Federal Pharmacy Senior Leaders Vision: Next Three - Five Years CAPT Brian LaPlant, US Public Health Service CDR Paul Michaud, US Coast Guard CDR Ron Nosek, USN (Ret), Dept. of Veterans Affairs Col Dave Bobb, USAF (Ret), Defense Health Agency CAPT Brandon Hardin, US Navy Col Melissa Howard, US Air Force COL Kevin Roberts, US Army
CPE Information and Disclosures CAPT Brian LaPlant, USPHS; CDR Ron Nosek, USN (Ret) VA; CDR Paul Michaud, USCG; Col Dave Bobb, USAF (Ret) DHA; CAPT Brandon Hardin, USN; Col Melissa Howard, USAF; and COL Kevin Roberts, USA “declare no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.” The American Pharmacist Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
CPE Information Target Audience: Pharmacists and Pharmacy Technicians ACPE#: 0202-0000-18-205-L04-P/T Activity Type: Knowledge-based
Learning Objectives 1 . State joint and service-specific key initiatives and their impact on pharmacy operations and patient care services. 2. Discuss strategic goals and the impact their implementation will have on the delivery of care. 3. List examples of federal pharmacy programs that improve access and quality of care to our military and veteran populations. 4. Discuss the DoD Military Medicine transition and organization changes under the Defense Health Agency.
Self-Assessment Questions Rear Admiral Ty Bingham, new CPO for the USPHS lists which of the the following priorities for USPHS Pharmacists? A. National Opioid Crisis Response B. Team Medicine Approach C. Pharmacists in Direct Patient Care Roles D. Documenting Pharmacist Impact Across the Nation E. All of the above
Self-Assessment Questions Which of the following are Centralized Models of Pharmacy Care in the VA? A. Consolidated Mail Outpatient Pharmacy (CMOP) B. Virtual Pharmacy Services C. Anticoagulation Hubs D. All of the above
Self-Assessment Questions What Electronic Health Record system has the U.S. Coast Guard chosen to implement? A. EPIC B. MHS Genesis C. Allscripts D. GE Healthcare
Self-Assessment Question The Defense Health Agency will become responsible for healthcare operations at all MTF pharmacies through a phased in approach that started on 1 October 2018. A. True B. False
Self-Assessment Questions TRUE/FALSE : The MHS Prescription Drug Monitoring Program will provide visibility of state prescription data to MTF users, but will not provide MTF prescription data to states for civilian providers to view.
Self-Assessment Questions Which of the following is a measure of performance that supports the DHA Clinical Pharmacy Service Line? a. Wait time b. National Contract Compliance c. RVU's/FTE d. B2G d. All the above e. None of the above
U.S. Public Health Service We Achieve It Together Brian N. LaPlant, PharmD, MS, MHA Captain, USPHS North Central Regional Chief Pharmacist Bureau of Prisons
United States Public Health Service Prevention through Active Community Engagement (PACE) USPHS initiative to align community outreach activities with the initiatives of the Office of the Assistant Secretary for Health and the Office of the Surgeon General Builds relationships Commissioned Corps City/State Health Institutions Education Institutions Federal Partners Local Communities Achievements 81 individuals trained as trainers for naloxone administration 117 individuals trained on how to administer naloxone Health Prevention Outreach to 2,453 individuals 54 officers conducted 296 hours of community service Goal to more fully engage pharmacists in this effort
PHS Pharmacists by Agency Total 1319 Pharmacists* IHS 567 NIH 14 FDA 424 HRS A 14 BOP 152 DOD TMA 8 DHS 48 S AMHS A 5 CMS 46 AHRQ 1 CDC 24 ACF 1 *As of 9/ 4/ 18 OS 15
United States Public Health Service Office of the Surgeon General Priorities Opioids and Addiction Tobacco Health and the economy Health and National Security Emerging Public Health Threats Oral Health Community Health and Economic Prosperity Better health through better partnerships. - VADM Jerome Adams, Surgeon General
United States Public Health Service Pharmacy Chief Professional Officer RADM Ty Bingham National Opioid Crisis Response Team Medicine Approach Pharmacists in Direct Patient Care Roles Clinical Outcomes Documenting Pharmacist Impact Across the Nation Pharmacy Professional Advisory Committee 26 Voting members, plus chair and chair elect 5 Subcommittees Additional Workgroups Pharmacist Opioid Overdose Response Training Initiative (POORT) Tobacco Cessation ADAPT Provider Status VA-PHS BPS Prep Study Group
