Community Practice

A new specialty certification may be on the horizon. The Board of Pharmaceutical Specialties (BPS) could offer ambulatory care certification as early as 2008. "BPS got the ball rolling, but we have not committed to the development of this specialty," said BPS executive director Richard Bertin. "It is up to the profession to present arguments, pro and con, before that decision can be made."

The National Community Pharmacists Association is warning that implementation of a proposed rule for reimbursement for generic drugs through Medicaid may result in many pharmacies pulling out of the program or going out of business. Citing the results of a recent Government Accountability Office study and its own internal polling of members, Bruce Roberts, NCPA executive VP/CEO, warned that under the new rule patients would face a "serious danger of losing access to lifesaving prescriptions. What we're faced with is not a natural disaster but a public policy disaster."

As part of the 1987 international Montreal Protocol treaty to reduce/eliminate substances depleting the ozone layer, CFC (chlorofluorocarbon) propellants in albuterol metered-dose inhalers (MDIs) are gradually being replaced by HFAs (hydrofluoro-alkanes). The transition need not be complete until Dec. 31, 2008, when albuterol CFC-MDIs must be discontinued as mandated by the Food & Drug Administration. But the change is well under way. As Patty Johnson, spokeswoman for GlaxoSmithKline, noted, "We [GSK] already transitioned to Ventolin HFA MDI in early 2006."

The Agency for Healthcare Research & Quality (AHRQ) recently released guides for clinicians and consumers on the use of analgesics for treating pain associated with osteoarthritis (OA). The guides draw on a report, called "Comparative Effectiveness and Safety of Analgesics for Osteoarthritis," based on a review of 351 published research studies. It represents the most comprehensive analysis to date of analgesics for osteoarthritis pain.

A major change in the treatment of advanced or metastatic colon cancer has been made in a new update from the National Comprehensive Cancer Network (NCCN). The network's "Clinical Practice Guidelines in Oncology: Colon Cancer," published in January, were revised to reflect new scientific data and expert judgment.

Migraines are now viewed as a chronic disorder with episodic manifestations, and emphasis should be put on evaluating impairment between headache attacks. This is the gist of a new consensus statement recently released by the National Headache Foundation (NHF), an organization focusing on migraine prevention.

Pharmacy representatives attending an American Medical Association's Current Procedural Terminology (CPT) editorial panel meeting recently in San Diego have asked the panel to make codes for medication therapy management (MTM) permanent.

Switching community-acquired pneumonia patients as quickly as possible from intravenous to oral antibiotics reduces hospital stays and improves the quality of care, according to many studies. One recent study suggests that even patients with severe CAP may be safely moved to oral antibiotics early in their stay. Health-system pharmacists should be aggressive in promoting that switch, say several clinical pharmacists.

A 75-year-old man, D.P., is seen regularly in your hospital clinic for severe chronic obstructive pulmonary disease (COPD) as a result of a 50-year pack-a-day habit (FEV<50% predicted). He quit smoking last year but still admits to being a heavy drinker. His current medications include fluticasone/ salmeterol 250/50 mcg (Advair, GlaxoSmithKline) one puff twice daily and albuterol inhaler when needed. He has had several COPD exacerbations within the past year, necessitating oral steroid therapy. He was just diagnosed with osteoporosis: recent X-rays show two vertebral fractures. His physician is contemplating osteoporosis therapy. What do you recommend?

Practitioners will now have access to consensus standards for the treatment of venous thromboembolism (VTE). The National Quality Forum (NQF) has announced publication of a new report, National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism: Policy, Preferred Practices, and Initial Performance Measures.

CHD Meridian Healthcare, an I-trax Inc. company, appears to have struck the right note with large corporations seeking to bring on-site clinics to their employees.

Picture this. A man walks into a pharmacy to buy condoms. He hopes he can quickly whisk them from the shelf and pay for them without attracting attention. But ... they are locked up in a case along with the razor blade cartridge replacements. A note on the cabinet states, "Please ask attendant for assistance for items in this case."

