august september issue 2013 palmetto pharmacist

Palmetto Pharmacist • Volume 53, Number 4 1

PharmacistPalmetto

The Official Journal of the South Carolina Pharmacy Association • Vol. 53, Num. 4

Fall’ Love SCPhA

in

with

2 Palmetto Pharmacist • Volume 53 Number 4

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Palmetto PharmacistVolume 53, Issue 4 Sept/October 2013The Palmetto Pharmacist, the official publication of the South Carolina Pharmacy Association, is distributed to association members as a membership service. Statements of fact and opinion are made by the authors alone and do no imply an opinion on the part of the officers or members of SCPhA. For advertising rates and other information, contact SCPhA.

What’s Inside...

5 SCPhA: It is Contagious President Steve McElmurray discusses the importance of passing on the value of membership

11 Member Update Information about members from across the state!

14 SCCP Study Looks at Media Portrayals of RPhs A new study conducted by SCCP looks at how pharmacists are portrayed in tv and movies 16 Pharmacists and Medication Adherance SCCP student Kristen Flake looks at the role pharmacists play

19 Creating Competitive Success Strategy for Independent Pharmacies Roland Thomas presents his next installment in a series of articles that give independent pharmacists an edge

31 Journal CE SCPhA brings back home study CE for you!

Regular Columns 21 PCSP 24 SCCP 28 Financial Forum 31 Journal CE 38 Classifieds

Advertisers 2 Smith Drug Company 4 Pharmacists Mutual 7 CardinalHealth 25 Display Options 26 PACE 38 JonWallace,AttorneyatLaw 39 Mutual Drug of North Carolina 40 QS/1


Palmetto PharmacistVolume 53, Number 3 June/July 2013 The Palmetto Pharmacist, the official publication of the South Carolina Pharmacy Association, is distributed to association members as a membership service. Statements of fact and opinion are made by the authors alone and do no imply an opinion on the part of the officers or members of SCPhA. For advertising rates and other information, contact SCPhA.

Board of Directors

President/Chairman of the Board

Steve McElmurray, RPh

Immediate Past President John Pugh, PharmD, RPh

President-Elect Bryan Amick, PharmD, RPh

Treasurer Pamela Whitmire, PharmD, RPh

Low Country Region Kristy Brittain, PharmD, RPh

Pee Dee Region Jarrod Tippins, PharmD, RPh

Midlands Region Patti Fabel, PharmD, RPh

Upstate Region Ed Vess, PharmD, RPh

At-Large DirectorWilliam Wynn, PharmD, RPh

Speaker, House of Delegates Michael Gleaton, PharmD, RPh

Speaker-Elect, House of Delegates Sarah Braga, PharmD, RPh

CEO Craig Burridge, MS, CAE

REGION DELEGATESLow Country Region Midlands Region Don Neuroth, RPh Craig Harmon, RPhDavid Proujan, RPh Sarah Braga, PharmD, RPh Tray Till, RPh Lynn Connelly, RPhWayne Weart, PharmD Kevin Brittain, PharmD, RPh Brian Clark, PharmD, RPh Upstate Region Pee Dee Region David Banks, RPh Jim Shuler, RPhSteve Greene, PharmD, RPh Kelly Jones, PharmD, RPh Walter Hughes, RPh Dan Bushardt, RPh Linda Reid, RPh

SCPhA STAFF Craig Burridge Chief Executive Officer Laura Reid Director of EventsKeenan Grayson Director of Membership Cassandra Hicks-Brown Director of Operations/ACPELauren Sponseller Director of CommunicationsJon Wallace, BS Pharm, JD SCPhA General CounselCecily DiPiro, RPh PPN Network Coordinator

PALMETTO PHARMACIST STAFF

Jennifer Simmons Layout/Design/ContentCraig Burridge Managing Editor

What’s Inside...

5 Metathesiophobia President Steve McElmurray discusses the irrational fear of change

7 State Phair 2013 A look at SCPhA’s 2013 Annual Convention

16 Legislative Wrap Up At the close of the legislative session, see how things tied up 21 A Perspective on Pet Medications Information on veterinary medications

25 My SCPhA Rotation Journal SCCP Student Michelle Nations discusses her rotation with SCPhA

33 Pharmacy Camp Attracts Young Audience A special camp at SCCP provides a unique experience for students

Regular Columns 18 SCCP 32 Financial Forum 36 Journal CE 33 Classifieds

Advertisers 2 Smith 4 Pharmacists Mutual 15 Mutual Drug of North Carolina 34 Display Options 42 PACE 43 Jon Wallace, Attorney at Law 44 QS1

LaurenLesesne

MeganMontgomery,PharmD,RPh


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PRESIDENT’S PLATFORM

SCPhA: It is Contagious

“ “

Itisthestartofanewmembershipyear.ItisthattimewhenSCPhAsendsoutrenewalnoticesandremindersaboutpayingyourdues.

Ifyouarelikeme,youareincrediblybusy.Work,friends,andfamilyarejustthetipoftheicebergwhenitcomestoobligationsanddemandsonyourtime,energyandresources.Itiseasytograbthatrenewalformfromyourmailbox,openitup,andsetitina“todo”pile,puttingitoffuntillater.However,I’mheretotellyoutopickituprightnow,fillitout,andsenditintoday.Youcanevensaveyourselfastampandrenewonline.YourduestoSCPhAwillbethebestinvestmentyoumakeallyear.

Withthemanydemandsthatweface,itisnicetoknowthatSCPhAistheretobackusup.OvertheyearsasIhaveservedinvariouscapacitiesontheBoard,ithasbecomeveryapparenttomethatSCPhAworkstirelesslytoprotectandadvancetheprofession.Betweentheamazingleaderswhoself-lesslygivetheirtimeandenergytotheprofessiontotheincrediblestaffwhoistheretosupportallofourendeavors,themoneythatyoupayinduesisdefi-nitelyworthit.

Ifyousendinyourrenewal,youarehelpingtosup-porttheprofession,too.Yoursupporthelpstoin-vestinthefutureofpharmacy.AportionofSCPhAduesgoestoourlegislativeefforts,whichadvancetheprofessionandprotectusagainstotherspecialinterestgroupsvyingtogettheirlegislationpassed.Duescoverthecontinualmonitoringofthehundredsofprofession-relatednewsstoriesthatcirculateeachday.Ourstaffkeeptheireyesoutforimportantin-formationthatcouldimpactus,whilesiftingthroughthemanystoriesthatdon’t.ThentheysharethatinformationviaSmallDoses,thePalmettoPharma-cist,SCPhA’swebsite,Facebook,Twitter,andmore!Inaddition,SCPhAprovidespersonalassistancetoallofthemembers(andnon-members)whocallinsearchofhelpandguidance.Whetherthestaffisansweringquestionsaboutlicensingprocedures,pharmacylaw,orupcomingcontinuingeducation,theyaretheretohelpandassistinanywaytheycan.Thisyear,I’dliketopersonallygiveyouallachal-lenge.

PRESIDENT’S PLATFORM

Inadditiontosendinginyourownduesrenewals,IwantyoualltofindsomeoneelseintheprofessionwhoisnotcurrentlyamemberofSCPhAandinvitethemtojoin.TellthemabouttheamazingbenefitsofSCPhA.AskthemtosupportpharmacyinSouthCarolina.Mentionittoyourco-workers,peers,family,andfriendswhoareapartofthiswonderfulprofession.Themorewehave,thelouderourvoicewillbe!

With the many demands that we face, it is nice to know that SCPhA is there to back us up.


Name

License/RegistrationNumber Degree(s)

Address

City State Zip

Phone Fax

Email

Company/PharmacyName

Address

City State Zip

WorkPhone WorkFax

NABPeID BirthDateandMonth(DDMM)

Membership Type: (Please select one) RegularRPhMember($150)Associate(Non-RPh)Member($150)VestedMember($2000one-timefee,noadditionaldues)FirstYearPracticingRPhMember($75)RetiredRPhMember($75)PharmacyTechnicianMember($35)Spouse/JointMembership($250percouple): SpouseName:__________________

Additional Contributions:

SC Pharmacy Advocacy Committee:Whileyour SCPhAduesautomaticallyassistpharmacyadvocacyefforts,youraddi-tionalcontributiontothePharmacyAdvocacyCommitteesup-portsgreateradvocacyinthelegislativearena.ContributionAmount:$50 $100 $250$500 $1,000 Other$______*Contributions to the PAC are not tax-deductible.

SC Pharmacy Foundation:Helppreservethepastandin-vestinthefutureofpharmacy.ContributionstotheSCPharma-cyFoundationarecompletelytaxdeductible.ContributionAmount:$50 $100 $250$500 $1,000 Other$______

Payment Information: TotalDuetoSCPhA:$___________________Check;check#__________(madepayabletoSCPhA)CreditCard: MC Visa AMEX DiscoverBillingAddress__________________________________BillingCity,State,Zip_____________________________CardNumber____________________________________Exp.Date___________CVV#____________________

ReadytobeapartofSouthCarolina’sleadingprofessionalpharmacyassociation?FillouttheformbelowandreturntoSCPhAwithpaymenttojoinfor2013-2014today.SCPhA’smembershipyearisfromOctober1,2013-September30,2014.

Please return to SCPhA, along with payment, to: 1350 Browning Road, Columbia, SC 29210

or you can fax credit card payments to 803.354.9207. Register online at www.scrx.org For questions, call 803.354.9977

SCPhA dues are NOT tax deductible as charitable contributions for income tax purposes. However, they may be tax deductible as ordinary and necessary business expenses subject to restrictions imposed by law with respect to asso-ciation lobbying activities. The Revenue Reconciliation Act of 1993 states that Association dues used for lobbying activities are not deductible as a business expense. As a result 15% of SCPhA dues cannot be deducted as a business expense for federal income tax purposes.

SCPhAMembership2013-2014

What’s new this year? SCPhA Student Association Fall 2013

willmarktheinauguralyearoftheSouthCaro-linaPharmacyStudentAssociation,undertheumbrellaofSCPhAandtheleadershipoftheJuniorBoard.

Member Referral Program ThisisanexcitingnewincentivetoencourageyourpeerstojoinSCPhA!EachtimethatamemberreferssomeonewhojoinsSCPhA,theirnamewillbeenteredintoadrawingtowin$1,000 CASH!ThewinnerwillbedrawnatSCPhA’sAnnualConventioninJune2014!

New Website! Therumorsaretrue—weareswitchingtoanewdatabaseandwebsitethatwillallowourmembersgreateraccesstoinfor-mation24/7!


cardinalhealth.com/GenerationRx

For more information about the award, visit cardinalhealth.com/GenerationRx

This award recognizes a pharmacist who has demonstrated excellence in community-based prescription drug abuse prevention. We celebrate this group’s outstanding efforts and commitment to raising awareness of the dangers of prescription drug abuse among the general public and among the pharmacy community.

© 2013 Cardinal Health. All rights reserved. CARDINAL HEALTH, the Cardinal Health LOGO, and EssENTIAL TO CARE are trademarks or registered trademarks of Cardinal Health. All other marks are the property of their respective owners. Lit. No. 5CR11959_sC (06/2013)

The south Carolina Pharmacy Association and the Cardinal Health Foundation congratulate the Presbyterian College School of Pharmacy’s APhA-ASP GenerationRx Project as the recipient of the 2013 Cardinal Health GenerationRx Champions Award!


Support Pharmacy in South Carolina

Yes, you can make a difference

Pharmacy is counting on you

will help us protect and defend pharmacy in South Carolina

Help us have a stronger voice at the SC State House.

Any amount that you can give

Contribute to the SC Pharmacy Advocacy Committee today!

Want a sticker like this?

Get one when you

contribute at least $25

Yes! I want to help support the SC Pharmacy Advocacy Committee

Name______________________________________Company___________________________________Address____________________________________City_________________ State______ Zip__________Phone______________________________________Email_______________________________________

Contribution Amount $____________Payment type: Check enclosedCredit Card: Visa AMEX MC DiscoverCard #______________________________________Exp. Date____________________ CCV#__________

Return to SCPhA: 1350 Browning Road, Columbia, SC 29210, or fax to 803.354.9207.

Name_______________________________________________

Address_____________________________________________

City________________ State____________ Zip____________

Phone_______________________________________________

Email________________________________________________

Contribution Amount: $___________

Payment: ___Check enclosed or ____ Credit Card

Type: AMEX Visa Discover MasterCard

Card Number _________________________________________

Exp. Date______________ CCV #________________________

Billing Address________________________________________

City_______________ State___________ Zip______________


Not in this photo? You should be!

Save the Date for the 2014 Legislative Day

March 19, 2014 Columbia, SC


Tenta�ve Event Details Friday, December 6

6 pm‐7 pm Welcome Recep�on

Saturday, December 7 8 am‐12 pm

New Drug Update (4 hours) Wayne Weart, PharmD, FAPhA,

FASHP, BCPS Sunday, December 8

8 am‐12 pm Assessing Your Fraud, Waste and

Abuse Compliance Program (2 hours) Craig Burridge, MS, CAE

Pharmacy's Niche in Improving Health Literacy (2 hours) Craig Burridge, MS, CAE

Complete this form and return with

payment to SCPhA, 1350 Browning Rd., Columbia, SC 29210 or fax to 803.354.9207.

Visit www.scrx.org to register online. Call 803.354.9977 with ques�ons.

