FR190-Younger

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Deborah Hubbell, BSPharm, University of Connecticut
Steve Kozel, PharmD, UCLA
Greg Yeakel, BSPharm, Iowa State University
Deirdre Younger, BSPharm, MS, University of Maryland, College Park
Disclosure
 We have NO actual or potential conflict of interest
in relation to this educational activity or
presentation
Objectives
 List the most current clinical issues affecting college
health pharmacists
 Describe current funding or other business-related
challenges in providing college pharmacy services
 Describe strategies on other campuses for managing
challenging pharmacy issues
Why are we here?
 To gain a better understanding of who we are as college
health pharmacists and explore what we can offer to
our health centers
 Presenters will share their experiences on the topic
areas
 Audience is invited to share their experiences also to
expand the knowledge base of everyone in attendance
Topics for Discussion
 Role of the pharmacist in immunizations
 H1N1 and the role of the pharmacist
 Integrating Pharmacy with the Health Center
 Generating Operating Revenue
 Identifying Unmet Health Services Needs
 As time allows, other topics identified by the audience
H1N1 and the Role of the Pharmacist
Deborah Hubbell, BSPharm, University of Connecticut
Role of the pharmacist in
immunizations
 Campus Outreach Vaccination Clinics
 Student Athlete Vaccination
 Accessibility to all students and staff
H1N1 and the Role of the
Pharmacist
Mass Vaccination Effort
(lessons learned at UConn)
Including:
 Vaccine allocation
 Storage
 Distribution
 Recordkeeping
A virus emerges
 First illness in Mexico and the United States in
March/April 2009
 CDC lab confirms on April 15, 2009
 CDC activates EOC on April 22, 2009
 US government declares public health emergency on
April 26, 2009
April 29, 2009 - WHO signals global pandemic
of novel influenza A (H1N1) was underway
(worldwide pandemic alert level to Phase 5)
June 11, 2009  Phase 6
By June 19, 2009, all 50 states in the
United States, the District of Columbia,
Puerto Rico, and the U.S. Virgin Islands
had reported novel H1N1 infection
What did this mean to College
Health?
 CDC concluded novel H1N1 flu was causing a greater
disease burden on people younger than 25 years of age
 ACHA Pandemic Influenza Surveillance Project was
launched in August 2009
 ACHA released “Interim Guidance for Managing On-
Campus Novel H1N1 Flu Pandemic”
What did this mean to UConn?
Connecticut Department of Public Health:
Launch of SHS Flu Hotline and
www.flu.uconn.edu
VPSA H1N1 Task Force
Objectives
 To identify the challenges, risks and issues within
Student Affairs that may arise as a result of an
H1N1 outbreak
 To develop and implement a detailed response
plan to address those challenges
 To serve as the Divisional contact for all matters
related to H1N1 and a resource for other Student
Affairs departments with issues or inquiries arising
out of H1N1
VPSA H1N1 Task Force
Membership
 Committee Chairs: Mike Kurland, Director of Student





