Key Themes for 2018 ASHP Midyear Clinical Meeting

Each year, in anticipation of the ASHP Midyear meeting, I take a few minutes to reflect on the key issues currently impacting pharmacy. In reviewing this year’s educational program, I see several themes that will be addressed in a variety of forums when we get together with our colleagues in Anaheim in a few weeks. Here is a summary of those topics that I believe will have the greatest impact on pharmacy practice over the next year:

1. Use of technology to improve quality and efficiency

   Advances in technology continue to improve the quality and efficiency of pharmacy services. The ability to integrate and share patient data between various health information systems has allowed pharmacists to become more involved in the review and monitoring of patient drug therapy from not only within the walls of the hospital but from any location with secure internet access. This increase in availability of patient data combined with the development of more sophisticated clinical decision support and artificial intelligence systems is having a dramatic impact on the practice of pharmacy. Access to this type of advanced technology will be absolutely critical as pharmacists begin exploring area such as personalized medicine and pharmacogenomics.

2. Discharge management and comprehensive medication management

   Due to a number of financial incentives recently implemented by CMS, hospitals and health systems are highly motivated to reduce patient hospital readmissions. Numerous studies have shown that involving a pharmacist in the review of patient discharge medication regimens, and the counselling of patients on the medications that they are to take following a hospital stay, significantly reduces the risk of an adverse drug event and improves overall medication regimen adherence. Many hospitals have created pharmacy teams that facilitate patient discharge by completing the discharge medication reconciliation process, reviewing proposed take home meds, assisting with the resolution of issues with third party payors, and counselling patients and/or caregivers. This type of program is a critical component of the broader comprehensive medication management initiative which is focused on improving patient outcomes and assuring better continuity of care.

3. Antimicrobial Stewardship

   One of the primary themes of last year’s midyear meeting was antimicrobial stewardship, and it appears it will remain high on the agenda. With the implementation of a variety of regulatory requirements, most hospitals are either creating or expanding their own antimicrobial stewardship programs (ASP). As technology, such as rapid diagnostic testing, becomes more readily available in hospitals across the country, the need to have well trained pharmacists involved in ASP has been recognized. Reducing the time from patient culture and sensitivity results availability, to the time that patient drug therapy is reviewed and adjusted, has shown to have a significant impact on improving patient outcomes and reducing emerging antibiotic resistance. Assuring that appropriately trained pharmacists are available 24×7, either within the hospital or from a remote location, to review lab results and recommend adjustments in drug therapy is a critical component to a successful antimicrobial stewardship program.

4. Specialty pharmacy

   Specialty pharmacy has emerged as a growing area of pharmacy practice due to the high cost of the medications managed and dispensed by these pharmacies. Specialty pharmacies typically provide care to patients that have very complex chronic illnesses that require treatment with medications that are either very expensive, require special monitoring, or have limited or restricted distribution networks. In order to assure that these critical drug therapies are properly managed, the specialty pharmacies are required to provide services beyond those provided by a traditional pharmacy. These services include:

   • 24-hour access to pharmacists via phone or video connection
   • Adherence management programs
   • Assistance with insurance and payor information
   • Enrollment in drug distribution and patient assistance programs
   • Patient and caregiver education on the handling, storage and administration of the drugs

   Many hospitals and health systems are creating their own specialty pharmacies as a means of controlling costs and improving patient access to these expensive medications.

5. Opioid stewardship and pain management

   According to the CDC, in 2017 more than 72,000 people in the U.S. died from drug overdoses with two-thirds being linked to an opioid drug. As a result, an opioid crisis has been declared in the United States and several state and federal regulations have been passed that will result in the creation and funding of opioid management programs. Pharmacists have an opportunity to play an important role in reducing the patient risks associated with opioids by developing and participating in opioid stewardship programs. In addition, pharmacists can utilize their access to and knowledge of drug use data to identify inappropriate opioid prescribing by physicians and use by patients.

As always, it will be exciting to reconnect with my pharmacy colleagues and hear more about these important topics at the ASHP Midyear meeting.

Kevin Jones, RPh, MBA, is VP of Pharmacy Services at PipelineRx. He has over 25 years of experience as a pharmacist and pharmacy manager in the hospital, institutional and home care settings, including serving as Director of Pharmacy at Denver Health Medical Center.