Marialice S. Bennett

Practice-based research network as a research training model for community/ambulatory pharmacy residents

OBJECTIVE To describe our experience with a practice-based research training network (PBRTN) in a 1-year residency program. SETTING Ohio State University in Columbus from 1997 to 2007. PRACTICE DESCRIPTION The program includes two accredited postgraduate year 1 residencies and one postgraduate year 2 residency. Seven residents, 11 preceptors, and three faculty members participated during the time frame discussed in this article. Practice settings included three community sites and three ambulatory sites. PRACTICE INNOVATION The PBRTN includes a residency director, a research director, preceptor and resident members, and research faculty. The group works collaboratively to meet training goals. The PBRTN maintains a project timeline, foundational training, and structured research development, implementation, and presentation phases. Each resident submits five required research products: abstract, grant, poster, podium presentation, and research manuscript. MAIN OUTCOME MEASURES Quantitative measures included the number of abstracts, grants, and peer-reviewed publications over two time periods, one before and one after a deliberate attempt to increase the research focus of the residencies. The ratio of research products to number of residents was used as a measure of productivity. Postresidency career choice and postresidency publications are reported. RESULTS Over a decade, the program has produced 37 graduates, 50 abstracts, 15 grants, and 12 peer-reviewed publications. The publication-to-resident ratio increased from 0.25 in the pre-emphasis period of 1997-2001 to 0.56 in 2002-2007, after the research focus was intensified. Of graduates, 38% are in faculty positions, with 48 postresidency publications. CONCLUSION Use of a PBRTN has successfully provided research training and improved research outcomes for the program. This model could be implemented in other residencies.

Current trends in outpatient pharmacy services and billing

OBJECTIVES To provide a summary of community and ambulatory pharmacy practices and billing patterns for medication therapy management (MTM) services and to identify reasons pharmacists report not billing for direct patient care services. DESIGN Cross-sectional study. SETTING United States, February 2011. PARTICIPANTS Members of the American College of Clinical Pharmacy Ambulatory Care Practice and Research Network, American Society of Health-System Pharmacists Ambulatory and Chronic Care Practitioners, and American Pharmacists Association MTM e-community. INTERVENTION Online survey. MAIN OUTCOME MEASURES Practice setting, pharmacy services performed, billing technique, and payer, as well as reasons for not billing. RESULTS MTM services were provided by 287 pharmacists. The most common practice settings included physician office (23.6%), health-system outpatient facility (21.7%), and community pharmacy (20.2%). A total of 149 of 276 pharmacists (54.0%) reported billing for MTM services; 16 of 276 (5.8%) did not know if they were currently billing. Community pharmacists were more likely to bill than all other sites combined (80.5% vs. 53.1%, P < 0.001), and pharmacists with >75% of visits face-to-face were more likely to bill (66.2% vs. 46.6%, P < 0.002). CONCLUSION A variety of MTM services are provided in outpatient settings with inconsistent billing techniques and reimbursement. Pharmacists should continue to work toward consistent, sustainable reimbursement to expand MTM services.

Strategies to improve compensation for pharmaceutical care services.

In the past decade, the pharmacy profession has made remarkable strides in implementing a wide range of pharmacy-based patient care services. To foster greater awareness of the value of these services among payers and to ensure the long-term success of pharmaceutical care, pharmacists need to focus more attention on obtaining compensation for these services. In the long run, pharmacists are likely to receive greater net profits from pharmaceutical care than from dispensing. As Norwood et al. noted, pharmacies keep all the revenues they receive from pharmaceutical care as profits and to cover operating expenses, whereas they keep only about 29% of the revenues from the sale of products. By exploring innovative markets for pharmaceutical care services and continuing to improve rates of reimbursement from third party payers, pharmacists can further enhance the revenues they obtain from their growing array of patient care services.

Impact of an Elective Course in Community and Ambulatory Care Pharmacy Practices on Student Perception of Patient Care.

