Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

The Centers for Disease Control and Prevention (CDC) have produced the first set of 

 for people who have received either 2 doses of the Pfizer/BioNTech or Moderna vaccine or the 1 dose of the Johnson & Johnson/Janssen vaccine.

For the purposes of the guidance, a person is considered fully vaccinated for COVID-19, ≥2 weeks after receiving the second dose of the 2-dose vaccines and the ≥2 weeks after receiving the vaccine of the single-dose vaccine. The recommendations are also only for non-health care settings.

Visit with other fully vaccinated people in an indoor space without mask wearing or social distancing.

Visit with unvaccinated people from a single household without mask wearing or social distancing, if the unvaccinated people are at low risk for severe COVID-19 disease

Abstain from quarantine and testing after a known exposure, if the exposure was to asymptomatic people.

The guidance also recommends that fully vaccinated people continue to:

Wear a well-fitted face covering in public

Continue mask wearing, social distancing, and other infection control measures when visiting with unvaccinated people at increased risk of severe disease or if visiting with unvaccinated people from multiple households

Undergo testing if COVID-19 symptoms occur

Follow CDC and health department travel requirements

Continue avoiding medium- and large-sized in-person gatherings.

1. Centers for Disease Control and Prevention. Interim public health recommendations for fully vaccinated people. Published March 8, 2021. Accessed March 8, 2021. 

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html

Articles

The CDC has issued interim guidance for masking, social distancing, hand hygiene, and other infection control measures for people who are fully vaccinated for COVID-19.

CDC Issues First Recommendations For People Fully Vaccinated for COVID-19

 administered and 523,000 deaths in the US as of this article’s press time, keeping up with pandemic news is more important than ever. Check back to 

to stay informed on the latest coronavirus-related news and research.

 Patrick Bordnick, dean of the Tulane University School of Social Work, guides us through some key self-care recommendations, featuring the school’s diverse set of self-care resources.

 will soon be available on DrugTopics.com. In this issue, pharmacists offer advice on how to approach complementary and integrative therapies, and our cover story, in celebration of Women’s History Month, highlights the achievements from women in pharmacy practice.

Christine Blank writes on a recent meta-analysis exploring the 

comorbid relationship between asthma and migraine.

® this week will dive into research on the effect of exercise on migraine symptoms.

The American Pharmacists Association (APhA) 2021 Annual Meeting & Exposition kicks off virtually on March 12.

NCPA Survey Finds Most Adults Prefer Local Pharmacist Over Mail Order

Results of a new national survey showed that more than 8 in 10 adults prefer their local pharmacists over mail order services.

Here’s a preview of the featured content to watch for this week on Drug Topics®.

This Week on Drug Topics: March 8  to 12

In the late 1970s, I worked at a paper mill for 3 summers while I was in pharmacy school. Of all my lessons learned running jackhammers in steel tanks, shoveling bark in the woodyard, and muscling cast iron boiler parts, I can still see a sign in the personnel director’s office. It was a sheet of paper that read, “Don’t start vast projects with half-vast ideas.” Say it quickly and it really makes sense.

I can’t think of a more lucid example of a vast project that has been implemented with “half-vast” ideas and implementation than the COVID-19 vaccine rollout. There isn’t a community pharmacist whose day-to-day activities has not been altered by this historic event. Patients call incessantly asking when it is their turn to get their dose of the precious vaccine. Even the leadership in Washington and our state capitals see the community pharmacist as the answer.

The news, whether on the internet or television or in your local newspaper, is chock-full of vaccine stories. Patients read the headlines and pick up the phone and call the pharmacy for information. Small community pharmacies can field 100 phone calls or more a day for patients to be put on the “list.” Forget the internet; most patients, especially the elderly, want to speak to a human, a human who can get them this life-preserving shot in the arm.

We’ve all seen the colossal success in West Virginia, one of the few states to use independent pharmacists to administer vaccines in the nursing homes. In my home state of Pennsylvania, we were ranked in the very bottom of percentage of shots administered versus received in the initial rollout. West Virginia, early on under the leadership of Gov James “Big Jim” Justice, deployed small, independent pharmacies as the best option. My daughter Gretchen Garofoli, PharmD, BCACP, CTTS, and her team of pharmacists, Krista Capehart, Pharm D, MSPharm, BCACP, AE-C; Betsy Elswick, PharmD; Ashleigh Barrickman, PharmD, BCACP; Heather Johnson, PharmD; Ashlee McMillan, PharmD; and Angela Goodhart, PharmD, are mostly responsible for West Virginia’s success. Gretchen was featured on local news channels, NPR, PBS, and even the British Broadcasting Corporation’s (BBC) World News. Capehart has been featured on many news outlets as well and was featured giving Justice his vaccine.

