

9:00 AM -11:00 AM Management of Family-Centered HIV/AIDS: A Review of HIV Pathophysiology and the Use of Antiretroviral Medications in Pregnant Women and Children

11:00 AM -11:45 AM Compounding, Dispensing, Counseling, and Caring: The Community Pharmacist as a Critical Component of the Multidisciplinary Care of Pediatric HIV Patients

11:45 AM -12:30 PM Lunch Break

12:30 PM -1:00 PM Treating the Child and the Family: An Overview of Issues Related to Medication Adherence

1:00 PM - 4:00 PM Patient Observation in the Family-Centered HIV Clinic

4:00 PM - 4:30 PM Post-Test and Program Evaluation

Appendix G: Family-Centered HIV Pharmacy Practicum (Program Agenda)



Appendix H: HIV Update for Pharmacists (Program Agenda)


Appendix I: Quick Tips on How to Reach Community Pharmacists

Do you find it challenging to contact community pharmacists? Below are some helpful ideas.

How to Identify Pharmacies: • Contact the State Board of Pharmacy for a list of pharmacy addresses • Perform Internet searches (e.g., based on geographical data and zip codes) • Ask Medicaid, wholesalers or drug representatives where patients fill prescriptions

• Look in the phone book or the internet for wholesalers’/drug representatives’ contact information

• How to identify pharmacies dispensing HIV medications: • Obtain a list from the AIDS Drug Assistance Program (ADAP)

o ADAP also provides data on the number of prescriptions filled by specific pharmacies • Contact Ryan White funded medical practices

How to Reach Pharmacists: • Contact pharmacy schools, get involved with student organizations • Contact local, state, and /or national pharmacy associations • Contact the State Board of Pharmacy for a list of pharmacists and their contact information • Target pharmacists participating in regional trainings /conferences • Target pharmacy chains and independent stores in the community Modes of Intervention: • Surveys (including Needs Assessment surveys): telephone/ e-mail/ postal mail

• Advantage (e-mail and postal mail): pharmacists can complete the survey at their convenience • Disadvantage (e-mail and postal mail): low response rate • Encourage participants to fill out surveys at conferences and other events

• Interview individual pharmacists: in-person or via telephone • Offer incentives for completing the survey:

• Offer CE certificate • Wave registration fee for a training/ conference • Offer chance to win a raffle ticket, gift card

Developed by members of the Meeting the Resource Needs of Community Pharmacists Workgroup, a national AETC Workgroup coordinated by the AETC National Resource Center (NRC)

Alabama Pharmacy Assn. 1211 Carmichael Way Montgomery, AL 36106-3672 Voice: 334-271-4222 Fax: 334-271-5423 http://www.aparx.org

Alaska Pharmaceutical Assn. 203 West 15th Avenue, #100 Anchorage, AK 99510-1188 Voice: 907-563-8880 Fax: 907-563-7880 http://www.alaskapharmacy.org

Arizona Pharmacy Association 1845 E. Southern Avenue Tempe, AZ 85282-5831 Voice: 480-838-3385 Fax: 480-838-3557 http://www.azpharmacy.org

Arkansas Pharmacists Assn. 417 South Victory Little Rock, AR 72201 Voice: 501-372-5250 Fax: 501-372-0546 http://www.arpharmacists.org

California Pharmacists Assn. 4030 Lennane Drive Sacramento, CA 95834 Voice: 916-444-7811 Fax: 916-444-7929 http://www.cpha.com/

Colorado Pharmacists Society 6825 E Tennessee Ave Ste 440 Denver, CO 80224-1662 Voice: 303- 756-3069 Fax: 303-756-3649 http:// www.copharm.org

Connecticut Pharmacists Assn. 35 Cold Spring Road, Ste. 125 Rocky Hill, CT 06067 Voice: 860-563-4619 Fax: 860-257-8241 http://www.ctpharmacists.org

Delaware Pharmacists Society 27 North Main Street Smyrna, DE 19977 Voice: 302-659-3088 Fax: 302-659-3089 http://www.depharmacy.net

Florida Pharmacy Association 610 North Adams Street Tallahassee, FL 32301 Voice: 850-222-2400 Fax: 850-561-6758 http://www.pharmview.com

Georgia Pharmacy Association 50 Lenox Pointe, NE Atlanta, GA 30324 Voice: 404-231-5074 Fax: 404-237-8435 http://www.gpha.org

Hawaii Pharmacists Association PO Box 1510 Honolulu, HI 96701 Voice: 808-330-7738 Fax: 808-488-8601 http://www.hipharm.org/