Objective. To determine the impact of an elective course on students’ perception of opportunities and of their preparedness for patient care in community and ambulatory pharmacy settings. Design. Each course meeting included a lecture and discussion to introduce concepts and active-learning activities to apply concepts to patient care or practice development in a community or ambulatory pharmacy setting. Assessment. A survey was administered to students before and after the course. Descriptive statistics were used to assess student responses to survey questions, and Wilcoxon signed rank tests were used to analyze the improvement in student responses with an alpha level set at 0.05. Students felt more prepared to provide patient care, develop or improve a clinical service, and effectively communicate recommendations to other health care providers after course completion. Conclusion. This elective course equipped students with the skills necessary to increase their confidence in providing patient care services in community and ambulatory settings.

Heart failure assessment at the community pharmacy level: A feasibility pilot study

BACKGROUND A key element missing in disease-management programs for heart failure (HF) is participation of the community pharmacist. The purpose of this study is to determine if a simple and efficient clinical tool will allow community pharmacists to identify patients at risk for worsening HF. DESIGN The One Minute Clinic for Heart Failure (TOM-C HF) was developed as a simple six-item symptom screening tool to be used during routine patient/customer interactions. SETTING Ten community pharmacies located in the upper Midwest. PATIENTS Self-identified HF patients. RESULTS 121 unique patients were evaluated over a 12-month period. The application of this clinical tool took between 1 and 5 minutes in over 80% of the interactions. Seventy-five patients (62%) had one or more signs or symptoms of worsening HF. The most common symptoms detected included edema (39%) and increased shortness of breath (17%). Self-reported weight gain of more than 5 pounds was seen in 19% of patients. CONCLUSION The TOM-C HF tool was used to identify patients in a time-efficient manner in the community pharmacy setting who appear to be developing worsening HF. Inclusion of the community pharmacists as an early screen for HF decompensation may be an important link in disease-management programs to help reduce hospital readmission rates.

Development of a medication therapy management superbill for ambulatory care/community pharmacy practice

OBJECTIVES To explain the purpose of superbills, suggest strategies for incorporating superbills into pharmacy practice, and propose a model superbill for consideration by practitioners. PRACTICE DESCRIPTION Ambulatory pharmacies in the United States. PRACTICE INNOVATION Superbills have been used by physicians and other health care providers for many years as a way of efficiently communicating to the office staff, the patient, and even the insurer the types of services that have been provided at the point of care. The profession of pharmacy has not routinely used superbills in the past; however, given the recognition of pharmacists as providers of medication therapy management (MTM) services, immunizations, disease management, and other specialty preventive health services, the time has come for pharmacists to begin using superbills. MAIN OUTCOME MEASURES Not applicable. RESULTS A sample superbill, suitable for adaptation by individual providers of medication therapy management and other clinical pharmacy services, is provided in this article. CONCLUSION Superbills may or may not improve the pharmacists overall ability to receive insurance remuneration, but the authors believe that greater recognition by patients of the nondispensing activities of pharmacists can be achieved by using a superbill and that this may lead to more opportunities for payment for MTM in the future. Research is needed to assess whether incorporating superbills into a variety of pharmacy practice settings improves patient perceptions of the pharmacist and to discover how superbills effect practice efficiency.

Perseverance will lead to a stronger tomorrow.