The South Carolina Pharmacy Associa�on is accredited by the Accredita�on Council for Pharmacy Educa�on as a provider of con�nuing pharmacy educa�on. Con�nuing educa�on credits will be available to par�cipants who fully a�end the program and then complete an online educa�onal ac�vity evalua�on. A unique code given at each ac�vity must be provided in the evalua�on to receive credit. Grievances regarding the educa‐�on program must be submi�ed in wri�ng to the SCPhA ACPE Administrator immediately following the program.

Registra�on Informa�on: Name____________________________________________________________ □ Technician □ Pharmacist □ Student Email________________________________________________________________Phone______________________________________ Address_________________________________________________________________________________________________________ License/Reg #_____________________ NABP eID#_______________________________Birthdate (MM/DD)_______________________ Payment Informa�on: Payment Type: □ Check _____________ Total Amount Due: $_____________ Credit Card Type: □ MC □ Visa □ AMEX □ Discover Name on Card___________________________________________________ Card #_____________________________________________________________ Exp. Date____________________ CVV_____________ Billing Address ___________________________________________________________________________________________________ Cancella�ons will only be accepted if received more than 5 business days before the event. If applicable, a refund will be issued less a $25 processing fee. Please note that the threat of inclement weather is not considered sufficient to override our cancella�on policy.

Please join SCPhA for our annual CE Escape, where you will enjoy great weekend full of learning, relaxing and holiday shopping!

December 6‐8, 2013 The Wes�n, Hilton Head Island, SC

Call 800.681.4000 by November 6, 2013 to receive the group rate of $99 per room!

Members Before November 6 A�er November 6 □ Full Registra�on ($149) □ Full Registra�on ($169) □ Saturday Only ($99) □ Saturday Only ($109) □ Sunday Only ($99) □ Sunday Only ($109) □ Student Registra�on ($79)

Non‐Members *If renewing or joining on this form, select from the member rates above* Before November 6 A�er November 6 □ Full Registra�on ($179) □ Full Registra�on ($199) □ Saturday Only ($119) □ Saturday Only ($129) □ Sunday Only ($119) □ Sunday Only ($129)

I would like to register a guest (includes all except CE credit): Qty. _____ x $79 Guest Name(s): _________________________________ I would like to donate to the student scholarship fund: □ $100 □ $50 □ $25 □ Other: ______________ To renew or join SCPhA now, please select your member type below: □ Pharmacist ($150) □ Associate ($150) □ Re�red ($75) □ First Year ($75) □ Technician ($35) □ Student (free!)


LynnConnelly,formerSCPhAPresident,recentlyhadaveryinterestingexperience.HehadstudentsinhispharmacyfromalloftheschoolsofpharmacyinSouthCarolina. From left to right: Charles (Max) Lesslie, a P2 student at SCCP USC campus, Caleb Fackler, a P1 student at SCCP MUSC campus, Lynn Connelly, owner Medicine Mart Pharmacy in West Columbia, Jeanita (Jenny) Pinkerton, a P3 student at South University College of Pharmacy, Amber Rish, a P4 student at Presbyterian College School of Pharmacy

Tenta�ve Event Details Friday, December 6

6 pm‐7 pm Welcome Recep�on

Saturday, December 7 8 am‐12 pm

New Drug Update (4 hours) Wayne Weart, PharmD, FAPhA,

FASHP, BCPS Sunday, December 8

8 am‐12 pm Assessing Your Fraud, Waste and

Abuse Compliance Program (2 hours) Craig Burridge, MS, CAE

Pharmacy's Niche in Improving Health Literacy (2 hours) Craig Burridge, MS, CAE

Complete this form and return with

payment to SCPhA, 1350 Browning Rd., Columbia, SC 29210 or fax to 803.354.9207.

Visit www.scrx.org to register online. Call 803.354.9977 with ques�ons.

The South Carolina Pharmacy Associa�on is accredited by the Accredita�on Council for Pharmacy Educa�on as a provider of con�nuing pharmacy educa�on. Con�nuing educa�on credits will be available to par�cipants who fully a�end the program and then complete an online educa�onal ac�vity evalua�on. A unique code given at each ac�vity must be provided in the evalua�on to receive credit. Grievances regarding the educa‐�on program must be submi�ed in wri�ng to the SCPhA ACPE Administrator immediately following the program.

Registra�on Informa�on: Name____________________________________________________________ □ Technician □ Pharmacist □ Student Email________________________________________________________________Phone______________________________________ Address_________________________________________________________________________________________________________ License/Reg #_____________________ NABP eID#_______________________________Birthdate (MM/DD)_______________________ Payment Informa�on: Payment Type: □ Check _____________ Total Amount Due: $_____________ Credit Card Type: □ MC □ Visa □ AMEX □ Discover Name on Card___________________________________________________ Card #_____________________________________________________________ Exp. Date____________________ CVV_____________ Billing Address ___________________________________________________________________________________________________ Cancella�ons will only be accepted if received more than 5 business days before the event. If applicable, a refund will be issued less a $25 processing fee. Please note that the threat of inclement weather is not considered sufficient to override our cancella�on policy.

Please join SCPhA for our annual CE Escape, where you will enjoy great weekend full of learning, relaxing and holiday shopping!

December 6‐8, 2013 The Wes�n, Hilton Head Island, SC

Call 800.681.4000 by November 6, 2013 to receive the group rate of $99 per room!

Members Before November 6 A�er November 6 □ Full Registra�on ($149) □ Full Registra�on ($169) □ Saturday Only ($99) □ Saturday Only ($109) □ Sunday Only ($99) □ Sunday Only ($109) □ Student Registra�on ($79)

Non‐Members *If renewing or joining on this form, select from the member rates above* Before November 6 A�er November 6 □ Full Registra�on ($179) □ Full Registra�on ($199) □ Saturday Only ($119) □ Saturday Only ($129) □ Sunday Only ($119) □ Sunday Only ($129)

I would like to register a guest (includes all except CE credit): Qty. _____ x $79 Guest Name(s): _________________________________ I would like to donate to the student scholarship fund: □ $100 □ $50 □ $25 □ Other: ______________ To renew or join SCPhA now, please select your member type below: □ Pharmacist ($150) □ Associate ($150) □ Re�red ($75) □ First Year ($75) □ Technician ($35) □ Student (free!)

Meet Lisa Fitzgerald Honeycutt!LisaistheownerandpharmacistatTegaCayPhar-macyinFortMill,SC.LisaopenedherpharmacyinFebruaryof2005andhasbeeninbusinessforover8years.Lisahastwochildren;a14-year-oldsonwhoplaysinthebandatNationalFordHighSchool,anda12-year-olddaughterwhodancesandattendsschoolatFortMillMiddleSchool.Outsideofpharmacy,LisaisontheBoardoftheFortMillCommunityPlayhouseandisontheAdvisoryBoardatYadkinValleyBank.Lisadecidedtoopenherownpharmacywhenshewasworkingparttimeforachaindrugstoreandstayingathomewithherchildren.ShemissedinteractingwithhercustomersandopenedTegaCayPharmacytohavemoreofarelationshipwithhercustomers.

Mostpharmaciesexperienceanumberofstrugglesandsuccessesthathelpthemtogrowanddevelopstrongerbusinessmodels.OneofthestrugglesthatLisaisdeal-ingwith,alongwithmostotherpharmacies,istheissueofmandatoryordiscountedmail-orderprescriptions.Almosteverypharmacyinthestatehasfeltsignifi-cantlydecreasedsalesduetothesepolicies.ForLisa,inparticular,BankofAmericaemploysalargeportionofthepopulationinherarea.InadditiontoMedicareandotheragencies,BankofAmericahasimplementedamandatorymail-orderpolicyforitsemployees.Hercustomersseemtobeoutragedthattheydon’thaveachoice.Mail-orderisabigissuethatisaffectingphar-macieseverywhere.ThisisanissuethattheSCPhABoardiscurrentlyresearchingtoseewhatcanbedoneabouttherelevantlegislation.PleasefeelfreetoemailourCEO,CraigBurridge,[email protected],forcurrentinformationregardingthislegislation.

OneofLisa’smostnotablesuccessesishercustomerretentionrate.Lisamaintainsahealthynumberofloyalcustomers.Despitethefactthatshehaslostsalesandrevenuefromcustomerswhohavebeenforcedintomail-order,thosecustomerscontinuetovisitherforconsultationonthemedicationsthattheyarereceiv-ing.HavingrelationshipswithhercustomersisthereasonthatLisadecidedtoopenherownpharmacyandiswhatgivesTegaCayPharmacyitsuniquesenseofcommunityandpersonalizedcare.Shealsogoesaboveandbeyondbyallowingstudentsfromalocalhighschoolshadowherwork.Shehadonestudentwhoshadowedwithherfortwoyearsandisnowabout

tostartherFresh-manYearatClemsonUniversitytopursueadegreeinBiomedicalEngineering.An-otherstudentwhoshadowswithherisaSeniorandacertifiedCPhTandcontinuestoworkwithherinthesummers.LisaisalsoapreceptorforPharmacyTechni-cianStudentsatYorkTechnicalCollege.

Inanefforttogrowwiththechangingatmosphereinpharmacy,TegaCayPharmacyisplanningtorenovatethestorefronttoaccommodateforaprivateMTMandImmunizationarea.Theplanistode-creasetheworkspacebehindthecounterandplacemorefocusonan“infrontofthecounter”modelandprovidemoreprivacyforimmunizationsandMTMconsultations.StopbyTegaCayPharmacytoseewhatLisaisupto!

MEMBERS


MEMBERS

Ann Rabon, Owen Drug

Banks Pharmacy

Greg Mayer, Apothecare Pharmacy

Riley’s Drugs

Florence Pharmacy


MEMBERS

M&H Drugs, Johnston, SC

Longs Long Term Care Facility

Medicine Mart Pharmacy, Lexington , SC

Walgreens, Batesburg-Leesville

Riley’s Pharmacy, Lexington Virginia College, Florence


SCCP

Popquiz:nameafamousportrayalofapharmacistinatelevisionseriesorinfilm?

It’snoteasy.Andchancesareifonedoescometomindit’sprobablysomeoneusedasacomicfoilorbehavingerratically(thinkMr.Gowerfrom“It’saWonderfulLife”).

AresearchprojectunderwayattheSouthCarolinaCollegeofPharmacyaimstoexposenegativestereo-typesabouttheprofessionandeducateHollywoodalongthewayaboutthesignificantrolepharmacistsplayintoday’shealthcaresystem.

“Itsoundsstrange,butIdohaveapassionforthis,”saidpharmacyprofessorBrandonBookstaver,whoservesasvicechairofthecollege’sDepartmentofClinicalPharmacy&Outcomes.“Ithinkit’simpor-tantforustoworktochangesomeofthemispercep-tionsaboutwhatwedo.”

TheprojectwasbornoutofaconversationlastyearbetweenBookstaverandfirstyearpharmacystudentAmyYanicak,whowaslookingforanovelstudentresearchtopic.Partofthediscussionwasaboutwhypharmacy—rankedasoneofAmerica’smosttrustedprofessions--israrelyreflectedaccuratelyintheme-dia,eveninshowsabouthealthcareworkers.

Yanicaksecuredfundingfortheprojectfromtwogrants,onefromtheHonorsCollegeScienceUnder-graduateResearchFellowshipsprogramandtheotherfromtheMagellanScholarProgramintheOfficeofResearch.Bookstaversignedonasthefacultymentorfortheproject.

Withthehelpofseveralstudentassistantsandstaffmembers,theInternetandaNetflixaccount,theteambeganananalysisofscoresoffictionalshowsandmovieswhereapharmacistappearsasacharacter,evenifonlyforafewseconds.Thegoalistocatchasmanyreferencesaspossibleoverthepast35yearsandclassifytheportrayalsaspositive,negativeorneutralusingastandardsurveytool.

Sofar,theteamhasanalyzedmorethan200portray-alsinAmericanfilmsandTVshowsrangingfrom“TwoandHalfMen”to“HouseM.D.”

“Everybody’shadtositthroughsomeprettystrange

SCCP Study Looks at Media Portrayals of Pharmacistsstuff.It’sbeenmostlydramas,thrillersand,forsomereason,quiteafewhorrormovies,”Yanicaksaid.Whiletheresearchwon’tconcludeuntilthissummer,thepreliminaryresultsarenotencouraging.

“Unfortunately,it’sverynegative,”Bookstaversaid.“Often,pharmacistsarevictimsofcrimesorperpetra-torsofcrimesthemselves.Eveninashowlike“ER,”theyshowuponlyonceortwice,andwhentheydo,they’reeithermakingamistakeorappearingunpre-pared.”

Notalldepictionshavebeenbad.Yanicak’spersonalfavoriteis“InOldCalifornia,”whereJohnWayneportraysapharmacistwhofightsoutlawswhilesavingagroupofgoldminersfromtyphoidfever.Unfortu-nately,itwasfilmedin1941soitfelloutsidethescopeoftheresearch.

Whileitmaybetemptingtoshrugoffthenegativeportrayals,Yanicaksaidshefearstheabsenceofphar-macistsascompetentprofessionalscouldbeharmfultofuturerecruitmentandbuildingpatienttrust.That’simportantbecausepharmacistsaretakingonmoreresponsibilitiesaspatientcaredeliverymodelsevolveandissueslikemedicationsafetygetmoreattention.

“Iwanttogointohospitalpharmacy,andwouldhateforpeopletothinkthatwhatseeonTVishowitworksintherealworld,”Yanicaksaid.

Theprojectisscheduledtowrap-upthissummer,andthegroupwillpresentthefindingstotheSouthCaro-linaSocietyofHealth-SystemPharmacyinthefall.Theteamalsoissendingletterstotelevisionandfilmwritersidentifiedthroughtheresearch,askingthemwhytheychosetodepictpharmacistsastheydid.

