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Study: An aspirin a day could keep cancer away

BY Michael Johnsen
BOSTON – An analysis of data from two major, long-term epidemiologic studies published last week found that the regular use of aspirin significantly reduces the overall risk of cancer, a reduction that primarily reflects a lower risk of colorectal cancer and other tumors of the gastrointestinal tract. 
 
The findings, published online in JAMA Oncology, suggest that the use of aspirin may complement, but not replace, the preventive benefits of colonoscopy and other methods of cancer screening.
 
"We now can recommend that many individuals consider taking aspirin to reduce their risk of colorectal cancer – particularly those with other reasons for regular use, such as heart disease prevention – but we are not at a point where we can make a general recommendation for overall cancer prevention," stated Andrew Chan, chief of the Clinical and Translational Epidemiology Unit in the Massachusetts General Hospital Division of Gastroenterology, the senior and corresponding author of the report. "Our findings imply that aspirin use would be expected to prevent a significant number of colorectal cancers above and beyond those that would be prevented by screening and may have even greater benefit in settings in which the resources to devote to cancer screening are lacking."
 
A large number of studies have supported the ability of regular aspirin use to prevent colorectal cancer, but aspirin's effects on overall cancer risk has not been clear. To investigate that question, the research team analyzed 32 years worth of data from almost 136,000 participants in the Nurses' Health Study and the Health Professionals Follow-up Study. They found that participants who reported regular aspirin use – defined as taking either a standard or a low-dose aspirin tablet at least twice a week – had a 3% absolute lower risk of any type of cancer than did those not reporting regular aspirin use. Regular aspirin use reduced the risk of colorectal cancer by 19% and the risk of any gastrointestinal cancer by 15%. 
 
No reduction was seen in the risk of breast, prostate or lung cancer. 
 
Aspirin's protective benefit appeared after five years of continuous use at dosages ranging from 0.5 to 1.5 standard tablets a week or one low-dose tablet a day. The researchers estimate that regular aspirin use could prevent close to 30,000 gastrointestinal tract tumors in the U.S. each year and could prevent an additional 7,500 colorectal tumors among U.S. adults over 50 who have endoscopic screening and 9,800 among the almost 30 million who are not screened. 
 
The benefit related to other gastrointestinal tumors appeared after six years and at the same dosage level – equivalent to a daily low-dose tablet – used to prevent cardiovascular disease.
 
"At this point, it would be very reasonable for individuals to discuss with their physicians the advisability of taking aspirin to prevent gastrointestinal cancer, particularly if they have risk factors such as a family history," Chan said. "But this should be done with the caveat that patients be well informed about the potential side effects of regular aspirin treatment and continue their regular screening tests. Furthermore, aspirin should not be viewed as a substitute for colonoscopy or other cancer screening tests."
 
 
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Elevated professional status drives patient access

BY Jim Frederick

Converging trends in health care, including a rapidly aging baby boomer population, a steady rise in chronic disease and massive policy changes such as those associated with the Affordable Care Act, are creating increased demands for patient care just as the shortage of primary care physicians continues to become ever more pronounced — in five years it is expected that the United States will have about 100,000 fewer primary care physicians than needed — and threatening to further compromise an already overtaxed healthcare system.

(Click here to view the full report.)

The Pharmacy and Medically Underserved Areas Enhancement Act — now pending in Congress as H.R. 592 and S. 314 — would address that by leveraging the convenience and the clinical expertise of the community pharmacist, helping to expand access to care for millions of underserved Americans, lowering the cost of delivery of critically important frontline health services and fostering new models for collaborative care.

The legislation “would designate pharmacists as healthcare providers in Medicare Part B — empowering them to deliver services to Medicare patients in underserved communities, according to pharmacists’ scope of practice laws in each state,” explained Steve Anderson, president and CEO of the National Association of Chain Drug Stores. He called the growing support for the legislation from Congress and within the U.S. population “just one example of the growing recognition of pharmacy’s value, and the ability of highly trusted, highly educated and highly accessible pharmacists to improve and save lives.”

