Sleep apnea may up diabetes risk, study finds
NEW ORLEANS Sleep apnea may cause metabolic changes that increase insulin resistance, according to researchers from the University of Pittsburgh Medical Center.
The intermittent hypoxia associated with sleep apnea causes a distinct drop in insulin sensitivity in mice, even though chronic hypoxia, such as that associated with high altitude, did not.
“As sleep apnea continues to rise with the rate of obesity, it will be increasingly important to understand both the independent and interactive effects of both morbidities on the development of metabolic disorders,” stated lead researcher Euhan John Lee. “This research demonstrated that intermittent hypoxic exposure can cause changes in insulin sensitivity and insulin secretion, which may have important consequences in metabolically vulnerable diabetic patients who present with co-morbid sleep apnea,” he said.
NACDS chief: Pharmacy in ‘watershed moment’
PALM BEACH, Fla. —It rained hard on the third morning of the 2010 National Association of Chain Drug Stores Annual Meeting here, forcing the hundreds of retailers and vendors into The Breakers’ indoor spaces to try to maintain their meeting schedules despite the weather. The storm was an inconvenient reminder that not all things in business can be controlled or anticipated, and it was an apt metaphor for the unsettled, shifting world of pharmacy retailing in an era of health reform, reimbursement challenges and a halting economic recovery.
The chain pharmacy industry, NACDS leaders repeated throughout the four-day event last month, is navigating in uncharted waters—but in a boat made more seaworthy by the efforts of the group and its members. Incoming NACDS chairman Larry Merlo, his predecessor Andy Giancamilli and the organization’s president and CEO Steve Anderson all reminded the roughly 2,000 retail and supplier executives, pharmacy educators, health industry experts and guests who made the trek to Palm Beach that the industry now operates in a time of unprecedented challenges to the healthcare system, unsustainable growth in health costs and the uncertainties of a shiny, new health-reform law. But they also asserted that community pharmacy is far more unified, focused and respected as a contributing member of an integrated healthcare team than it was in years past.
“We realized that we had to stop whining and start winning. We realized that we couldn’t just go into congressional offices and say what we were against,” Anderson said at the conference kickoff on April 25. “And, though reimbursement looms large…we had to describe the way that pharmacy improves lives and saves long-term healthcare costs. So we are. And it is working.”
In his first address as NACDS chairman, Merlo immediately challenged industry leaders to meet health reform head on. He called on the representatives of every retail pharmacy channel to stake their claim to a rapidly evolving healthcare system—a system in desperate need of new, more cost-effective solutions and closer coordination among patients, payers and healthcare providers.
“We must define the value for community pharmacy in a reformed healthcare delivery system,” said Merlo, who also is president of CVS/pharmacy. “If you want to define the healthcare equation as access, cost and quality, I would offer that our industry—community pharmacy—is in the best position to effectively and positively contribute to all three pillars of that healthcare equation.”
Anderson urged attendees to “stay vigilant” as the Obama administration begins to interpret and implement the changes wrought by the health-reform law. But he also cited a list of whole or partial victories for retail pharmacy over the past two years, culminating with the inclusion in the healthcare bill of many of the provisions sought by pharmacy advocates.
Among them: “a much-improved definition and calculation method” for reimbursing pharmacies that dispense generic drugs to Medicaid patients, a conditional exemption on the accreditation requirement for pharmacies selling durable medical equipment and new support for pharmacist-provided medication therapy management services.
In a larger sense, Anderson said, pharmacy also is gaining ground as a full participant in a health-and-wellness “renaissance” shaping the way health care is provided in the United States. “Together, we are creating a renaissance,” he asserted. “I am convinced people will look back 20 or 30 years from now, and will see these times…as a historic, watershed moment.”
Merlo agreed. “As an industry, I believe we are positioned to help control the costs of health care by advocating for the value of what I’m going to call ‘pharmacy care,’” he said. “Our strategy for ensuring the use of cost-effective medications is pretty clear; we need to promote adherence and effectiveness.”
Pharmacy care, Merlo asserted, “is the cost-effective treatment of disease, particularly chronic disease, through better mechanisms to promote adherence and effectiveness. The terminologies have been out there for years: MTM, disease management. It doesn’t matter what we call it; the time is now to examine the trends in the delivery of health care and the role of community pharmacy, not just today but into the future as well,” said NACDS’ new chairman. “Most important of all, we must ensure that the value of the pharmacy industry and its pharmacists is recognized by payer reimbursement policies—not just for the products we sell, but for the services we provide.”
Giancamilli, the outgoing chairman, said the industry’s best days are still to come. “Everything we are doing today truly is creating a legacy of greater success in the future,” he said. “Despite our remarkable progress, I know that NACDS’ greatest work in political engagement lies ahead.”
Q&A: Won’t you be a Good Neighbor
Drug Store News: What are some of the highlights across the front end of the concept Good Neighbor Pharmacy?
Jerry Cline, SVP retail sales and marketing: The two most significant highlights for me are Home Health Care and Diabetes Shoppe. The future owner of Burt’s Good Neighbor Pharmacy—Robbie Leark—is building a team who is going to specialize in home health care and ambulatory supplies, as well as diabetes testing, counseling and support. All of these solutions are provided through AmerisourceBergen under the Good Neighbor Pharmacy umbrella. Those solutions will differentiate the store, particularly considering the demographics supporting the store’s location and patient population.
AJ Caffentzis, group VP retail solutions: The other point I’d throw in there is that all of the HBC/OTC planograms are being driven by the work that we do out of our front-end solution team and the work we do with manufacturers in developing best-in-class planograms for all the various categories. Those planograms are in this store and on display prominently. We also have the solutions to show what the business moves and what items move the best under our Business Coaching solution. Our front-end solutions work with our InSite platform. That helps us with Business Coaching and helps the owner/operator make strong, positive decisions to drive his or her business. (Note: InSite is a business intelligence application that supports AmerisourceBergen’s retail pharmacy clients across the United States with dashboards and scorecards that provide rich analytics and personalized information.)
DSN: And behind the bench? What’s under the hood at this store?
Caffentzis: One feature that comes to mind is the use of our technology solutions—the ability to use the right robots for the right-sized store to help the pharmacist and the technicians automate the script-filling process. The second feature that stands out is the construction of consultation rooms for the patient and pharmacist. Those consultation rooms are the separator for community pharmacy and the independent pharmacist. The pharmacist will spend some time with the patient to discuss treatments and the patient’s health. The consultation rooms are going to help the pharmacist do just that.
Cline: The feature I would highlight is that we’ve installed a new pharmacy system in the store called ComputerRx. It’s a select pharmacy system that will feed information from the store into our data warehouse and then be fed into our InSite system, which will allow the business coach to work with Leark and his team to improve performance in his store and drive additional value in specific areas. Without that coaching piece powered by InSite, that additional value would not be possible.