National pharmacy benefit management company Medco will significantly improve access to its services for limited English proficient members in 2009, the U.S. hhs.gov/” rel=”nofollow”>Department of Health and Human Services (HHS) announced today.

As the nation’s largest mail-order pharmacy operation, Medco dispenses more than one hundred million prescriptions a year through the mail. Following an investigation of a complaint filed on behalf of a Spanish-speaking member with HHS’ Office for Civil Rights (OCR), Medco developed a multi-faceted plan to improve services to non-English speakers.

“These actions will significantly improve members’ ability to manage and make informed decisions about their own health care — a critical objective under the federal law prohibiting discrimination based on national origin,” said Robinsue Frohboese, acting director of HHS’ Office for Civil Rights. “Industry action like this is needed to combat health care disparities and promote health care reform to improve access and delivery of quality health care for all. We hope and expect that others in the industry will follow Medco’s lead.”

In 2009, Medco’s efforts will focus first on the needs of Spanish-speaking members. In addition to expanding its pool of bilingual customer service representatives who speak Spanish, Medco will revise its systems to enhance its ability to route Spanish-speaking members who need help with prescription drug questions or problems directly to bilingual staff, including pharmacists where possible and appropriate. Medco will continue to use a telephonic interpreter service available for more than 150 other languages to communicate with other non-English speakers.

A critical improvement in Medco’s internal computer systems will flag language preference on an ongoing basis to aid effective communication with limited English proficient persons during member-Medco contact. Medco will work to implement this improved ability to identify and track individuals’ language preferences so that important written communications and outbound telephone calls are placed to members in their primary language. Medco will also review how best to notify limited English proficient members that language assistance services are available.

Medco has committed to developing an evaluation process with respect to interpreter competency. Staff at call centers and pharmacies expected to communicate directly with members in languages other than English will be assessed as to language proficiency, and those serving as interpreters will be assessed for interpreting competency. Medco will train all relevant staff on system changes intended to improve access to limited English proficient members, and will monitor the results of these efforts through periodic assessments.

“Consistent with our commitment to making medicine smarter, we value this opportunity to collaborate with HHS on initiatives that will help empower patients with information to improve their understanding and use of pharmacy benefits, and enable greater adherence to their physician’s prescribed therapy,” said Glenn Taylor, Medco’s group president of Key Accounts.

Under Title VI of the Civil Rights Act of 1964 and its implementing regulations, recipients of federal financial assistance are required to take reasonable steps to provide meaningful access to their programs by limited English proficient individuals who are eligible to receive their services.

A copy of Medco’s written commitments and OCR’s closure letter, along with more information about OCR’s enforcement of Title VI and other federal civil rights laws, can be found at http://www.hhs.gov/ocr.

Source
HHS

John A. Gans, PharmD, Executive Vice President and Chief Executive Officer for the American Pharmacists Association (APhA) has been selected as a recipient of the gov/” rel=”nofollow”>Food and Drug Administration ’s (FDA) Commissioner’s Special Citation Award. The award will be bestowed upon Dr. Gans today during a ceremony at Martin’s Crosswinds, Greenbelt, Maryland.

The award is being presented to Dr. Gans in recognition of 20 years of outstanding leadership in ensuring issues of importance to pharmacists and the APhA are considered in FDA regulatory decision-making.

In congratulating Gans, Dr. Joshua Sharfstein, Acting Commissioner of Food and Drugs, Principal Deputy Commissioner said, “You have been chosen for this award because you have provided invaluable assistance to the FDA. To be selected for special recognition should be most satisfying since accomplishments such as yours impact the well being of the public.”

Dr. Gans has been APhA’s Executive Vice President and Chief Executive Officer since 1989, focusing on positioning pharmacists as valued members of the healthcare team who can improve medication use and advance patient care. Prior to joining APhA Gans served on the faculty and was Dean of the School of Pharmacy at the Philadelphia College of Pharmacy and Science (now known as the University of the Sciences in Philadelphia), where he earned his pharmacy degree in l966 and his doctorate in pharmacy in 1969.

Dr. Gans began his career in 1966 as a community pharmacist in Broomall, Pennsylvania. During 1967-68, Dr. Gans held a residency at the Hospital of the University of Pennsylvania. Following his residency, he became Assistant Director of Pharmacy at the Hospital of the University of Pennsylvania and held that position from 1968-70. He was a pioneer in the area of parenteral nutrition and clinical pharmacy. From 1974 to 1985, he served as the Managing Director of Pharmaservices, a consultant firm to nursing homes.

Dr. Gans has served as the Founding Chairman of the Delaware Valley Regional Poison Control Program, which established a 24-hour regional poison control center in 1985. In 1980-81, he served as President of the Pennsylvania Society of Hospital Pharmacists and, in 1986-87, as President of the American Society of Hospital Pharmacists.

