Eileen Oldfield Associate Editor

Recent spike in HIV cases linked to intravenous drug use.

Amid an HIV outbreak in Indiana and associated public health emergency declaration from Gov. Mike Pence yesterday, the pharmacist’s role as a disease educator is moving to the forefront.  

“Pharmacists can educate [HIV-infected patients] about risk reduction strategies, advocate for testing and testing frequency, and refer them to community sites to access services, such as testing,” said Eric K. Farmer, PharmD, BCPS, AAHIVP, an HIV clinical pharmacist at Indiana University Health’s Life Care Clinic, in an exclusive interview with 

. “Of course, pharmacists can always counsel on good sexual health practices, and other kinds of services that are available, like pre-exposure prophylaxis.”

Public health officials have linked the 79 HIV cases reported in Scott County, Indiana, in recent months to intravenous drug use, according to 

Locally and nationally, pharmacists should address adherence to HIV treatment and any other medications the patient might be taking, including OTC medicines, during each patient interaction, Dr. Farmer said.  

Additionally, pharmacists could bridge the gap between patients and other health care team members by encouraging patients to understand their lab test results and various medications. Pharmacists should also stress the importance of bringing complete medication lists when visiting health care providers, Dr. Farmer said.  

Staying aware of antiretroviral medications stocks should be a particular focus for pharmacists, especially in community pharmacies that might not stock the therapies regularly, Dr. Farmer stressed.

“These are typically medicines that patients cannot go without, so pharmacists should problem-solve ways to get a patient a 3-day supply until some can be ordered, or refer a patient somewhere else where they can access medications,” Dr. Farmer said. “For retail pharmacies, it’s very common to have a medication-stocking issue with antiretrovirals. These are very expensive medications, and they’re very expensive to have sitting on the pharmacy shelves, so a lot of times, pharmacies won’t carry them unless they know they have a patient that is on them.”  

Dr. Farmer recommended understanding the local and regional HIV resources available to patients and providers, including AIDS Education and Training Centers or the Clinicians Consultation Center. Pharmacists can also find local and regional HIV and AIDS clinics and then refer concerned patients to these resources.  

Dr. Farmer offered 2 key pieces of advice for pharmacists who may encounter HIV-related questions.  

“I always tell my pharmacy colleagues to consider any drug interaction with an antiretroviral significant, until they learn otherwise. Regardless of when you graduated, seek out and do a continuing education credit on HIV,” Dr. Farmer said. “In the last year, there have been 4 new antiretrovirals that have come on the market, so things are changing rapidly.”   

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In Indiana HIV Outbreak, Pharmacists Spearhead Disease Education

Amid an HIV outbreak in Indiana and associated public health emergency declaration from Gov. Mike Pence yesterday, the pharmacist’s role as a disease educator is moving to the forefront.

Locally and nationally, pharmacists should address adherence to HIV treatment and any other medications the patient might be taking, including OTC medicines, during each patient interaction, Dr. Farmer said.

Additionally, pharmacists could bridge the gap between patients and other health care team members by encouraging patients to understand their lab test results and various medications. Pharmacists should also stress the importance of bringing complete medication lists when visiting health care providers, Dr. Farmer said.

“These are typically medicines that patients cannot go without, so pharmacists should problem-solve ways to get a patient a 3-day supply until some can be ordered, or refer a patient somewhere else where they can access medications,” Dr. Farmer told 

. “For retail pharmacies, it’s very common to have a medication-stocking issue with antiretrovirals. These are very expensive medications, and they’re very expensive to have sitting on the pharmacy shelves, so a lot of times, pharmacies won’t carry them unless they know they have a patient that is on them.”

Dr. Farmer recommended understanding the local and regional HIV resources available to patients and providers, including AIDS Education and Training Centers or the Clinicians Consultation Center. Pharmacists can also find local and regional HIV and AIDS clinics and then refer concerned patients to these resources.

Dr. Farmer offered 2 key pieces of advice for pharmacists who may encounter HIV-related questions.

“I always tell my pharmacy colleagues to consider any drug interaction with an antiretroviral significant, until they learn otherwise. Regardless of when you graduated, seek out and do a continuing education credit on HIV,” Dr. Farmer told 

. “In the last year, there have been 4 new antiretrovirals that have come on the market, so things are changing rapidly.”

The pharmacist's role as a disease educator is moving to the forefront.

Costs have risen 120% in aggregate since 1995.

Cancer drug prices have increased 10% each year since 1995, even after adjusting for inflation and incremental health benefits.

In 1995, 58 leading cancer drugs cost approximately $54,100 for each year of life they were expected to add. The same drugs cost approximately $207,000 for each additional year of life in 2013—an increase of about 120%, in aggregate, a new study from the Massachusetts Institute of Technology (MIT) revealed.

The rising drug prices may reflect more social tolerance for significant health care costs, despite criticism by physicians and other health care groups, the authors said.

“I think the value of good health has really increased enormously over the last few decades,” said study co-author Ernst Berndt, the Louis E. Seleye Professor in Applied Economics at MIT’s Sloan School of Management, in a press release. “We treasure our health and are willing to pay a fair bit for that.”

Although the study found a positive correlation between therapy efficacy and cost, prices tended to increase more than quality.

“We found that the greater the improvement of the drug over existing therapies, the higher the price,” Berndt said in a press release. “So, price was related to quality—but price increased more than did quality.”

In 2013, a group of 100 prominent oncologists claimed that pricing policies involved finding the cost of the most recent similar drug available, and pricing the new product within 10% to 20% of that drug’s cost. Although that assertion is consistent with reference price models of demand, it is often challenging to determine the extent to which a drug’s price relates to its development cost, Berndt said.