Notice that all 7 leaders from the West Virginia’s School of Pharmacy are women. At the end of the day, they go home and manage their households and take care of Ethan, Luke, Gwyn, Ainslee, Connor, Macy, Lila, and Ava. These amazing women saw a vast project and used their leadership skills and connections to implement the rollout of vaccines to the long-term care facility residents.

Two other women I’m familiar with are Pennsylvania residents and pharmacists. Molly Beimel, PharmD, from my birthplace of St. Marys, Pennsylvania, spearheaded her independent pharmacy’s efforts and pulled off a 1200-dose clinic at the local Catholic high school. Even closer to me is my wife, Denise Kreckel, RPh, who, along with her colleagues at Centre Volunteers in Medicine in State College, Pennsylvania, conducted the same 1200-dose clinic, however, with the Pfizer vaccine. With such precision, my wife handled the numerous storage requirements of this delicate vaccine from dry ice to thawing, reconstitution, and administration. I was amazed to see this 5-foot, 2-inch powerhouse impact the lives of so many in our community. 

Women make up about a quarter of Congress and of Pennsylvania’s state representatives in Harrisburg. On the national and state levels, the rollout of the vaccine has been abysmal. Is there any wonder the amazing success of West Virginia and the clinic success in Pennsylvania are led by women pharmacists? There is no doubt their vast ideas are making up for the “half-vast” vaccine rollout on the federal level. 

In an opinion piece, pharmacist Pete Kreckel highlights the ways that women have been leading the COVID-19 vaccination effort.

Women Pharmacists Are Leading Successful COVID-19 Vaccination Programs

In the first study of its kind, investigators indicated that migraine may be a potential risk indicator for asthma, and vice versa.

The first meta-analysis of population-based studies that assessed the comorbid relationship between migraine and asthma was published in 

Migraine is frequently comorbid with asthma, the investigators noted, as a condition recognized as “acephalic migraine” and “pulmonary migraine”.

“The common pathophysiologic mechanisms of inflammation and immune dysfunction between the 2 diseases could explain the bidirectional association. For example, atopy, various inflammatory mediators, or elevated neuropeptide mediators contribute to both migraine and asthma,” the investigators wrote in the study.

In addition, the shared triggering and environmental factors such as air pollutants are related to the occurrence or aggravation of asthma and the rate of emergency department visits for migraine. Emotional stress or psychological distress, as anxiety or depression, due to asthma could increase susceptibility to migraine and vice versa.

After an extensive review of published literature on the topic, the investigators analyzed 15 studies that included nearly 1.2 million individuals.

“We found that migraine was associated with 54% increased prevalence and 42% greater risk of asthma, and vice versa, asthma associated with 45% increased prevalence and 47% greater risk of migraine,” the investigators wrote.

Still, the exact pathway leading to comorbidity of migraine and asthma remains unclear, the investigators said. “Previous studies have demonstrated an insight into the relationship between migraine and asthma from shared inflammatory, immune, and genetic factors.”

Studies have shown that allergic responses triggered by allergens such as pollen release various inflammatory mediators or elevated neuropeptide mediated by mast cells, leading to hypersensitivity of airway responses in patients with asthma. In migraine, mast cells in the dura matter activated by allergens may secrete proinflammatory and vasodilatory molecules, which are presumed to cause the activation of the trigeminal pain pathway underlying migraine pathogenesis.

In addition, parasympathetic hyperactivity is believed to be involved in the connection between asthma and migraine. An increased cholinergic tone has been suggested to trigger bronchospasm in asthma, they wrote.

Although migraine and asthma may share a pathogenesis process, it is difficult to confirm whether there is a direct relationship between the 2 diseases, the investigators acknowledged.

Their analysis was also limited because only 1 case-control study, primarily of adolescents, and 5 of 6 cohort studies were carried out in Asia, potentially limiting the generalizability of the findings to region and population, they wrote.

“Even so, our findings are still of important implications. The bidirectional relationship we found might aid in preventing or identifying people with these two diseases,” the investigators wrote. “It is necessary to get further information about potential overlapping pathways in pathogenesis, which may facilitate the development of new treatment strategies for migraine and asthma.”

1. Wang L, Zi-Ru D, et al. The comorbid relationship between migraine and asthma: A systematic review and meta-analysis of population-based studies. 

. January 13, 2021. doi:10.3389/fmed.2020.609528

Migraine is frequently comorbid with asthma. A new analysis examines whether there is a direct relationship between the 2 diseases.

Meta-analysis Examines Comorbid Relationship Between Migraine, Asthma

Keith Loria is a contributing writer to Medical Economics.