“I’mnotsureifwe’llgetmanyresponses,butmaybewe’llgetthemtoatleastthinkaboutpharmacymore,”Yanicaksaid.

Viewapreviewvideoabouttheresearch.Theresearchteambelievesithadidentifiedthevastmajorityoffictionalpharmacistportrayalsduringthelast35years.Topassalongatiptotheresearchteam,[email protected].

ByOfficeofMediaRelations,UniversityofSouthCarolina


Where would you prefer to have your HIPAA training?

Option A Option B

Yep. That’s what we thought. Get your HIPAA training online, 24 hours a day, 7 days a week with SCPhA’s on-line HIPAA training program.

Assessing Your Pharmacy’s HIPAA Policies & Procedurescreated by Craig Burridge, MS, CAE, CEO, South Carolina Pharmacy Association Goals and Objectives:1. Identify the laws covering confidentiality and their lead up to HIPAA.2. Recognize the standard principles governing confi-dentiality as it relates to patient records.3. Identify the need for and responsibilities of a pri-vacy officer and workforce training requirements.4. Differentiate between the proper uses and disclos-ers of protected health information and permitted uses and disclosures.5. Recognize when authorization is necessary for protected information.6. Identify the requirements for the distribution of Privacy Practices Notices.7. Know how to develop an electronic protected health information policy.8. Recognize how to mitigate and notify affected individuals in case of a breach of protected health information.9. Identify the expanded HIPAA requirements under the Health Information Technology for Economic and Clinical Health Act (HITECH)

Fees:SCPhA Members: $15\Non-Members: $25Please note that this is required in order to obtain 2 hours of CE Credit.

The South Carolina Pharmacy Association is accredited by the Accreditation Coun-cil for Pharmacy Education as a provider of continuing pharmacy education. This home study is approved for 2 contact hours of continuing pharmacy education credit (ACPE UAN: 0171-0000-13-074-H03-P). This CE credit expires 8/08/2016.

Register online at www.scrx.org, or follow the QR code to the right!


MEDICATION

Pharmacistsplayanintegralpartinteachingpatientsaboutmedicationadherencebecausetheyareoftenthemostaccessiblemembersofthehealthcareteam.Itiseasyforpatientstopickupthephoneandcalltheirlocalpharmacisttoaskhealth-relatedques-tions,whereasitmaytakelongertogetintouchwiththeirprimarycaredoctor.Ihavebeenabletoseefirst-handworkinginaretailpharmacyjusthowimportantpharmacistsarewhenitcomestoteach-ingmedicationadherence.Patientscomeintothepharmacytorefilltheirmedicationsthathavenotbeenfilledinmonths,andtheycomeupwithvariousreasonswhytheyhaven’tbeentakingthem;afewofthosereasonsbeingthattheyareoverwhelmedbythedosingregimenorthattheyjustsimplyforgettotakethembecausetheyaretakingsomanymedications.Thisisagreatopportunityforpharmaciststostepinandeducatetheirpatientsonthevalueoftheirdrugtherapy.

Therearemanychronicdiseasestatesthatrequirepatientstotakemultiplemedications.Someofthesediseasestatesincludecardiacdisease,respiratorydisease,diabetes,hypertension,organtransplant,HIV/AIDS,andpsychiatricdisorders.Whenapatienthasmorethanoneofthosediseases,theycanpotentiallybetakingupwardsoftenmedicationsaday,nottomentionthatalotofthosemedicationshavetobetakenmorethanonceaday.Sideeffectsfromonemedicationmaycausethemtotakeanothermedicationtotreatthosesideeffects,soessentiallyitisanever-endingcycle.Thiscreatesbarrierstomedicationadherenceforpatients,leadingtomorehospitalizationsandincreasinghealthcarecostsduetosuboptimaltreatment.

CraigBurridge,CEOoftheSouthCarolinaPharma-cyAssociation,assistedinmovinganon-pharmacistadherenceprogramtoNewYorkinthemid-90’sandhelpedmakeitacommunity-basedadherenceprograminvolvingpharmacists.Atthattime,hewastheExecutiveDirectorofthePharmacistSocietyoftheStateofNewYork,andtheprogramwasknownasCareLineTMComplianceandMonitoringSer-vices.AmentalhealthdoctorinCaliforniaoriginallydevelopedthisprogram,andherealizedthatpharma-

cistsplayanimportantroleinreachingpatientswithchronicdiseasesthatarenoncompliantwiththeirmedications.Communitypharmacist,inparticular,wouldphysicallymeetwiththepatientsenrolledinthisprogrammonthlytodo“post-diagnosticcare,”whilealsoconsultingwiththephysiciansandnursestodevelopaplanspecifictoeachpatient.Itwasverysuccessfulinnotonlymakingthepatientsmoreadherent,butalsosignificantlyreducingthehealthcarecostsofthesepatientswhohadunneces-saryadmissionstohospitals,nursinghomes,anddaycarefacilitiesforsimplereasonssuchasmedicationnoncompliance.Forexample,apatientthatmadethreeERvisitsinsixweekspriortobeingenrolledinthecomplianceprogramdidnotmakeasingletriptothehospitalaftertheprogram,savingthousandsofdollars.1Today,weseeclinicalpharmacistinahospitalsettingdomoreofthistypeofcare,butwiththesuccessesofthisprogramandmanyothers,itiseasytoseewhyitshouldalsobedoneinacommu-nitysetting.

TheCareLineTMprogramrecognizedearlyontheimportanceofmedicationadherence.InamorerecentretrospectivestudyconductedbySokoland

Pharmacists and Medication Adherence Kristen Flake, PharmD Candidate, SCCP, SCPhA Rotation


ACA Frequently Asked Questions

As an employer, do I need to do anything this year now that this is law? Thebulkoftheemployerrequirementsforcoverageandpenal-tiesdonotbeginuntil2014.Allofthedetailsarenotyetknown,andactionbyseveralfederalagenciesisrequiredtofurtherdefinesomeoftherequirements.

I heard about small business tax credits. When do they begin and am I eligible? BeginningJan.1,2010,certainsmallbusinesseswith10to25full-time-equivalentemployeesmayqualifyforataxcreditforcontributingtotheiremployees'healthcoveragenow.Morede-tailsarecomingsoon.

Will I be required to provide health care to my employees? Employerswith50ormorefull-time-equivalentemployees(seebelow)willberequiredtooffertheirfull-timeemployeesa"minimumessentialcoverage"healthbenefitspackagestartingin2014orpayapenaltyfornotdoingso.Minimumessentialcover-agehasnotbeenfullydefined;seemorebelow.

Will small businesses be required to provide coverage too? No.Employerswhohavefewerthan50full-time-equivalentsarenotsubjecttothelaw.

Do I have to provide coverage for my part-time employees? No.Part-timeemployeesarecountedonlyindeterminingwheth-eranemployermeetsthesmall-businessthresholdforcoverageunderthelaw.Innocasedoemployershavetoprovidehealthcarecoverageforpart-timeemployeesorpaypenaltiesforpart-timeemployees.

If I choose to provide health care coverage, how much will I have to provide? Coveredemployerswillhavetoprovide"minimumessentialcoverage"withatleasta60percentactuarialvaluetomeettherequirementsofthelaw.Thiswillbedefinedthroughtheregula-toryprocess.

Are there penalties for employers subject to the law who do not provide coverage? Yes.Anemployerwhoiscoveredbythelawmaychoosenottoprovidecoverage,butwillbesubjecttoapenaltyof$2,000perfull-timeemployeeannually.Employersmayexclude30full-timeemployeesincalculatingtheirpenalty.Forexample,acoveredemployerwhohas60full-timeemployeesandchoosesnottoprovidecoveragewouldfaceanannualpenaltyof$60,000.[60totalfull-timeemployees-30full-timeemployeesexcludedfromthecalculation=30;30x$2,000penalty=$60,000.]

associatesof137,277patientswhowereenrolledinmedicalanddrugbenefitplans,demonstratedtheimpactthatmedica-tionadherencecanhaveonhealthcareutilizationandcostsfor4chronicdiseasestates:diabetes,hypertension,hypercho-lesterolemia,andcongestiveheartfailure.Forall4conditions,hospitalizationratesweresignificantlylowerforpatientswhosustained80-100%medicationadherence.Fordiabetes,inparticular,wheremedica-tionadherenceistypically50-65%,thestudyrevealedthatmedicationadherencewasassociatedwithasubstantialreductioninmedicalcosts,whichincludedoutpatientservices,ERservices,andhospitalizations.Therewerehigherdrugcostsbecausethepatientsweremorecompliantwiththeirmedications,butthiswasoffsetbythesignificantreductioninmedicalcosts,stillleadingtoadecreaseinoverallhealthcarecosts.Thisneteconomicbenefitwasalsodemonstratedwithhypercholesterolemia.3

OnmyrotationwiththeSouthCarolinaPharmacyAssociation,Ihavebeenabletobetterunderstandthepotentialeconomicimpact that community pharmacists can haveonhealthcarecoststhroughadher-enceprograms.In2012,pharmacistsranked2ndonanannualpollconductedbyGallup,asoneofthecountry’smosttrustedprofessionals.2Withthatranking,aswellasbeingoneofthosemostacces-siblehealthcareprofessionals,itiseasytoseewhycommunitypharmacistshouldplayabiggerroleinpost-diagnosticcareforpatients.

References: 1. Max Wagener, Craig Burridge. Medi-cation Compliance: The Pharmacist and the Non-Compliant Patient. CE Program # 170-000-96-005-L042. Oldfield E. Pharmacists Rank Among Most Trusted Professionals [Internet]. Phar-macy Times. New Jersey: Intellisphere. 2012 December 11 [cited 2013 July 22]. Available from: http://www.pharmacytimes.com/news/Pharmacists-Rank-Among-Most-Trusted-Pro-fessionals3. Sokol, MC., McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adher-ence on hospitalization risk and healthcare cost. Med Care 2005 June;43(6):521-30.


Members (SCPhA, GPhA, KPhA, MPhA, NCAP, TPA, VPhA) Early Bird Registration Regular Registration Before Dec. 17 After Dec. 17 Extras □ Full Registration $229 $259 □ Guest Registration: includes all except CE ($149) □ Friday Only $129 $149 Guest Name: ________________Guest Shirt Size (S-2X): ____ □ Saturday Only $89 $109 □ Addt’l Friday Reception tickets ($69) Qty: _________ □ Sunday Only $89 $109 □ Friday Paint and Mingle tickets ($49) Qty: _________ □ Saturday & Sunday Only $159 $189 Back by popular demand! After the reception, you can □ Student Registration $149 join us for a Paint and Mingle networking experience! At this optional event, you will paint a piece of artwork while getting to know fellow attendees. Take home your art to remember the weekend. No artistic ability required. Non-Members *If renewing or joining on this form, please select from the member rates above* Early Bird Registration Regular Registration Before Dec. 17 After Dec. 17 Extras □ Full Registration $319 $369 □ Guest Registration: includes all except CE ($149) □ Friday Only $159 $179 Guest Name: ________________Guest Shirt Size (S-2X): ____ □ Saturday Only $119 $139 □ Addt’l Friday Reception tickets ($69) Qty: _________ □ Sunday Only $119 $139 □ Friday Paint and Mingle tickets ($49) Qty: _________ □ Saturday & Sunday Only $219 $249 Please see above for description. I would like to sponsor a student to attend: □ Full Sponsorship ($149) □ Partial Sponsorship ($99) □ Other Amount: __________ To renew or join SCPhA now, please select your member type below: □ Pharmacist ($150) □ Associate ($150) □ Retired ($75) □ First Year ($75) □ Technician ($35) □ Student (free!) Registration Information: State: □ SC □ GA □ KY □ MS □ NC □ TN □ VA □ Other: ______ Full & Student Registrants, select your shirt size (S-2X): ___________ Name____________________________________________________________ □ Technician □ Pharmacist □ Student Email________________________________________________________________Phone_____________________________________ Address_________________________________________________________________________________________________________ License/Reg #___________________ NABP eID#_____________________________Birthdate (MM/DD)_____________________ Payment Information: Payment Type: □ Check _____________ Total Amount Due: $____________ Credit Card Type: □ MC □ Visa □ AMEX □ Discover Name on Card__________________________________________ Card #__________________________________________________________Exp. Date____________________CVV______________ Billing Address___________________________________________________________________________________________________ Cancellations will only be accepted if received more than 5 business days before the event. If applicable, a refund will be issued less a $25 processing fee. Please note that the threat of inclement weather is not considered sufficient to override our cancellation policy.

The South Carolina Pharmacy Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. Continuing education credits will be available to participants who fully attend the program and then complete an online educational activity evaluation. A unique code given at each activity must be provided in the evaluation to receive credit. Grievances regarding the education program must be submitted in writing to the SCPhA ACPE Administrator immediately following the program.

January 17-19, 2014 Omni Grove Park Inn ● Asheville, NC

Partnering State Associations: Georgia ● Kentucky ● Mississippi

North Carolina ● Tennessee ● Virginia

Gather your friends for a weekend of fun, facts and facials! Full registration includes:

CE programming, breakfast on Saturday and Sunday, a dinner reception on Friday,

an event t-shirt and gift bag!

Rooms and spa appointments are available at the Omni Grove Park Inn. Call 800.438.5800 by December 17 to take advantage of our group rate!

Complete this form and return, with payment, to SCPhA, 1350 Browning Road, Columbia, SC 29210 or fax to 803.354.9207.

Visit www.scrx.org to register online. Questions? Call Laura Reid, Director of Events, at 803.354.9977.