Seeking to provide hard data on the efficacy and impact of medication therapy management (MTM) sessions, a Florida Quality Improvement Organization (QIO) is studying the MTM results of Humana and AvMed Medicare patients in that state. The Florida Medicare Quality Improvement Organization (FMQAI) is working with the two prescription drug plans (PDPs) and pharmacists to set up the programs and educate patients and will publish its results in late 2007. FMQAI is the third-largest QIO in the country and has the second-largest beneficiary population.

For years, industry experts have touted the advantages of e-prescriptions, hoping to reduce medical errors and increase efficiency, while at the same time auger in a new era of electronic medical records. Still adoption of e-prescription technology has lagged in the United States. While more than 90% of pharmacies have the ability to receive e-prescriptions, fewer than 5% of doctors have ordered a prescription electronically.

Have you heard the joke about the pharmacist? Well you can bet Nicholas Hoesl has. In more than 40 years as a pharmacist, Hoesl has probably heard them all, and he has taken it as his mission to share humor with the rest of the world.

Less than a year after it first began to receive applications, interest in the Pharmacy Compounding Accreditation Board's (PCAB) seal of approval appears to be growing. "We now have 100 pharmacies going through the process," said Ken Baker, the board's executive director. "We are looking to reach 300 by the end of 2008. Interest among compounding pharmacies has been extremely high."

On average, people who have a first cancer have a 14% higher risk of a subsequent primary cancer than the general population, according to a major monograph just released by the National Cancer Institute (NCI). The report, "New malignancies among cancer survivors," looks at two million cancer survivors over a nearly 30-year period and is called "by far the largest study to date of subsequent cancers."

The Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) recently released guidelines for the diagnosis and treatment of community-acquired pneumonia (CAP). These guidelines are the first collaborative effort between these two organizations on CAP guidelines. IDSA last updated its CAP guidelines in 2003.

New data from an innovative head-to-head phase II study of Abraxane (paclitaxel protein-bound particles for injectable suspension [albumin bound], Abraxis BioScience) versus standard Taxotere (docetaxel, Sanofi-Aventis) showed that weekly Abraxane boosted the tumor response rate by more than 60% over Taxotere given every three weeks in first-line treatment of metastatic breast cancer.

According to recent results from a Crohn's and Colitis Foundation study, 65% of patients with ulcerative colitis (UC) are poorly compliant with their medication. Now, a new therapy for the condition with once-daily dosing may offer patients a better chance for compliance. In January, the Food & Drug Administration approved Lialda, from Shire plc. Lialda is a delayed-release mesalamine product that utilizes MMX technology, a pH-dependent gastro-resistant coating that delays the release of the medication until it reaches the colon, the site of the inflammation in UC.

When it comes to the cost of dispensing medications and the dispensing fee paid by Medicaid, a new study confirms the bad news that many pharmacists already know. The national average cost of dispensing medications is $10.50 per prescription, not including the cost of the medicine, according to The Cost of Dispensing, a national study released recently by the Coalition for Community Pharmacy Action (CCPA). The coalition is an alliance between the National Association of Chain Drug Stores and the National Community Pharmacists Association.

An increasing number of community pharmacies are venturing into the specialty pharmacy arena. Despite what some industry experts describe as a fragmented marketplace, community pharmacy leaders say they are poised to take on and develop this segment of the industry and keep specialty drugs in their settings.

Like it or not, health-system pharmacies are under tremendous pressure to perform at a high level. Addressing patient safety concerns, improving outcomes, implementing state-of-the-art technology, and keeping drug costs down requires a juggling act that pharmacists must perform on a daily basis.

NIOSH, the National Institute for Occupational Safety and Health, is updating its list of hazardous pharmaceutical products. The new list will become part of the organization's 2004 alert, Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health Care Settings.