As the United States surpasses 26 million COVID-19 infections, immunization against the disease is critical. President Biden has pledged to increase the vaccine supply so that 100 million doses can be distributed during his first 100 days in office, and that means that community pharmacies should prepare to do their share.

But pharmacists still need to oer other immunizations as well, so the addition of these expected COVID-19 vaccinations will only add to the pharmacy’s workload. That’s why pharmacists need to think about how to improve workflow eciencies and create a stronger system management. Technology is often the answer.

Technology allows for faster counting and better record keeping, and for those pharmacies that can invest in automation, the impact can be exponential in improving eciencies, both in vial dispensing and in medication adherence packaging.

Peter Saad, PharmD, MBA, director of product strategy at pharmacy automation company Parata Systems, noted that the COVID-19 vaccine efforts will be new waters for retail pharmacy, as much of the process will be dierent, including, but not limited to, billing and tracking.

“Technology and automation will be key in streamlining processes for these pharmacies by freeing up time for pharmacists and technicians to focus on the clinical initiative of vaccine efforts and understanding the new waters,” Saad said.

More than ever, pharmacists are seen as frontline medical providers for the vaccine, and as such, they need to be front of house counseling patients. That’s why we are seeing retail pharmacies invest in technology, whether new to automation, or scaling their existing automation.

“Tactically, there are a variety of ways pharmacists can rely on technology for workflow and system management,” Saad said.

These include syncing patient medication regimens to monthly cycles to limit time to dispense/sell in the pharmacy, allowing more time for vaccine discussion and distribution; using Health Insurance Portability and Accountability Act compliant online form submission and preemptively inputting patients before arrival to streamline the vaccination process; and automating the filling process or hiring an additional pharmacy technician, as at least 1 technician will likely be occupied with receiving and inputting patient and vaccine information.

“If possible, have all refills filled via central fill, which allows for the ability to fill prescriptions quickly without using new resources, as this supports the bottom line and returns pharmacists and techs to activities that support patient care,” Saad said.

Jason Turner, PharmD, owner of Moundsville Pharmacy in Moundsville, West Virginia, said a great way to create a strong foundation of efficiencies in a pharmacy is to initiate a medication synchronization program.

“Medication synchronization changes your workflow from being ‘on demand’ workflow, meaning when the patient calls in the prescription, you begin to work on it in a way where your pharmacy team is in control of when you process a large percentage of your prescription volume,” he said.

For example, there are 1800 patients enrolled in Moundsville Pharmacy’s SyncRx program—73% of monthly prescription volume.

“We are able to schedule the work with a strategy to be most efficient in our prescription processing and most available to our patients for clinical services, such as immunization,” Turner said.

Jason Ausili, PharmD, chief clinical officer for FDS, a provider of pharmacy technology solutions for independent pharmacists, noted that tech can help drive immunization efficiencies in numerous ways.

“It can be used for billing the medical benefit for vaccine and/or administration fees in a way that is streamlined with workflow, provide automated reporting to state registries for reportable vaccine events, and allow a pharmacist to query state registries for vaccine eligibility at the patient level,” Ausili said. “Tech makes clinical documentation easy and efficient and makes the patient scheduling process a more automated and organized experience.”

At Moundsville Pharmacy, there are 2 Kirby Lester units, a ScriptPro SP 200, and a Parata PASS 300VP to increase efficiencies in the sta, workflow, and programs.

Turner recommends using dierent colored paper for each immunization record, which allows the staff to access and recognize vaccines in the workflow quickly, from billing to vaccinating, documenting, and record storage.

“For larger pharmacy teams, I would create a workflow for your immunization prescriptions,” he said. “This way, if a patient comes in and requests a vaccine, everyone knows how that clipboard is to flow to maximize your eciency and not disrupt existing workflow.”

Because vaccine billing can be challenging, Turner suggests directing vaccine billing to 1 or 2 vaccine specialists to make sure they are processed timely and identify quickly if you are unable to bill a payer through your pharmacy management system.

Maximizing the features of pharmacy software is no longer an option, as many pharmacies continue to use their software the way they did 5 or even 10 years ago, either not detecting the upgrades in their pharmacy management systems or not knowing how to incorporate them into their workflow.

Too often pharmacies invest in automation, counting technology, or a fancy new bell or whistle for their pharmacy management system, only to find that it doesn’t change the outcome.

“Over the years, in working with and training pharmacy owners in medication synchronization, it has become clear that the physical workflow of the pharmacy—how the prescription moves about the pharmacy—and the processes that support pharmacy workflow really dictate the eciency of a pharmacy,” Turner said.

The expense of automation technology and lack of cash flow for retail pharmacies are no question the largest barriers for adoption. But Saad said the best way to increase efficiencies with existing staff is by incorporating automation.