Idaho State Pharmacy Assn. P.O. Box 140117 Boise, Idaho 83714 phone: 208-424-1107 fax: 208-376-3131 http://www.idahopharmacy.org

Illinois Pharmacists Association 204 W. Cook Street Springfield, IL 62704-2526 Voice: 217-522-7300 Fax: 217-522-7349 http://www.ipha.org

Indiana Pharmacists Alliance 729 N. Pennsylvania St. Indianapolis, IN 46204-1128 Voice: 317-634-4968 Fax: 317-632-1219 http://www.indianapharmacists.org

Iowa Pharmacy Association 8515 Douglas Avenue, Ste. 16 Des Moines, IA 50322 Voice: 515-270-0713 Fax: 515-270-2979 http://www.iarx.org

Kansas Pharmacists Association 1020 SW Fairlawn Rd. Topeka, KS 66604-2275 Voice: 785-228-2327 Fax: 785-228-9147 http://www.kansaspharmacy.org

Kentucky Pharmacists Assn. 1228 U.S. 127 South Frankfort, KY 40515 Voice: 502-227-2303 Fax: 502-227-2258 http://www.kphanet.org

Louisiana Pharmacists Assn. 450 Laurel St., Ste. 1400 Baton Rouge, LA 70801 Voice: 225-346-6883 Fax: 225-344-1132 www.louisianapharmacists.com

Appendix J: List of State Pharmacy Association

Maine Pharmacy Association PO Box 1450 Scarborough, ME 04074 Voice: 207-396-5340 Fax: 207-396-5326 http://www.mparx.com

Maryland Pharmacists Assn. 650 W. Lombard Street Baltimore, MD 21201-1513 Voice: 410-727-0746 Fax: 410-727-2253 http://marylandpharmacist.org

Massachusetts Pharmacists Assn. 500 West Cummings Park Woburn, Massachusetts 01801-6585 Voice: 781-933-1107 Fax: 781-933-1109 www.masspharmacists.org

Michigan Pharmacists Assn. 815 N. Washington Ave. Lansing, MI 48906-5198 Voice: 517-484-1466 Fax: 517-484-4893 www.michiganpharmacists.org

Minnesota Pharmacists Assn. 1935 W. County Rd. B2, Ste. 165 Roseville, MN 55113 Voice: 651-697-1771 Fax: 651-697-1776 http://www.mpha.org

Mississippi Pharmacists Assn. 341 Edgewood Terrace Dr. Jackson, MS 39206-6299 Voice: 601-981-0416 Fax: 601-981-0451 http://www.mspharm.org

Missouri Pharmacy Association 211 E. Capitol Ave. Jefferson City, MO 65101-3001 Voice: 573-636-7522 Fax: 573-636-7485 http://www.morx.com

Montana Pharmacy Association PO Box 1569 Helena, MT 59624-1569 Voice: 406-449-3843 Fax: 406-442-8018 http://www.rxmt.org

Nebraska Pharmacists Assn. 6221 South 58th St., Ste. A Lincoln, NE 68516 Voice: 402-420-1500 Fax: 402-420-1406 http://www.npharm.org


Nevada Pharmacist Association PO Box 35668 Las Vegas, NV 89133 Phone: 702-683-1955 Fax: 702-657-2089 www.nevadapharmacistassoc.com

New Hampshire Pharmacists Assn. 26 S. Main Street, PMB #188 Concord, NH 03301 Voice: 603-229-0292 Fax: 603-224-7769 http://www.nhpharmacists.org

New Jersey Pharmacists Assn. 760 Alexander Road, PO Box 1 Princeton, NJ 08543-0001 Voice: 609-275-4246 Fax: 609-275-4066 http://www.njpharma.org

New Mexico Pharmacists Assn. 2716 San Pedro NE, Suite C Albuquerque, New Mexico 87110 Voice: 505-265-8729 Fax: 505- 255-8476 http://www.nm-pharmacy.com

New York, Pharmacists Society of the State of 210 Washington Ave. Extension Albany, NY 12203 Voice: 518-869-6595 Fax: 518-464-0618 http://www.pssny.org

North Carolina Association of Pharmacists 109 Church Street Chapel Hill, NC 27516 Voice: 919-967-2237 Fax: 919-968-9430 http://www.ncpharmacists.org

North Dakota Pharmacists Assn. 1641 Capitol Way Bismarck, ND 58501-2195 Voice: 701-258-4968 Fax: 701-258-9312 http://www.nodakpharmacy.net

