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Target tests new baby sections at 10 Chicago stores

BY Alaric DeArment

MINNEAPOLIS — Target is hoping to enhance the experience of customers shopping for baby items with a new pilot program in Chicago.

(See below for a video from Target about the program.)

The mass merchandise retailer said the program, which it is testing in 10 stores, would include a redesigned layout, knowledgeable "Baby Advisors" and interactive digital content. The advisers offer personalized and unbiased information about baby products using in-store iPads to help customers view the chain’s product assortment, providing what the chain called an "extended aisle" for access to additional items and information. The new layout allows customers to more easily find items and interact with products through lowered displays. Interactive content and expert advice is being offered under a partnership with BabyCenter.

"We’ve heard from moms that they love shopping for baby, but are hungry for information on what’s best and want help in making the smartest choices," Target group VP stores for the Chicago region Mary-Farrell Tarbox said. "Target is excited to officially unveil its enhanced baby experience program in the Chicago area. This offering will help guests feel more confident about their purchases and to easily navigate Target’s baby offerings, both in-store and online."


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Certifying specialty pharmacy care

BY Gary Rice, MS, MBA

Countless industries are continuously updating and retooling their approaches to production, organization, communication, training and other systemic procedures to keep up with ever-changing landscapes. The specialty pharmacy industry is no different and, in fact, has reached a critical point when it comes to training, qualifying and educating the growing number of pharmacists practicing in this complex area.

To treat such chronic diseases as cancer, multiple sclerosis and rheumatoid arthritis, specialty drugs can require special handling, distribution and administration.

Specialty drugs require special handling, distribution and administration to treat such diseases as cancer, multiple sclerosis and rheumatoid arthritis. Due largely to a robust pipeline of new biologics, additional indications on existing medications and innovative drug therapies for medical conditions previously untreated, specialty pharmacy has rapidly become one of the fastest-growing segments in pharmacy. And its projected growth is staggering. U.S. spending on specialty prescription drugs is projected to increase 67% by the end of 2015, according to Express Scripts. Prescription drug spending on eight of the top 10 specialty therapy classes will continue to increase over the next three years, and what was a $90 billion market in 2012 is projected to grow to more than $100 billion in 2013. While these dollars are spent in about 3% to 5% of the population, they will account for more than 55% of total pharmacy costs, according to CuraScript.

These statistics are expected to rise along with the aging population and increases in such age-related diseases as Alzheimer’s disease, cancer and cardiovascular diseases. This tremendous growth signals that the specialty pharmacy industry must make available to its pharmacists and to important stakeholders — including patients — a standardized, uniform tool for ensuring highly qualified, highly trained professionals: professional certification. It’s essential to public health, to the growth of the industry and its partner industries, and to general healthcare resource management that specialty pharmacists become as knowledgeable and competent as possible within the space of high-cost, highly managed drugs — and that they learn to keep the pace with the ever-evolving technology.

Certification programs ensure specialty pharmacists possess the most up-to-date skills — something that benefits all sectors of the industry, as well as public health. To the individual pharmacist, certification provides the opportunity to sharpen existing skills and prove to employers a dedication to their craft, to patients and to the evolving industry. On the flip side, those who choose to forgo certification — and the education and training associated with the certification criteria and process — may not be able to withstand the demands of innovation and risk being under-qualified for such expectations. To those who employ specialty pharmacists, certification offers a systematic procedure for proving competency — ensuring continued confidence from healthcare institutions — and processes for developing and securing top talent within the industry. Industrywide, certification helps create standards to enhance quality and establishes new benchmarks that elevate patient care and safety, reinforcing confidence in where the industry is headed.

And the certification ball is moving. Already we are seeing the demand for certification-like programs, largely from payers who are eager to work with accredited pharmacies employing only cutting-edge technologies and the highest-trained staff. Universities also are seeking training programs to help prepare aspiring pharmacists in the area of high-cost, complex pharmaceuticals. Indeed, certification will become an important benchmark as this rising industry continues to evolve and become more relevant, providing an important educational point of reference and a track record of competent experienced staff.

