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OPA Student Legislative Night

On February 21, 2018, I had the privilege of attending the Ohio Pharmacists Association’s Student Legislative Night. Three keynote speakers, Cathy Kuhn, Megan Marchal, and Antonio Ciaccia, discussed their involvement with advocacy throughout their careers and current legislation that challenges the practice of pharmacy. I went to this event as I am interested in advocacy on the state level. I intend to become an advocate, not just for the practice of pharmacy, but for other issues that are important to me, such as housing and employment discrimination and food insecurity among impoverished populations. Throughout the night, two points continuously resonated with me while the speakers were presenting. First, getting involved in advocacy is easy. Secondly, navigating the political sphere while lobbying is arduous. 

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First off, what is the Ohio Pharmacists Association (OPA)? As stated by The OPA, “The Ohio Pharmacists Association (OPA) was formed September 2, 1879 in Columbus, Ohio under the name Ohio State Pharmaceutical Association (OSPA). The purpose of the Association was to elevate the character of the pharmaceutical profession, by uniting the reputable druggists of the state in order to foster the education of those learning the art and thereby stimulate the talent of those engaged in pharmacy. In cooperation with its members and leaders, the present-day OPA continues to function by this purpose and act to positively impact the profession as these past extraordinary individuals did.” The OPA works to advance the practice and wellbeing of pharmacists by being advocates for legislation that improves the quality of the profession.

As stated by both Kuhn and Marchal, getting involved in advocacy is easy. Kuhn is the current president of the OPA, while Marchal is simultaneously an OPA member and currently serving as a chairman for the Ohio Board of Pharmacy (OBP). While Kuhn and Marchal had different experiences with advocacy in college, both noted that their current positions were achieved just by attending OPA meetings. They attended both general and committee meetings, and soon were asked to be on different committees, such as the Medication Therapy Management Committee and the Membership Committee. Soon afterwards, Kuhn was asked to run for president of the OPA, while Marchal was asked to be a chairman for the OBP. These ladies showed me that being an advocate doesn’t require some superior level of expertise/knowledge, but just by showing up to OPA meetings, my concerns can be addressed. I can become a voice for those in my community and address the issues that are conflating the pharmacy practice.

However, as stated by Ciaccia, advocacy becomes tricky while lobbying. Ciaccia works as a lobbyist for the OPA, speaking for the pharmaceutical profession. Ciaccia must navigate the political sphere, convincing legislators from both ends of the political field to either support, defeat, or negotiate on a bill. However, there is often conflicts of interest. Ciaccia admitted this happened when he was lobbying against House Bill 231, which would require pharmacists to maintain a supply of lockable vials for medications. While Ciaccia does not think the bill is feasible or viable, he noted that the two people that introduced the bill were representatives Ginter and Sprague, both of whom helped Ciaccia pass earlier bills. If he argued against their bill, he knew he would lose their support on future, more important pieces of legislation. To try and speak for the profession while simultaneously maintaining their support, Ciaccia worked against his interests and negotiated on the bill to make it reasonable. He taught me that you must be willing to make sacrifices to gain future support on more pivotal bills.

Overall, I know I would like to become an advocate, but perhaps not a lobbyist. Knowing myself, there are certain issues I would not and could not get myself to negotiate on to possibly benefit me in the future. Furthermore, I know I am not good at “navigating the battlefield” and being able to charismatically change someone’s view points. With that in mind, I know I would not like to go into lobbying. However, I do want to become an advocate and be the voice for people within my community and address their concerns with those that can make a difference.

 

Reflection on debating Mandatory Counseling for Pharmacists

When we take a stance on any issue, we often paint in ourselves a monochromatic view by thinking the issue is either black or white, right or wrong. We usually don’t consider the arguments presented by the opposing side, even though they could present valid points. In reality, most issues present a grey area, with pros and cons for each opposing view point. Recently, within my “advocacy in pharmacy” class at The Ohio State University, we discussed the arguments for and against mandatory counseling for pharmacists. By discussing the arguments for each side, we diverged from the typical debating format (where we defend the side we believe in) and constructed compelling arguments for both standpoints, for and against. As we concluded, the issue itself is a grey area, with captivating arguments for both fronts.