Ohio Pharmacists Association 2155 Riverside Drive Columbus, Ohio 43221-4052 Voice: 614-586-1497 Fax: 614-586-1545 http://www.ohiopharmacists.org

Oklahoma Pharmacists Assn. 45 NE 52nd St., PO Box 18731 Oklahoma City, OK 73154 Voice: 405-528-3338 Fax: 405-528-1417 http://www.opha.com

Oregon State Pharmacists Assn. 29702-B SW Town Center Loop West Wilsonville, OR 97070-6481 Voice: 503-582-9055 Fax: 503-582-9046 http://www.oregonpharmacy.org

Pennsylvania Pharmacists Assn. 508 North 3rd Street Harrisburg, PA 17101-1199 Voice: 717-234-6151 Fax: 717-236-1618 http://www.papharmacists.com

Puerto Rico, Colegio de Farmaceuticos de PO Box 360206 San Juan, PR 00936-0206 Voice: 787-753-7157 Fax: 787-759-9793 www.colegiofarmaceuticos.com

Rhode Island Pharmacists Assn. 1643 Warwick Avenue Warwick, RI 02889 Voice: 401-737-2600 Fax: 401-737-0959 http://www.ripharmacists.org

South Carolina Pharmacy Assn. 1350 Browning Road Columbia, SC 29210-6903 Voice: 803-354-9977 Fax: 803-354-9207 http://www.scrx.org

South Dakota Pharmacists Assn. PO Box 518 Pierre, SD 57501 Voice: 605-224-2338 Fax: 605-224-1280 http://www.sdpha.org

Tennessee Pharmacists Assn. 500 Church Street, Suite 650 Nashville, TN 37219 Voice: 615-256-3023 Fax: (615) 255-3528 http://www.tnpharm.org

Texas Pharmacy Association P.O. Box 14709 Austin, Texas 78761-4709 Voice: 512-836-8350 Fax: 512-836-0308 http://www.texaspharmacy.org

Utah Pharmacists Assn. 1125 S. Blackhawk Blvd. Mount Pleasant, UT 84647 Voice: 435-462-5323 Fax: 435-462-5325 http://www.upha.com

Vermont Pharmacists Assn. PO Box 790 Richmond, VT 05477-0790 Voice: 802-434-3001 Fax: 802-434-4803 http://www.vtpharmacists.org

Virginia Pharmacists Association 2530 Professional Road Richmond, VA 23235 Voice: 800-527-8742 Fax: 804-285-4227 http://www.vapharmacy.org

Washington D.C. Pharmaceutical Association 908 Caddington Ave Silver Spring, MD 20901-1109 Phone: 301-593-3292 Fax: 301-593-7215

Washington State Pharmacists Association 1501 Taylor Ave., SW Renton, WA 98055-3139 Voice: 425-228-7171 Fax: 425-277-3897 http://www.wsparx.org/

West Virginia Pharmacists Association 2016 1/2 Kanawha Boulevard E. Charleston, WV 25311-2204 Voice: 304-344-5302 Fax: 304-344-5316

Wisconsin, Pharmacy Society of 701 Heartland Trail Madison, WI 53717 Voice: 608-827-9200 Fax: 608-827-9292 http://www.pswi.org/

Wyoming Pharmacy Assn. PO Box 228 Byron, WY 82412-0228 Voice: 307-272-3361 Fax: 307-548-6259 http://www.wpha.net/


Appendix K: List of Pharmacy Schools

ALABAMA Auburn University Harrison School of Pharmacy 2316 Walker Building Auburn University, AL 36849-5501 Tel: (334) 844-8348 FAX: (334) 844-8353 www.pharmacy.auburn.edu Samford University McWhorter School of Pharmacy 800 Lakeshore Drive Birmingham, AL 35229 Tel: (205) 726-2820 FAX: (205) 726-2759 http://www.samford.edu/schools/pharmacy.html ARIZONA Midwestern University College of Pharmacy-Glendale 19555 N. 59th Avenue Glendale , AZ 85308 Tel: (623) 572-3500 FAX: (623) 752-3510 www.midwestern.edu/Pages/CPG.html University of Arizona College of Pharmacy 1295 N. Martin Street P.O. Box 210202 Tucson, AZ 85721 Tel: (520) 626-1427 FAX: (520) 626-4063 www.pharmacy.arizona.edu ARKANSAS University of Arkansas for Medical Sciences College of Pharmacy 4301 West Markham Street Slot 522 Little Rock, AR 72205 Tel: (501) 686-5557 FAX: (501) 686-8315 www.uams.edu/cop CALIFORNIA Loma Linda University School of Pharmacy West Hall 1316 11262 Campus Street Loma Linda, CA 92350 Tel: (909) 558-7442 FAX: (909) 558-7973 www.llu.edu