To fill these growing demands, the specialty pharmacy industry is working diligently to make available certification opportunities. One such opportunity is the Certified Specialty Pharmacist. Available through the Specialty Pharmacy Certification Board, the certification program provides verifiable evidence of proficiency in all aspects of specialty pharmacy practice. Administered twice yearly in April and October, CSP was created by industry experts using a nationally recognized certification program and examination development process, providing an objective method for measuring the knowledge and ability of specialty pharmacists.

Such credentials as the CSP are a key indicator to employers, manufacturers, patients, payers, other healthcare providers and the general public that a professional is an expert in specialty pharmaceuticals and demonstrates proficiency in specialty pharmacy management duties in a variety of practice settings. It’s critical that individual specialty pharmacists and the industry as a whole embrace certification to help ensure a dedicated work force is keeping pace with inevitable growth and the technological and scientific advancements that come with it. With the continued expansion in the marketplace and the demand placed on high-cost, complex pharmaceuticals, those involved with specialty pharmacy must commit to bettering their careers and their skills sets by investigating and completing certification. If you’re connected in any way to specialty pharmacy, or wish to be, it’s that important.


Gary Rice, RPh, holds a Master of Science degree and MBA, and serves as both board president of the Specialty Pharmacy Certification Board and VP of clinical services at Diplomat Specialty Pharmacy.

 

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Screening for risks

The healthcare industry has been laser-focused on prevention since it became obvious that stemming the tide of disease in our country required an upstream solution. From tackling prediabetes in adults to preventing childhood disease with infant immunizations, health professionals are onboard — with most finding a way to incorporate disease prevention into everyday practice.   

But one area of preventive care is often overlooked. According to the Centers for Disease Control, a full 75% of the morbidity and mortality in adolescents is a direct result of preventable risk behaviors.1 Such organizations as the American Medical Association, American Academy of Pediatrics and American Academy of Family Physicians all recommend annual screening of adolescent risk behaviors. But despite these statistics and evidence-based recommendations from leading organizations, teens have been overlooked in standards of care to date. A survey of AAP’s fellows revealed that fewer than 25% of providers regularly screen teens for risk behaviors.2  

Rapid Assessment for Adolescent Preventative Services, or RAAPS, is an adolescent risk-screening tool that was born out of research and a practical need to overcome some of the most common barriers to adolescent risk screening: time, provider confidence, lack of counseling tools and resources, and teen engagement.  

RAAPS was designed to be quick and effective for ease-of-use in a retail setting, and screening teens in this setting is especially important. Because teens utilize health care less than any other segment of the population, a visit with them may be the only health care they receive for that year — or longer.

Despite the need to screen for risky behaviors, it can be a struggle to connect with teens using a traditional interview style or incorporate long surveys into the practice workflow. Prior to RAAPS, a 72-question survey — known as Guidelines for Adolescent Preventive Services, or GAPS — was the best option for providers, but this survey took nearly 30 minutes for teens to complete and was not a good fit in a clinic environment.  


Rapid Assessment for Adolescent Preventative Services, or RAAPS, is an adolescent risk-screening tool used to overcome some of the most common barriers to adolescent risk screening, including time, provider confidence, lack of counseling tools and resources, and teen engagement.

RAAPS was developed to fit easily into the workflow. The team of industry leaders and academic experts at the University of Michigan incorporated evidence-based literature and completed a validation study to ensure identification of the top contributors of morbidity and mortality in adolescents.
Equally important as the science that went into the survey was the group of consulting experts: teens themselves. The team had strong teen involvement in every aspect of development to make the survey more engaging and to help teens feel more comfortable answering sensitive questions. This collaborative development process led to some innovative features that increase both engagement and effectiveness in the teen population.  

For example, the RAAPS survey can be completed on any device with Internet access — such as an iPad, Kindle or Android-powered tablet — which provides the mobility and flexibility for the survey to be used in almost any care setting, as well as minimizes “shoulder surfing” by both casual observers and protective moms. Audio and multilingual options help improve health literacy, which is especially important among underserved populations. The short, 21-question format decreases survey fatigue, and the technology interface provides better quality data. As research shows, teens are more likely to provide honest answers with technology than with face-to-face or paper surveys.3

Because adults aren’t the only ones who forget half of what they hear in an appointment, teens can choose to e-mail themselves the individualized health messages they receive from the RAAPS system that are specific to their identified risk behaviors following completion of the survey questions. These messages can serve as reminders of what was discussed and as a resource that can be referred to at a later time, increasing their exposure to the messages and increasing the chance that they will make positive behavior changes.