Dr. Gans will step down in July as EVP and CEO of APhA after nearly 20 years of service to the organization.

Source
American Pharmacists Association (APhA)

A marker in the blood of both cats and humans that was identified in a recent study might signal both species’ susceptibility for a painful bladder disorder called interstitial cystitis, a condition that is often difficult to diagnose.

Follow-up studies of the chemicals that appeared in blood samples suggest that the way tryptophan, an essential amino acid, is processed in cats and humans with interstitial cystitis ultimately could affect the way signals are transmitted in the brain. The results, while preliminary, suggest that the disease is not just a malfunction of the bladder, but might instead have origins in the central nervous system, researchers say.

Symptoms of interstitial cystitis, known as IC, include recurring discomfort or pain in the bladder and pelvis, and often both an urgent and frequent need to urinate. A diagnosis typically follows tests to rule out other diseases, such as infections or cancer. No diagnostic test currently exists for IC, and the cause is unknown. Treatments range from oral medications to exercise for humans, and maintaining a safe environment for cats.

“What we know now is that this testing method is very sensitive and specific for the disorder in both humans and domestic cats. So far it hasn’t missed one diagnosis,” said Tony Buffington, senior author of the study and professor of veterinary clinical sciences at Ohio State University.

The research is published in the current issue of the journal Analyst.

Buffington and colleagues collected samples from cats with feline interstitial cystitis, healthy cats and cats with other diseases, as well as samples from humans with the painful bladder syndrome, healthy humans and humans with other urological illnesses.

He and colleagues used infrared microspectroscopy to tell the difference between blood samples indicating the presence or lack of disease based on the samples’ molecular profiles. Infrared spectroscopy identifies the biochemical content of a blood sample based on where peaks of molecules appear in the infrared spectrum. Samples from humans and cats with interstitial cystitis demonstrated nearly identical molecular peaks.

“It’s a powerful enough technique that we might even be able to identify subtle differences in patients with multiple diseases that exist in addition to, but that are unrelated to, the interstitial cystitis,” he said.

The researchers then determined the chemical structures within those molecular profiles, which showed that blood from cats with the syndrome contained at least 20 percent more tryptophan and kynurenine than did samples from healthy cats. Kynurenine is a brain compound produced when tryptophan breaks down in the body. An elevated level of kynurenine suggests that tryptophan is being diverted from its conversion into a chemical responsible for sending signals in the brain.

This testing method differentiated between diseases in humans as well, classifying the samples as coming from either healthy subjects, IC patients, or patients with another urological disorder, Buffington said.

In addition to improving the potential to diagnose interstitial cystitis, understanding chemical processes related to this chronic disease could offer new directions for the pursuit of treatments and even prevention strategies, he said.

“It’s all speculative, but it may be that there is some kind of primary central nervous system disorder that results in problems in the bladder in some people, and in the gut or other organs in others,” Buffington said. “It is possible that this is a biomarker for the underlying vulnerability or susceptibility.”

Buffington has led studies that show that in cats, feline interstitial cystitis can be managed through a series of changes to the affected animals’ environment that reduce stressors and promote stability and predictability.

“We can put these cats into recovery, but I don’t think we cure them. It’s a chronic condition. It’s like lactose intolerance - you won’t get that gene back, but you can learn to avoid milk,” he said.

So far, humans with the disorder have the option of bladder distention, dietary changes, exercise, oral drugs, electrical nerve stimulation or surgery. But all treatments target only symptoms because the underlying cause of the disease is unknown.

Buffington plans to test human samples from patients diagnosed with irritable bowel syndrome and fibromyalgia to see if the same biomarker is associated with these chronic pain disorders as well. These disorders, like IC, are categorized as what are known as medically unexplained or functional syndromes, and Buffington has explored the possibility that a common link exists among these types of diseases.

He published a review paper in the April issue of the journal Psychotherapy and Psychosomatics in which he suggested that traumatic events experienced by pregnant females might transmit to fetuses a genetic change associated with the stress response.

Buffington suggests that such a genetic change would mean offspring born to these mothers might then have a genetic predisposition to be more vulnerable to certain stressors, and that in some individuals that vulnerability could lead to development of a chronic pain disorder in response to stress.

“When products of the stress response cross the placenta, they can change gene expression in offspring,” Buffington said. “My guess is that there are patterns or groups of genes that are changed. And these groups could have something to do with the magnitude and quality of the stress response. I think it’s another useful way to look at how these things develop.”

The biomarker study was supported by a grant from the Interstitial Cystitis Association.

Buffington co-authored the study with Daniel Rubio-Diaz, Monica Giusti and Luis Rodriguez-Saona of Ohio State’s Department of Food Science and Technology; Megan Pozza and Judi Stella of the Department of Veterinary Clinical Sciences; Jordan Dimitrakov of the Harvard Urological Diseases Center; and Jason Gilleran of Ohio State’s Division of Urology.

Source: Ohio State University