Thomas J. Long School of Pharmacy & Health Sciences at the University of the Pacific 3601 Pacific Avenue Stockton, CA 95211 Tel: (209) 946-2561 FAX: (209) 946-2410 www.pacific.edu/pharmacy/index.html Touro University – California College of Pharmacy 1310 Johnson Lane Mare Island Vallejo, CA 94592 Tel: (707) 638-5221 FAX: (707) 638-5266 http://www.tumi.edu/cop.html University of California, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences 9500 Gilman Drive, MC 0657 La Jolla, CA 92093-0657 Tel: (858) 534-1366 FAX: (858) 534-8248 www.ucsd.edu

University of California, San Francisco School of Pharmacy 521 Parnassus Ave. Rm C-156 Box 0622 San Francisco, CA 94143-0622 Tel: (415) 476-1225 FAX: (415) 476-6632 http://pharmacy.ucsf.edu

University of Southern California School of Pharmacy 1985 Zonal Avenue Los Angeles, CA 90089-9121 Tel: (323) 442-1369 FAX: (323) 442-1681 www.usc.edu/schools/pharmacy

Western University of Health Sciences College of Pharmacy 309 E. Second Street Pomona , CA 91766-1854 Tel: (909) 469-5581 FAX: (909) 469-5539 www.westernu.edu COLORADO University of Colorado at Denver and Health Sciences Center School of Pharmacy C-238, 4200 E. Ninth Avenue Denver, CO 80262 Tel: (303) 315-5055 FAX: (303) 315-6281 www.uchsc.edu/sp/sp/

CONNECTICUT University of Connecticut School of Pharmacy 69 N. Eagleville Road, Unit 3092 Storrs, CT 06269-3092 Tel: (860) 486-2129 FAX: (860) 486-1553 http://pharmacy.uconn.edu DISTRICT OF COLUMBIA Howard University College of Pharmacy, Nursing, and Allied Health Sciences School of Pharmacy Sixth & “W” Streets, NW Annex 2, Room 203 Washington, DC 20059 Tel: (202) 806-5431 FAX: (202) 234-1375 www.howard.edu FLORIDA Florida Agricultural and Mechanical University College of Pharmacy and Pharmaceutical Sciences New Pharmacy Building , Room 333 1415 S. Martin Luther King, Jr. Blvd. Tallahassee, FL 32307 Tel: (850) 599-3301 FAX: (850) 599-3347 www.famu.edu Nova Southeastern University College of Pharmacy 3200 S. University Drive Ft. Lauderdale, FL 33328 Tel: (954) 262-1304 FAX: (954) 262-3995 http://pharmacy.nova.edu/home.htm Palm Beach Atlantic University Lloyd L. Gregory School of Pharmacy 900 South Olive Avenue West Palm Beach, FL 33401 Tel: (561) 803-2731 FAX: (561) 803-2703 www.pba.edu University of Florida College of Pharmacy Box 100484 J. Hillis Miller Health Center Gainesville, FL 32610 Tel: (352) 273-6312 FAX: (352) 273-6306 www.cop.ufl.edu


GEORGIA Mercer University College of Pharmacy and Health Sciences 3001 Mercer University Drive Atlanta, GA 30341-4155 Tel: (678) 547-6304 FAX: (678) 547-6315 www.mercer.edu/pharmacy South University School of Pharmacy 709 Mall Boulevard Savannah, GA 31406-4811 Tel: (912) 201-8120 FAX: (912) 201-8154 www.southuniversity.edu University of Georgia College of Pharmacy 250 W. Green Street Athens, GA 30602-2351 Tel: (706) 542-1914 FAX: (706) 542-5269 www.rx.uga.edu HAWAII University of Hawaii at Hilo College of Pharmacy 60 Nowelo Street, Suite 101 Hilo, HI 96720 Tel: (808) 443-5900 FAX: (808) 933-0861 http://pharmacy.uhh.hawaii.edu IDAHO Idaho State University College of Pharmacy PO Box 8288 970 South 5th Avenue Pocatello, ID 83209 Tel: (208) 282-2175 FAX: (208) 282-4482 http://pharmacy.isu.edu/live/ ILLINOIS Midwestern University Chicago College of Pharmacy 555 - 31st Street Downers Grove , IL 60515 Tel: (630) 971-6417 FAX: (630) 971-6097 www.midwestern.edu/Pages/CCP.html Southern Illinois University Edwardsville School of Pharmacy Campus Box 2000 Edwardsville, IL 62026-2000 Tel: (618) 650-5150 FAX: (618) 650-5152 http://www.siue.edu/PHARMACY/