Members (SCPhA, GPhA, KPhA, MPhA, NCAP, TPA, VPhA) Early Bird Registration Regular Registration Before Dec. 17 After Dec. 17 Extras □ Full Registration $229 $259 □ Guest Registration: includes all except CE ($149) □ Friday Only $129 $149 Guest Name: ________________Guest Shirt Size (S-2X): ____ □ Saturday Only $89 $109 □ Addt’l Friday Reception tickets ($69) Qty: _________ □ Sunday Only $89 $109 □ Friday Paint and Mingle tickets ($49) Qty: _________ □ Saturday & Sunday Only $159 $189 Back by popular demand! After the reception, you can □ Student Registration $149 join us for a Paint and Mingle networking experience! At this optional event, you will paint a piece of artwork while getting to know fellow attendees. Take home your art to remember the weekend. No artistic ability required. Non-Members *If renewing or joining on this form, please select from the member rates above* Early Bird Registration Regular Registration Before Dec. 17 After Dec. 17 Extras □ Full Registration $319 $369 □ Guest Registration: includes all except CE ($149) □ Friday Only $159 $179 Guest Name: ________________Guest Shirt Size (S-2X): ____ □ Saturday Only $119 $139 □ Addt’l Friday Reception tickets ($69) Qty: _________ □ Sunday Only $119 $139 □ Friday Paint and Mingle tickets ($49) Qty: _________ □ Saturday & Sunday Only $219 $249 Please see above for description. I would like to sponsor a student to attend: □ Full Sponsorship ($149) □ Partial Sponsorship ($99) □ Other Amount: __________ To renew or join SCPhA now, please select your member type below: □ Pharmacist ($150) □ Associate ($150) □ Retired ($75) □ First Year ($75) □ Technician ($35) □ Student (free!) Registration Information: State: □ SC □ GA □ KY □ MS □ NC □ TN □ VA □ Other: ______ Full & Student Registrants, select your shirt size (S-2X): ___________ Name____________________________________________________________ □ Technician □ Pharmacist □ Student Email________________________________________________________________Phone_____________________________________ Address_________________________________________________________________________________________________________ License/Reg #___________________ NABP eID#_____________________________Birthdate (MM/DD)_____________________ Payment Information: Payment Type: □ Check _____________ Total Amount Due: $____________ Credit Card Type: □ MC □ Visa □ AMEX □ Discover Name on Card__________________________________________ Card #__________________________________________________________Exp. Date____________________CVV______________ Billing Address___________________________________________________________________________________________________ Cancellations will only be accepted if received more than 5 business days before the event. If applicable, a refund will be issued less a $25 processing fee. Please note that the threat of inclement weather is not considered sufficient to override our cancellation policy.

The South Carolina Pharmacy Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. Continuing education credits will be available to participants who fully attend the program and then complete an online educational activity evaluation. A unique code given at each activity must be provided in the evaluation to receive credit. Grievances regarding the education program must be submitted in writing to the SCPhA ACPE Administrator immediately following the program.

January 17-19, 2014 Omni Grove Park Inn ● Asheville, NC

Partnering State Associations: Georgia ● Kentucky ● Mississippi

North Carolina ● Tennessee ● Virginia

Gather your friends for a weekend of fun, facts and facials! Full registration includes:

CE programming, breakfast on Saturday and Sunday, a dinner reception on Friday,

an event t-shirt and gift bag!

Rooms and spa appointments are available at the Omni Grove Park Inn. Call 800.438.5800 by December 17 to take advantage of our group rate!

Complete this form and return, with payment, to SCPhA, 1350 Browning Road, Columbia, SC 29210 or fax to 803.354.9207.

Visit www.scrx.org to register online. Questions? Call Laura Reid, Director of Events, at 803.354.9977.

STORE PLANNING

Creating a Competitive Strategy for Independent Pharmacy Success By Roland Thomas

This is the Fourth of a Series of Topics that began with creating a Business Model followed by develop-ing the optimum size for your pharmacy, Location evaluation and we now step inside the pharmacy to discuss Pharmacy Layout and Design.

PHARMACY LAYOUT Quiteoften,pharmacylayoutanddesignarethoughtofasoneinthesame.Nottrue.Layout,orfloorplan,hastodowithfunctionalitywhiledesigndealswithaesthetics.Ilookatlayoutanddesignastwosidesofthesamecoin.Likethefirsthomeonebuilds,linesandtextonasheetofpapermaybesomewhatbor-ingcomparedtolookingatprettypictures.However,itismuchmoreimportanttocreatethebestLAY-OUTthanover-emphasizingthedesignfeatures.Inthissessionwewilldiscusslayoutprinciplesandthendesignapplication.Itishumannatureforustobemoreinterestedinhowthefinalprojectwilllooklikethatcanleadonetooverlookingthebestlayout.AlthoughtherearenotwoIndependentPharmaciesjustalike,thereisoneBESTLAYOUTorFLOORPLANforeachpharmacy.

Aswediscussedtheimportanceofdevelopingabusi-nessmodelinourfirstarticleandthenpharmacysize,thosewillnowbeincorporatedinthepharmacyplan-ningprocess.Experiencehastaughtustheprinciplesapplicableindevelopingthebestlayout.Theprocessconsistsofseveralthingsthatmustbeconsideredsimultaneously.Properspaceutilization,workflow,departmentalization,customertrafficflow,versatil-ity,securityandefficiencyshouldallbeconsideredbecauseeachwillaffecthowwellthepharmacyfunctionsbothinpeakandoff-peakperiods.First,let’sexaminespaceutilization,whichisnotalwaystakenseriouslybysomestoreplanners.Everythingshouldbeincorporatedwithinthefourwallsrightdowntotheleastinsignificantitem.Itisnotunusualforustoseeafloorplanshowingablankstorageroomoroffice.Theyshouldbeplannedjustliketheotherspaces.Awastedsquarefootcoststhesameasaproductivesquarefoot.

Itshouldnotappearovercrowded.Conversely,emptyshelvesorwideopenspacesmaygivetheconsumertheimpressionthatyouaregoingoutofbusiness.Anglesorcurvedcountersanddisplaysareappealingbuttheirover-usecanwasteasmuchas40%ofthespace,costmuchmoreinitiallyandaremoredifficulttomakechangeslater.Productscanbestbedisplayedonstraightshelves.Casestudieshaveprovedthatanglesandcurvedfixturesdonotbringaboutthebestoutcome.Thebestapproachtocreatingthebestlayoutistodeterminefunctionalityandhowyourcustomersrespondeitherfavorablyorunfavorably.Wehaveusedon-siteanalysestodeterminehowmostcustomersreactwhentheyenterthepharmacy.Ratherthanforcethemwesimplytakeadvantageofwhatwehavelearnedabouthu-manbehavior.Byapplyingthatknowledgehelpsthepharmacyplannertocreatethemostfunctionalandprofitablelayoutpossible.

PHARMACY DESIGN Certainly,asthelayoutisbeingcreated,thestoreplannershouldkeepdesignfeaturesinmindbutnotfullyaddresseduntilthebestlayoutiscreated.Anexperiencepharmacyplannershouldhavegainedextensiveknowledgebymonitoringtheoutcomesofpreviousprojects.Manyyearsago,AmericanDrug-gistcreated“StoreoftheMonth”.Thisstartedawaveofreallyuniquedesignsfromalloverthecountry.Iparticipatedaswellbecauseitwouldgiveeachofuswelcomedpublicity.Thebestlayoutandunderstand-ingconsumerhabitswerenotseriouslyconsideredbecausetheywantedsomethinguniquetopublish.AmericanDruggistdiscontinuedtheideaafterdis-coveringthatmostofthe“StoresoftheMonth”werenolongerinbusiness.Theconsumerwasleftoutoftheplanningprocess.AfewdecadesagoANationalDrugWholesalercreatedwhattheycalled“ThePharmaceuticalCenter”wherebyallmerchandise,includingpharmaceuticals,wereallplacedbehindcloseddoors.TheconceptwasendorsedbyAPhAandithadgoodintentions.Theideawastocreateamoreprofessionalappearanceandmanypharmacy


Compounding Labs

Pharmacy Planning & Design

Patient Consultation Areas

Merchandising

Stocking Lozier Distributor

Retail and Pharmacy Fixtures

Custom Wood Work

Professional Installation and Delivery

9517 Monroe Road, Suite A • Charlotte, NC 28270

1-800-321-4344www.displayoptions.com

Rx Planning Specialist

Roland Thomas 70 years combined experience

in over 2,000 pharmacies.

Division of Display Options, Inc.

schoolsweredelighted.AftermorethanthirtyhadopenedthroughouttheCountry,theprogramwasdiscontinued.Inthemindsoftheconsumers,ThePharmaceuticalCenterdidnotlooklikeapharmacyandthereforewasunsuccessful.Ihaveseensomeveryimpressivelookingpharmaciesinmytravelsbutmanywerenotasfunctionalastheycouldhavebeen.Wemustnotoverlookthetypicalconsumerandhowtheyreactfavorablyorunfavorablytoeverythingoutsideandinsidethepharmacy.Apharmacycanhavegreatde-signfeatureswithoutsacrificingthebestlayout. RECAP Ihaveexperiencedpersonalownershipinapharmacywhichwascreatedasanexperimentalprojectsothatwecouldlearnthroughtrialanderror.Iwassurprisedbysomeoftheresults.ItledmetorealizethatPHARMACYLAY-OUTismoreimportantthanAUNIQUEPHARMACYDESIGN.Thisisnottoimplythatpeopledonotliketoshopatamodernup-to-datepharmacythatiskeptclean,neatandproperlymaintained.Wecanagainlearn,notbyemulating,butbyobservingChainDrugStoresthathaveagreateropportunitytotestideasbeforeimplementingthem.Theyemphasizewhattheysellwithmostlyneutralback-grounds.Theyhavelearnedhowmostconsumersrespondandhaveincorporatedtechniquesthathaveproventobeef-

STORE PLANNING

fective,bothinhowtheyfunctionandperform.AnInde-pendentdoesnothavetolookdifferentjustforthesakeofbeingunique.ThisisnottosaythatanIndependentPhar-macyshouldnotdistinguishitselffromthechain.Whatyouofferismuchmoreimportanttoyourcustomersthanthedesign.Wecanstandoutsidethedoorandaskcustom-ersspecificquestionsaboutthephysicalaspectsandifonecantellyouthecolorofthefloor,describethefixturesthatdisplaymerchandiseorotherspecificdesignfeatures,someonehaserredinmyopinion.Wewanttheconsumertocomplimenttheoverallappearanceofthepharmacy.Thepharmacyshouldbewelllit,wellmerchandised,lookup-to-datebutstilllooklikeapharmacyshouldlookinthemindsofthecustomers.Averyattractivepharmacythatoverlooksfunctionalityandtypicalconsumerreac-tionusuallycostsmore,increasesoverheadandadverselyaffectsthebottomline.

Ournexttopicwillcoverwhatwehavelearnedaboutmerchandising,productsandservicesthatdifferentiateyourpharmacyfromothers.

Roland G Thomas is a Pharmacy Planning Specialist with Rx Planning Solutions – a division of Display Options in Charlotte, NC. Roland has had the privilege of working with pharmacists all of the Southeastern United States, planning and designing pharmacies for over 35 years.


Greetings from PCBy Cliff Fuhrman, Dean, Presbyterian College School of Pharmacy

PCSP

AswemovetowardtheentryofourfourthpharmacyclasshereatPresbyterianCollegethisfall,Iwouldliketoprovideyouwithafewpostcardsofoursummerendeavors.

Wearedelightedtoannouncethat,asofthissummer,thePresbyterianCollegeSchoolofPharmacy’sinauguralclassbeganitsadvancedfourth-yearrotations.Eachstudentwilldonine,month-longpharmacypracticerotationsoverthecourseofoneyear,withfourrequiredrotations(AdvancedCom-munity,AdvancedInstitutional,AcuteCare,andAmbulatoryCare)andfiveelectiverotationsinanareaorareasoftheirspecificinterests.

Thestudentsareinavarietyoflocal,regional,andnationalsettings,withafewstudentsdoingrotationsasfarawayasAlaskaandHawaii.Withindependentpharmacists,governmentfacilities,andhealthcaresystempartnersthroughouttheUpstate,theOfficeofExperientialEducationcoordinatesamassiveefforttoplace76studentswithhundredsofprecep-torsoverthecourseoftheirfourthyear.TheofficestafftraveledtoHiltonHeadinJune2013fortheannualSouthCarolinaPharmacyAssociationmeet-ing,wheretheywereabletoconnectwithmanycurrentandpotentialpreceptors.FeedbackhasbeenoverwhelminglypositiveaboutPCSPstudentsandPCSP’scurriculum.

Studentsaregettinghands-onexperiencewiththementorshipofprofessionalpharmacistsinsuchdiversesettingsasVeteransAffairsfacilities,freeclinics,teachinghospitals,retailandindependentpharmacies,healthcareadministrativeorganiza-tions,andanimalhospitals.Applyingtheknowl-edgetheyhaveaccumulatedoverthepastthreeyearsoftheirpharmacyeducation,thesestudentsaretakingthefinalstepstowardbecomingthenewgenerationofpharmacistsandhealthcareteammem-bers.WethankallofyouwhohavebeenpreceptorsforourstudentsduringtheirIPPEandAPPErota-tions.Ifyouhavenothadtheopportunitytosignup

asoneofourpreceptors,weencourageyoutodoso.Theexperientialrotationsareamajorlearningexpe-rienceinourcurriculum,andourstudentscanlearnfromeachandeveryoneofyou.

