mrm.pharmacist.com · Web viewcan play in caring for patients who are victims of abuse. Violence, whether interpersonal, group, or self-directed, is a controversial social, economic,

Region 1 Midyear Regional MeetingBuffalo, NY

November 9th-11th, 2018

Proposed Resolutions

Proposing APhA-ASP ChapterPolicy Numb

er

Page Numb

erAlbany College of Pharmacy and Health Sciences R1.1 2D’Youville College School of Pharmacy R1.2 3Husson University School of Pharmacy R1.3 4Long Island University Arnold & Marie Schwartz COP and HS R1.4 7MCPHS University – Boston R1.5 8MCPHS University – Worcester R1.6 9Northeastern University School of Pharmacy R1.7 10St. John's University College of Pharmacy and Health Science R1.8 12The University of Rhode Island College of Pharmacy R1.9 15Touro College of Pharmacy R1.10 16University at Buffalo The State University of New York SOP R1.11 18University of Connecticut School of Pharmacy R1.12 19University of New England College of Pharmacy R1.13 21Western New England University College of Pharmacy R1.14 23

APhA Academy of Student Pharmacists Region 1 Midyear Regional Meeting 2018

R1.1

Proposing APhA-ASP Chapter: Albany College of Pharmacy and Health Sciences

Proposed Resolution Title/Topic: Increase the Opportunity for Counseling on all New Opioid Prescriptions

Proposed wording:APhA-ASP encourages increased counseling for each patient that is prescribed a new opioidmedication. Upon initiation of a new opioid, each patient will be presented with the opportunityfor counseling by the pharmacist, and patients will have the option of accepting or decliningnew opioid counseling.

Background Statement:Increasing medication counseling on all new opioid prescriptions would educatepatients on the potential for addiction and would work to reduce the opioid epidemic.According to the National Institute of Drug Abuse, more than 115 people in the United Statesdie of overusing opioids every day. 1 This is a staggering statistic, and pharmacists shouldpersistently work alongside other healthcare providers to reduce this ever growing epidemic.The opioid overdose crisis has immense effects on the health of the community, as well ashaving effects on both social and economic welfare. 1A main source of the opioid epidemic stems from a lack of education regarding the truerisks of opioid use. Proper counseling is an essential part in preventing drug abuse, andtherefore would be an essential piece in reducing the potential for addiction to develop. Bytargeting education prior to opioid use, pharmacists would be able to avert the potential foropioid misuse before it has even arisen.

References:1. https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

Are there any adopted resolutions currently on the books related to this Proposed Resolution? Yes ___ No_X_

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https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis


If yes, please provide the number and title of the adopted resolution(s) as well as your rationale for the addition of this Proposed Resolution:

Author of Proposed Resolution: Katelyn Masullo

Author Phone Number: 518-423-8400

Author Email Address: [email protected]

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R1.2

Proposing APhA-ASP Chapter: D’Youville College School of Pharmacy

Proposed Resolution Title/Topic: Pharmacists Rights

Proposed wording: APhA-ASP encourages student pharmacists to have the ability to prescribe birth control without the need of a doctors permission.

Background Statement:Allowing pharmacists to prescribe birth control without doctor’s permission.a. When patients are on their last refill and they come in having completed their birth controltablets, but they have no more refills, them not taking their pills on time can disrupt their entirecycle and throw off the efficacy of the pharmacotherapeutics of the regimen.b. Perhaps allowing pharmacists to only prescribe in emergency cases and not as newprescription’s.Are there any adopted resolutions currently on the books related to this Proposed Resolution? Yes ___ No_X_


Author of Proposed Resolution: Jay Shah



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R1.3

Proposing APhA-ASP Chapter: Husson University School of Pharmacy

Proposed Resolution Title/Topic: Interpersonal Violence Trainings

Proposed wording:APhA-ASP encourages all pharmacy entities to develop a strategy and/or training plan for addressing suspected or confirmed cases of intimate partner and domestic violence in patients.

Background Statement:This policy proposal’s aim is to address the role that pharmacists in both community and hospital settingscan play in caring for patients who are victims of abuse. Violence, whether interpersonal, group, or self-directed, is a controversial social, economic, and political issue that has received a great deal of attention in the last several years. Regardless of how you feel about this issue and its social implications, it is hard to dismiss the impact or prevalence of violence in our modern society. The World Health Organization 1 defines violence as:“The intentional use of physical force or power, threatened or actual, against oneself, another person, oragainst a group or community that either results in or has a high likelihood of resulting in injury, death,psychological harm, mal-development, or deprivation.” 1Per the National Domestic Violence Hotline’s 2016 Statistics, 24 people per minute are victims of rape,physical violence, or stalking by an intimate partner, which is equal to approximately 12 million people per year in just the United States. 2 More than 1 in 3 (35.6%) women and 1 in 4 (28.5%) men have experienced rape, physical violence, or stalking from an intimate partner In their lifetime, and nearly half of all women and men have experienced psychological aggression by an intimate partner in their lifetime. Domestic violence can affect anyone, however it is most common in immigrant and ethnic minorities who are living below the poverty line. The single biggest predictor of experiencing or committing abuse as an adult is abuse as a child.The majority of states in the U.S. have instituted laws which require health professionals, service workers,and other public health officials to report suspected domestic violence to state agencies. In the State of Maine, pharmacists are considered an accountable party “when acting in a professional capacity” in reporting suspected interpersonal violence (IPV) against children and other family members, and are required to file a report with the leader of their organization to be submitted to the Department of Health and Human Services (DHHS). 3 Likewise, health care providers are required to report all types of violence (excluding threats), in the Commonwealth of Massachusetts to their state HHS Board. Similar regulations are present in other states. In spite of these , only