University of Illinois at Chicago College of Pharmacy 833 South Wood Street M/C 874 Chicago , IL 60612 Tel: (312) 996-7240 FAX: (312) 996-3272 www.uic.edu/pharmacy/ INDIANA Butler University College of Pharmacy and Health Sciences 4600 Sunset Avenue Indianapolis, IN 46208 Tel: (317) 940-9735 FAX: (317) 940-6172 http://www.butler.edu/academics/aca_pharmacy.asp Purdue University School of Pharmacy and Pharmaceutical Sciences 575 Stadium Mall Drive West Lafayette, IN 47907 Tel: (765) 494-1368 FAX: (765) 494-7880 http://www.pharmacy.purdue.edu/ IOWA Drake University College of Pharmacy and Health Sciences 2507 University Avenue Cline Hall Suite 106 Des Moines, IA 50311 Tel: (515) 271-1814 FAX: (515) 271-4171 www.pharmacy.drake.edu University of Iowa College of Pharmacy 115 South Grand Avenue Iowa City, IA 52242 Tel: (319) 335-8794 FAX: (319) 353-5594 http://pharmacy.uiowa.edu/ KANSAS University of Kansas School of Pharmacy 1251 Wescoe Hall Drive Room 2056 Malott Hall Lawrence, KS 66045-7582 Tel: (785) 864-3591 FAX: (785) 864-5265 www.pharm.ukans.edu/dean/index.htm

KENTUCKY University of Kentucky College of Pharmacy 725 Rose Street, Suite 327 Lexington , KY 40536-0082 Tel: (859) 323-7601 FAX: (859) 257-2128 www.uky.edu/Pharmacy LOUISIANA University of Louisiana at Monroe College of Pharmacy 700 University Avenue Monroe, LA 71209-0400 Tel: (318) 342-1600 FAX: (318) 342-1606 www.ulm.edu Xavier University of Louisiana College of Pharmacy #1 Drexel Drive New Orleans, LA 70125 Tel: (504)520-7421 FAX: (504) 520-7930 www.xula.edu/pharmacy MARYLAND University of Maryland School of Pharmacy 20 North Pine Street Baltimore, MD 21201-1180 Tel: (410) 706-7651 FAX: (410) 706-4012 www.pharmacy.umaryland.edu MASSACHUSETTS Massachusetts College of Pharmacy and Health Sciences School of Pharmacy-Worcester 19 Foster Street Suite 400 Worcester, MA 01608 Tel: (508) 890-8855*1911 FAX: (508) 890-8515 http://www.mcphs.edu/ Massachusetts College of Pharmacy and Health Sciences School of Pharmacy-Boston 179 Longwood Avenue Boston, MA 02115 Tel: (617) 732-2781 FAX: (617) 735-1082 http://www.mcphs.edu/ Northeastern University Bouvé College of Health Sciences School of Pharmacy 360 Huntington Avenue Boston , MA 02115 Tel: (617) 373-3380 FAX: (617) 373-7655 www.bouve.neu.edu/pharmacy


MICHIGAN Ferris State University College of Pharmacy 220 Ferris Drive Big Rapids, MI 49307 Tel: (231) 591-2254 FAX: (231) 591-3829 www.pharmacy.ferris.edu University of Michigan College of Pharmacy 428 Church Street Ann Arbor, MI 48109-1065 Tel: 734-764-7144 FAX: 734-763-2022 www.umich.edu/~pharmacy/ Accreditation History Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences 259 Mack Avenue Suite 2620 Detroit, MI 48201 Tel: 313-577-1574 FAX: 313-577-0457 Web Site: www.cphs.wayne.edu Accreditation History MINNESOTA University of Minnesota College of Pharmacy 308 Harvard Street SE 5-130 Weaver-Densford Hall Minneapolis, MN 55455-0343 Tel: 612-624-1900 FAX: 612-624-2974 www.pharmacy.umn.edu/ MISSOURI St. Louis College of Pharmacy College of Pharmacy 4588 Parkview Place St. Louis, MO 63110 Tel: 314-446-8341 FAX: 314-446-8304 Web Site: www.stlcop.edu/ University of Missouri-Kansas City School of Pharmacy 5100 Rockhill Road Kansas City, MO 64110-2499 Tel: 816-235-1609 FAX: 816-235-5190 www.umkc.edu/pharmacy