Anothermajorprojectforusthissummeristheim-plementationofournewlyawardedNIHgrant.TheEuniceKennedyShriverNationalInstituteofChildHealthandHumanDevelopmentoftheNationalInstitutesofHealth(NIH)awardeda$440,000,five-yearBiomedical/BiobehavioralResearchAdminis-trationDevelopment(BRAD)AwardtotheschooltobuilditsresearchinfrastructureforthesupportofthegraduatePCSPandundergraduatePCfacultymembersandtheirstudentsinthepursuitofresearchandscholarlyactivity.Dr.SarahSweitzer,DirectorofResearch,andMs.GenevraKelly,DirectorofGrantsandSponsoredResearch,areresponsibleforthisproject.

Relatedtoourresearchaward,wewelcomedourinaugural2013PharmacyResearchSummerInterns(PRSI)!Wewerepleasedtoreceiveover25ap-plicationsforthefiveinternshipsavailable.These


studentswereselectedfromahighlycompetitivepoolofapplicantsandrepresentbothPCSPstudentsandpre-pharmacystudentsfromacrossSouthCarolina.Theinternsspenteightweeksengagedinfaculty-mentoredpharmacyresearchprojects.Theinternswerepartici-patingindiverseresearchprojectsthatspannedfromexploringhowpharmacistscompoundedpaingelscrosstheskin,tounderstandingthemolecularmarkersthatidentifythetransitionofhumanpapillomavirus(HPV)frominfectiontocancer,todeterminingtherationalebasisforusinghaloperidolinthetreatmentofagita-tionintheintensivecareunit.Aspartofthisintensiveresearchexperience,thestudentsalsoparticipatedinweeklyjournalclubandscientificwritingseminars.Inaddition,inthetraditionofthePCmotto“asweliveweserve,”theinternsvolunteeredwithHabitatforHuman-ityandpaintedtheinsideofthecurrentHabitatHouseinLaurens.ThanksgoouttoourPRSImentors:Drs.Asbill,Freeland,Happe,Messersmith,andRomero-Sandoval.

Also,thestudentsandfacultyofPCSPrecentlyattendedthe62ndAnnualSchoolonAlcoholismandOtherDrugDependencies.Thisinternationallyrecognizededu-cationalprogramwasheldontheUniversityofUtahSchoolofMedicinecampus,whichislocatedinthefoothillsoftheWasatchMountains,justtwomileseastofdowntownSaltLakeCity,Utah.

PCSPstudentsSarahMasi,JeanWhyte,andSamanthaHillandfacultymemberDr.DavidEagertonjoinedpharmacystudentsandfacultyfromacrossthenation.Duringthesix-dayprogram,studentsincreasedtheirunderstandingaboutthescienceofaddictiontoalcoholandotherabusedsubstancesandlearnedmoreabouttheprocessofrecoveryfromaddition.Studentsalsohadop-portunitiestonetworkwiththeirpeerstodevelopnewideasforeducatingtheircommunitiesaboutprescriptiondrugabusethroughtheGenerationRXproject.

Ithasbeenabusysummerforusasyoucansee.Welookforwardtoadmittingour80studentsoftheClassof2017andseeingallofourstudentsbackhereinthefall.

Fraud, Waste and Abuse Manual

Why waste your precious time starting something from scratch? Get help creating your Fraud, Waste, and Abuse Manual for your pharamcy by purchasing our starting template today!

This manual outlines the regulatory envi-ronment and essential elements of a com-pliance program and, in Part II, includes sample policies and procedures that may be useful to pharmacies in developing or updating their compliance programs. Be-yond this manual, however, each pharmacy must undertake a detailed risk assessment and self-audit to ensure that its particular compliance program is properly tailored to its business.

Pricing:SCPhA Members $195

Non-Members $495

Purchase it online at www.scrx.org!


The publication of the “FINAL” HIPAA rules in January 2013 means pharmacies must take action to replace or revise their existing HIPAA compliance program. The Office of Civil Rights begins active enforcement September 23, 2013.HIPAATrack is presented by NCPA as the EXCLUSIVE HIPAA compliance program for NCPA members. It is officially endorsed by Federation of Pharmacy Networks buying groups as the ONLY HIPAA Compliance Program recommended to FPN’s 13,000 member pharmacies.

So has the PRS HIPAA Compliance Program!

HIPAATrack includes:

ExclusionTrack (for the initial term of your HIPAATrack purchase)This program automates monthly checks of OIG/GSA exclusion lists, as now required by Fraud, Waste and Abuse rules.

One year of LicenseTrackThis customizable program will notify you by email when any facility or employee licenses and certifications are expiring.

Two new programs that are a part of the PRS Compliance Assistance Suite are included with HIPAATrack.Bonus!

8 0 0 - 3 3 8 - 3 6 8 8www.prspharmacyservices.com/hipaa

➲ Policies and Procedures to comply with FINAL HIPAA rules

➲ Enhanced online employee training & tracking

➲ Risk Analysis and Management Program

➲ Disaster Recovery Program

➲ Task Notification System keeps you on track

➲ Seamless auto-updating

Introducing:

HIPAATrack


SCCP

Veterinarypharmacyisacareerchoiceforagrowingnumberofpharmacyschoolgraduatesandtraditionalpharmaciesarefillingmoreprescriptionsforanimals,requiringmorepharmacistswhoarecomfortablewithandcompetentinveterinarypharmacy.

AbillintheHouseofRepresentatives,HR1406Fair-nesstoPetOwnersAct,wouldrequireveterinarianstogiveanimalownersahand-writtenprescriptionthatcanbefilledattheveterinarian’sofficeoratalocalpharmacy.Ifitpasses,pharmacistslikelywillhavetofillevenmoreprescriptionsforpetpatientsandneedtobeadequatelypreparedtodoso.

“Youhavetobeawareofthespeciesyou’retreat-ing,”saidJessicaGaskins,thevolunteerpharmacistwiththeSouthCarolinaAquariumandanadjunctclinicalassistantprofessorattheSouthCarolinaCollegeofPharmacy(SCCP).“Forinstance,ifapharmacistisfillingaprescriptionforanoralbeta-lactamantibiotic,theyneedtoknowtoaskwhatkindofanimalit’sfor.Ifitisforabunny,anoraldoseofthismedicationwillcausedysbiosisthatcanleadtodeath.

“Therearealotofdifferencesincarebetweenani-malsandhumans.Legallywearenotallowedtotellpatientswhichover-the-counterdrugstouseintheiranimals.”

UsingmostOTCdrugswithanimalsconstitutesoff-labeluseandthusrequiresaprescription,perthe1994AnimalMedicinalDrugUseClarificationAct.“IwishIcouldsendeverypharmacyabigposterthatsays‘Tylenolkillscats’,”Gaskinssaid.“Aspharma-cists,weneedtobeabletostepupourgame.”

AttheSCCP,weinstructallfuturepharmacistsonbasicveterinarycalculationsandoffersomeexperi-enceincompoundingveterinaryproducts.Inaddi-tiontotheexperientialeducationtheCollegeoffers,Gaskinsteachesanelectivethatcoversanatomy,physiology,andpharmacotherapyinapproximately10animalspecies,aswellasareasofveterinaryphar-macyincludingdruginformation,lawsandethics

ofveterinarypharmacy,variousdiseasestatesandpropertreatment,toxicologyandparasitology,andcase-basedmedicationdosingregimens.

VeterinarypharmacywasnotanunusualchoiceforGaskins.ShegrewuparoundhorsesinCharlestonandvolunteeredwithanequineveterinarianwhenshewasinhighschool.Shefoundshelikedveteri-narymedicineandpharmacologyanddecidedtoseeifshecouldfindacareerthatcombinedthetwo.AftergettingherPharmDin2011fromtheMedicalUniversityofSouthCarolina(MUSC)campusoftheSCCP,shecompletedaveterinarymedicineresiden-cyatNorthCarolinaStateUniversity,oneofjusttwospecialtyresidenciesinthecountryofferingveteri-narypharmacy.AnelectivecourseonfishveterinarymedicineledtoanintroductiontoShaneBoylan,theveterinariantheCharlestonAquarium,andeventuallyherpositionthere.

Asaveterinarypharmacist,shehastobeabletore-calibratedosagesofahumandrugforadministrationtoananimalorcompounddrugstomakethempalat-abletoparticularspecies.Attheaquarium,Gaskinsparticipatesindifferentproceduresandsurgeries,andtakescareofdrugdosing,drug/druginteractions,andprovidesdruginformation.

Recently,shehasworkedondevelopinganovelagent,extractedfrombeepropolis,tohelptreatchitinolyticdiseaseinhorseshoecrabs.Medicationsforthebacterialinfectionhaveprovedtroublesomeforcrabsandotheraquaticinvertebratesbecausethemedicationsarenotwaterproof;thenewanti-micro-bialbandageshehasdevelopedis.

Veterinary PharmacyJoseph DiPiro, Dean, South Carolina College of Pharmacy


“Allanimalshavedifferentphysiologies,anatomiesanddrugmetabolisms,”shesaid.“You’vegottoreallysearchthepharmacyliteratureandtherearealotofgrayareas,especiallywithexotics.It’sprettymuchlimitedtocasestudies.Butifsomebodyhasasickorinjured$150,000showkoi,theyarenotgoingtoflushitdownthetoilet!Theywanttogetittreated.”

GaskinsplayedakeyroleinthesalvationofChuckNorris,asshehaschristenedaparticularlyruggedyellow-belliedslider.ThefemaleturtlehadbeenrunoverbyacaronJohnsIslandandafriendbroughtittoGaskins’house.Gaskinsprovidedinitialtreat-ment,consultingwithBoylanonalate-nightcall,andbroughttheanimalintotheAquarium.Despiteagrimprognosis,theyoperatedandinserted23pinstorebuildtheturtle’sshell.Today,ChuckNorrisiswellonthewaytorecovery.

Asaveterinarypharmacist,Gaskinsisfacedwithaconstantly-changingclinicalpharmacychallenge,requiringinnovativethinkingandanunusualinterac-tionbetweenpatientandpharmacist.“Iloveitwhenmypatientstrytobiteme,”shesays.

Whilebiting,notedinreptilesandotherexoticnon-domesticatedspecies,isauniquesignofrecovery,itisunlikelymanypharmacistssharethatsentiment.However,veterinarypharmacyisaneededservicethepharmacyprofessionhastoprovideandcanopenaworldofopportunitiesformanypharmacistsenter-ingthefield.


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A Preventable Problem: Improper Medication Use Medications, when used appropriately, are the most effective tools we have in fighting disease, including chronic diseases such as diabetes and coronary heart disease. Unfortunately, improper medication use costs our nation an estimated $290 billion annually in total direct and indirect health care costs. Many of these costs can be prevented by reengineering and improving the medication use system. As recommended by the Institute of Medicine, systems must be designed to make the health care system safer at all levels.

The Solution: Pharmacists’ Patient Care Services• Pharmacists increase patients’ understanding of their medication regimen to improve their health outcomes.• Pharmacists assist prescribers in avoiding potential medication-related problems and improve treatment outcomes.

Pharmacists: The Medication Therapy Expert on the Integrated Health Care Team Pharmacists, trained with a focus and level of expertise on medication therapy that exceed those of other health care providers, are ideally suited to be the health care professionals to improve medication use and outcomes. Pharmacists in all patient care settings provide patient care services such as comprehensive and targeted medication therapy reviews, anticoagulation monitoring, pharmacotherapy consults, immunizations, wellness programs, and many other diverse services that help minimize risk and optimize outcomes associated with medication therapy.

Successful States Using Innovative Pharmacists’ Patient Care ServicesSeveral innovative programs that use pharmacists’ provided patient care services have been recognized through funding in the Health Care Innovation Awards from the CMS Innovation Center.

Through the collaboration of pharmacists, with other members of the health care team, these programs are projected to provide cost savings by improving the standards of care using evidence-based medication therapies and improving medication adherence and management, leading to reduced hospitalizations, readmissions, adverse drug events, and emergency department visits. [1] The following are four examples:

Patient Access to Pharmacists’ Patient Care Services: THE KEY TO IMPROVING MEDICATION USE AND LOWERING HEALTH CARE COSTS

CALIFORNIA“Integrating clinical pharmacy services into safety, net clinics”

The University of Southern California is integrating clinical pharmacy services into safety net clinics, providing medication therapy management (MTM), disease state management, medication reconciliation, medication access services, patient counsel-ing, drug information education, preventive care programs, provider education, and qual-ity improvement reviews for care providers and for the underserved and vulnerable. This integration will improve medication adher-ence, confirm the appropriateness and safety of medication use, and reduce avoidable hospitalizations and emergency department visits, while improving patient and popula-tion health. The projected cost savings over a 3-year period is $43.7 million from an award amount of $12 million.

HAWAII“Pharm2Pharm, a formal hospital pharma-cist–to–community pharmacist collaboration”

Integrated into hospital and ambulatory care teams, pharmacists contribute to better care transitions for the elderly by improving medication reconciliation and management in three rural counties of Hawaii through the decision-making support and enhanced com-munication abilities of hospital and commu-nity pharmacists. The projected cost savings over a 3-year period is $27.1 million from an award amount of $14.3 million.

VIRGINIA“Improving health for at-risk patients (IHARP) in 23 southwest Virginia counties through a collaborative pharmacist practice model”

Pharmacists trained in transformative care and chronic disease management protocols provide medication adherence, management through care coordination, and shared access

to electronic medical records for patients with multiple chronic diseases in 23 underserved rural counties in southwest Virginia. The projected cost savings over a 3-year period is $4.3 million from an award amount of $4.1 million.