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56% of domestic violence cases were reported to law enforcement from 2006 to 2015, and of those reports 75% were submitted by the victim themselves. 4 The most common reasons victims cited for not reporting violence are the personal nature of the incident, fear of retribution from the perpetrator, and a desire to protect the perpetrator.Pharmacists are uniquely poised within the community to undergo surveillance for domestic violence. They have significant medical knowledge (so as to detect physical signs of domestic violence), they engage withpatients regularly, they are familiar with motivational techniques, and are generally considered to be one of the most trustworthy of any profession. 5 Despite these tremendous potential benefits of pharmacy intervention, several key studies commenting on the role of healthcare providers found pharmacists rate their impact as minimal in terms of screening, identifying, and referring patients who are victims of IPV. Barnard et. al. 6 conducted a cross-sectional study of pharmacists practicing throughout the southeastern United States, and found that 67.4% of pharmacists reported receiving no formal IPV-related training, and 77.6% of respondents rated themselves as “Unsure” when questioned about their state laws regarding mandatory reporting. The majority of pharmacists indicated that they were interested in undergoing formal IPV screening trainings and felt that all pharmacists should be mandated to train in this area. The most common concerns cited were a lack of time and maintaining patient confidentiality. Additionally, Cerulli et. al. 7 conducted a survey of pharmacy students at Albany College of Pharmacy following a 1.5 hour seminar on IPV that assessed their willingness to attend further trainings on this subject and whether or not this topic was important to their future practice. Of the 241 participating students, 89.9% percent of participants thought that the information presented to them was relevant to practice. Of the students who had previously worked as a technician or intern in a community setting, 61% reported that they hadencountered an IPV victim in their practice, but 60% of them felt unprepared to address the situation in actual practice. The results of these studies indicate that there is a mismatch between desire to help patients experiencing IPV and amount of formal training to support it. It should also be pointed out that the states in which these surveys were conducted are all states that require mandatory reporting by law, which goes on to show that legal requirements need to be supported with trainings and ongoing education.Aside from the ethical obligations for preventing violence, recognizing the physical signs (e.g., brokenbones, bruises and black eyes, limps, etc.) can be an effective preventative strategy for many of the chronicconditions associated with IPV. Women who have experienced IPV are more likely to perceive their overall health as poor, and are predisposed to headaches, insomnia, choking sensations, hyperventilation, and other somatic pain disorders. 1 Victims of domestic abuse, especially as children, experience 3 to 5 times higher rates of depression, suicidality, post-traumatic stress disorder, and substance use disorder than nonvictims. Furthermore, PTSD (which is highly correlated with the degree of life-threatening violence) is associated with a lower degree of reporting domestic violence

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and a prolonged time course of abuse. The complications associated with abuse are costly. The CDC estimates that the cost of domestic violence in 2017, excluding costs associated with the criminal justice system, exceed 11.4 billion dollars. 8 Treatment for violence-associated disorders can proceed for 15 years or longer post-intervention. With the strain on our healthcare system brought on by an already aging population and chronic diseases, preventing violence is a wholly preventable cost that can be mitigated by investing in proper training for healthcare professionals.Opponents of this plan could make the argument that cases of interpersonal violence are simply too rarein clinical practice to warrant the additional time and economic commitments necessary for training. They could say that it is the job of law enforcement, not healthcare professionals, to deal with cases of domestic violence and it is a waste of resources for pharmacy to get involved. The fact of the matter is that as long as pharmacists are mandated to report suspected incidents of domestic violence, they have to be accessible to patients who are dealing with situations like this every step of the way. Demographic data shows that interpersonal violence is highly concentrated in underserved populations with little support structures in place, and someone has to take on the role of advocate for these patients. Intervention by law enforcement is only a small part of combating violence and providing pharmacists with the training to recognize signs of violence, strategies to approach patients, and tips for educating patients on their options is an excellent opportunity to connect with patients before it may be too late.