The “lack of pharmacist recognition as a provider by third-party payers, including Medicare, has limited the number and types of services pharmacists can provide, even though they are fully qualified to do so,” Anderson said. “The adoption of policies and legislation to increase access to much-needed services for underserved Americans, such as … the Pharmacy and Medically Underserved Areas Enhancement Act, would allow Medicare Part B to utilize pharmacists to their full capability by providing those underserved beneficiaries with services not currently reaching them.”

Among the nation’s pharmacy leaders, the bill is perhaps better known simply as provider status legislation. Why? It would confer professional status as healthcare providers on pharmacists who provide health services to seniors in need, putting them on roughly equal footing with other professional caregivers, such as nurse practitioners and physician assistants, as members of the modern, coordinated healthcare team.

“H.R. 592 and S. 314 would build on existing law that allow nurse practitioners and physician assistants to be reimbursed by Medicare by covering services delivered by pharmacists,” noted the Patient Access to Pharmacists’ Care Coalition, an advocacy group whose members include NACDS, the National Community Pharmacists Association, the National Consumers League, the National Rural Health Association and many other groups.

“Similar to the law for NPs and PAs,” added the advocacy group in a report, “the Pharmacy and Medically Underserved Areas Enhancement Act would limit rates to 80% or 85% of what would be paid to physicians, helping limit Medicare spending while improving access.”

Unleashing innovation in cost-effective care
Efforts to expand the pharmacist’s scope of practice have steadily gained traction in Congress. Prior to the end of the last session, H.R. 592 had drawn 264 Democratic and Republican co-sponsors in the House — more than 60% of the total membership — and 41 co-sponsors in the Senate.

Public support for elevated status for pharmacists also is solid. The most recent national opinion research poll from NACDS shows that more than 8-in-10 consumers are in favor of the bill.

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Doctorate required

BY Jim Frederick

Left to right: Alexa Mitchell and Holly Moore, both second-year pharmacy students at Washington State University
College of Pharmacy, work with clinical assistant professor Kimberly McKeirnan, PharmD, to deliver health screenings
at a local Albertsons pharmacy.

Going back at least to the mid-1800s, many community pharmacists have been given the informal title of “doc” or “doctor” by grateful local residents, particularly in smaller towns and rural communities where the local pharmacist might be the only health provider within miles. These days, the title is more than honorary; it’s a requirement.

(Click here to view the full report.)

Before they even attend their first class, today’s prospective pharmacists have undergone the rigorous selection process required of any student applying to one of the nation’s 135 colleges of pharmacy. Once enrolled, they begin an intensive, six- or seven-year journey toward the doctor of pharmacy degree now required to practice pharmacy in the United States. By the time a student has earned a doctor of pharmacy, they will have completed approximately 140 graduate school-level required course credit hours — about one-third of which are experiential in nature via prescribed types of clinical practice mentoring.

“The doctor of pharmacy degree program requires at least two years of pre-professional (undergraduate) study followed by four academic years of professional study,” noted the American Association of Colleges of Pharmacy. What’s more, said the organization, “a growing number of first-year students enter a pharmacy program with three or four years of college experience.”

Given the fact that pharmacists literally bear responsibility for the health, well-being and in some cases the lives of patients, it’s no surprise that they undergo extensive training and advanced education before donning the white coat. In addition, the field of pharmacy has become increasingly complex as advances in pharmaceutical therapy and genomics have taken hold — and as pharmacists’ patient-care activities have become more integrated with those of doctors and other members of the healthcare team.

Harry Leider, chief medical officer for Walgreens, said, “The level of education and training pharmacists receive has increased significantly in recent years. Pharmacy students are now required to earn a doctor of pharmacy degree (PharmD), which typically takes seven to eight years to complete — including undergraduate and pharmacy school education. Many pharmacists go on to receive additional specialized training in areas of growing need like immunizations, diabetes or HIV/AIDs.”