WISCONSIN“Retooling the pharmacist’s role in improving health outcomes and reducing health care costs”

Transforming the role of pharmacists from drug dispensers to drug therapy coordina-tors and managers, pharmacists are working collaboratively with physicians and other prescribers to revise prescription drug thera-pies based on evidence-based standards of care, targeting patients with diabetes, chronic heart failure, asthma, and geriatric syndromes to improve medication adherence and pro-vide medication therapy management. The projected cost savings over a 3-year period is $20.4 million from an award amount of $4.1 million.

[1] CMS: Center for Medicare and Medicaid Innovation. Health Care Innovation Awards: Project Profiles. http://innovations.cms.gov/initiatives/innovation-awards/project-profiles.html


Gorilla Photo Courtesy: Ron Brasington/Riverbanks Zoo and Garden

Select the Pharmacy Night you wish to attend: 2013 □ Greenville (August 20) □ Myrtle Beach (September 10) □ Columbia (September 24) □ Charleston (October 2) □ Florence (October 17) □ Rock Hill (November 5) 2014 □ Aiken (January 23) □ Charleston (February 4) □ Columbia (February 11) □ Greenville (March 18) *Cities with more than one Pharmacy Night will have different topics.

SCPhA Member: Qty. ______ ($15 ea.) Non-Member: Qty. ______ ($25 ea.) Student: Qty. ______ ($10 ea.) *If renewing or joining on this form, please select the member rate. To renew or join SCPhA now, please select your member type below: □ Pharmacist ($150) □ Associate ($150) □ Retired ($75) □ First Year ($75) □ Technician ($35) □ Student (free!)

Name____________________________________________________________ □ Technician □ Pharmacist □ Student Email_________________________________________________________ Phone______________________________ License/Reg #________________ NABP eID#______________________ Birthdate (MM/DD)__________________ Payment Type: □ Check _________ Total Amount Due: $_____________ Credit Card Type: □ MC □ Visa □ AMEX □ Discover Name on Card________________________________________ Card #____________________________________________________ Exp. Date____________________ CVV_____________ Billing Address ___________________________________________________________________________________________ Cancellations will only be accepted if received more than 5 business days before the event. If applicable, a refund will be issued less a $5 processing fee.

South Carolina Pharmacy Association is accredited by the accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This activity is eligible for ACPE credit; see final CPE activity announcement for specific details.

Pharmacy Nights are back! ○ Network with your peers while you eat dinner. ○ Get 2 hours of continuing education. ○ Meet SCPhA’s new CEO, Craig Burridge. ○ Get to know your Region SCPhA leadership. ○ Learn about the Association, events and activities. ○ Renew your SCPhA membership!

6:00 PM - 7:00 PM: Registration and Dinner 7:00 PM - 9:00 PM: Program (2 Hours CE)

$15 for 2013-2014 SCPhA Members $25 for Non-Members

$10 for Students (no CE credit provided)

Pharmacy Night Locations

August 20, 2013 and March 18, 2014: Greenville Virginia College ● 78 Global Dr., Greenville, SC September 10, 2013: Myrtle Beach Grand Strand RMC ● 809 82nd Pkwy., Myrtle Beach, SC September 24, 2013 and February 11, 2014: Columbia SCPhA Office ● 1350 Browning Rd., Columbia, SC October 2, 2013 and February 4, 2014: Charleston Bon Secours Hospital ● 2095 Henry Tecklenburg Dr., Charleston, SC October 17: Florence Virginia College ● 2400 David H. McLeod Blvd., Florence, SC November 5: Rock Hill Piedmont Medical Center ● 222 S. Herlong Ave., Rock Hill, SC January 23: Aiken Aiken Tech ● 2276 J. Davis Hwy., Graniteville, SC

*Locations are subject to change. Please check www.scrx.org for specific event de-tails closer to each Pharmacy Night.

Complete this form and return to SCPhA, with payment, to SCPhA, 1350 Browning Road, Columbia, SC 29210 or fax to 803.354.9207. Visit www.scrx.org to register online. Call 803.354.9977 with questions.


CESAR FAXU n i v e r s i t y o f M a r y l a n d , C o l l e g e P a r k

A Weekly FAX from the Center for Substance Abuse Research

Thepercentageofadmissionstostate-fundedsubstanceabusetreatmentfacilitiescitingopiatesotherthanheroinasaprimarysubstanceofabusecontinuetoincrease,accordingtorecentlyreleaseddatafromthenationalTreatmentEpisodeDataSet(TEDS).Admissionsfortheprimaryabuseofotheropiates*haveincreasedfrom1.0%in1997to10.1%in2011(themostrecentyeardataareavailable).Opiatesotherthanheroinaremorelikelythaneithercocaine(7.8%)ormethamphetamine(5.6%)tobecitedasaprimarysubstanceofabusebytreatmentclients.Treatmentadmissionsfortheprimaryabuseofmarijuanaandheroinhaveremainedrelativelystableinrecentyears,ataround18%and14%-15%,respectively.

September 15, 2013Vol. 22, Issue 37

National Treatment Admissions for Opiates Other Than Heroin Continue to Increase; Surpass Admissions for Cocaine and Methamphetamine

Percentage of All

Admissions

19921993

19941995

19961997

19981999

20002001

20022003

20042005

20062007

20082009

20102011

0%

4%

8%

12%

16%

20%

Heroin

Cocaine

Other Opiates

Marijuana

Methamphetamine

Primary Substance of Abuse (Other Than Alcohol**) at Admission to U.S. State Licensed or Certified Substance Abuse Treatment Facilities,

Ages 12 and Older, 1992 to 2011

SOURCE:AdaptedbyCESARfromtheOfficeofAppliedStudies,SAMHSA,Treatment Episode Dataset (TEDS) Highlights—2011, National Admissions to Substance Abuse Treatment Services,2013.Availableonlineathttp://www.samhsa.gov/data/2k13/TEDS2011/TEDS2011N.pdf.

**Whilethefocusofthisanalysisisontreatmentadmissionsfordrugsotherthanalcohol,itshouldbenotedthatadmissionsfortheprimaryabuseofalcoholdecreasedovertheperiodfrom59.3%in1992to39.3%in2011.

301-405-9770(voice) 301-403-8342(fax) [email protected] www.cesar.umd.edu TheCESAR FAX isindependentlyfundedbyCESARandmaybecopiedwithoutpermission.PleaseciteCESARasthesource.

NOTES:TEDSdataareofadmissionstotreatmentages12andolderforabuseofalcoholand/ordrugsinfacilitiesthatreporttoStateadministrativedatasystems.DataincluderecordsforadmissionsthatwerereceivedandprocessedthroughOctober15,2012.TEDSadmissionsdonotrepresentindividuals;anindividualadmittedtotreatmenttwicewithinacalendaryearwouldbecountedastwoadmissions.Admissionscanreportuptothreesubstancesofabusethatledtothetreatmentepisode.

*ThecategoryOtherOpiatesincludesnon-prescriptionmethadone,buprenorphine,codeine,hydrocodone,hydromorphone,meperidine,morphine,opium,oxycodone,pentazocine,propoxyphene,tramadol,andanyotherdrugwithmorphine-likeeffects.


inancial orumThis series, Financial Forum, is presented by Pro Advantage Services, Inc., a subsidiary of Pharmacists Mutual Insurance Company, and your State Pharmacy Association through Pharmacy Marketing Group, Inc., a company dedicated to providing quality products and services to the pharmacy community.

FINANCIAL FORUM

HOW MUCH RETIREMENT INCOME SHOULD YOU WITHDRAW?

Thebigquestion:howmuchistoomuch?Inthefirstfewyearsofretirement,somecouplesreally“liveitup”…andsomeofthemriskspendingdowntheirretirementsavings.Theirportfoliosaren’tearningenoughtomakebacktheincomethey’rewithdraw-ing.

Somenewretireesendupwithdrawingasmuchas7-10%oftheirretirementassetsannually.Abullmarkettendstoencouragethiskindofexuberance.Butwhathappenswhenthebullsdon’trun?Whatifyourportfolioonlyreturns1-2%thisyear?Canyouseethepotentialproblem?

Ultimately,theanswerishighlypersonal.Thereisno“standard”retirementincomewithdrawalrate.Yourwithdrawalrateshouldbedeterminedincon-sultationwithyourfinancialadvisor,whocanhelpyouevaluatesomeveryimportantmatters:yourrisktolerance,yourageandhealth,andyourlifestyleneeds.

Manynewretireesaretoldthata4-5%annualwithdrawalratemakessense.Ifyouwithdraw4-5%fromyourretirementnesteggannuallyandyourinvestmentssteadilyearnabout5-6%year-to-year,itisquitepossiblethatyourinvestedassetswilllastaquarter-centuryorlongergivenmildinflation.Butthat’saratherstablescenario.Evenmorevari-ablescomeintoplay.

Consumercosts.Overthepast50years,consumerpriceshaveincreased(onaverage)about4%annu-ally.Soyoumightassumethatyourportfolioshouldgenerateatleasta4%annualreturnjusttohelpyoukeepupwiththecostofliving.Butifyouretirewiththatassumptionandinflationshouldspikenotably

higherforsomereasonafteryouretire,youmayneedtoadjustyourwithdrawalrate.

Nowconsiderthepriceofhealthcare.Inrecentyears,healthcarecostshaveincreasedatamuchgreaterratethaninflation.Thesamegoesfornursinghomecare.

Marketdips.Whenyouare35or40,yourinvest-mentshavetimetoreboundfromamarketdownturn.Whenyouare70,thingsaredifferent.

Let’sciteanexample:let’ssayyouare70yearsold,andyouhave$250,000inyourportfolio.Allofasudden,yourportfoliohastworeallybadyears:youlose12%inYear1and7%inYear2.Soat72,yourportfolioisnowworth$204,600.Youwanttogetbackto$250,000orbetter.Howlongwillthattake?Well,yourportfoliowouldhavetogainalmost23%inYear3togetbacktothat$250,000level.Soifyousufferthroughacoupleofbadyearswithill-choseninvestmentsorill-advisedassetallocations,yournesteggmaybeconsiderablysmallerandyourincomewithdrawalratemayhavetochange.

*Thisisahypotheticalexampleandisnotintendedtoimplytheperformanceofanyspecificinvestment.Themeritofconservativewithdrawals.Withongoingimprovementsinhealthcare,today’sretireesstandagoodchanceoflivingintotheireightiesandnineties(andperhapsevenlonger).Thisisagoodreasontoexercisealittlemoderationwhenschedulingretire-mentincome.

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Learning objectives: Aftercompletingthisactivity,theparticipantshouldbeableto:1.Defineculturalcompetence2.Understandtheneedforculturalcompetencyinthepracticeofpharmacy3.Identifypersonalculturalcompetencylevelthroughassessment4.Identifybarrierstocross-culturalcommunication5.Describemethodsandmnemonicmodelsforover-comingcross-culturalcommunicationbarriers

Goal/Objective: Toeducatepharmacyprofessionalsontheimportanceofculturalcompetencyinprovid-ingeffectivepatientcare.

Summary: ThepopulationdemographicsoftheUnitedStatesarerapidlyshifting,asarethedemo-graphicsofstudentpharmacists.However,atthecurrentpaceofnewgraduatesenteringthemarketandreplacingpharmacistsfrompreviousdecades,thedemographicmakeupofpracticingpharmacistswillremainprimarilyCaucasianformanyyearstocome.Inordertocontinueprovidingeffectivecommunica-tionwithpatients,pharmacistsmustlearntoaccu-ratelyassesstheirownlevelofculturalcompetencyanddevelopmethodstoimprovethoseskills.Asaresult,theneedforculturallycompetentpharmacists

JOURNAL CEAchieving Cultural Competency and Its Role in Pharmacy By Kelly Clark, PharmD, SouthUniversity School of Pharmacy - Columbia

isnecessaryinordertocontinueprovidingeffectivecommunicationwithpatients.Waystoassessper-sonalculturalcompetencylevelswillbeaddressed.Inaddition,methodstoimprovecompetencyskillswillbereviewed.Commonbarrierstocross-culturalcommunicationarediscussed,includingtoolsavail-abletopharmacistsinordertoovercomethesebarri-ers.

Conclusion:Culturalcompetencyisacontinualprocess.Pharmacistsmustcontinuetolearnaboutdifferentculturesandaspectsofeach.Beingcultur-allycompetentcanaidpharmacistsinbetter,moreeffectivecommunicationwiththeirpatients.

Keywords: culturalcompetence,cross-culturalcom-munication,barriers

INTRODUCTIONForcenturies,thepopulationoftheUnitedStates(US)hasbeencomprisedofamultitudeofeth-nicities.However,eventodaythemajorityofthepopulationremainsCaucasian.1Regardless,theUSpopulationiseverchanging;andwithinthepastde-cadethischangehasbeenrapid.AsimplereviewofthedataprovidedinTable1illustratestheethnicityshiftsoftheUSpopulationwithinrecentyearsandfutureprojections.

2

INTRODUCTION

For centuries, the population of the United States (US) has been comprised of amultitude of ethnicities. However, even today the majority of the populationremains Caucasian.1 Regardless, the US population is ever changing; and within thepast decade this change has been rapid. A simple review of the data provided inTable 1 illustrates the ethnicity shifts of the US population within recent years andfuture projections.

Table 1. Diversity of US Population 2006, 2011, 2060 (projected)

Abbreviations used: US, United States.Source: References 1 and 2.