Pharmacy Opioid Overdose Response Training (POORT) Goals Train pharmacists to respond to opioid overdoses by connecting to community training programs Connect with local communities and increase engagement Survey completed August 2018 726 Pharmacy Officers completed 370 had received opioid training 61 identified as instructor for opioid overdose response training 137 officers carry naloxone Image from: http:/ / www.wvxu.org/ post/ us-surgeon-general-brings- naloxone-message-northern-kentucky
Naloxone Initiatives/Partnerships USPHS Commissioned Officers Alaska State Troopers Alaska Health and Social Services
United States Public Health Service Food and Drug Administration Generic epinephrine 0.3 mg and 0.15 mg injector approval Approval of atropine injection, 2mg/0.7ml, single dose autoinjector Opioid Epidemic Response POORT activities Advancing the development of improved medication-assisted treatments of opioid use disorder Final Approval of the Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS) Inter-agency collaborations Treatment guidelines Task forces
United States Public Health Service National Clinical Pharmacy Specialist 297 Active Certifications 216 Pharmacists 4 Agencies BOP IHS USCG ICE 29 Pharmacists certified under the revised, comprehensive criteria
United States Public Health Service NCPS Outcomes Data standardization for each disease state Anticoagulation Year # of Total Visits Total Total Average Avg TTR by Facilities Patients Providers TTR by Patient clinic FY 2014 2 914 54 5 58.7% 58.79% FY 2015 38 27709 2245 225 65.01% 63.52% FY 2016 37 27548 2039 211 66.72% 67.68% FY 2017 63 40707 3156 365 68.07% 67.22% Grand Total 140 96878 7494 809 66.75% 66.18%
United States Public Health Service NCPS Outcomes (continued) Diabetes Year # of Facilities Total Total Visits Average Average of A1c Patients baseline A1c change FY 2015 7 787 5093 9.9 -1.6 FY 2016 11 840 7008 10.2 -1.8 FY 2017 19 2458 9510 10.1 -1.8 Grand Total 37 4085 21611 10.1 -1.7 HIV Year # of Total Total Average of Average of Absolute Facilities Visits Patients Base VL <50 end VL <50 improvement in (% pts) (% pts) % of patients FY 2017 5 1005 171 46.9% 82.86% 35.95%
United States Public Health Service NCPS Outcomes (continued) HTN (FY 2013 to FY 2017) Year # of Total Total Avg Avg Change in Change in Facilities Visits Patients baseline baseline systolic diastolic systolic diastolic Grand 24 11289 3213 144 84 -11.46 -6.57 total Tobacco Cessation (FY 2008 to FY 2017) Year # of Facilities Total Visits Total Patients 6 month quit rate (avg by clinic) Grand total 44 17476 6391 25.61%
Bureau of Prisons Awarded 2018 Category III APhA Foundation Pinnacle Award Collaborative Practice Agreements 274 CPAs, 103 Pharmacists Certifications 38 Pharmacists with BPS Certifications 32 Pharmacists with NCPS Certifications Clinical Outcomes Diabetes 2.1% decrease in HbA1c HIV 92% undetectable viral load Hepatitis C 87% SVR
Key Points Pharmacists are an integral part of the response to the opioid crisis It is important for pharmacists to continue to transition into direct patient care roles “If you dislike change, you’re going to dislike irrelevance even more” – General (Ret.) Eric Shinseki Clinical outcomes should be objective, standardized, and communicated Documenting pharmacist impact across the nation
Federal Pharmacy Leaders Vision: Next Three to Five Years CDR Ronald A. Nosek, Jr., US Navy (Ret) RPh, MS, FAPhA, FASHP Department of Veterans Affairs
Overview and Key Initiatives VHA and PBM Overview Top Priorities Next 3-5 years EHR Modernization Community Care for Veterans Centralized Models of Pharmacy Care Suicide Prevention
Veterans Health Administration VHA is the largest integrated health system in the United States. 172 VA Medical Centers 1,062 Outpatient Points of Care >9 million enrolled Veterans Pharmacy Services Approximately 8,300 Pharmacists; 600 Residents/Fellows; 4,400 Technicians 260 outpatient pharmacies; 7 mail order pharmacies 151.5 million Rx’s annually (>80% filled by mail) Drug Cost: $4.8 billion (FY2017)
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