To begin, what is mandatory counseling? Mandatory counseling requires pharmacists to counsel patients on medications they are prescribed. As defined by American Society for Pharmacy Law, counseling is required by a pharmacist or a pharmacy intern when dispensing a medication to a new patient, dispensing a new medication to an existing patient, or when adjustments are made to a current prescription. Some of the many compelling arguments that were constructed by the class are as follows:Image result for pharmacy counseling

For Mandatory Counseling

  • it would increase medication adherence for patients
  • it would increase the accessibility of pharmacists while keeping pharmacists knowledgable on medications
  • it would help to combat the opioid epidemic plaguing Ohio
  • it would build the relationship between the pharmacist and the patient

Against Mandatory Counseling

  • it would decrease productivity within the workplace
  • it would increase wait times for patients
  • it would decrease professional autonomy
  • it could increase frustration from patients towards the pharmacist.

Before heading into the discussion, I was completely for mandatory counseling. My viewpoint seemed obvious. It would help decrease adverse drug events, save patients money, and address the opioid epidemic. It seemed like a no-brainer. After the discussion I do not know where I stand. By placing myself at the other end of the spectrum (against mandatory counseling) I challenged myself to confront my biases and think about counseling from a different perspective. I did not consider obstacles such as timing, workflow management, reimbursement, increase in documentation, and from a patient perspective, forcing them to receive a medical service they may or may not want. After learning about those challenges, my opinion was swayed to an extent. Overall, I still feel that mandatory counseling is good in intent and should be implemented to some degree, but to what degree I do not know. The concerns I mentioned above, as well as others that were stated, need to be addressed and resolved. My opinion falls into that grey area, where the pros and cons need to be throughly analyzed and addressed in an appropriate manner before I make my final opinion.

Another problem I recognized in myself was how inadequate my argument for mandatory counseling was. As stated in the previous paragraph, I essentially only had three viable arguments for the promotion of mandatory counseling. This might be okay if I am just talking to someone on the street. However, if I were to push for legislation or convince pharmacies to adopt counseling practices, these points are very weak. I would need to address those concerns listed above and rebuttle arguments opposing mandatory counseling. Furthermore, I would need to provide sufficient data/evidence to prove my points as well as expand upon more arguments in favor of mandatory counseling. This same logic can be applied to any stance on any issue, whether social, political, or economic. I need to consider the opposing side and look at the issue from all angles to create a solid, foundational argument.

Overall, I challenge everyone to undertake this approach to debating any issue. By constructing arguments for both sides on whatever issue is being discussed, it forces people to critically think about their stance and its relative strength. It helps establish considerable points that need to be addressed, and encourages people to negotiate. I encourage this approach as who knows, the end result could be that you switch your view completely.

Pharmacists and Trust

Within the medical world, pharmacists are at the forefront of patient care. They act as the mediators between the patient and the prescriber, ensuring that the patient’s concerns are addressed and proper medications are administered. However, one of the main issues surrounding pharmacy is the concept of trust. According to a recent Gallup poll from 2017, pharmacists were among the most trusted professionals, with 62% of of respondents saying they either highly or very highly trusted pharmacists. While this number is relatively high, pharmacists fall short to nurses, military officers, grade school teachers, and medical doctors. Furthermore, 38% of respondents said they had average, low, or very low trust in pharmacists. So, this begs the question: how can pharmacists gain more patient trust?

First, pharmacists can advocate for better representation in film and television. According to a recent article in the Pharmacy Times“In 2015, researchers conducted a study to determine whether pharmacist characters were depicted in a positive, negative, or neutral manner in films and TV shows available in the United States between 1970 and 2013. Their data found that of the 231 pharmacist portrayals identified, 145 (63%) were negative, 56 (24%) were neutral, and 30 (13%) were positive. Additionally, very few pharmacist characters were recurring ones on TV.” Demonstration, Projector, Movie Projector, Cinema, Film

Unfortunately, a lot of negative representations are derived from true scenarios, such as pharmacists secretly selling illicit drugs. Today’s pharmacists are mainly altruistic and don’t fall into bad practices. Because of this, they can and should prompt directors to stop misrepresenting pharmacists in television and film and instead opt for a more positive viewing of them and their practice. This in turn will show patients that pharmacists are not secretly drug dealers or practicing bad behaviors, as was presented previously on screen.

Secondly, pharmacists can adopt practices that promote honesty. When pharmacists know that a shady practice is occurring or that they made a mistake, they should be upfront about it to the patients. People are generally more trusting of those that admit their mistakes and work towards correcting themselves and averting the problem in the future. People are also more trustworthy of professionals that counteract unacceptable practices. One of those practices is prescribing placebos without patient consent.