The team also added innovative features just for health professionals. Risk assessment can uncover a broad range of risk behaviors, and clinicians have indicated that they have significant experience talking with teens about some topics, but not others, particularly sex and mental health.  

Evidence-based talking points were developed for each question to help professionals in their discussions with teens across all of the potential risk behaviors. Health messages appear for professionals as a PDF document linked directly to each teen’s completed survey. These health messages focus on what has been proven to be most effective in messaging to teens: providing ideas for changing behaviors, rather than focusing on why they should change, and including such self-efficacy messages as, “You can make a difference in your life and the lives of your friends by making safe driving choices.”  Each message includes national or government websites specifically for teens, as well as hotline numbers where applicable. Since 2001, there has been a massive growth in teens using the Internet to seek health information, yet few take steps to ensure the credibility of the online sources they are finding.  RAAPS is giving them reputable resources.  

RAAPS users report that these messages have helped them increase the effectiveness of their counseling sessions and, most importantly, build trust and rapport to support ongoing discussions, not just one-time encounters.

Another useful feature is access to risk data. Prior to having an online system, clinicians would have to counsel hundreds of teens with paper surveys and had no way of easily tracking individual outcomes or reviewing all of the risk data that had been collected, outside of time-intensive chart reviews full of human error. So, when building the reporting features, the RAAPS team asked clinicians what questions they had about their teen populations and created reports that responded to such questions as:  

  • What is the effectiveness of the risk counseling I am providing?
  • What are the greatest risks in my teen population?
  • Are my programs and services focused on the greatest risks?

Teen risks change over time, and having accessible data that reveals changing trends is critical for professionals serving adolescent populations. For example, a review of RAAPS 2012 data shows a significant increase in mental health risks among teens, even surpassing the usual issues of teen drinking, drugs and unprotected sex.

Used in care settings ranging from hospital outpatient clinics to school-based health centers, and with a benchmark database of more than 33,000 completed surveys, RAAPS’ innovative approach has engaged teens and improved the effectiveness of both the identification and reduction of risk behaviors. And the data from RAAPS has been used to change service at all levels.

Consider a case study in Michigan, which began as a pilot and rapidly expanded across the state. The data from this initiative has been collected and analyzed at the state level and used to inform changes in Medicaid programming. Increased awareness from this project of the unique needs in teen populations also spurred adoption of an adolescent risk assessment guideline for Michigan.

Despite these successes, risk screening is not yet a standard practice among care providers serving the adolescent population. With 75% of all illness and death in the teen population attributable to preventable risk behaviors, and more than 75% of providers failing to routinely screen adolescents for these behaviors, the issue cannot be ignored. To learn more about RAAPS, visit RAAPS.org.

Jennifer Salerno is a nurse practitioner and former director of the University of Michigan Regional Alliance for Healthy Schools (RAHS) school-based health center program and the UM Adolescent Health Initiative, where she developed the RAAPS screening tool. Salerno is currently a consultant to the Michigan Department of Community Health, overseeing grant funding for the transformation of adolescent healthcare delivery in Michigan. She serves as a board member and adviser on many state and national organizations focused on adolescent health.

References:

1 Centers for Disease Control and Prevention [CDC]. (2012). The youth risk behavior surveillance system – United States 2011. MMWR  61(4). Retrieved from http://www.cdc.gov/mmwr/pdf/ss/ss6104.pdf.
2 American Academy of Pediatrics (AAP) Periodic Survey of Fellows #71, conducted in 2008.
3 Paperny, D. M., Aono, J. Y., Lehman, R. M., Hammar, S. L., & Risser, J. (1990). Computer-assisted detection and intervention in adolescent high-risk health behaviors. The Journal of Pediatrics, 116(3), 456-462.
 

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