Karen Berger, PharmD

Tanvee Thakur, PhD, BPharm, recently completed a project with the 

 (CPF) focused on enhancing transparent opioid education.

Thakur is currently a scientist at RTI Health Solutions. At the time of the project, Thakur was pursuing her PhD at the University of Wisconsin-Madison School of Pharmacy. During this time, Thakur recalled talking to pharmacists about the opioid crisis and the importance of patient education, but observed that very few providers were truly engaging with patients about the risks of opioids.

Through more discussion, Thakur realized that “both patients and doctors wanted pharmacists to educate patients about opioids, but pharmacists were sometimes unsure how to discuss this sensitive topic without sounding accusing,” she said. Thakur thought that a patient handout would help both pharmacists and patients discuss opioids.

Working with Betty Chewning, PhD, FAPhA, as a co-principal investigator, Thakur developed a handout for pharmacists to assist in counseling on opioid prescriptions. Pharmacists could use the handout during counseling to highlight important information, guide essential talking points, and distribute to the patient with a reminder to call with any questions. 

After using the handout during patient counseling, the pharmacist would fill out a survey to answer questions such as:

Do you feel more confident in counseling?

The research was done at 3 pharmacies (2 rural and 1 urban): Hayat Pharmacy in Milwaukee, Wisconsin and 2 Reedsburg Medical Center community pharmacies 

Thakur and Chewning analyzed 57 real-time surveys of pharmacists who used the opioid handouts. Pharmacists reported that using handouts in conjunction with counseling was the most helpful method, but the most important thing was just making an effort to talk about opioids. “It is up to the individual comfort of the pharmacist on which way to use the handout, but pharmacists felt more satisfied when they addressed opioid risks and safety, rather than avoiding the topic,” Thakur said.

“On the patient side, it was like a normal counseling session,” Thakur explained. The hardest part was finding pharmacists to participate, as many were too busy. Still, we had a few amazing pharmacists who participated and made sure the surveys were completed,” she said.

Although Thakur was not sure what to expect in terms of results, she noted that she was pleasantly surprised. Along the lines of adding more time, she mentioned how busy community pharmacists can easily incorporate opioid counseling. Pharmacists can access the handout from the CPF website. “Even though there is limited time to counsel, pharmacists can take 40-50 seconds and make a brief statement. We can show patients that we care about their safety by saying, ‘I care about you and your loved ones being safe. That’s why I’m telling you this medication is an opioid and has overdose and dependency risks.’

We can explain that opioids should only be used as prescribed, then disposed of safely to keep the patient and the patient’s family safe. Then remind the patient to read the handout at home and call if questions arise. This takes less than a minute and is a wholesome approach to patient education,” Thakur explained.

The CPF, led by Anne Marie (Sesti) Kondic, PharmD, executive director, is a non-profit organization dedicated to advancing community pharmacy practice and patient care delivery through grant funding and resource sharing.

Articles

Tanvee Thakur, PhD, BPharm, recently completed a project focused on enhancing transparent opioid education. 

Pharmacist-Led Project Targets Opioid Education and Safety

Two pharmacists recently completed a series of unique projects in collaboration with the Community Pharmacy Foundation (CPF) to address the opioid crisis in their communities.

, recently completed 2 projects with the help of CPF focused on the integration of community pharmacists into contingency management and opioid education. 

Throughout her experience in hospital pharmacy and clinical practice, Dragatsi became acutely aware of the unaddressed needs relating to adverse drug effects (ADEs) or interactions that undermined treatment goals.

Knowing she wanted to help patients in these situations, Dragatsi went on to earn her BCPS and formed her own company, 

As a consultant pharmacist, Dragatsi studied the most complex patient medication lists from all over Maine. She soon identified almost $50,000 worth of preventable ADEs in 11 patients. This discovery led Dragatsi to form new relationships with practice sites and federally funded health care centers.

“I saw an opportunity to perform innovative pharmacy practice...but needed to figure out how to do this in a financially viable way,” she said.

Dragatsi submitted a grant proposal to CPF on integrating pharmacists into the medication review process and addressing ADEs. The grant was approved.