REFERENCES1. Dutton MA, Green BL, Kaltman SI, Roesch DM, Zeffiro TA, Krause ED. Intimate Partner Violence, PTSD, andAdverse Health Outcomes. J Interpers Violence. 2006;21(7):955-968. doi:10.1177/08862605062891782. Statistics. The National Domestic Violence Hotline. https://www.thehotline.org/resources/statistics/.Accessed October 12, 2018.3. Title 22, §3477: Persons mandated to report suspected abuse, neglect or exploitation.https://www.mainelegislature.org/legis/statutes/22/title22sec3477.html. Accessed October 11, 2018.4. Statistics B of J. Bureau of Justice Statistics - Police Response to Domestic Violence, 2006-2015 Press Release.https://www.bjs.gov/content/pub/press/prdv0615pr.cfm. Accessed October 12, 2018.5. Inc G. Honesty/Ethics in Professions. Gallup.com. https://news.gallup.com/poll/1654/Honesty-Ethics Professions.aspx. Accessed October 12, 2018.6. Barnard M, West-Strum D, Holmes E, Yang Y, Swain KA. Community Pharmacists’ Awareness of IntimatePartner Violence: An Exploratory Study. Innov Pharm. 2013;4(1). doi:10.24926/iip.v4i1.288

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https://news.gallup.com/poll/1654/Honesty-Ethics


7. Cerulli C, Nichols-Hadeed C, Raimondi C, Stone JT, Cerulli J. Facilitating Intimate Partner Violence Educationamong Pharmacy Students: What Do Future Pharmacists Want to Know? Curr Pharm Teach Learn.2015;7(3):283-291. doi:10.1016/j.cptl.2014.12.0148. Intimate Partner Violence: Consequences. Centers for Disease Control and Prevention.https://www.cdc.gov/violenceprevention/intimatepartnerviolence/consequences.html. Published August 24,2017. Accessed October 12, 2018.



Author of Proposed Resolution: Grace Gould



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R1.4

Proposing APhA-ASP Chapter: Long Island University Arnold & Marie Schwartz COP and HS

Proposed Resolution Title/Topic: Opioid Naivety

Proposed wording:APHA-ASP encourages opioid naïve patients to attempt non-opioid therapy initially for themanagement of pain. This will function to maintain opioid naivety in patients which will reducethe exposure and ubiquity of opiates. There will be exceptions to this such as cancer patients,post-op patients, etc.

Background Statement:Reasoning:-Over prescribing of opioids due to lack of prescriber knowledge/education on opioidmedications.-Opioid medications do NOT provide clinically significant pain relief when compared to non-opioid pain medication in the treatment of lower back and knee pain. *-Maintenance of opioid nativity in patients eliminates risk of addiction and respiratorydepression and should be maintained as long as possible.-Over prescribing as led to unnecessary amounts of opioids being stored in patient homes andthus has increased the exposure and accessibility to these medications excessively.

Effect of Opioid vs Non opioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip orKnee Osteoarthritis Pain: The SPACE Randomized Clinical Trial. Krebs EE, et al. JAMA. 2018.



Author of Proposed Resolution: Zak Amin


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R1.5

Proposing APhA-ASP Chapter: MCPHS University Boston

Proposed Resolution Title/Topic: Required Opioid Reversal Agent Training for Student Pharmacists

Proposed wording:1. APhA-ASP recommends the training and certification of opioid reversal agents by all student pharmacistsprior to completion of their pharmacy program.2. APhA-ASP recommends that all schools of pharmacy offer opioid reversal agent training and certificationwithin the pharmacy school curriculum.

Background Statement:Schools of pharmacy should provide the opportunity for students to gain knowledge and training on the usage of opioid reversal agents. This training should allow for students to learn about the administration and effects of the opioid reversal agents. From this training, students will be able to administer the reversal agent in an emergency situation and can properly counsel patients on this medication. Schools of pharmacy should implement the required completion of the training into their curriculum, similar to how some schools require their students to be CPR certified. Schools of pharmacy could collaborate with an organization that could come in and offer the education and training of opioid reversal agents. Due to the opioid epidemic, many states have implemented laws that caused an increase in the access to naloxone. Family members and friends of people who use opioids can obtain naloxone in retail pharmacies. Throughout 2007-2016 there was a 79% average increase in the amount of naloxone dispensed from retail pharmacies. 1 Due to this large increase in the dispensing of naloxone, this will cause pharmacists to have to counsel more patients or family members on signs and symptoms of overdose and how to properly administer the medication. Student pharmacists should be required to gain the knowledge and training on opioid reversal agents to be able to properly counsel patients and family members. Student pharmacists should also be trained to administer an opioid reversal agent when necessary.1. Jing Xu, Corey S. Davis, Marisa Cruz and Peter Lurie, State naloxone access laws are associated with anincrease in the number of naloxone prescriptions dispensed in retail pharmacies, Drug and AlcoholDependence, 10.1016/j.drugalcdep.2018.04.020, 189, (37-41), (2018).


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Author of Proposed Resolution: Delaney Corcoran



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R1.6

Proposing APhA-ASP Chapter: MCPHS University - Worcester

Proposed Resolution Title/Topic: Prescription Monitoring

Proposed wording:APhA-ASP proposes that PDMPs be implemented on a federal level with the anticipation of assisting with the opioid crisis.