“Not only will it allow pharmacists to move to the front of the pharmacy and practice at the top of their license, but it will allow for value-adding activities for patients, all the while technology is handling routine prescription fills quietly in the back of the pharmacy,” he said. “When pharmacies start to hit 200 scripts a day, there will already be ROI from the technology, helping to fix that cash flow problem and making the cost worth it almost instantaneously.”


In 2021, there will be a lot of buzz around the approved COVID-19 vaccines and their availability, and although these vaccines have given pharmacists opportunities, they also have added pressure.

“The most important first step is to train your staff in how to respond to calls and inquiries about the vaccine,” Turner said. “This will help to keep inquiries consistent, concise, and informative for the patient. Utilize your automated attendant to record a manager’s message at the beginning of every received call and your on-hold system to provide additional information.”

The pharmacy management system will be able to record and bill immunizations. However, understanding what insurance you can and cannot bill will be important, keeping in mind that, even if you cannot bill the insurance, you cannot deny the patient the vaccine.

Additionally, when the vaccine supply increases, retail pharmacies will be busier than ever, which means long lines made even longer with social distancing efforts.

Saad said that although billing will be unified, normal business activities, in combination with vaccine efforts, will be hard to manage without relying on assistance, including technology and automation.

“After the pandemic passes, retail pharmacies need to accept what they have known for a decade: Fee for service is no longer viable,” he said. “If they don’t pivot their pharmacist role to one that is more collaborative and clinical in nature, they will be out of business in the next decade. Free up pharmacist time using automation, work to identify clinical services, and start providing."

Pharmacies can leverage technology for their workflow and system management. Here’s how.

Improve Immunization Efficiencies With Automation

The COVID-19 vaccination effort is well underway in the US, with over 82.57 million administered doses and 8.3% of the population fully vaccinated against the virus as of press time.

This week, President Biden promised that the federal government will have enough doses of the COVID-19 vaccine to vaccinate approximately 300 million Americans by the end of May, and the FDA authorized the third vaccine for COVID-19.

Here’s a roundup of the latest coronavirus-related news:

IDSA: COVID-19 Testing, Masking Still Needed to Control Pandemic

In a briefing, the Infectious Diseases Society of America (IDSA) stressed the continued importance of COVID-19 control measures that have been there from the start.

Biden Pledges Enough COVID-19 Vaccines for All US Adults By End of May

President Biden promised that the federal government will have enough doses of the COVID-19 vaccine to vaccinate approximately 300 million Americans by the end of May, which is 2 months earlier than anticipated.

Shingles Vaccination Counseling During the COVID-19 Pandemic

 from the CDC regarding vaccination against 

 during the COVID-19 pandemic designates it as an essential preventive care service for older adults that should not be delayed or discontinued unless a patient is suspected or confirmed to have COVID-19.

Study Results Show Half of Severe COVID-19 Patients Have Damage to the Heart

Approximately 50% of patients hospitalized for severe COVID-19 and with elevated troponin levels presented lasting heart damage, including myocarditis, infarction, ischemia, as well as combinations of all 3, according to a recent study.

FDA Updates Storage, Transportation Guidance for Pfizer-BioNTech COVID-19 Vaccine

Officials with the FDA recently announced updates to required storage and transportation conditions for the Pfizer-BioNTech COVID-19 vaccine.

FDA Grants Emergency Use Authorization to Third COVID-19 Vaccine

The FDA has granted emergency use authorization (EUA) to Johnson & Johnson for its COVID-19 vaccine.

Here's a roundup of the latest coronavirus-related news.

Coronavirus News Roundup: FDA Authorizes Johnson & Johnson Vaccine; Biden Pledges Vaccine Supply for All US Adults by End of May 

Most Americans prefer their local pharmacists over prescription drug mail order services, according to results of a new national survey released by the National Community Pharmacists Association (NCPA).

The survey, which was conducted by Public Policy Polling on February 26-27, polled 1390 adults on where they prefer to get their prescription medications from.

According the results, 85% of adults who responded prefer getting their prescriptions from a local pharmacist instead of a mail order service. Thirty-six percent of respondents said that their pharmacist knows them better than a mail order company, 32% said their pharmacists answers their questions and provides counseling, and another 15% reported concerns that their prescriptions may get lost in the mail, exposed to the elements, or stolen.

Mail order pharmacies have been around for a while, but the COVID-19 pandemic showcased an increased demand for convenience in the health care space. Online retail giant Amazon made waves in recent months with the l

aunch of its online pharmacy and drug delivery service

. Customers who are members of the loyalty club Prime will receive 2-day shipping on their medications, as well as discounts on generic and prescription drugs. However, NCPA’s findings indicate that most patients still value the personal interactions with their pharmacist over the ability to get medications shipped directly to their door. 