MISSISSIPPI University of Mississippi School of Pharmacy Post Office Box 1848 University, MS 38677 Tel: 662-915-7265 FAX: 662-915-5118 www.olemiss.edu/depts/pharm_school MONTANA University of Montana College of Health Professions and Biomedical Sciences Skaggs School of Pharmacy 340 Skaggs Building Missoula, MT 59812-1512 Tel: 406-243-4621 FAX: 406-243-4209 www.health.umt.edu/ NORTH CAROLINA Campbell University School of Pharmacy PO Box 1090 205 Day Dorm Road Room 101 Buies Creek , NC 27506 Tel: 910-893-1686 FAX: 910-893-1943 www.campbell.edu/pharmacy/ University of North Carolina At Chapel Hill School of Pharmacy 100C Beard Hall, CB #7360 Chapel Hill, NC 27599-7360 Tel: 919-966-1122 FAX: 919-966-6919 www.pharmacy.unc.edu Wingate University School of Pharmacy 316 N. Main St Campus Box 3087 Wingate, NC 28174 Tel: 704-233-8015 FAX: 704-233-8332 E-Mail: [email protected] Web Site: www.wingate.edu NORTH DAKOTA North Dakota State University College of Pharmacy, Nursing and Allied Sciences 123 Sudro Hall Fargo, ND 58105-5055 Tel: 701-231-7609 FAX: 701-231-7606 www.ndsu.edu/pharmacy

NEBRASKA Creighton University Medical Center School of Pharmacy and Health Professions 2500 California Plaza Omaha, NE 68178 Tel: 402-280-2950 FAX: 402-280-5738 http://spahp2.creighton.edu/admission/pharmacy University of Nebraska Medical Center School of Pharmacy and Health Professions 986000 Nebraska Medical Center Omaha, NE 68198-6000 Tel: 402-559-4333 FAX: 402-559-5060 www.unmc.edu/pharmacy NEW JERSEY Rutgers, the State University of New Jersey Ernest Mario School of Pharmacy William Levine Hall 160 Frelinghuysen Road Piscataway, NJ 08854-8020 Tel: 732-445-2675 FAX: 732-445-5767 http://pharmacy.rutgers.edu/ NEW MEXICO University of New Mexico College of Pharmacy MSCO9-5360 1 University of New Mexico Albuquerque, NM 87131-5691 Tel: 505-272-0906 FAX: 505-272-6749 http://hsc.unm.edu/pharmacy NEVADA University of Southern Nevada College of Pharmacy 11 Sunset Way Henderson, NV 89014 Tel: 702-990-4433 ex. 2017 FAX: 702-990-4435 www.usn.edu NEW YORK Albany College of Pharmacy and Health Sciences 106 New Scotland Avenue Albany, NY 12208 Tel: 518-445-7212 FAX: 518-445-7294 www.acp.edu


Long Island University Arnold and Marie Schwartz College of Pharmacy and Health Sciences 75 DeKalb Avenue At University Plaza Brooklyn, NY 11201 Tel: 718-488-1004 FAX: 718-488-0628 www.liu.edu St. John Fisher College Wegmans School of Pharmacy 3690 East Avenue Rochester, NY 14618 www.sjfc.edu/pharmacy St. John's University College of Pharmacy and Allied Health Science 8000 Utopia Parkway Jamaica, NY 11439 Tel: 718-990-6411 FAX: 718-990-1871 www.new.stjohns.edu/academics/graduate/pharmacy University at Buffalo The State University of New York School of Pharmacy & Pharmaceutical Sciences 126 Cooke Hall Amherst, NY 14260-1200 Tel: 716-645-2823 FAX: 716-645-3688 www.pharmacy.buffalo.edu OHIO Northeastern Ohio Universities College of Pharmacy 4209 State Rt. 44 Rootstown, OH 44272-0095 Tel: 330-325-6461 FAX: 330-325-5930 www.neoucom.edu/audience/gradschool/pharmacy/pharmacy Ohio Northern University College of Pharmacy 525 S. Main St. Ada, OH 45810 Tel: 419-772-2277 FAX: 419-772-2720 www.onu.edu/Pharmacy Ohio State University College of Pharmacy 500 West 12th Avenue Columbus, OH 43210 Tel: 614-292-5711 FAX: 614-292-3113 www.pharmacy.ohio-state.edu