Within just 1 week of beginning the project, Dragatsi became keenly aware of the opioid crisis’s effects on her community. New legislation forced patients to taper off opioids, but the patients needed help. Dragatsi incorporated this into her project.

“I accumulated a treasure trove of new clinical information centering around effective OTC medication use in patients as part of self-care when tapering off opioids,” Dragatsi said.

In the polypharmacy patients, Dragatsi was able to identify $280,890 worth of preventable adverse effects and reduce some of the concurrent medication use. In patients with chronic pain, there was a 43.3% reduction in morphine milligram equivalents due to patient self-care education.

Dragatsi applied (and was approved) for a second CPF grant to further tackle the opioid problem. “I knew that there was a need for pharmacists to be educated and integrated into the medication-assisted therapy process meaningfully, and to know how to reduce stigma using new terminology,” she said.

Dragatsi had many goals as part of this project, including:

creating a 17-month calendar of self-care clinical pearls, such as the beneficial impact of smoking cessation and OTC self-care tips on opioid tapering;

surveying pharmacists for baseline knowledge about 17 clinical pearls;

producing patient leaflets (with project support by 

educating pharmacists based on survey data, using written and live continuing medical education courses.

However, early in the project course, Dragatsi faced a major hurdle.

“I was diagnosed with a highly invasive and rare form of breast cancer,” Dragatsi shared. “I was not expected to live very long after project completion.” Her colleagues, 

Stephanie Nichols, PharmD, BCPS, BCPP, FCCP

, and Megan Jennison, PharmD, provided crucial project support during the treatment phase. “Day by day, my strength and cognitive acuity returned,” Dragatsi said.

In terms of results, Dragatsi observed that all of the material provided to patients “really contributed to patient resilience. This is beneficial for countering hypertension, high cholesterol, and bacterial and viral infections,” she said. She also emphasized that as pharmacists, we tend to focus on prescription drugs, often overlooking the benefits of OTC medications. “In the OTC realm, there is a lot of patient benefit to be realized,” she said.

In this project, Dragatsi was able to personally help 22 patients taper down and off of opioids by working closely with providers and using OTC products. Overall, Dragatsi & Co. assisted over 100 patients in tapering opioids.

Today, Dragatsi is “enjoying full health, strength, and cognition with no signs of the end of my remission.” She credits working on the CPF projects as part of her cancer recovery.

So what can pharmacists do in practice to help patients as Dragatsi did? Dragatsi recommends pharmacists think about how to take a few minutes to achieve maximum effect. “Work smart, not hard. Teach patients how to invest in personal resilience, and make their day better as well as your own for having done so,” she said.

Elizabeth Dragatsi, RPh, BCPS, worked on 2 projects integrating community pharmacists into contingency management and opioid education.  

Pharmacist Tackles Opioid Crisis With Innovative Projects

October is American Pharmacists Month. This celebration—recognizing pharmacists’ contributions to health care and all they do for their communities—includes Women Pharmacist Day (October 12); Pharmacy Week (October 18-24), acknowledging the invaluable contributions of pharmacists and technicians to patient care; and Pharmacy Technician Day (October 20).

Pharmacists are busier than ever with flu season and the coronavirus disease 2019 (COVID-19) pandemic, making it particularly important this year to take the time to celebrate and acknowledge our pharmacy staff’s contributions.

Let’s take a look at a few ways that pharmacists are celebrating the value of the profession this month.

5 Ways to Celebrate American Pharmacists Month

1. Provide coffee and treats, or a catered meal, for pharmacy staff throughout the month to demonstrate appreciation.

2. Decorate the pharmacy with signs or displays that promote American Pharmacists Month.

3. Use your pharmacy's social media page to introduce your employees, share brief bios about each staff member, and post pictures highlighting activities in the pharmacy.

4. Give back to the community by offering health screening events or promoting flu vaccinations.

5. Recognize your technicians on Pharmacy Technician Day (October 20) and celebrate their contributions.

Trisha Winroth, PharmD, pharmacy manager at Walgreens in Lowell, Massachusetts, plans to celebrate her team during the month of October, showing her appreciation with gifts like jewelry, personalized mugs, wine, shopping bags, or water bottles.