“Most Americans clearly are not willing to substitute personal care for the perception of convenience,” NCPA CEO B. Douglas Hoey, RPh, MBA, said in a statement. “When they need medicine, they want to talk to a health care provider who knows them.”

Patients also rely on their pharmacists for more than filling prescriptions. According to the survey, approximately half of respondents said they’ve consulted their pharmacist for minor ailments, such as bee stings, cold sores, or diaper rash.

“That goes back to the trust factor,” Hoey said. “Most Americans visit their pharmacist more frequently than they visit their primary care physician. For any Americans, the local pharmacist is the only accessible health care provider. And it’s now very common for pharmacists to provide a full range of health care services beyond filling prescriptions.”

1. National Consumer Survey: More than 8 in 10 Adults Prefer their Local Pharmacist over Mail Order. News release. NCPA; March 4, 2021. Accessed March 5, 2021. 

https://ncpa.org/newsroom/news-releases/2021/03/04/national-consumer-survey-more-8-10-adults-prefer-their-local

Results of a new national survey showed that more than 8 in 10 adults prefer their local pharmacists over mail order services. 

NCPA: Most Adults Prefer Local Pharmacist Over Mail Order

As the United States approaches the 1-year anniversary of the start of shut downs related to the coronavirus 2019 (COVID-19) disease in the United States, there’s a sense of both hope, due to the recent authorization of 3 vaccines, and fatigue because many people feel worn out from dealing with business, educational and recreational closings and limitations.

Accelerated vaccination efforts, rumored easing of 

 recommendations among those who have been fully vaccinated, and the complete lifting of masking restrictions in certain states like Texas, could all lead to even those people who have been most vigilantly staying at home during this pandemic, tempted to relax their protocols. However, officials with Infectious Diseases Society of America hosted a briefing that serves as a reminder that infection prevention measures that have existed from the beginning, testing and wearing masks, will be just as important to ending the pandemic as the vaccines.

In her opening remakes in the briefing, Romney M. Humphries, PhD, D(ABMM), M(ASCP), professor of pathology, microbiology and immunology at Vanderbilt University Medical Center in Nashville, Tennessee, stated that although vaccination may be seen as a priority to many, robust testing for COVID-19 remains essential to infection control. It’s an important tool in not only finding cases, but helping with enrollment for therapeutic clinical trials, determining a community’s quarantine requirements, tracking spikes in cases, and monitoring for variants and further evolution in the virus. Then Mary K. Hayden, MD, FIDSA, professor of internal medicine and pathology at Rush Medical College in Chicago, Illinois, spoke about how one of the difficulties of testing is the vast number of scenarios. She stressed that testing was important not only because of public health implications, but it can also help prevent spread in the home due to family members taking measures, such as wearing masks and having the COVID-19 positive person be physically separated from others.

Humphries discussed whether COVID-19 testing in schools could be a helpful way to control the spread of the disease as well as an avenue for keeping schools open. Testing for COVID-19 in schools would likely follow the patterns of many other things in schools: wealthy districts would have the needed resources and poorer districts might not. She also noted that a lack of infrastructure made it unlikely that schools would be a major area of testing.

She said that other measures, such as having children with symptoms remain at home and monitoring their disease course would be just as helpful in controlling the spread.

In a briefing this morning, the Infectious Diseases Society of America (IDSA) stressed the continued importance of COVID-19 control measures that have been there from the start.

Hispanic and Latino adults have a high prevalence of cardiovascular risk factors, but low adherence to stroke prevention strategies, according to new research.

Less than half of the Hispanic/Latino adults with history of 

 or transient ischemic attack (TIA) had healthy blood pressure and cholesterol, according to the results of a 

Overall, 59% of participants had high blood pressure, 65% had high cholesterol, and more than one-third had type 1 or type 2 diabetes.

About half of participants were taking anticlotting medications. Less than half were taking cholesterol-lowering statin drugs and a quarter were taking both medications, which is the mainstay of stroke prevention.

“It’s a wake-up call for the medical community. Despite our best efforts, Hispanic and Latino populations still seem to be undertreated for their vascular risk factors,” said Fernando D. Testai, MD, PhD, FAHA, co-author of the study and an associate professor of neurology at the University of Illinois at Chicago, in a 

“I didn’t expect the numbers to be so dismal. We found many of the participants with previous stroke knew about their vascular risk factors; however, the data indicate they are receiving inadequate treatment and support, which are a real concern,” Testai added.

Health care professionals can help inform and support Hispanic and Latino adults about the importance of adopting healthy lifestyle behaviors to reduce their cardiovascular risk, according to Testai.

