A P-5 student recounts his experience as an AMCP/Pfizer Intern

Preventing diabetic complications by implementing hypertension management:

My project as an AMCP/Pfizer intern

By: Rahul Bhambri, PharmD '09

Managing hypertension in persons with diabetes is essential in preventing micro/macro-vascular complications including neuropathy, nephropathy, and retinopathy. Cardiovascular disease is also a major complication which can lead to an increase in mortality among diabetic patients. A major cardiovascular risk factor contributing to morbidity and mortality among diabetics is hypertension. Interestingly enough, a recent study supported by the American Diabetes Association revealed that clinicians treat hypertension in diabetics less intensively than in patients with hypertension alone. The findings suggest that a more aggressive role is needed in treating hypertension in the diabetic population. This study was what sparked my interest to pursue a project geared towards managing hypertension in diabetic patients.

During my time in Virginia Beach as an AMCP/Pfizer intern, I had the opportunity to work on my project for Optima Health, a subdivision of the Sentara network. One of the goals for the MCO (managed care organization) was to improve upon diabetes management. This was the same objective I had when coming up with my project. I was privileged to have Beth Brusig, PharmD, as my preceptor. She is the clinical pharmacy specialist for Optima Health and provided me with much insight for my project. We came up with a project plan to recognize hypertensive diabetic members and their current drug treatment regimen. The objective of my project was to identify members with diabetes who were not receiving optimal therapy for hypertension and hyperlipidemia and to have them placed on a drug regimen consisting of statins, ACE Inhibitors or ARB’s. The study design consists of three components: a provider educational piece, a member specific profile which lists the most recent cholesterol levels and other lab data, and a provider specific summary sheet which lists all the patients that are not receiving preferred therapy according to national evidenced-based clinical practice guidelines. The rationale for this study design was to measure the change in therapy among patients not on optimal therapy.

In addition to my primary project, I also worked on many other assignments for the MCO. The director of pharmacy had me do a cost analysis on Adderall XR vs. Concerta to determine which stimulant would cost the least amount of money based on manufacturer rebates and marketshares in both the commercial and Medicaid sectors. I also researched drug indications for the prior authorization department and presented my findings to physicians and pharmacists at the Pharmacy & Therapeutics Committee at Norfolk General Hospital. Another task entailed assessing claims data to examine Humira utilization to see if members tried using a disease-modifying antirheumatic drug (DMARD) before implementing the biologic agent. During my last week at Optima Health I also presented a disease management educational lecture on hypertension for the prior authorization staff.

After nine weeks in Virginia Beach, I completed my tenth week at the AMCP headquarters in Alexandria, VA. There I had the opportunity to participate as a peer reviewer for the Journal of Managed Care Pharmacy (JMCP). This final week was perhaps the most exciting week of the entire internship because I was given the opportunity to sit in key meetings, such as the Joint Commission of Pharmacy Practitioners (JCPP) meeting, where leaders from all different facets of pharmacy meet to discuss key issues affecting pharmacy practice today.

I also had an opportunity to work on an additional research project with Dr. Carl Tullio, my Pfizer clinical education consultant (CEC). This project focused on managing diabetes by targeting A1C% and LDL levels in the military population of southern Virginia. I am expected to present my findings for both projects at the 2007 AMCP Educational Conference and the 2007 ASHP midyear meeting.

I highly encourage every pharmacy student to apply for this internship because it not only provides an opportunity to network with key opinion leaders in the small realm of pharmacy but it also bestows a better understanding of the myriad career opportunities available upon graduation. I truly enjoyed this internship and the summation of these experiences have provided me with an in depth look at managed care pharmacy.

Summer at Nuclear Diagnostics

By: Kajal Sheth, PharmD ‘08

The word "nuclear" probably brings thoughts of radiation, danger, and hazardous situations to the minds of many. But when I first heard about nuclear pharmacy during the 2006 LIU career fair, I felt the urge to learn more about this new and exciting field. As pharmacy students we don’t really hear much about this branch of pharmacy in any of our classes. I thus applied for a summer intern position at Nuclear Diagnostic Products in Plainview, New York and was lucky enough to get the position.

My daily commute from New Jersey to Long Island five days a week was challenging at times, yet it was all worth the effort. As an intern, I learned about topics that I had never learned in school. I learned about medications used to diagnose and treat patients with cancers and infections of specific organs. Interestingly enough, those same medications -- radioactive material -- can be used for various diagnostic scans when different target specific non-radioactive compounds are added to them. For example, we have all heard about the radioactive iodine species, I131 and I121, used in thyroid scans and in the treatment of hypothyroidism. I learned how these radioactive species are made, both in injectable and capsule formulations. Radioactive substances have no odor, no color, and for the most part, are invisible. Radioactivity is not measured in terms of grams or liters, rather, it has its own specific unit called "curie". There are specific devices to measure radioactivity. Also, I came to know that there are special quality control processes executed every time radioactive doses are sent out to clinics. These quality control processes ensure that the level of radioactivity is safe in all dispensed radioactive species. The regulations regarding the delivery of radioactive materials vary from state to state.

The major concern of many is probably the question of how safe it is to work with radiation. With my limited, but nonetheless quality experience, let me assure you all that as long as you follow the radiation minimization guidelines, it is very safe to work in a nuclear pharmacy.

Overall, it is good to get exposed to different branches of pharmacy to find out where your true interest lies and to experience new things in life. My unique internship experience last summer totally changed my whole outlook towards the profession of pharmacy. Nuclear pharmacy is yet another example of how pharmacists can serve the community via the safe handling of hazardous materials.

We are fortunate to be a part of a profession that presents itself in a variety of forms. I recommend that every student apply for internship positions in different areas of pharmacy.

The Importance of Experience

By: Jessica Macauda, PharmD ‘10

Today, many students in pharmacy school have little experience in pharmacy practice. As informative as our clerkships are, more experience is needed as a part of our preparation. Whether you are contemplating community, clinical, industry or other fields of pharmacy, there are opportunities available to you. Ask your friends, do some research on the Internet- you are bound to find something new. Take advantage of a part-time job at a local pharmacy- even if it is only a few hours every other weekend. Every hour spent in practice will only benefit you because one day you will be the pharmacist or the person in charge.

After six years of schooling, you do not want to be overwhelmed due to a lack of experience in practice. As crude as it sounds, knowledge is only half the job. The ability to apply that knowledge and understand your patients' concerns makes all the difference. Experience now can help you determine what field of pharmacy is right for you. There are hundreds of types of positions available to a PharmD today. Discover where you belong in this limitless field so that your time can be devoted to our main goal -- pharmaceutical care.

Pharmacy is not a perfect world. There will be instances in our careers where we just want to retaliate, but that is unprofessional. Without having experience with many different patients and situations, how can we apply our knowledge? During our sixth year rotations we will be confronted with multiple questions, issues and pharmacy settings. Why not create a simpler transition for yourself and experience pharmacy practice now? It will be a little taste of what is yet to come.