As the ethnicity percentages have shifted over time for the US population, so havethe ethnicity percentages of pharmacy graduates. In 1980, the ethnicity percentagesfor graduates obtaining their first professional degree in pharmacy were 85.2%Caucasian, 3.4% African-American, 3.7% Hispanic/Latino, 3.9%Asian/Hawaiian/Pacific Islander and 0.1% American Indian/Alaskan Native.3 Whencompared to 2010 data in each category respectively of 59.9%, 6.5%, 4.3%, 21.4%,and 0.4%3, the shift in demographics is apparent especially in respect to theCaucasian and Asian/Hawaiian/Pacific Islander groups. This data is depicted belowin Table 2.

Table 2. Comparison of ethnicity changes for first professional degree-

obtaining graduates

Ethnicity 1980(%) 2010(%)

Caucasian 85.2 59.9African-American 3.4 6.5Hispanic/Latino 3.7 4.3Asian/Hawaiian/Pacific

Islander

3.9 21.4

American Indian/

Alaskan Native

0.1 0.4

Source: Reference 3.

Ethnicity 2006(%) 2011(%) 2050

projected(%)

Caucasian (non-

hispanic)

66.4 63.4 42.6

Hispanic/Latino 14.8 16.7 30.6African American 12.8 13.1 13.2Asian 4.4 5 7.9Native American/

Alaskan native

1 1.2 0.7

Hawaiian/Pacific

Islander

0.2 0.2 0.2


JOURNAL CE

AstheethnicitypercentageshaveshiftedovertimefortheUSpopulation,sohavetheethnicitypercent-agesofpharmacygraduates.In1980,theethnicitypercentagesforgraduatesobtainingtheirfirstprofes-sionaldegreeinpharmacywere85.2%Caucasian,3.4%African-American,3.7%Hispanic/Latino,3.9%Asian/Hawaiian/PacificIslanderand0.1%AmericanIndian/AlaskanNative.3Whencomparedto2010dataineachcategoryrespectivelyof59.9%,6.5%,4.3%,21.4%,and0.4%3,theshiftindemographicsisapparentespeciallyinrespecttotheCaucasianandAsian/Hawaiian/PacificIslandergroups.ThisdataisdepictedbelowinTable2.

Evenwiththeincreaseindiversityofpharmacistsintherecentpast,themajority(upwardsof90%)ofpharmacistspracticingtodayareCaucasian.2Keep-ingallofthesestatisticsinmind,itisimportantforallcurrentandfuturepracticingpharmaciststobeculturallycompetentinordertobesuccessfulhealth-careproviderstoanevolvingpopulation.

DEFININGCULTURALCOMPETENCECulturalcompetencecanbedefinedinmanyways.However,alldefinitionshaveacommontheme.Simplydefined,culturalcompetenceistheattitudes,knowledge,andskillsthatallowintegrationandtranslationofknowledgeaboutvariousculturesintothepracticeofpharmacy.2Morespecificallyculturecompetenceishavingtheabilitytoprovidecaretopatientswithdiversevalues,beliefsandbehaviorsandtotailorthatcaretopatients’social,cultural,andlinguisticneeds.4Additionally,culturalcompetencemaybedefinedasasetofcongruentbehaviors,at-titudes,andpoliciesthatcometogetherinasystemoragency,oramongprofessionals,thatenableseffec-tiveworkincross-culturalsituations.5 Beingabletodefineculturalcompetenceisonestepinachievingculturalcompetency.

PERSONAL ASSESSMENT OF CULTURAL COMPETENCEBeforeonecanunderstandtheculturalneedsofothers,self-assessmentshouldoccur.Therefore,anassessmentofpersonalculturalcompetencyisthenextstepinworkingtowardcompetency.Itshouldbenotedtheculturalcompetencyisnotsomethingoneachievesonlyonetimeinhisorherlife..Culturalcompetencyisaskillthatislearnedovertimeandevolvesovertimewiththechangingenvironment.Learningtoevaluateculturalcompetencylevelsmustbepartofanongoingefforttoprovidebetterhealthcare6Conversely,alackofculturalcompetencymayincreasethecostofhealthcare,discriminateagainstpopulationswithdisproportionatelyhigherratesofdiseasessuchasdiabetes,cancer,andinfantmortal-ity;thus,potentiallyopeningthedoorformalpracticesuits.7Asapharmacist,knowingyourcompetencylevel(includinglimitations)willallowyoutoiden-tifyareasforgrowthandseekoutopportunitiestoimproveyourculturalknowledge.Doingsowillpro-videyouwithmoretoolsandopportunitiestodeliverbetterpatientcare.6

Manyresourcesareavailabletoprovideassessmentofculturalcompetence,includingbooks,articlesandwebsites.TheQualityofCulturequizisavailableonline,easytoaccessandfreeofcharge.Thequizconsistsof23multiplechoiceandtrue/falseques-tions.6Ittakesabout10minutestocompleteandprovidesanexplanationofquestionsmissedaftercompletion.Thetopicscoveredinthequizare6:• Clinicaloutcomes• Priorassumptionsandprejudices• Medicalhistoryanddiagnosis• Patientcompliance• Workingwithaninterpreter• Backgroundsofculturalgroups• Commonhealthproblems

2

INTRODUCTION

For centuries, the population of the United States (US) has been comprised of amultitude of ethnicities. However, even today the majority of the populationremains Caucasian.1 Regardless, the US population is ever changing; and within thepast decade this change has been rapid. A simple review of the data provided inTable 1 illustrates the ethnicity shifts of the US population within recent years andfuture projections.

Table 1. Diversity of US Population 2006, 2011, 2060 (projected)

Abbreviations used: US, United States.Source: References 1 and 2.

As the ethnicity percentages have shifted over time for the US population, so havethe ethnicity percentages of pharmacy graduates. In 1980, the ethnicity percentagesfor graduates obtaining their first professional degree in pharmacy were 85.2%Caucasian, 3.4% African-American, 3.7% Hispanic/Latino, 3.9%Asian/Hawaiian/Pacific Islander and 0.1% American Indian/Alaskan Native.3 Whencompared to 2010 data in each category respectively of 59.9%, 6.5%, 4.3%, 21.4%,and 0.4%3, the shift in demographics is apparent especially in respect to theCaucasian and Asian/Hawaiian/Pacific Islander groups. This data is depicted belowin Table 2.

Table 2. Comparison of ethnicity changes for first professional degree-

obtaining graduates

Ethnicity 1980(%) 2010(%)

Caucasian 85.2 59.9African-American 3.4 6.5Hispanic/Latino 3.7 4.3Asian/Hawaiian/Pacific

Islander

3.9 21.4

American Indian/

Alaskan Native

0.1 0.4


Ethnicity 2006(%) 2011(%) 2050

projected(%)

Caucasian (non-

hispanic)

66.4 63.4 42.6

Hispanic/Latino 14.8 16.7 30.6African American 12.8 13.1 13.2Asian 4.4 5 7.9Native American/

Alaskan native

1 1.2 0.7

Hawaiian/Pacific

Islander

0.2 0.2 0.2


JOURNAL CE• Commonbeliefsandculturalpractices• Bodylanguage• Relatingtopatients’families• Culturallycompetentorganizations

Thisquizallowsyoutolearnmoreaboutanyofthetopicsprovidingreadingandsuggestedactivitiespost-assessment.Post-assessmentactivitiesincludeinternallinkstoinformationfoundintheProvider’sGuideofthequizandexternalwebsitelinkstopro-videresourcesandinformationonthetopicsallowingforfurtherself-education

TheCulturalCompetenceHealthPractitionerAs-sessment(CCHPA)isanalternativeself-assessmenttool.Itisalsoonlineandfreeofcharge.TheNa-tionalCenterforCulturalCompetencehasdesignedtheCCHPAtopromoteculturalcompetenceasanessentialapproachforpractitionersintheeliminationofhealthdisparitiesamongracialandethnicgroups.8

Theself-assessmentsdescribedaboverepresentaverysmallsampleoftheassessmentsandtoolsavail-abletopharmaciststodeterminepersonalculturalcompetency.Regardlessoftheassessmenttoolscho-sen,completingtheself-assessmentisanimportantstepinthejourneytobeingculturallycompetent.

METHODSTOIMPROVECULTURALCOMPE-TENCYSKILLSOnceyouhavedeterminedapersonalcompetencylevelandidentifiedlimitations,improvementincertainskillswillbenecessary.Thetablebelowlistswaysimprovementcanbeachieved.

Culturalcompetenceencompassesadesiretonotallowbiasesandinturntreateveryindividualwithrespect.Formostpeopleculturalcompetencetakesconsistentindividualpracticeovertime.6

CROSS-CULTURAL COMMUNICATION BAR-RIERSPartofcontinuingtolearntoimproveculturalcompetencyinvolvesidentifyingcross-culturalcommunicationbarriersandmethodstoovercomethesebarriers.Thisknowledgewillallowyoutobeamoreeffectivecommunicator.Cross-culturalcommunicationbarrierscanbebrokendowninto8categories:Lackofknowledge,fearanddistrust,stereotyping,assumedsimilarity,nonverbalcommu-nication,authority,physicaltouch/contactandverballanguagesandstyles.Table3detailshowHalburandHalburdescribeeachofthe8barriers.2

CROSS CULTURAL COMMUNICATION TOOLSTherearemanymethodsandmodelsavailableforpharmaciststousetocommunicateeffectivelyincross-culturalsituationsaswell.Effectivecom-munication(verbalandnonverbal),aswellasactivelistening,areimperativeforpatientunderstandingincross-culturalinteractionswiththepharmacist.Toolsavailabletoaidthepharmacistincommunicationandactivelisteningincludeinterpreters,Kleinman’squestions,andseveralmnemonicmodels.

Interpretersplayamajorroleincross-culturalcom-municationinmanysituations,astheirusecanresult

4

Common beliefs and cultural practices Body language Relating to patients’ families Culturally competent organizations

This quiz allows you to learn more about any of the topics providing reading andsuggested activities post-assessment. Post-assessment activities include internallinks to information found in the Provider’s Guide of the quiz and external websitelinks to provide resources and information on the topics allowing for further self-education

The Cultural Competence Health Practitioner Assessment (CCHPA) is an alternativeself-assessment tool. It is also online and free of charge. The National Center forCultural Competence has designed the CCHPA to promote cultural competence as anessential approach for practitioners in the elimination of health disparities amongracial and ethnic groups.8

The self-assessments described above represent a very small sample of theassessments and tools available to pharmacists to determine personal culturalcompetency. Regardless of the assessment tools chosen, completing the self-assessment is an important step in the journey to being culturally competent.

METHODS TO IMPROVE CULTURAL COMPETENCY SKILLS

Once you have determined a personal competency level and identified limitations,improvement in certain skills will be necessary. The table below lists waysimprovement can be achieved.

Table 3 Methods to Improve Cultural Competency Skills

Immerse self in a community you would like to learn more about

Work with culturally/ethically organized student groups, patient

groups or community groups

Read about culture-specific disease states and evidence-based

intervention and practice

Host a brown bag event focused on cultural competency by inviting a

speaker or panel of speakers to discuss methodology and cultural

beliefs

Reach out to religious leaders or organizations

Seek out traditional cultural healers

Talk with patients from diverse backgrounds in your community

Continue to learn: lifelong process/requires ongoing continuing

education utilizing multiple modalities



JOURNAL CEinbetterpatientcare.2Forexample,aninterpreterisvitaltothepharmacist-patientrelationshipwhenneedingtoovercomelimitedEnglishproficiency.2 ProfessionalinterpretersshouldbeusedwhenthereisaneedtoovercomelimitedproficiencyofapatienttospeakEnglishversusfamilymembersorfriends.Familymembersandfriendsmayeditordistortinformationtoprotectthepatientfrombadnews.2 Additionally,usingfamilymembersorfriendsasinterpreterscouldbeviewedasadirectviolationofapatient’sconfidentiality.Aculturallycompetentpharmacistshouldbeabletorecognizewhenaninterpreterwouldbehelpfulornecessary.

Manytimespharmacistsareinasituationwheretheyneedtoelicitpatients’healthbeliefs.TheKleinmanquestionsprovideanexcellentmeanstoobtainthepatient’shealthbeliefsinanappropriatemanor.2Thequestionsare:91. Whatdoyouthinkcausedyourproblem?2. Whydoyouthinkyourproblem/sicknessstartedwhenitdid?3. Whatdoyouthinkyoursicknessdoestoyou?Howdoesitwork?4. Howsevereisyoursickness?Willithaveashortorlongcourse?5. Whatkindoftreatmentshouldyoureceive?6. Whatarethemostimportantresultsyouhopetoreceivefromthistreatment?7. Whatarethechiefproblemsyoursicknesshascausedyou?8. Whatdoyoufearmostaboutyoursickness?Kleinman’squestionsputtheinitialassessmentintothehandsofthepatient.Thisallowsthepharmacistanopportunitytodecidehowtoapproachthecross-culturalsituation.