Many physicians regularly prescribe placebos to their patients. According to a survey done by the British Medical Journalanywhere between 48%-58% of physicians prescribe placebos regularly. Although this article does not examine the United State’s physicians and their practices, it is safe to say that a relatively close amount of physicians in the US adopt the same practices. According to the American Medical Association, prescribing placebos is not an illegal practice. However, physicians must get informed consent, meaning patients must know about the study, the risks and benefits of participating in the study, and give their willing and voluntary consent to participating. With such a significant amount of physicians prescribing placebos, there’s bound to be cases where patients do not give their informed consent. Because pharmacists are the mediator between the patient and the physician, whenever they encounter a prescription for a placebo, they should contact the patient directly and make sure they gave their informed consent on the study.

Finally, pharmacists should adhere to confidentiality. As technology is becoming more advanced, it is easy for patient information to be obtained. Although online medical records and prescription records are beneficial for a pharmacist’s practice, they should take extreme caution when accessing this information by adopting simple practices. These practices can include adjusting computers so they can not be seen by patients from any angle, making sure waiting areas are far enough away from the counter so patients can not overhear any communication going on between the pharmacist and his/her current patient, and providing private rooms for management and consultative services.

Overall, pharmacists are seen as one of the most trustworthy professionals, but they can do more to increase trust between them and the patients. By advocating for better representation and adhering to practices that promote confidentiality and privacy, pharmacists can decrease bad perceptions of their profession and can promote an idea of confidence and assurance for patients. I wrote on this issue because I know that pharmacists are very well received. However, since pharmacists are at the forefront for the medical field, I feel they should be the most trusted professionals. By encouraging positive practices and behaviors from inside the field, this will help the relationship between the professionals and their patients, leading to a better medication experience for all involved.

 

What is Pharmacy?

What is the first thing that pops into your mind when you hear the word “pharmacy?” Probably someone in a white lab coat standing/sitting behind a counter dispensing pills or making medications. While partially true, that narrowed down view does not encompass everything about the field of pharmacy. With this in mind, we need to ask ourselves: What is pharmacy?

Pharmacy is an expansive field.Image result for Pharmacy

Pharmacy is defined as the practice of compounding (creating) and dispensing (distributing) of medications. However, it is an expansive field that involves many disciplines. These disciplines include:

  • Medicinal chemistry
  • Pharmaceutics
  • Pharmacognosy
  • Pharmacology
  • Pharmacy Practice
  • Pharmacy Administration

Overall, these disciplines stretch across many facets, from research, sales, and politics to the practice of pharmacy itself. All employees are working to ensure that safe, effective, medications are being created and given to patients to improve health and financial outcomes.

                                                                                                  Pharmacists are evolving, accessible care givers.

Image result for PharmacyPracticing pharmacists provide a variety of services towards all patients to improve their health, essentially being care givers. Pharmacists stereotypically compound medications and dispense them. However, automation is becoming more prevalent in the medical field, so pharmacists are evolving their practice to include more management and consultative services. Through services such as Medication Therapy Management (MTM), Medication Reconciliation, and general consultations, pharmacists perform a comprehensive review of the patient’s medications. Therefore, the pharmacists can find problems with the patient’s medications and ensure they are following their regimen and taking the correct dosage. In turn, the patient will experience improved health outcomes and possibly save money.

Furthermore, pharmacists are the most readily available, accessible care giver. Whereas talking to doctors and physicians requires scheduling an appointment, pharmacists are available 24/7 to perform said services, typically at no additional cost (for the time being). They are the most trusted of all medical professionals because of their interactions with patients.

Pharmacists are pivotal in collaborative practice.

Pharmacists also play an important role in interdisciplinary practice. More often than not, care givers like physicians and nurses collaborate with pharmacists in a clinical setting. Pharmacists act as the mediator between health care professionals and the patients, as they are the most knowledgeable on medications. The pharmacists can make suggestions to the physicians to ensure patients get the correct medications and the right dosage when they are discharged. Pharmacists can also ensure patients are taking the correct dosage of morphine, or other opioids that are given after surgery. By providing suggestions, the pharmacists help patients to gain optimal health outcomes.

Overall, pharmacy is an expansive and expanding field. While pharmacists do work in the community setting as both compounders and dispensers, as technology advances, those positions will diminish. Pharmacists will evolve to become more patient-oriented. They provide needed consultative and management services, helping patients to better their health-related outcomes while saving money and eliminating financial barriers. Additionally, pharmacists are at the forefront in innovative research. They are continuously doing research to create new and more effective medications. Altogether, pharmacists are more than just their stereotypes, and play a pivotal part in patient care.