Background Statement: Prescription drug monitoring programs (PDMPs) should be implemented on a federal

level with oversight by the DEA. In addition, creating user friendly system to system communication and standardization

that will be accessible to any registered pharmacist, regardless of the state they practice.

As a result, this will decrease drug diverse across state lines and hopefully stifle a small amount of controlled substance abuse.

Bao, Y., Wen, K., Johnson, P., Jeng, P., Meisel, Z. and Schackman, B. (2018). Assessing the Impact Of State Policies For Prescription Drug Monitoring Programs On High-Risk Opioid Prescriptions. Health Affairs, [online] 37(10), pp.1596-1604. Available at: https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.0512?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed.



Author of Proposed Resolution: Davia McKoy & Maxime Langlois



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R1.7

Proposing APhA-ASP Chapter: Northeastern University School of Pharmacy

Proposed Resolution Title/Topic: Community pharmacy implementation and reading of tuberculosis (TB) skin test.

Proposed wording:APhA-ASP supports the expansion of community pharmacy point-of-care testing to include diagnostic tuberculosis (TB) screening and consultation for eligible patients with uncomplicated symptoms of TB.

Background Statement:Tuberculosis (TB) is a potentially serious infectious disease that is easily detectable with the utilization of a TB skin test. Pharmacists can play an important role in the early detection and management of TB. Eligible patients require a documented TB test prior to the administration of antibiotics.

The American Thoracic Society suggests the following list of persons in whom tuberculin testing is indicated:

(i) Persons with signs (e.g., radiographic abnormality) and/or symptoms (cough, hemoptysis, weight loss, etc.) suggestive of current tuberculosis disease.(ii) Recent contacts with known tuberculosis cases or persons suspected of having tuberculosis.(iii) Persons with abnormal chest roentgenograms compatible with past tuberculosis.(iv) Persons with medical conditions that increase the risk of tuberculosis (silicosis, gastrectomy, diabetes, immunosuppressive therapy, lymphomas, etc.).(v) Groups at high risk of recent infection with M. tuberculosis, such as immigrants from Asia, Africa, Latin America, and Oceania; some inner-city and "skid-row" populations; personnel and long-term residents in some hospitals, nursing homes, mental institutions and prisons.

At the community pharmacy setting, a patient would answer a questionnaire that would help pharmacists determine if they meet the criteria for a potential TB skin test. If eligible, community pharmacists could complete and analyze a two part TB skin test. Skin testing for tuberculosis (TB) utilizes a form of the diagnostic reagent tuberculin. The Mantoux technique, utilizes a purified protein derivative (PPD-S) which is injected intradermally Because the test is traditionally read at 48 and 72 hours, patients can easily return to their local pharmacy to have the test read. The test would be read positive if there is an increase in diameter of test site.

Community pharmacists would have to undergo a TB test-specific course and become certified, similar to vaccination certification, in order to provide this service.

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The test results would be documented and sent to the patients’ primary care physician post-screening.



Author of Proposed Resolution: Kevin Kim



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R1.8

Proposing APhA-ASP Chapter: St. John’s University College of Pharmacy & Allied Health Sciences

Proposed Resolution Title/Topic: Proactive Preparation of Pharmacists and Student Pharmacists for the Adoption of Blockchain Technology in the Healthcare Systems

Proposed wording:APhA-ASP encourages proactive and pre-emptive preparation of the adoption of blockchain technology into healthcare systems. Such measurements include:a. Development of education programs, such as email blasts and presentations, to educate pharmacists andstudent pharmacists on the background of blockchain technology, the benefits of its implementationswithin various healthcare systems, and the means by which successful implementations can propelpharmacist into leadershipb. Promotion of grants for the creation of prototypes and research studies on the effectiveness ofintegrating blockchain technologies into healthcare records and information processing.

Background Statement:This action serves to demonstrate a need within the profession of pharmacy for the pre-emptive preparation of blockchain implementation into the interprofessional healthcare system.“Bitcoin” founder, Satoshi Nakamoto, first introduced Blockchain technology in 2008, as a solution to the double spending issues of currency without a trusted authority or central figure. As of December 2017, Bitcoin’s reported valuation was $19,783.21—a drastic increase from it’s 2010 outset value of just $0.30. 13 This value surge demonstrated the currency’s effectiveness to the masses—including the successful implementation of blockchain technology for the first time. The first drastic change in Total Market Capitalization of the “cryptocurrency sector” occurred in July 2017, resulting in numerous entities successfully adapting Bitcoin’s original blockchain technology into their own respective projects.Numerous entities claiming the successful integration of blockchain technology into their systems have already emerged. For example, PokitDok—in collaboration with McKesson Ventures—maintained nearly a $50 million valuation as of 2017. IBM, (the founding company of Watson AI Health and Micromedex), now also maintains the top “news source” with respect to the adoption of blockchain technology into healthcare systems and the technology’s potential use alongside artificial intelligence. In addition, John Halamka’s, the CIO of Beth Israel Deaconess Medical Center and the CIO of Harvard Medical School, recently launched his new academic journal, “Blockchain in