Learning to collaborate
“The role of the pharmacist is rapidly changing,” agreed the University of Pittsburgh School of Pharmacy in a mission statement. “Pharmacists are able to contribute to the healthcare team by utilizing tools and skills that facilitate patient care. With significant national support for pharmacists’ ability to impact the healthcare of patients, there is an imperative need to address the significant gaps in access to patient care services.”

“Pharmacists are patient-care providers who focus on the appropriate, safe and effective use of medications while collaborating with members of a healthcare team,” added Pitt Pharmacy School dean Patricia Kroboth. “Changes in the U.S. healthcare system are driving an exciting evolution of responsibilities and roles for pharmacists. Our graduates practice in a variety of environments on the continuum of keeping healthy communities healthy to caring for the sickest of the sick.”

At the University of North Carolina’s Eshelman School of Pharmacy, the education of prospective pharmacists now features “more patient-care experience, expanded research … and a flipped classroom that shifts the lecture[s] outside of class and replaces them with more interactive, team-oriented and critical-thinking activities.” In this “new curriculum,” said Russ Mumper, Eshelman’s vice dean and professor, “the role of patient care … will begin much earlier in the student’s educational process.”

According to Evan Robinson, founding dean of Western New England College School of Pharmacy, new educational guidelines from the American Association of Colleges of Pharmacy reflect the dramatic evolution of pharmacy practice. This expansion of pharmacists’ expertise and engagement comes as pharmacists fill a broader and more clinical role as frontline patient care providers, working in partnership with physicians and health systems as part of an integrated care team focused on improving patient outcomes and long-term wellness.

“Pharmacists have been very effective communicators, and now the question is, ‘How do we grow in our role as educators?” Robinson said. “The goal now is to enhance our therapeutic knowledge to make us far more valuable as a member of the interprofessional team in collaborative services for patient care and outcomes management, whether it’s in a patient-centered medical home, in care-based activities, etc.”

The nation’s schools of pharmacy have significantly expanded their curricula and community outreach, said the pharmacy educator, to give newly minted doctors of pharmacy the fully rounded, advanced-degree education in pharmacotherapy and health sciences they’ll need for today’s more complex and clinically oriented model of pharmacy practice. But today’s pharmacy students also are gaining a deeper understanding of patient relationships, empathetic long-term care, counseling on healthier lifestyle choices for patients, the management of chronic diseases and the team-based approach to patient care that increasingly defines today’s healthcare system.

“Our curricula have evolved in a very solid, stepwise, evidence-based manner to try and find ways to capitalize collaboratively for patient outcomes,” Robinson said.

‘Redefining pharmacy’s role’
Today’s pharmacy curricula is preparing new generations of community pharmacists for work as behavior management experts spending less time dispensing and more time on patient management activities.

“Communication skills are critical,” said pharmacy educator Kimberly McKeirnan. “As pharmacists, we regularly interact with people who are faced with difficult situations like health concerns of their own, health concerns of a family member or financial difficulties.”

As a result, “PharmD education includes training and opportunity to practice communicating — interviewing and counseling patients, effective communication with other healthcare providers,” said McKeirnan, clinical assistant professor in the College of Pharmacy at Washington State University Health Sciences.

Pharmacy schools are aligning with the changes in pharmacy practice in order to better prepare students for a more clinical and holistic approach to patient care by pharmacists. At the University of Iowa’s College of Pharmacy, for instance, “classes are now organized by disease state and will be team-taught.”

“PharmD students in small groups will learn about the scientific process, develop a scientific project and present findings,” the school reported recently. “An essential piece of the [new] ‘Learning and Living’ curriculum is having pharmacy students and other health sciences students collaborate. There will be more flexibility for students seeking dual degrees and additional specialization.”

According to Donald Letendre, dean of Iowa’s pharmacy school, the college is “redefining the role pharmacy will play in tomorrow’s healthcare system one outcome at a time, … from the discovery of new drug therapies to groundbreaking delivery models for patient care … advancing the world of pharmacy by achieving outcomes that matter.”

“Our students are rubbing elbows with nurses and physicians every day,” Letendre said. “We are always at the forefront of innovation.”

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