“Almost 80% of people in this study were overweight or obese, and a significant number continued to smoke despite having a history of stroke and other cardiovascular events,” Testai said.

“Access to care is another important area that we need to address to reduce cardiovascular risk in this population,” he added. Not having health insurance was associated with decreased statin use and unhealthy cholesterol levels, the researchers reported.

The researchers reviewed data from the Hispanic Community Health Study/Study of Latinos that involved more than 16,000 participants between 2008 and 2011.

1. Bai F, Chen J, Pandey D, et al. Stroke risk factor status and use of stroke prevention medications among Hispanic/Latino adults in HCHS/SOL. 2021. Doi: 

https://doi.org/10.1161/STROKEAHA.120.031216

2. Major cardiovascular risk factor rates are high in the U.S. Hispanic/Latino population. News release. American Heart Association; March 4, 2021. Accessed March 4, 2021. 

https://newsroom.heart.org/news/major-cardiovascular-risk-factor-rates-are-high-in-the-u-s-hispaniclatino-population?preview=e926

Hispanic and Latino adults have a high prevalence of cardiovascular risk factors, but many are receiving inadequate treatment. 

Study Shows Low Adherence to Stroke Prevention Strategies Among Hispanic and Latino Adults 

A collaborative pilot project involving community pharmacists and physicians effectively increased adherence to the opioid use disorder (OUD) medication buprenorphine, according to the results of a recent study.

An article detailing the study, which was supported by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, was published in 

Buprenorphine has been used in opioid addiction treatment for nearly 2 decades, however, providers must complete training and receive a waiver to prescribe the medication to treat OUD. Less than 10% of primary care providers are authorized to prescribe buprenorphine and more than 20 million Americans live in a county without a buprenorphine-waivered physician. This lack of access creates barriers to treatment, especially for those in underserved communities, according to NIH.

To help address the lack of access and adherence to buprenorphine, investigators from Duke University studied the transfer of care of 71 participants using buprenorphine maintenance therapy for OUD from waivered physicians to trained community pharmacists.

“Community pharmacists are among the most trusted health care professionals in the US,” said Li-Tzy Wu, ScD, RN, MA, one of the study’s authors and director of the Community-Based Substance Use Disorder Research Program at Duke University School of Medicine. “Community pharmacies are highly accessible, even in…US rural areas.”

Six physicians and 6 community pharmacists took part in the initial phase of the pilot project. Participating community pharmacies included Health Park Pharmacy in Raleigh, North Carolina; Clinic Pharmacy in Durham, North Carolina; and Josef Pharmacy, also in Durham.

Participants, physicians, and pharmacists who participated reported high rates of satisfaction with the program, according to the findings. More than 90% of patients said they were “very satisfied with their experience and the quality of treatment offered,” the investigators wrote. In addition, patients noted that “treatment transfer from physician's office to the pharmacy was not difficult at all” and that “holding buprenorphine visits at the same place the medication is dispensed was very or extremely useful/convenient,” according to the study.

Moreover, the program appeared to be effective. With the physician-pharmacist collaborative model, nearly 89% of participants remained in the study and 95.3% adhered to the daily medication regimen. In addition, during the 6-month trial of the program in 2018, no opioid-related emergencies or hospitalizations were reported. The proportion of opioid-positive urine drug screens was less than 5% at month 6 among participants who completed all urine drug screens in the study.

The initial treatment phase, in which the buprenorphine dose is gradually increased until a satisfactory daily dose is reached, was carried out under the care of a waivered physician. Participants attended monthly maintenance visits during which pharmacists dispensed buprenorphine, assessed how well the medication was working, and provided counseling and referrals to specialists as needed. Pharmacists provided feedback to the partnering physician to adjust buprenorphine dosage as needed. Pharmacists used prescription drug monitoring programs at 96.8% of visits. No opioid‐related safety events were reported.

“Community pharmacists are experts in medication therapy management and are natural partners of physicians, providers, [and] prescribers,” Wu said. For this reason, community pharmacists may further help address the physician shortage in the United States, Wu noted. 

Overall, the results of pilot study offered strong support for advancing physician-pharmacist team-based approaches to leverage community pharmacies as a resource in expanding access to OUD treatment, according to NIH. However, larger clinical trials are needed to establish strategies and approaches to most effectively implement team-based buprenorphine care and respond to the needs of diverse clinical settings and populations, the investigators concluded.

Wu LT, John W, Ghitza UE, et al. Buprenorphine physician-pharmacist collaboration in the management of patients with opioid use disorder: results from a multisite study of the National Drug Abuse Treatment Clinical Trials Network. 