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Healthcare Today.”—showing a continued interest successfully adapting and implementing blockchain within the healthcare sector.The Office of the National Coordinator recently offered a cash prize for an academic paper that best captures the potential use of blockchain technology for electronic health record management, data security, interoperability and other critical big data management tasks. Over 70 remarkable academic papers were submitted from several high profile institutions such as MIT, Mayo Clinic, Deloitte, IBM, and National Quality Forum. 1 The ONC decided on fifteen winners (instead of one) due to the diversity of the possibilities proposed. Fifteen submissions were chosen to win. These winners had proposed solutions to issues such as health algorithms and security 7,14,17 , international health interoperability ,2,4,9,11 advancing of patient reported outcomes, 5,8 predictive and streamlined research protocols for drug development and post market approval, 4,17 and payment/reimbursement alternatives. 3,16

As of October 11th, 2018, the Senate Banking Committee held a hearing with Dr. Nouriel Roubini and Mr. PeterVan Valkenburgh to discuss the opportunities and challenges of blockchain technology implementation. The Senate committee and the two witnesses discussed points addressed by the SEC (Securities Exchange Commission) and CFTC (U.S Commodities Futures Trading Commission) The committee was quick to dismiss the technologies which were previously mentioned, as these are not “tokenized” currencies. This statement is important to remember as many of the issues discussed on news and media are exclusively related to financial issue of cryptocurrencies, not the information storage and processing methods of blockchain technology.ConclusionThe debate is no longer if this technology will be adopted; it has shifted to when it will become adopted. This Wild West scenario provides an excellent opportunity for pharmacists to take charge in becoming the predominant blockchain technology educators and experts amongst the healthcare society. Mark Treshock of IBM explains the power of the “First Movers Advantage.” He claims that this advantage is the ability to overcome the “corporate institutional inertia.” 15 This institutional inertia is one that the profession of pharmacy is constantly battling with. Unfortunately, the opportunity may also pose a risk for pharmacists, as was the case in the adoption of the electronic prescription. Transferring to the electronic prescription took several years -- years that could have saved lives and prevented numerous detrimental errors. We must not allow history to repeat itself. We must learn from our mistakes and learn to not only accept, but also embrace the exponential evolution of technology. Whether or not this technology is adopted, we need to take the measures to become the possible experts in this field in order to increase our own value within the healthcare realm.References:1. Bresnick, J. (2017, April 14). Exploring the Use of Blockchain for EHRs, Healthcare Big Data. RetrievedOctober 10, 2018, from https://healthitanalytics.com/features/exploring-the-use-of-blockchain-for-ehrs-

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healthcare-big-data2. Broderson, C. (2016, August). Blockchain: Securing a New Health interoperability Experience. RetrievedOctober 10, 2018.3. Culver, K. (2016, August). Blockchain Technologies: A whitepaper discussing how the claims process canbe improved. Retrieved October 10, 2018.4. Ekblaw, A. (2016, August). A Case Study for Blockchain in Healthcare: “MedRec” prototype for electronic health records and medical research data. MIT Media Lab and Beth Israel Deaconess Medical Center. Retrieved October 10, 2018.5. Goldwater, Jason. (2016, August 8). The Use of a Blockchain to Foster the Development of Patient-Reported Outcome Measures. National Quality Forum. Retrieved October 10, 2018.6. Gropper, Adrian. (2016, August 7) Power the Physician-Patient Relationship with HIE of One BlockchainHealth IT. Retrieved October 10, 2018.7. Ivan, Drew (2016, August). Moving Toward a Blockchain-based Method for the Secure Storage of PatientRecords. Retrieved October 10, 2018.8. Kuo, T. (2016, August). ModelChain: Decentralized Privacy-Preserving Healthcare Predictive ModelingFramework on Private Blockchan Networks. Health System Department of biomedical Informatics,University of California San Diego. Division of Health Services Research & Development, VA San Diego Healthcare System. Retrieved October 10, 2018.9. Kraweic, RJ. (2016, August). Blockchain: Opportunities for Health Care. Deloitte. Retrieved October 10,2018.10. Linn LA, Koo MB. Blockchain for health data and its potential use in health IT and health care relatedresearch. ONC/NIST Use of Blockchain for Healthcare and Research Workshop. Gaithersburg, Maryland,United States: ONC/NIST; Retrieved October 11, 2018.11. Peterson K, Deeduvanu R, Kanjamala P, Boles K. A blockchain-based approach to health informationexchange networks. ONC/NIST Use of Blockchain for Healthcare and Research Workshop. Gaithersburg,Maryland, United States: ONC/NIST; Retrieved October 11, 2018.12. Prakash R. Adoption of blockchain to enable the scalability and adoption of accountable care. ONC/NIST Use of Blockchain for Healthcare and Research Workshop. Gaithersburg, Maryland, United States: ONC/NIST; Retrieved October 11, 2018.13. Price, R (2017, November 28). Someone in 2010 bought 2 pizzas with 10,000 bitcoins — which todaywould be worth $100 million. Business Insider. Retrieved October 9, 2018, fromhttps://www.businessinsider.com/bitcoin-pizza-10000-100-million-2017-11

