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.