Delivered by Marialice S. Bennett, BSPharm, FAPhA, incoming President of the American Pharmacists Association, at APhA2011, the Association’s Annual Meeting and Exposition, March 27, 2011, Seattle, WA. Good morning. It is with honor and humility that I stand before you today, ready to serve as the 156th president of the American Pharmacists Association (APhA). I have been a pharmacist since 1969 and a member of the Association for almost as long. Some of my dearest friends are my former students and residents and current pharmacist colleagues. My most treasured professional accomplishments have come from creating innovative practices such as University Health Connection, an interprofessional health care practice, and developing our community and ambulatory care pharmacy residency programs. I have been coming to APhA Annual Meetings for over 20 years and made so many friends across our profession and around our country. We are all blessed to be a part of the great family of pharmacy. It is a privilege to speak with you today and to serve as your president. I thank you for the opportunity. Thank you also to my family and colleagues, many of whom are here today. I want to thank my supportive husband, Jon, who is so enthusiastic about becoming the first gentleman. I am so blessed to have our three wonderful sons, Jay, Vince, and Bryan, here with us today along with their special mates, Jess, Rebecca, and Michelle, and our three precious grandchildren, Josie, Lulu, and Hudson. I am honored to have my two big brothers Ed and Howard, my sister-in-law Karen, and five of my nieces here as well. I want to thank my colleagues at Ohio State University (OSU) for their support—especially my dean, Robert Brueggemeier, my chair, Milap Nahata, and my practice family from University Health Connection. Last, but not least, thanks to my many friends and colleagues in both my personal and professional life who continue so generously to support me on this journey. Let us also take a moment to thank our president, Harold Godwin. Harold has been a wonderful president of our Association and leader of our profession at a difficult time for our country, our patients, and our peers. Harold is a mentor of mine dating back to my days as a student at OSU and as an intern at the OSU Medical Center. He made a huge impact on my career, and it is an honor to follow in his footsteps as president of APhA. Building on his own strong legacy in pharmacy, Harold helped set the vision for our profession and the mission for our Association: to create demand for pharmacist-provided medication therapy management (MTM) services and their implementation. A tomorrow with this sort of demand would indeed be a stronger one for our profession, for our patients, and for our nation. But how will we get there from here?

Future Challenges: Changing Health Care Delivery and Advancing Patient Care

Our current health care system involves multidisciplinary groups of practitioners who function as freestanding silos and in which a “team” approach means an awareness and tolerance of other disciplines as patients are handed from one practitioner to another. Pharmacy has advanced from clinical pharmacy through pharmaceutical care to the dawning of medication therapy management services. With each step pharmacy has become more focused on direct patient care. As technology and technicians improve the dispensing process and as electronic databases evolve, the pharmacist will increasingly be positioned to be more available and better equipped to provide direct patient care and medication therapy management services. Over the next decade, I see pharmacy and other health care providers moving to an interdisciplinary team approach in which decisions are made by consensus and through which each discipline has an equal opportunity for input.1 To accommodate such a change, I envision a new health care delivery model based on the following components: n Wellness and prevention services as the entry point into the system. n An interdisciplinary delivery model with providers having shared borders (a model in which our professional boundaries become blurred or overlap, and health care professionals share a common knowledge base, a common professional interest, and an instinct to help the patient). n “Physician extenders” providing disease and medication management services using evidenced-based medicine. n Systems that are outcomes driven and outcomes justified. n A broader acceptance and use of complementary and alternative medicine within the delivery model. All of the above components are evolving or already exist in the current environment. The challenge to the system is to integrate them into successful delivery models. The challenge to the pharmacist is to identify, embrace, Future Challenges: Changing Health Care Delivery and Advancing Patient Care and drive their evolving roles within this new health care delivery model.

Perseverance will lead to a stronger tomorrow: Our Association is strong and is positioned to make ahuge impact on the delivery of health care in America.