“As a pharmacy manager, my team, both pharmacists and technicians, is the key to our success! I am only one person and can’t possibly meet the needs of a large and diverse patient population,” she said. "Their daily impact on patient care—from refilling prescriptions to calling doctors or patients [to] helping patients find resources to translating or explaining paperwork for a vaccine—touches far more lives than I could ever do alone.”

Cara Hoyt, PharmD, a pharmacist at Uptown Pharmacy in Westerville, Ohio, tries to celebrate her team all year round, particularly since October is prime time for flu shots. “October is always a busy month for our pharmacy,” she said. “Between doing vaccinations in house and onsite, we don’t get to celebrate every day. But we try to celebrate our fantastic team all year long! We provide meals, ice cream, and other treats during pharmacists month and [throughout] the year. We want to show our staff we care about them [because] we know we need our whole team to provide the best care.”

The Uptown Pharmacy team also works together to provide value to the community through other clinical services such as point-of-care testing for international normalized ratios, diabetes education, compounding, medication synchronization, a community residency program, and research projects.

In addition, Hoyt is advancing the pharmacy practice through the Community Pharmacy Foundation (CPF) by working on a transition-of-care study in partnership with a local emergency department doctor and home health care agency. “We know that pharmacists can add great value as part of the patient care team,” she said. “Pharmacists can help improve outcomes and reduce adverse effects and hospital readmissions.”

Ashley Abode, PharmD, the clinical services coordinator at Realo Drugs in New Bern, North Carolina, says they celebrate 

their technicians with coffee and treats in October and also year-round. Abode and her team are also hard at work demonstrating the value of pharmacists. For example, her staff provides diabetes education classes and a diabetes prevention program (now held virtually due to COVID-19). “We teach patients about nutrition and physical activity to help prevent diabetes. We have been very successful—about 67% of participants have achieved their weight loss goals,” she said.

Abode has also worked with the CPF on 2 projects, and although the grants are complete, the team is still providing the clinical services. The first project was to demonstrate the value of community pharmacists as part of a care team. To accomplish this, Abode and her team provide offsite medication reviews combined with services offered in the pharmacy, such as adherence packaging. The services have been so successful that referrals are rolling in.

The second project was to show the pharmacy team’s value in home health care. Adobe says that working with home health agencies on medication reviews has been very successful. And the pharmacy team is paid for services. “That is rewarding because providers realize our value,” she said.

Steve “Slava” Malen, PharmD, the pharmacy manager at Crossroads Specialty Pharmacy in Livingston, New Jersey, has something very special planned for the team. “I have the privilege of working at a specialty pharmacy that does compounding and [medication-therapy management]. We aren’t able to do any of these things without our amazing technicians, so we will have a sushi party to celebrate them,” he said.

vidually with each technician to gain new perspectives on what they would change within the pharmacy. “They are an important part of the pharmacy and deserve to be a part of the pharmacy’s constant evolution.”

Rannon Ching, PharmD, the pharmacist in charge at Tarrytown Pharmacy in Austin, Texas, plans to celebrate American Pharmacists Month by providing a catered lunch for the staff.

Ching noted that pharmacists are really on the front lines right now and are making a significant impact. In addition to providing glycated hemoglobin and glucose testing services, Ching and his team have also been busy providing COVID-19 diagnostic testing to patients. “It’s a great resource for our community, great for revenue, and we get same-day results, which makes patients happy,” he explained. So far, the pharmacy has tested 1700 patients for COVID-19.

Ching is also working with CPF to demonstrate how pharmacists can help with transitions of care to impact hospital readmission rates. Ching and other pharmacists meet with the patient to counsel on medications and provide the patient with an updated medication list. They also notify the primary care provider of any medication changes. Due to COVID-19, Ching is working on this project remotely but looks forward to returning to in-person consultations as soon as possible.

“Pharmacies and pharmacists are in a great position to leverage their accessibility, knowledge, and great relationships with patients and health care facilities to provide advanced services beyond just filling prescriptions,” he said. “The patients appreciate it and feel much more confident in their understanding of the plan.”