. Published online January 11, 2021. 2021;10.1111/add.15353. doi:10.1111/add.15353

Physician-pharmacist collaboration may increase adherence to opioid addiction treatment. News release. National Institutes of Health. January 11, 2021. Accessed February 8, 2021. 

https://www.nih.gov/news-events/news-releases/physician-pharmacist-collaboration-may-increase-adherence-opioid-addiction-treatment

Americans in underserved communities face barriers to opioid use disorder treatment.  

Pharmacist-Physician Collaboration Boosts Buprenorphine Access

Minh Dang, RPh, was in high school working as a cashier at an Osco Drug in a suburb of Boston, Massachusetts, in the late 1980s. A friendly kid who loved math and science, she wasn’t sure what career to pursue. One day, the store’s pharmacy manager pulled her aside and asked, “What do you think about a career in pharmacy?”

She was 16 or 17 years old at the time. Although there were doctors and nurses in her family, there wasn’t a single pharmacist. Dang now looks at that conversation as a pivotal point in her life.

Dang credits her success in the pharmacy profession today to the skills she learned working with patients early in her career. For example, during an internship at a pharmacy in Boston, she encountered a patient who insisted on speaking with a pharmacist instead of her. Dang calmly explained that she was the pharmacist, which confused him. Most pharmacists at the time were white men and she doesn’t remember knowing any Asian American women pharmacists at the time, she said. But Dang took the conversation in stride.

She asked how she could help, and that simple question persuaded the patient to open up to her. Dang’s advice for handling tense conversations with patients? “Be professional and kind and caring. They will convert.”

Since 2013, Dang has served as assistant dean for experiential education and professor of practice for clinical sciences at the School of Pharmacy and Health Sciences at Keck Graduate Institute in Claremont, California. This is a full-circle moment in her career because it’s now her mission to inspire students and connect them with real-world work experiences in pharmacy.

Women Are In the Majority, But Leadership Roles Lag

Dang is one of 5 women pharmacists featured in this story. Unlike her experience with the pharmacy manager at Osco Drug, most of the women featured had a role model in a relative who was a pharmacist. Some attributes shared by all of these women: an early passion and affinity for math and science and a desire to help people.

According to the American Pharmacists Association (APhA), 67% of its members are women. And the industry can look forward to welcoming many more women into its ranks in the future: As of fall 2019, 64% of pharmacy students were women, a metric that’s held steady for 20 years, according to Frank Fortin, CAE, senior vice president for communications, marketing, and media relations at APhA.

Debra Parker, PharmD, dean and associate professor at the College of Pharmacy at University of Findlay in Findlay, Ohio, looks to the 1960s as a decade when things started to change for women in professional roles, including pharmacists. In 1964, the Civil Rights Act was passed. The law made it illegal for most employers to discriminate against women in decisions about hiring and promotions; creating a work environment that’s hostile based on sex and sexual harassment was also rendered illegal. That was preceded in 1963 by the passage of the Equal Pay Act, which made it illegal to pay women a lower wage than their male colleagues when the decision is based on their sex.

That’s when you started to see women become more prevalent in many fields, said Parker, who noted that women represented only 15% to 16% of pharmacists in the mid-1960s. Although women will likely continue to form the majority of the pharmacist workforce, she said there are more men in leadership roles in pharmacy.

First Female Pharmacy School Dean in Ohio

In 2000, there were 82 pharmacy schools in the United States.

 Fifteen percent of them were led by a female dean, according to Parker. As of October 2020, there were 143 pharmacy schools

, 25% of which have a female dean, she said. That’s at odds with the number of pharmacy school graduates and women working as pharmacists.

The statistics about the percentage of women leading pharmacy schools were “startling” to Parker, she said. Parker is the only female dean among the 7 pharmacy schools in Ohio. She’s also the first female pharmacy school dean in the state. Although her counterparts at Ohio’s other pharmacy schools are all men, 2 of them have recently stepped down from their roles as dean and women have taken on those roles on an interim basis.

Parker didn’t have her sights set on a leadership role in academia. That said, she embraces the “lean in” approach, which, for her, means she doesn’t turn away from opportunities because she’s a mother. Instead, Parker focuses on how to make it work. She also credits her extremely supportive spouse.

While serving as a faculty member and an academic chair at the College of Pharmacy at University of Findlay, Parker was asked to take on the role of interim dean. “That was a little bit scary for me,” she said. “I had never aspired to being a dean, but I also felt that I knew the operations of our program and our university well enough that I could hold down the fort.”

But after serving on an interim basis starting in August 2014, she said to herself: “Why are you selling yourself short here? [You] can do this job.” She applied for it and was named dean in April 2015.

 published in a student newspaper at Findlay University after she was named dean, Parker stressed that the pharmacy program’s “family focus” is a distinguishing factor; it also makes her “confident and comfortable” in her role as dean.