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14. Shrier, A. (2016, August 8). Blockchain and Health IT: Algorithms, Privacy, and Data. Retrieved October 10, 2018.15. Treshock, M. (2018, June 12). First Mover advantage: Innovation through blockchain. Retrieved October 9, 2018, from https://www.ibm.com/blogs/blockchain/2018/06/first-mover-advantage-innovation-through-blockchain/16. Vian, K., Voto, A., & Haynes-Sanstead, K. (2016). A Blockchain Profile for Medicaid Applicants andRecipients. Institute for the Future. Retrieved October 11, 2018.17. Yerramsetti, S. K. (n.d.). Healthcare Challenges and How Blockchain Can Solve Them. Blockchain: TheChain of Trust and Its Potential to Transform Healthcare - Our Point of View. Retrieved October 12, 2018,from https://www-01.ibm.com/common/ssi/cgi-bin/ssialias?htmlfid=IUW03054USEN

Are there any adopted resolutions currently on the books related to this Proposed Resolution? Yes ___ No__X_


Author of Proposed Resolution: Krist Sokoli



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R1.9

Proposing APhA-ASP Chapter: The University of Rhode Island College of Pharmacy

Proposed Resolution Title/Topic: Mandatory Meningitis B Vaccination

Proposed wording: APhA-ASP encourages institutions of higher education, especially those who provide campus housing, to require mandatory vaccination against serogroup B meningococcal as a condition to enrollment.

Background Statement:Serogroup B meningococcal vaccination is considered a CDC Category B vaccine, meaning the CDC encourages providers to recommend the vaccine to patients who they believe are at risk, but it is not considered part of the typical childhood vaccine schedule. Typically, vaccination against MenB is reserved for those considered at increased risk for outbreak. In recent years, there have been notable MenB outbreaks on college campuses that then require reactive campus-wide vaccination to protect the population. These outbreaks could potentially be avoided if institutes of higher education mandated MenB vaccination for incoming students. There is limited evidence as to if college students can truly be considered ‘at risk’ of MenB, but it has recently been noted by the CDC that there is a higher risk of the disease amongst college students over those of the same age not enrolled in school. Although the overall risk of contracting MenB is quite low, proactive vaccination could save communities both time and money in the case of an outbreak on campus.https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2018-02/Mening-02-Meyer-508.pdfhttps://www.cdc.gov/vaccines/acip/recs/grade/menb-young-adults.html#modalIdString_CDCTable_0

Are there any adopted resolutions currently on the books related to this Proposed Resolution? Yes _X__ No___

If yes, please provide the number and title of the adopted resolution(s) as well as your rationale for the addition of this Proposed Resolution:2016.3 - Establishing Immunization RequirementsAPhA-ASP has recommended all receive CDC recommended vaccinations, but MenB vaccine does not fit into this group considering it is CDC Category B.

Author of Proposed Resolution: Erin Connolly**, Erinn Mangona*, Hailey Chapalandie*

Author Phone Number: 781 535 8152


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mailto:[email protected]


** Denotes final author, organizer, and research/creation of background statement* Denotes being responsible for the proposed concept and drafted wording that was presented for chapter approval

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R1.10

Proposing APhA-ASP Chapter: Touro College of Pharmacy

Proposed Resolution Title/Topic: Increasing Medication Adherence with Implementation of Multi-Dose Packaging

Proposed wording:APhA-ASP encourages implementation of multi-dose packaging particularly for patients with a heavy pill burden.

Background Statement:One of the primary roles of a pharmacist is to improve and monitor medication adherence. Nonadherence to medication for chronic diseases can lead to worse therapeutic outcomes, higher hospitalization rates, increased morbidity and mortality and increased health care costs. Most patients with chronic conditions take more than one medication and nonadherence is more prevalent for patients with multiple chronic conditions. The medications are packaged in disposable perforated pouches, which are labeled with the medication name, strength, and designated time to take the medication (morning, midday, evening or bedtime). The pouches are organized sequentially in a roll so that the patient can conveniently tear off the pouch and take the appropriate medications. There are multiple pharmacies that have implemented this multi-dose packaging. White Cross Pharmacy is a pharmacy based in North Providence, RI that utilizes multiple medication pouch packaging, MedPacks. CVS pharmacy has also started to implement multi-dose medication pouches, but they are only available in DC, Georgia, and South Carolina.A randomized clinical trial performed by STOMPP (Study to Measure the Impact of Pharmacists and Pharmacy Services on Medication Non-Adherence) compared the use of adherence medication packaging and the use of traditional pill bottles. This study concluded that patients had improved clinical outcomes and adherence rates when using blister packaging rather than traditional pill bottles.This proposal is directed towards mail order pharmacies and benefits patients with multiple chronic conditions such as hyperlipidemia, hypertension, or type 2 diabetes. Mail order prescription services can provide the proper manufacturing and preparation of these multi-medication pouches. Each pack will contain multiple medications and the time frame that the medication should be taken. This will decrease the confusion regarding how many tablets/capsules the patient should take and when the medication should be taken.Although this is a great way to improve patient adherence, cost and time are concerns regarding themanufacturing of the multi-dose packaging. However, the cost of manufacturing is negligible compared to the cost of hospitalization due to non-adherence. The packaging of inhalers, ointments, and creams would not be feasible and would need to be dispensed separately. Drug compatibility is another factor that may affect the

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packaging associated with multi-medication packaging, but medications that require special storage will be dispensed separately.