University of Cincinnati James L. Winkle College of Pharmacy 3225 Eden Ave Health Professions Bldg, Room 136 Cincinnati, OH 45267-0004 Tel: 513-558-3326 FAX: 513-558-4372 www.pharmacy.uc.edu University of Findlay School of Pharmacy 1000 N. Main Street Findlay , OH 45840 Tel: 419-434-5327 FAX: 419-434-4390 www.findlay.edu/academics/colleges/cohp/academicprograms/ University of Toledo College of Pharmacy 2801 West Bancroft Street Toledo, OH 43606-3390 Tel: 419-530-1931 FAX: 419-530-1907 www.utpharmacy.org OKLAHOMA Southwestern Oklahoma State University School of Pharmacy 100 Campus Dr. Weatherford, OK 73096 Tel: 580-774-3760 FAX: 580-774-7020 www.swosu.edu/pharmacy University of Oklahoma College of Pharmacy 1110 N. Stonewall-Room 133 PO Box 26901 Oklahoma City, OK 73190 Tel: 405-271-6485 FAX: 405-271-3830 www.oupharmacy.com OREGON Oregon State University College of Pharmacy 203 Pharmacy Building Corvallis, OR 97331-3507 Tel: 541-737-3424 FAX: 541-737-3999 www.pharmacy.oregonstate.edu Pacific University School of Pharmacy 222 S.E. 8th Ave Suite 451 Hillsboro, OR 97123 Tel: 503-352-7271 FAX: 503-352-7270 www.pacific.edu/pharmd

PENNSYLVANIA Duquesne University Mylan School of Pharmacy 306 Bayer Learning Center Pittsburgh, PA 15282-1504 Tel: 412-396-6377 FAX: 412-396-1810 www.pharmacy.duq.edu Lake Erie College of Osteopathic Medicine School of Pharmacy 1858 West Grandview Blvd. Eris, PA 16509 Tel: 814-866-8409 FAX: 814-866-8450 www.lecom.edu/pharmacy/ Temple University School of Pharmacy 3307 North Broad Street Philadelphia, PA 19140 Tel: 215-707-4990 FAX: 215-707-3678 www.temple.edu/pharmacy Thomas Jefferson University Jefferson College of Health Professions Jefferson School of Pharmacy 130 S. 9th Street Ste. 1520 Philadelphia, PA 19107 Tel: 215-503-9082 FAX: 215-503-9052 www.jefferson.edu University of Pittsburgh School of Pharmacy 1104 Salk Hall 3501 Terrace Street Pittsburgh, PA 15261 Tel: 412-624-2400 FAX: 412-648-1086 www.pharmacy.pitt.edu/ University of the Sciences in Philadelphia Philadelphia College of Pharmacy 600 South 43rd Street Philadelphia, PA 19104-4495 Tel: 215-596-8805 FAX: 215-596-8977 www.usip.edu Wilkes University Nesbitt College of Pharmacy & Nursing School of Pharmacy 84 West South St Wilkes-Barre, PA 18766 Tel: 570-408-4280 FAX: 570-408-7828 www.wilkes.edu/pharm/default.asp


PUERTO RICO University of Puerto Rico Medical Sciences Campus School of Pharmacy P.O. Box 365067 San Juan , PR 00936-5067 Tel: 787-758-2525*5427 FAX: 787-751-5680 www.upr.clu.edu/ RHODE ISLAND University of Rhode Island College of Pharmacy 41 Lower College Road Kingston, RI 02881 Ronald P. Jordan, RPh Tel: 401-874-2761 FAX: 401-874-2181 www.uri.edu/pharm SOUTH CAROLINA Medical University of South Carolina College of Pharmacy 280 Calhoun Street P.O. Box 250141, Qf108 Charleston, SC 29425 Arnold W. Karig, PhD MUSC Campus Dean Tel: 843-792-8450 FAX: 843-792-9081 E-Mail: [email protected] www.musc.edu/pharmacy/ South Carolina College of Pharmacy 280 Calhoun Street P.O. Box 250141 Charleston, SC 29425 Joseph DiPiro, PharmD Executive Dean Tel: 843-792-8450 FAX: 843-792-9081 E-Mail: [email protected] sccp.sc.edu University of South Carolina College of Pharmacy 700 Sumter St Coker Life Science Room 109 Columbia, SC 29208 Randall C. Rowen, Pharm.D. Campus Dean Tel: 803-777-4151 FAX: 803-777-2775 E-mail: [email protected] www.pharm.sc.edu