Severalmnemonicmethodsexisttoassistincross-culturalcommunicationbarriersituations.Afewofthemostcommoninclude:LEARN,SOLER,ETHNICandBATHE.LEARNstandsforlisten,explain,acknowledge,recommendtreatment(s)andnegotiatetreatment(s).10Whenlistening,thephar-macistshoulddosowithempathyandunderstandingtothepatient’sperceptionoftheproblem.Next,thepharmacistshouldexplaintheirperceptionsoftheproblem,followedbyacknowledging/discussingthedifferencesandsimilaritiesofbothperceptions.Thepharmacistthenrecommendstreatment,allwhilemaintainingpatientinvolvement.Finally,anegotia-tionoftreatmentoccurs,whichshouldbeacom-binationofideascomingfromboththepharmacist

andthepatient.10TheLEARNmodelisintendedtobeusedasasupplementtohistorytaking.Thismnemonicallowspharmaciststobuildtrust,opencommunicationandnegotiatetreatmentwithpatients.Bothpartiesinvolvedhavetheopportunitytodiscusstheproblem,sharingsimilaritiesanddifferences.Intheend,thepharmacistandthepatientnegotiatether-apy.2SOLERisdefinedassquarelyfacethepatient,useopenposture,leantowardthepatient,maintaineyecontact,andrelaxwhilecommunicatingwiththepatient.11Itisrecommendedtositatthe5o’clockpositioninordertoavoidstaringatthepatient.Anopenposturesimplymeansnotcrossingyourarmsorlegssothatyoudon’tappeardefensive.Thephar-macistshouldslightlyleantowardsthepatient,look-inggenuinelyinterested.Maintaineyecontact,beingcognizantnottostare.Finally,thepharmacistshouldrelax,inturnhelpingthepatientrelax.11

TheSOLERmethodallowspharmaciststoconveyasenseofrespecttotheirpatientsandfostertheirtrust;inotherwords,itisamechanismtoestablishrapportwiththepatient.2SOLERshouldbeusedasanintegralpartofactivelistening.NextETH-NIC,orexplanation,treatment,healers,negotiate,interventionagreement,andcollaboration,12 allowspharmaciststoaddressfolkhealersandspiritual-ity.2PharmacistscanuseETHNICtohavepatientsdescribetheirillness,whichtreatmentstheyhavetried,andwhetherornottheyhavesoughtadviceorhelpfromfolkhealers.12Boththepharmacistandthepatientworkcongruentlytoencompassthepatient,familyandtraditionalhealers.Finally,BATHEstandsforbackground,affect,trouble,handling,andempathy.13Thepharmacistcanaskthefollowingquestionstoelicitinformationneededfromthemne-monic:“Whatisgoingoninyourliferightnow?’(background),“Howdoyoufeelaboutthat?”(affect),“Whatistroublingyoumost?”(trouble),“Howareyouhandlingthis?”(handling).Thenthepharmacistshouldprovideempathyregardingthesituationbystatingsomethinglike“Iunderstandhowthismaymakeyoufeel”.Thismnemonicmethodallowspharmaciststoprovidebriefcounselinginterventions,addressingpsychosocialissuessurroundingtheprob-lem.2BATHEassessestheproblemandsupportsthepatient’sneedsandfeelingsatthesametime.2

Manysituationswillrequireusingmorethanoneofthetoolsavailabletoprovideeffectivecross-culturalcommunication.Throughpractice,apharmacistwilllearnwhichtoolsaremoreeffectiveincertain


JOURNAL CE

settingsandwhichtoolsworkbetterforthemperson-ally.

SUMMARYTheneedforpharmaciststobeculturallycompetentisevidentwiththeethnicitychangesournationisex-periencing.Itisimportantforpharmacistsofallagesandfromallwalksoflifetobeabletodefineculturalcompetencyandassesspersonalcompetency.Phar-macistsshouldrememberthatculturalcompetencyisanongoingprocess.Beingknowledgeableaboutwaystoimproveculturalcompetencyskills,aswellasthemethodsavailabletobettercommunicatein

5

Cultural competence encompasses a desire to not allow biases and in turn treatevery individual with respect. For most people cultural competence takesconsistent individual practice over time.6

CROSS-CULTURAL COMMUNICATION BARRIERS

Part of continuing to learn to improve cultural competency involves identifyingcross-cultural communication barriers and methods to overcome these barriers.This knowledge will allow you to be a more effective communicator. Cross-culturalcommunication barriers can be broken down into 8 categories: Lack of knowledge,fear and distrust, stereotyping, assumed similarity, nonverbal communication,authority, physical touch/contact and verbal languages and styles. Table 3 detailshow Halbur and Halbur describe each of the 8 barriers.2

Table 4. Cross-Cultural Communication Barriers

Barrier Explanation/example

Lack of knowledge Health care providers who are notknowledgeable about culturaldifferences risk misinterpreting patients’attempts to communicate

Fear and distrust People from different cultures are oftensuspicious of each other’s actions andmotives because they lack information.Pharmacists must take extra time tobuild trust with their patients

Stereotyping Making assumptions that cannot besubstantiated about all people from aparticular group

Assumed similarity Individuals involved in a conversationshare the same definitions and meaningsof both verbal and nonverbalcommunication. In reality, meanings ofboth verbal and nonverbalcommunication differ across cultures

Nonverbal communication Uses of nonverbal cues and the meaningsthey express vary greatly within andacross cultures. Eye contact may beconsidered rude or intimidating in somecultures

Authority Demonstrating respect for authority isimportant in some cultures

Physical contact/touch Varies greatly within and acrosscultures. Even though some pharmacistsmay not provide care that involvessignificant physical touch, it’s importantto understand how patient’s view it

6

Verbal languages and styles Pacing and timing of language can beassociated with communicationbreakdowns


CROSS CULTURAL COMMUNICATION TOOLS

There are many methods and models available for pharmacists to use tocommunicate effectively in cross-cultural situations as well. Effectivecommunication (verbal and nonverbal), as well as active listening, are imperativefor patient understanding in cross-cultural interactions with the pharmacist. Toolsavailable to aid the pharmacist in communication and active listening includeinterpreters, Kleinman’s questions, and several mnemonic models.

Interpreters play a major role in cross-cultural communication in many situations,as their use can result in better patient care.2 For example, an interpreter is vital tothe pharmacist-patient relationship when needing to overcome limited Englishproficiency.2 Professional interpreters should be used when there is a need toovercome limited proficiency of a patient to speak English versus family membersor friends. Family members and friends may edit or distort information to protectthe patient from bad news.2 Additionally, using family members or friends asinterpreters could be viewed as a direct violation of a patient’s confidentiality. Aculturally competent pharmacist should be able to recognize when an interpreterwould be helpful or necessary.

Many times pharmacists are in a situation where they need to elicit patients’ healthbeliefs. The Kleinman questions provide an excellent means to obtain the patient’shealth beliefs in an appropriate manor.2 The questions are:9

1. What do you think caused your problem?2. Why do you think your problem/sickness started when it did?3. What do you think your sickness does to you? How does it work?4. How severe is your sickness? Will it have a short or long course?5. What kind of treatment should you receive?6. What are the most important results you hope to receive from this

treatment?7. What are the chief problems your sickness has caused you?8. What do you fear most about your sickness?

Kleinman’s questions put the initial assessment into the hands of the patient. Thisallows the pharmacist an opportunity to decide how to approach the cross-culturalsituation.

Several mnemonic methods exist to assist in cross-cultural communication barriersituations. A few of the most common include: LEARN, SOLER, ETHNIC and BATHE.LEARN stands for listen, explain, acknowledge, recommend treatment(s) andnegotiate treatment(s).10 When listening, the pharmacist should do so withempathy and understanding to the patient’s perception of the problem. Next, the

suchsituations,aretoolsthatprovidepharmaciststheopportunitytoimprovehealthoutcomesfordiversepatientpopulations.


JOURNAL CE

RESOURCES

1. PopulationProjectionProgram,USCensusBureau.ProjectedDistributionofResidentPopula-tionbyRaceandHispanicOrigin:2012to2060.Availableat:http://www.census.gov/population/pro-jections/files/methodology/methodstatement12.pdf.AccessedFebruary9,2013.

2. HalburnKV,HalburnDA.EssentialsofCul-turalCompetenceinPharmacyPractice.Washington,D.C.:AmericanPharmacistsAssociation;2008.

3. TaylorD,PattonJ.ThePharmacyStudentPopulation:ApplicationsReceived2009-10,DegreesConferred2009-10,2010Enrollments.AmericanJournalofPharmaceuticalEducation.2011:Decem-ber15;75(10):S3.

4. BuckleyT.Culturalcompetency:Howtocommunicateeffectivelyacrossculturalboundaries.DrugTopics.2012;7:24-33.

5. USDepartmentofHealthandHumanServices.CulturallyandLinguisticallyAppropriateServicesinHealthCare.Availableat:http://www.hhs.gov/ash/oah/news/assets/tpp_training_linguisti-cally.pdf.AccessedFebruary9,2013.

6. ManagementSciencesforHealth.TheProvidersGuidetoQualityandCulture.Availableat:http://erc.msh.org/mainpage.cfm?file=3.0.htm&module=provider.AccessedAugust22,2012.

7. EdlinM.CulturalCompetencyMeansBetterPatientCare.DrugTopics.2012;6:18-19.

8. NationalCenterforCulturalCompetence.CulturalCompetenceHealthPractitionerAssessment.Availableat:http://nccc.georgetown.edu/features/CCHPA.html.AccessedFebruary9,2013.

9. KleinmanA,EisenbergL,GoodB.Culture,illnessandcare:clinicallessonsfromanthropologi-calandcross-culturalresearch.AnnInternMed.1978;88:251-258.

10. BerlinEA,FowkesWC.Ateachframeworkforcross-culturalhealthcareapplicationinfamily

practiceincross-culturalmedicine.WestJMed.1983;12(139):93-98.

11. EganG.TheSkilledHelper:AProblemManagementandOpportunityApproachtoHelping.PacificGrove,California:CambridgeBrooks/Cole;2002.

12. LevinSJ,LikeRC,GottliebJE.ETHNIC:aframeworkforculturallycompetentethicalpractice.PatientCare.2000;34:188-189.

13. StuartMR,LeibermannJR.TheFifteen-MinuteHour:AppliedPsychotherapyforthePri-maryCarePhysician.NewYork:Praeger;1993.


Achieving Cultural Competency and Its Role in PharmacyCorrespondence Course Program Number: 0171-9999-13-087-H04-P. 1.Completeandmailentirepage.SCPhAmemberscantaketheJournalCEforfree;$15fornon-members.Checkmustaccompanytest.Youmayalsocompletethetestandsubmitpaymentonlineatwww.scrx.org.2.Mailto:PalmettoPharmacistCE,1350BrowningRoad,Columbia,SC29210-6309.3.ContinuingEducationstatementsofcreditwillbeissuedwithin6weeksfromthedatethequiz,evaluationformandpaymentarereceived.4.Participantsscoring70%orgreaterandcompletingtheprogramevaluationformwillbeissuedCEcredit.Participantsreceivingafailinggradeonanyexaminationwillhavetheexaminationreturned.Theparticipantwillbepermittedtoretaketheexaminationonetimeatnoextracharge.

SouthCarolinaPharmacyAssociationisaccreditedbytheAccreditationCouncilforPharmacyEducationasprovidersforcontinuingphar-macyeducation.Thisarticleisapprovedfor1contacthourofcontinuingpharmacyeducationcredit(ACPEUPN0171-9999-13-087-H04-P.).ThisCEcreditexpires8/28/2016.

Name:_______________________________________________License#:__________________________

Address:________________________________________________________________________________

City:____________________________________________State:_____Zip:________________________

Phone:_______________________________________Email:____________________________________

NABPeID:_________________________________BirthMonth/BirthDate(MMDD):________________Evaluation: Circle the appropriate response Didthearticleachievethestatedobjectives?Notatall12345CompletelyOverallevaluationofthearticle?Poor12345ExcellentWastheinformationrelevanttoyourpractice?No12345YesHowlongdidittakeyoutoreadthearticleandcompletetheexam?______________CE credit will ONLY be awarded when a submitted test is accompanied by completing the evaluation above or online at www.scrsx.org

LEARNING ASSESSMENT QUESTIONS:1.Whichpopulationsubsethasthegreatestprojected%in-creaseintheUSbyyear2050comparedto2011data?a. Caucasianb. Hispanic/Latinoc. AfricanAmericand. Asian

2.Culturalcompetencyisachievedovertimeandevolveswiththechangingenvironment,meaningitisacontinuousprocessofevaluatingandlearning.a. Trueb. False

3.Whichofthefollowingisnotarecommendedmethodtoimproveculturalcompetencyskills?a. Reachouttoreligiousleadersororganizationsb. Seekouttraditionalhealersc. Immerseselfinacommunityyouwouldliketolearn moreaboutd. Readonlyaboutdiseasestatesbasedonyourculture

4.Whichofthefollowingwouldnotbeconsideredacross-culturalcommunicationbarrier?a. Knowledgeofculturaldifferencesb. Stereotypingc. Authorityd. Nonverbalcommunication

5.ThefirststepincommunicationusingtheSOLERmodelrequiresthepharmacistto:a. Sleepwellbeforeinteractingwiththepatientb. Simplyexplainthetreatmentoptionstothepatientc. Squarelyfacethepatientd. Seekmoreinformationfromthepatient’sfamily orfriendsconcerningthereligiousandethical viewsofthepatient

6.Whichofthefollowingcrossculturalcommunicationtoolswouldbemostappropriatewhendealingwithpatientswhohavestrongbeliefsinfolkhealingandspirituality?a. Professionalinterpreterb. BATHEc. Kleinman’squestionsd. ETHNIC

7.Whichofthefollowingisatruestatement?a. Usesofnonverbalcuesandthemeaningsthey expressdonotvarygreatlywithinandacross cultures.b. Demonstratingrespectforauthorityisimportantin allculturesc. Learningtoevaluateculturalcompetencylevels mustbepartofanongoingefforttoprovidebetter healthcared. Unfortunately,therearenotmanyresourcesavail abletoprovideassessmentofculturalcompetence andtheonesavailablearenoteasilyaccessible.


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