Delivered by Marialice S. Bennett, BSPharm, FAPhA, incoming President of the American Pharmacists Association, at APhA2011, the Association’s Annual Meeting and Exposition, March 27, 2011, Seattle, WA. Good morning. It is with honor and humility that I stand before you today, ready to serve as the 156th president of the American Pharmacists Association (APhA). I have been a pharmacist since 1969 and a member of the Association for almost as long. Some of my dearest friends are my former students and residents and current pharmacist colleagues. My most treasured professional accomplishments have come from creating innovative practices such as University Health Connection, an interprofessional health care practice, and developing our community and ambulatory care pharmacy residency programs. I have been coming to APhA Annual Meetings for over 20 years and made so many friends across our profession and around our country. We are all blessed to be a part of the great family of pharmacy. It is a privilege to speak with you today and to serve as your president. I thank you for the opportunity. Thank you also to my family and colleagues, many of whom are here today. I want to thank my supportive husband, Jon, who is so enthusiastic about becoming the first gentleman. I am so blessed to have our three wonderful sons, Jay, Vince, and Bryan, here with us today along with their special mates, Jess, Rebecca, and Michelle, and our three precious grandchildren, Josie, Lulu, and Hudson. I am honored to have my two big brothers Ed and Howard, my sister-in-law Karen, and five of my nieces here as well. I want to thank my colleagues at Ohio State University (OSU) for their support—especially my dean, Robert Brueggemeier, my chair, Milap Nahata, and my practice family from University Health Connection. Last, but not least, thanks to my many friends and colleagues in both my personal and professional life who continue so generously to support me on this journey. Let us also take a moment to thank our president, Harold Godwin. Harold has been a wonderful president of our Association and leader of our profession at a difficult time for our country, our patients, and our peers. Harold is a mentor of mine dating back to my days as a student at OSU and as an intern at the OSU Medical Center. He made a huge impact on my career, and it is an honor to follow in his footsteps as president of APhA. Building on his own strong legacy in pharmacy, Harold helped set the vision for our profession and the mission for our Association: to create demand for pharmacist-provided medication therapy management (MTM) services and their implementation. A tomorrow with this sort of demand would indeed be a stronger one for our profession, for our patients, and for our nation. But how will we get there from here?

2011 Presidential Address: Perseverance will lead to a stronger tomorrowOur Association is strong and is positioned to make a huge impact on the delivery of health care in America

Delivered by Marialice S. Bennett, BSPharm, FAPhA, incoming President of the American Pharmacists Association, at APhA2011, the Association’s Annual Meeting and Exposition, March 27, 2011, Seattle, WA. Good morning. It is with honor and humility that I stand before you today, ready to serve as the 156th president of the American Pharmacists Association (APhA). I have been a pharmacist since 1969 and a member of the Association for almost as long. Some of my dearest friends are my former students and residents and current pharmacist colleagues. My most treasured professional accomplishments have come from creating innovative practices such as University Health Connection, an interprofessional health care practice, and developing our community and ambulatory care pharmacy residency programs. I have been coming to APhA Annual Meetings for over 20 years and made so many friends across our profession and around our country. We are all blessed to be a part of the great family of pharmacy. It is a privilege to speak with you today and to serve as your president. I thank you for the opportunity. Thank you also to my family and colleagues, many of whom are here today. I want to thank my supportive husband, Jon, who is so enthusiastic about becoming the first gentleman. I am so blessed to have our three wonderful sons, Jay, Vince, and Bryan, here with us today along with their special mates, Jess, Rebecca, and Michelle, and our three precious grandchildren, Josie, Lulu, and Hudson. I am honored to have my two big brothers Ed and Howard, my sister-in-law Karen, and five of my nieces here as well. I want to thank my colleagues at Ohio State University (OSU) for their support—especially my dean, Robert Brueggemeier, my chair, Milap Nahata, and my practice family from University Health Connection. Last, but not least, thanks to my many friends and colleagues in both my personal and professional life who continue so generously to support me on this journey. Let us also take a moment to thank our president, Harold Godwin. Harold has been a wonderful president of our Association and leader of our profession at a difficult time for our country, our patients, and our peers. Harold is a mentor of mine dating back to my days as a student at OSU and as an intern at the OSU Medical Center. He made a huge impact on my career, and it is an honor to follow in his footsteps as president of APhA. Building on his own strong legacy in pharmacy, Harold helped set the vision for our profession and the mission for our Association: to create demand for pharmacist-provided medication therapy management (MTM) services and their implementation. A tomorrow with this sort of demand would indeed be a stronger one for our profession, for our patients, and for our nation. But how will we get there from here?