Are there any adopted resolutions currently on the books related to this Proposed Resolution? Yes ___ No__


Author of Proposed Resolution: Alison Ip



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R1.11

Proposing APhA-ASP Chapter: University at Buffalo The State University of New York SOP

Proposed Resolution Title/Topic: Pharmacist Therapeutic Substitution Rights

Proposed wording:APHA-ASP supports the substitution of therapeutically equivalent medications pursuant to the FDA's Approved Drug Products with Therapeutic Equivalence Evaluations without prior approval from prescriber.

Background Statement:The FDA’s “Approved Drug products with Therapeutic Equivalence Evaluations,” or the “Orange Book,” contains substitutable drugs that “demonstrate pharmaceutical equivalence and bioequivalence to be considered therapeutic equivalence.” 1 The University at Buffalo Chapter of APHA-ASP would like to propose legislature to support community pharmacist’s ability to make therapeutically equivalent substitutions without prior approval from the provider. An example of this situation would be if a patient’s insurance does not cover a specific PPI, a pharmacist would be able to substitute the preferred PPI product and inform the patient of such without waiting for the provider to send approval.This resolution would ensure that patients get the treatment that they need as soon as possible, and reduce extra work for pharmacists and pharmacy interns and staff, thereby helping with overall workflow and efficiency. In Hawaii’s state laws, among many other US states, states that “a pharmacist may substitute a therapeutically equivalent drug product listed in the current state drug formulary.” 1 If pharmacists in all states were able to do this, it would increase pharmacists’ ability to provide patient care and use their clinical knowledge to increase efficiency of workflow. Providers may still exercise their ability to dictate what is dispensed by indicating that the medication must be dispensed as written on the prescription.References:State regulations on generic substitution. Pharmacist's Letter/Prescriber's Letter 2006;22(9):220901.



Author of Proposed Resolution: Rachel Luconte


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R1.12

Proposing APhA-ASP Chapter: University of Connecticut School of Pharmacy

Proposed Resolution Title/Topic: Implementing smoking cessation products in the pharmacy

Proposed wording:APhA-ASP encourages smoking cessation aid products to be placed near the pharmacist in community pharmacy stores.

Background Statement:Cigarette smoking is still prevalent in the United States; in 2016, more than 15 of every 100 U.S. adultsaged 18 years or older currently smoked cigarettes. An estimated 37.8 million adults in the U.S. currently smoke cigarettes. The importance of smoking cessation cannot be overstated; cigarette smoking is the leading cause of preventable disease and death in the United States. Smoking cessation has improved; current smoking has declined from 20.9% in 2005 to 15.5% in 2016. 1 Although this is a modest improvement, the decline can improve, and pharmacists are ready to help.Currently, some pharmacies place over-the-counter smoking cessation products in the front of thecommunity store rather than placing such products in the pharmacy area. If such smoking cessation products and information were also placed in the pharmacy area, patient counseling with the pharmacist would be encouraged. Pharmacists are one of the most accessible health care professionals in the United States health system and are in a key position to provide smoking cessation counseling to patients in the community pharmacy setting. The evidence for the Clinical Practice Guideline for smoking cessation shows a strong dose-response relationship between intensity of counseling and cessation success. A randomized trial evaluating the effectiveness of a pharmacist-delivered smoking cessation program further supported this direct relationship. 2 Research is consistent showing pharmacists are effective in smoking cessation efforts; successful quit rates are higher with pharmacist- provided counseling. 3 Additionally, advertising smoking cessation in a pharmacy increases the number of patients who take advantage of smoking cessation services. 4 This evidence suggests that pharmacists are effective in smoking cessation counseling. If smokingcessation products were placed where the pharmacist is, then this would lead to more patient counseling and an increase in smoking quit rates.

References:1. Current cigarette smoking among adults in the United States. CDC.gov.https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm. AccessedSeptember 20, 2018.