Joy Vreeland, PharmD, BCPS, director of inpatient pharmacy at Boston Medical Center, had an uncle who was a pharmacist. That inspired her decision to work as a tech at CVS Pharmacy during her senior year of high school.

“I got a little taste of what retail pharmacy looks like,” she said. “The techs were wonderful. I had a lot of customer interaction. I thought, ‘This seems like it would be a good fit for my long-term interests.’”

That was before she understood the role of a hospital pharmacist. While she was a student at Northeastern University, she had a work experience in the intravenous room at Boston Children’s Hospital, where she helped treat very sick patients. “That was like a whole new world,” said Vreeland, who described the experience as “invigorating.”

She grew more certain about a career in hospital pharmacy in her last year of pharmacy school during a clinical rotation. That’s where Vreeland witnessed pharmacists working side by side with nurses and doctors in the treatment of patients.

Vreeland continues to make an impact at Boston Medical Center. “The easiest way to describe how great Joy is to describe the operation she runs,” said David Twitchell, PharmD, MBA, vice president and chief pharmacy officer at Boston Medical Center. “The [Boston Medical Center] inpatient and clinical pharmacy programs are [in my opinion] among the best in the country by any metric…The [Boston Medical Center’s] team shines because of Joy’s leadership.”

Firmly planted in Sebastian, Florida, for 37 years, Bay Street Pharmacy is owned by Theresa Tolle, BPharm, FAPhA, a pharmacist, and her husband, Joe.

The pharmacy is a short drive from Walgreens Pharmacy and Sebastian Discount Pharmacy. When asked how Bay Street Pharmacy thrives in the midst of heady competition, Tolle said she works hard to maintain relationships in the community. She registers the pharmacy to sponsor the American Cancer Society’s Relay for Life, is active in the local chamber of commerce, and serves on the board of the local hospital.

It helps that many of her employees have been at the pharmacy for 15 years or more, Tolle said. While she followed in her aunt’s footsteps as a pharmacist, she also spent years learning about working with customers at her parents’ feed store.

Tolle is past president of the Florida Pharmacy Association. In March, she starts her term as 2021-2022 president-elect of the American Pharmacists Association before she takes the reins as the organization’s president in March 2022.

Infectious Diseases Pharmacist Tackling COVID-19

Kaitlyn Rivard, PharmD, BCPS, an infectious diseases clinical pharmacist at Cleveland Clinic in Ohio, was 13 years old when she realized she wanted to be a pharmacist. At the time, her aunt had just graduated from pharmacy school. “She was a young professional. I liked that she was able to support herself and be independent, and she always genuinely liked her job. I wanted to be just like her,” she said.

She typically fills her days at Cleveland Clinic working collaboratively with physicians to select the timing, dosing, and the right combination of antibiotics to treat patients. Always in Rivard’s sights is making sure that drugs are used safely.

But she hasn’t been doing her day job at Cleveland Clinic since November. That’s when Rivard started leading the health system’s COVID-19 vaccination response from a pharmacy standpoint. At first, she thought her days would be spent managing the vaccine supply. Instead, because inventory is scarce and the need is so acute, she has been plugged into all aspects of the vaccination process, including deciding how many vaccination bays are required and keeping an eye on day-to-day operations.

Elizabeth Gooking Greenleaf, who started an apothecary shop in Boston in 1727, is recognized as the country’s first female pharmacist.

 As a mother of 12, she certainly embraced “leaning in,” as do the pharmacists featured here.

Although there is more work to be done to close gender gaps, women are increasingly breaking ground in pharmacy leadership. According to the 2019 National Pharmacist Workforce Study, of the actively practicing pharmacists who were in management positions in 2019, 58.8% were female, compared with 40.5% in 2009.

 Today, women are serving as pharmacists behind the counter, in team-based care at the patient bedside, and in boardrooms, as well as tackling the logistics to ensure an end to the deadly COVID-19 pandemic.

Surely, Greenleaf would be proud of the accomplishments of women in pharmacy today. But despite strides, a gender gap remains. To further advance women in the profession, continued mentorship and leadership development will be key.

Brown L. Years of rampant expansion have imposed Darwinian survival-of-the-fittest conditions on US pharmacy schools. 

Stubbs S. Debra Parker selected as new dean for the College of Pharmacy. The Pulse. April 7, 2015. Accessed February 6, 2021. 

https://pulse.findlay.edu/2015/uncategorized/news/debra-parker-selected-as-new-dean-for-the-college-of-pharmacy/

During Women’s History Month, we celebrate the achievements of women in pharmacy practice. 