Health Services and Denielle Burl, SA Director of Risk
Management
Clinical Staff – Mary Manton, M.D., Michele LaBonte,
A.P.R.N. , Deb Hubbell, R.Ph.
Communication Representative – Beth DeRicco (Wellness
& Prevention)
Residential Life – Maureen Armstrong, Scott Gallo
Dining Services – Dennis Pierce
Off-Campus Services – Jim Hintz
FLU KITS
 Tissues
 Hand sanitizer
 Masks
 Thermometer
 Flu information card
CDC Guidelines for antiviral use
Who may be considered for antiviral
chemoprophylaxis ?
 Persons at high risk for complications of influenza;
 Health care workers and emergency medical personnel;
 Pregnant women.
CDC Guidelines for antiviral use
Whom not to treat chemoprophylactically
 Groups of healthy children or adults based on
potential exposures in the community, workplace,
school, camp or other settings;
 If >48 hours have elapsed since the last close contact
 The close contact did not occur during the infectious
period
How to prophylax
 Antiviral drugs: oseltamivir (oral), zanamivir
(inhaled)
Vaccine purchase, allocation, and
distribution
 FDA approved four vaccines (made by CSL,
MedImmune, Novartis, Sanofi Pasteur)
 Vaccine procured and purchased by US
government
 Vaccine allocated across states proportional to
population
 Vaccine sent to state-designated receiving sites –
mix of local health depts & private providers
Delivery Model
 Public health-coordinated effort that blended
vaccination in public health-organized clinics and in
the private sector (provider offices, workplaces, retail
settings)
From: Robert L. Miller [mailto:[email protected]]
To: Kurland, Michael; Hubbell, Deborah; Olzinski, Mike
Subject: UConn H1N1 vaccine allocation
UConn SHS is authorized to administer:
1500 doses of flu mist lot# 500780P
400 doses of prefilled syringe (.5ml) lot#00249611A
Robert L. Miller, MPH, RS
Director of Health
Eastern Highlands Health District
4 South Eagleville Road
Mansfield Ct. 06268
860-429-3325
Initial Target Groups for SHS Clinics
 Pregnant women
 Household contacts and caregivers of infants less than
6 months of age
 Students aged 18 and under who have a high risk
medical condition
 EMS personnel and healthcare workers who have
direct clinical contact with patients
Mass Vaccination Clinics
 October 30 – 100
 Nov. 9 & 10 – 800
 Nov. 16 & 17 – 800
 Nov 30/Dec 1 – 600
 Dec . 7 & 9 – 400
 December 15 – 60
 January 6 – 380
 February 9 – 260
 In September, the original assumptions were that
75% of our students would want H1N1 vaccine.
 We estimated that 10% of those would go to their
home providers and 90% would use the MDA.
 So we planned for 1,000 per week over a 3-4
month period.
 In the end, we immunized 3,400 people.
2010-2011 Influenza Vaccine
 A/California/7/2009 (H1N1)–like virus
 A/Perth/16/2009 (H3N2)–like virus
 B/Brisbane/60/2008–like virus
Steven Kozel, Pharm.D.
UCLA
Arthur Ashe Student Health and Wellness Center
ABSTRACT
 College health pharmacies can fill a number of
roles in the student health service from providing
traditional pharmacy services, to generating
operating revenue, to providing services for the
students that are not met by the traditional
student health center service providers. For the
pharmacy to meet its potential, the pharmacy
needs to integrate with the student health center,
identify health center needs, and provide
evidenced based support for those activities.
Integrating the Pharmacy with the Health
Center
 Pharmacy and Therapeutics Function- the
pharmacy should assume a leadership role in this
function
 Quality Assurance Participation- the pharmacy
should participate in the organization’s continuous
quality assurance process.

A. Benchmark Medication Errors

B. Serve as an expert advisor to reduce the
potential for medication errors
Integrating the Pharmacy with the Health
Center
 Volunteer to assist with health center outreach
programs

A. Health Fairs

B. Immunizations-either as an
immunization provider or an educator
 Advise Student Health Advisory Committee
and/or Student Health Insurance Committee

A. Advocate for Pharmaceutical Benefit
plans that meet student needs
Integrating the Pharmacy with the Health
Center
 Establish the Pharmacy as the “Go To” Expert on
Pharmaceutical Benefits

A. Serve at the prescriber’s proxy for prior
authorizations

B. Facilitates timely medication availability

C. Free up providers to see additional patients
rather than spend time on insurance issues
Generating Operating Revenue
 Not For Profit vs For Profit Revenue Model
 Determine the organization’s policy
 Even a not for profit model “should generate revenue
that can support operations
 Non profit does not mean operating at a loss;
Generating Operating Revenue
 Budgets
 Insure that the pharmacy is recognized as a
responsible fiscal partner in the organization
 Participate in your financial review
 Review your performance monthly--this should be
data driven
Generating Operating Revenue
 Assure insurance claims are adjudicated promptly and
rejected claims are resolved in a timely manner.
 Identify financial problems promptly and develop a
plan of correction
 Ensure that the pharmacy performance is included in
the organization’s quarterly and annual financial
reports
Identifying Unmet Health Service Needs
 Collaborative Prescribing Protocols
 Facilitates management of medication shortages;
 Standardization of therapeutic medication classes
within the organization to improve quality and
minimize costs;
Identifying Unmet Health Service Needs
 Self care partnership; OTC’s as an alternative to a
clinic appointments-frees up clinic appointments and
directs patients to seek an appointment with a
provider when self care is not appropriate
 Emergency Contraception Services partnership with
Women’s Health;
 Medication Special Orders
 Specialty Pharmacy
Identifying Unmet Health Service Needs
 Alternative Prescription Service Models



i. Online Refill Requests
ii. Electronic Prescription Appointments
iii. Prescription and refill drop boxes
Identifying Unmet Health Service Needs
 Advertising Pharmacy Services



Business Cards;
OTC’s
Partnering with the clinic providers
Other Issues as Defined by Audience
 What are the other issues that college health
pharmacists face in today’s climate of poor economy,
lay-offs, furloughs, changes in how the Health Center
operates etc.?
 How do we overcome these challenges?
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