The federal 340B drug pricing program may also play a role in the cancer drug cost increases, as the discounts it requires for certain hospitals and clinics may prompt companies to raise therapy prices.

The researchers concluded that price increases relate to research and drug development costs, which also prompt manufacturers to discover new therapies.

“We believe the direction of causation runs from prices to research and development costs—as prices increase, manufacturers are willing to spend more to discover new drugs&mdash;rather than the other way around,” the authors concluded.

Cancer Drug Costs Soared in 2 Decades

In 1995, 58 leading cancer drugs cost approximately $54,100 for each year of life they were expected to add. The same drugs cost approximately $207,00 for each additional year of life in 2013—an increase of about 120%, in aggregate, a new study from the Massachusetts Institute of Technology (MIT) revealed.

At this year’s International Consumer Electronics Show, the show-stealing technology was not a fancy new tablet, a wearable device, or a smartphone with lots of features. Instead, the technology category to which those products belong became the show’s sweetheart.

, the category’s products include anything that can connect to the Internet and communicate data, regardless of whether those products pertain to health or other areas. Wellknown Internet of Things products include Wi-Fi—controlled thermostats and smart door locks, as well as the smartphones used to control these devices. The collected data are often stored on a cloud server or another vendor server, and device features include trend tracking and reminders based on time or location.

In a 2014 report on the technologies, information technology research and advising company Gartner Inc estimated that the Internet of Things will include 25 billion technology units by 2020.

The products also extend to health care and have the potential to improve care across the provider spectrum, proponents state. Although many devices cater to individual patient needs or goals, the ability to share data with family members or providers can also create avenues for personalizing health care.

Within pharmacy, uses for Internet of Things technologies are still evolving, 

 contributor Timothy Aungst, PharmD, notes. Still, the ability to track, store, and analyze data in real time can offer a number of advantages for patients and their health care providers.

“What is most fascinating about all these developments is that patients will soon be able to track their overall health at all times, before their providers and health care team will know,” Dr. Aungst said in an interview with 

. “This is a huge change from when patients would only get their vitals and laboratory tests done in an office, and had to wait until the data was mailed to them. . . This change may inspire patients to take more charge of their health, but also leaves them to interpret their health. As such, a new conversation may develop about how to communicate with patients about their devices and data tracking, informing them what matters clinically, and resolving health issues that require further assessment.”

Despite the technologies’ newfangled nature, several options for pharmacy have emerged. Smart pill bottles and ingestible pill sensors can confirm medication adherence, whereas other technologies can monitor a patient’s vital signs and provide real-time data collection, Dr. Aungst said. That data, in turn, can be integrated into an overall care plan and could be used to expand the pharmacist’s patient care opportunities.

Despite this, most of the technologies remain in an exploratory phase, although several pilot programs and ongoing studies are assessing where to incorporate the technologies.

“What this really comes down to for pharmacy and pharmacists is that mobile and technology options offer the opportunity for increased patient engagement,” he said. “On one hand, this can increase the relationship between patients and opportunities to expand clinical practice, but there may be several limitations. This includes scalability, education of patients, ability to use technology in care, and overall cost… Other issues are keeping pharmacists up-to-date on these technological changes and how they can be incorporated into practice.”

At this year's International Consumer Electronics Show, the show-stealing technology was not a fancy new tablet, a wearable device, or a smartphone with lots of features. Instead, the technology category to which those products belong became the show's sweetheart. 

The "Internet of Things" that Can Change Health Care

Communication helps pharmacists better assess difficulties patients encounter during treatment.

Prior to dispensing a prescription to a patient, it may pay to walk a mile in his or her shoes.  

As the health care system moves toward value-based care, the ability to understand a patient’s feelings could be the key to ensuring high-quality interactions. Known as clinical empathy, this involves communicating with patients to understand their perspective on their disease, medication, and overall health.  

Ultimately, clinical empathy helps build the patient respect necessary for better health outcomes.  

“Until someone gains respect for you, they won’t value what you have to offer them in terms of knowledge,” said Gloria Grice, PharmD, who specializes in patient communication and building patient relationships, in an exclusive interview with 

. “The key to earn the respect of patients is to respect them, which includes their beliefs, perspectives, opinions, and feelings.”  

Developing that relationship can mean addressing patients’ emotional responses to therapy, as well as acknowledging their concerns or frustrations.  

“It’s really important that pharmacists do not ignore the emotion simply because it can be a little uncomfortable,” Dr. Grice said. “Additionally, we should encourage a patient to expand when they express a feeling by saying things like, ‘tell me more’ or ‘it’s ok to be upset.’”  

While ignoring an emotional response may seem more natural, it is a professional pitfall that prevents deeper connection with patients, Dr. Grice said.  

Other pitfalls include rushing interactions, which may make patients feel as if they are a burden to the pharmacist, or unintentionally embarrassing patients, if the pharmacist is not accustomed to addressing emotions.  

Luckily, empathy and communication are learned skills, so pharmacists can develop them through practice and experience. The St. Louis College of Pharmacy, where Dr. Grice is an associate professor, teaches these skills through its internally developed Patient-Centered Communication Tools. Based on a physician-training model, the tools emphasize relationship-building communication and have empathy at their core.  

“It may help to think of the patient in front of you as a family member or friend,” Dr. Grice told 

. “It could be helpful to ask a colleague to offer feedback on how empathetic you were with a patient.”  

Despite its importance, empathy is not a stand-alone quality in effective patient communication.  

“Communication is much more complicated, and involves a lot more than just empathy,” Dr. Grice said. “It includes confidence, effective questioning, appropriate language, non-verbal demeanor. All of these things—tied with empathy, understanding, and incorporating a patient’s perspective and strong knowledge&mdash;will make the encounter with a patient successful.” 