SOUTH DAKOTA South Dakota State University College of Pharmacy 1 Administration Lane Box 2202 C Brookings , SD 57007-009 Tel: 605-688-6197 FAX: 605-688-6232 www.3.sdstate.edu/academics/collegeofpharmacy/index.cfm TENNESSEE East Tennessee State University College of Pharmacy P.O. Box 70414 807 University Parkway Johnson City, TN 37614 Larry D. Calhoun, PharmD www.etsu.edu/pharmacy/ University of Tennessee College of Pharmacy 847 Monroe Avenue Suite 226 Memphis, TN 38163 Tel: 901-448-6036 FAX: 901-448-7053 www.pharmacy.utmem.edu TEXAS Texas A& M University Health Science Center Irma Lerma Rangel College of Pharmacy MSC 131 1010 West Avenue B Kingsville, TX 78363-8202 Tel: 361-593-4723 FAX: 361-593-4233 www.pharmacy.tamhsc.edu Texas Southern University College of Pharmacy and Health Sciences 3100 Cleburne Street Houston, TX 77004 Tel: 713-313-4277 FAX: 713-313-1091 www.tsu.edu Texas Tech University Health Sciences Center School of Pharmacy 1300 South Coulter Amarillo, TX 79106 Tel: 806-354-5463 FAX: 806-356-4613 www.ttuhsc.edu/sop/ University of Houston College of Pharmacy 141 Sciences & Research Bldg 2 4800 Calhoun Houston, TX 77204-5000 Tel: 713-743-1253 FAX: 713-743-5678 www.uh.edu/pharmacy/

University of Incarnate Word Feik School of Pharmacy 4301 Broadway, CPO #99 San Antonio, TX 78209 Tel: 210-883-1000 FAX: 210-822-1516 www.uiw.edu/pharmacy/ University of Texas at Austin College of Pharmacy, The 1 University Station A 1900 PHR 2.112 Austin, TX 78712-0120 Tel: 512-471-1737 FAX: 512-471-8783 www.utexas.edu/pharmacy/ UTAH University of Utah College of Pharmacy 30 South 2000 East Room 201 Salt Lake City, UT 84112-5820 Tel: 801-581-6731 FAX: 801-581-3716 www.pharmacy.utah.edu VIRGINIA Hampton University School of Pharmacy Hampton, VA 23668 Tel: 757-727-5071 FAX: 757-727-5840 www.hamptonu.edu Shenandoah University Bernard J. Dunn School of Pharmacy 1460 University Drive Winchester, VA 22601 Tel: 540-665-1282 FAX: 540665-1283 www.su.edu/academic/pharmacy.asp University of Appalachia College of Pharmacy 1060 Dragon Road Oakwood, VA 24631 Tel: 276-498-4190 FAX: 276-498-4193 www.uacp.org/ Virginia Commonwealth University at the Medical College of Virginia Campus School of Pharmacy 410 North 12th Street MCV Box 980581 Richmond, VA 23298-0581 Tel: 804-828-3006 FAX: 804-827-0002 www.pharmacy.vcu.edu


WASHINGTON University of Washington School of Pharmacy H364 Health Sciences Box 357631 Seattle, WA 98195-7631 Tel: 206-543-2030 FAX: 206-685-9297 www.dept.washington.edu/pha Washington State University College of Pharmacy P.O. Box 646510 105 Wegner Hall Pullman, WA 99164-6510 Tel: 509-335-4750- FAX: 509-335-2530 www.pharmcay.wsu.edu

WISCONSIN University of Wisconsin-Madison School of Pharmacy 777 Highland Ave. Madison, WI 53705-2222 Tel: 608-262-1414 FAX: 608-262-3397 www.wisc.edu/pharmacy/ WEST VIRGINIA University of Charleston School of Pharmacy 2300 MacWorld Ave.S.E. Charleston, WV 25304 Tel: 304-357-4858 FAX: 304-357-4868 www.pharmacy.ucwv.edu/

West Virginia University School of Pharmacy P.O. Box 9500 1136 Health Science North Morgantown, WV 26506-9500 Tel: 304-293-5101 FAX: 304-293-5483 www.hsc.wvu.edu/sop WYOMING University of Wyoming School of Pharmacy 1000 E. University Ave. Dept 3375 Laramie, WY 82071 Tel: 307-766-6120 FAX: 307-766-2953 www.uwyo.edu/pharmacy/


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