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2. Dent L, Harris K, Noonan C. Randomized trial assessing the effectiveness of a pharmacist-deliveredprogram for smoking cessation. The Annals of Pharmacotherapy. 2009;43, 194-201.https://doi.org/10.1345/aph.1L556. Accessed September 15, 2018.3. Augustine JM, Taylor AM, Pelger M, Schiefer D, Warholak TL. Smoking quit rates among patients receivingpharmacist-provided pharmacotherapy and telephonic smoking cessation counseling. J Am Pharm Assoc (2003). 2016;56(2):129-136. doi: 10.1016/j.japh.2016.02.001 [doi]. Accessed October 10, 2018.4. Marin Armero A, Calleja Hernandez MA, Perez-Vicente S, Martinez-Martinez F. Pharmaceutical care insmoking cessation. Patient Prefer Adherence. 2015;9:209-215. doi: 10.2147/PPA.S67707 [doi].



Author of Proposed Resolution: Krystal Scinto



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R1.13

Proposing APhA-ASP Chapter: University of New England College of Pharmacy

Proposed Resolution Title/Topic: Reports for Tablet and Encapsulating Machines

Proposed wording:APhA-ASP recommends the registration of all undocumented tablet and encapsulating machines with the DEA and recommends all tablet and encapsulating machine transactions to be filed in compliance with DEA standards.

Background Statement:Pros: Compliance with current DEA mandates creates a closed system that allows the DEA to track and prevent unsolicited sales and uses of tablet and encapsulating machines.1. From Executive Order 13659 under Obama Registration Executive Order 13659: Streamlining theExport/Import Process for America’s Businesses – Feb 19, 20142. Comes revisions to Title 21-Food and Drugs of the Code of Federal Regulations. The final rule is Revision of Import and Export Requirements for Controlled Substances, Listed Chemicals, and Tableting and Encapsulating Machines, Including Changes To Implement the International Trade Data System (ITDS);Revision of Reporting Requirements for Domestic Transactions in Listed Chemicals and Tableting andEncapsulating Machines; and Technical Amendments – Dec 30, 20163. Tablet and encapsulating machine mandates are defined under PART 1310: RECORDS AND REPORTS OF LISTED CHEMICALS AND CERTAIN MACHINES; IMPORTATION AND EXPORTATION OF CERTAIN MACHINES – April 1, 2018 HIGHLIGHTS of Part 1310: Export, import, or domestic transfer of tablet or encapsulating machines require:i. Registration as a regulated person: an individual that has created an online login username andpassword for Tableting/Encapsulating Machines under the DEA’s Diversion Control Division.Accounts require company name or full name, email address, phone number, and location(Street Address, City, State).ii. An electronic DEA Form 452 completed within 15 calendar days prior after order has beenshipped by seller; info on submission instructionsiii. An oral report to the DEA agent in charge of the area of the seller as much in advance of theconclusion of the transaction as possibleiv. DEA issued transaction identification number (TIN)v. Kept record of transaction for 2 years after date of transaction

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Cons: Current DEA mandates increase burden for individuals in the market for tablet and encapsulating machines and provide no tracking method for tablet or encapsulating machines in current U.S. circulation that were acquired by individuals prior to April 1, 2018.



Author of Proposed Resolution: Cody Hutchins



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R1.14

Proposing APhA-ASP Chapter: Western New England University College of Pharmacy

Proposed Resolution Title/Topic: Pharmacy Technician Administration of Immunizations

Proposed wording:1. APhA-ASP recognizes the importance of immunizations and the valuable role they play in protecting thepublic.2. APhA-ASP encourages state pharmacy associations to actively pursue state regulations that would allowpharmacy technicians with the proper training and certification to administer immunizations.

Background Statement:Utilizing pharmacy technicians for the administration of immunizations may enhance patient care and workflow efficiency. Pharmacy technicians currently play an important role in facilitating pharmacy-based immunization programs. With the exception of Idaho, nearly all states prohibit technicians from administering vaccines. Idaho has adopted rules to allow pharmacy technicians to administer immunizations if the technician has completed specific training on administration techniques and on basic life support. This task is performed at the discretion of the supervising pharmacist, and the pharmacist would still be responsible for clinical aspects of immunizing such as prescribing the right vaccine to the right patient.1If safety can be reasonably assured through training and supervision, it may be appropriate to delegate vaccine administration to appropriately trained pharmacy technicians. Such delegation may enhance workflow efficiency, which may result in added value for patient care and potentially improve access to community pharmacy-based immunizations.

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References1. Atkinson D, Adams A, Bright D. Should Pharmacy Technicians Administer Immunizations? Inov Pharm2017;8(3): Article 16. http://pubs.lib.umn.edu/innovations/vol8/iss3/16

Are there any adopted resolutions currently on the books related to this Proposed Resolution? Yes _X_ No___

If yes, please provide the number and title of the adopted resolution(s) as well as your rationale for the addition of this Proposed Resolution:2002.11 - Pharmacy Technician TrainingAPhA-ASP encourages State Boards of Pharmacy to require all employers of pharmacy technicians to provide training programs including, but not limited to; defining technician roles and responsibilities, third party billing, patient confidentiality, and communication skills.

Rationale behind the addition of this Proposed Resolution is that technicians are already being provided several training programs and the addition of the immunization training with certification would even further enhance the technicians’ role in pharmacy and would also enhance workflow efficacy.

Author of Proposed Resolution: Kelsey Shadick



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