October is American Pharmacists Month. This year more than ever, take time to acknowledge the valuable contributions of your pharmacy staff.

Celebrate the Pharmacy Profession

According to a Council for Responsible Nutrition 2019 

, 77% of adults in the United States take dietary supplements, the highest number reported to date.1 This places pharmacists in a unique position to offer both products and educational advice. What are patients looking for, and how can pharmacists help? 

Neal Smoller, PharmD, is a holistic pharmacist, founder of Supplement School, and owner of Village Apothecary in Woodstock, New York. Smoller shared what he sees as the biggest trends in supplements: collagen and cannabidiol (CBD). According to Smoller, collagen is a “trendy protein supplement that we use as a cornerstone of holistic care.” He noted that his patients who are protein-deficient often take collagen, and praises its unique amino acid profile and structure. “People aren’t getting enough collagen-rich foods like organ meats or bone broth in their diets, so it’s my protein of choice for omnivores who want to supplement. It supports a healthy [gastrointestinal] tract, healthy joints, and optimal protein levels.” Smoller said that CBD is popular in his patients for anxiety, sleep, and pain.

Jennifer Burch, PharmD, CDCES, is the pharmacist and owner of Central Pharmacy/Central Compounding Center South in Durham, North Carolina. She sees a high demand for supplements pertaining to the immune system and stress, especially during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Some popular supplements include vitamin A, vitamin D, vitamin C, N-acetylcysteine, glutathione, zinc, theanine, melatonin, probiotics, digestive enzymes, and CBD oil.

With all the products out there, what should pharmacists look for when deciding what to stock? Smoller recommends that no matter what brands pharmacists decide to keep in their pharmacies, the products should meet high quality standards, “this includes not just GMP compliance and cleanliness, but therapeutic requirements, and ethics of the brand in question.” For example, with collagen, Smoller looks for products with excellent farming standards that are proven to be low in heavy metals, and ensures the manufacturing process has no dilution or spiking of the protein. With CBD, Smoller noted that there are “too many products with poor quality.” He deals with transparent brands, or “those that give us full access to their production flow and a certificate of analysis on each lot (third party verified),” he said.

During COVID-19, Smoller saw an uptick in demand for immune blends, zinc, and vitamin C among patients looking to boost their immune system. Smoller stocks and recommends zinc lozenges “but we give people honest advice—no supplement will protect you as the charlatans are advising. Be healthy and well, but don't get a false sense of security or the illusion of control from a supplement.”

Burch recommended that pharmacists stock “high-quality multivitamins—not ‘one-a-day’ vitamins.” She recommends offering brands that are labeled “pharmaceutical grade or professional grade,” and contain activated nutrients like methylcobalamin instead of cyanocobalamin. Some of her preferred brands include Xymogen, Ortho Molecular, and Thorne.

In terms of probiotics, Burch recommended Enterobiotic SBO by Natural Creations. “I have been using it with great results for over 20 years, long before many others were on the market. It contains 14 organisms including Saccharomyces boulardii which has an antagonistic effect against Candida albicans. It also contains fructo-oligosaccharides, a prebiotic which helps feed good bacteria in the gut.” Burch noted it has worked well for her patients, and local gastroenterologists recommend it as well.

Burch also suggested stocking a high-quality chelated magnesium. The advantage of chelated magnesium, she explained, is to help with absorption and delivery to the tissue.

“Magnesium oxide is a common magnesium patients pick up at the pharmacy, but it cannot be absorbed, so it causes diarrhea. When using magnesium for leg cramps or headache, we need to get the magnesium into the tissue, so the chelated form does this best.”

Both Smoller and Burch emphasized that, as the most accessible and trusted health professionals, pharmacists can use their drug and supplement expertise to help patients find the right products.

Dietary Supplement Use Reaches All Time High. News Release. Council for Responsible Nutrition; September 30, 2019. Accessed July 5, 2020. https://www.crnusa.org/newsroom/dietary-supplement-use-reaches-all-time-high

What supplements are patients looking for the most, and how can pharmacists help?