Conscious Pharmacist Podcast

CP44: Pharmacists on The Frontline of Covid-19 Pandemic- A Conversation with Dr Richard Dang, PharmD, APh, BCACP

• Michelle J Sherman

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Pharmacists on The Frontline of Covid-19 Pandemic- A Conversation with Dr Richard Dang, PharmD, APh, BCACP

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Speaker 1:

You're listening to the conscious pharmacist podcast, a show for pharmacists, healthcare providers who have answered the call to practicing on purpose. Now here's your host, internationally recognized HIV pharmacist, author, speaker, patient advocate, and president of mish RX pharmacists consulting services and your conscious pharmacists, Michelle Sherman. You're listening to the pharmacy podcast network.

Michelle:

This is Michelle Sherman, president of Michelle Rex pharmacist consulting services and your host for the conscious pharmacist podcast. Welcome today to today's episode where I'm so pleased to have as a guest on our show, Dr. Richard dang from UAC, who's an innovative advanced practice pharmacist and he is chairperson of the California pharmacists association covert 19 taskforce. Welcome to the show. Richard. I'm Michelle. Thank you for having me. No, absolutely. Um, you know, with these very challenging times that we're living through globally and it's been such a big challenge for everybody in the U S and here in California and you know, especially for our fellow pharmacists who are on the frontline of this pandemic and the work that you've done and the work of the task force has been extraordinary. So we're just get started with the, with the, with the show and it just, for our listeners that don't know who you are, just let us know w what's your current field of practice and how did you get to doing what you're doing today?

Richard Dang:

Yeah, absolutely. Um, so I am currently an assistant professor of clinical pharmacy and residency program, director of our community based pharmacy residency program at the university of Southern California school of pharmacy. Uh, I've been with USC, uh, pretty much all my life. Uh, depending on what status you want to talk about. I went to USC for undergrad in pharmacy school. I did my residency there. Um, and I worked there as a pharmacist and now currently as a faculty member. Um, so currently for my practice, I'm working with our USC pharmacies and clinics that we own and operate across the Los Angeles area. We actually have five separate pharmacies, um, outpatient pharmacies. Um, and I'm working in our ambulatory care clinic. Uh, that's a collaboration with our department of family medicine physicians where before Kobe, we primarily provided international travel health services. Uh, but that's taken a huge hit. Uh, with the current situation with no one traveling. Um, but some of our other clinical services involve diabetes, banishment, um, asthma, um, anticoagulation and other disease state management programs, and a very robust immunization, uh, programming, uh, working with our student health centers and family medicine, um, to work with their patients. Um, kind of where I got to where I am now. As I kinda mentioned, I went to USC for pharmacy school. Uh, and upon graduation I completed my residency also in community based pharmacy practice at USC. Um, and in that residency I was basically introduced to the workplace that I'm currently in now. Um, so that was where we were primarily providing those robust clinical services in collaboration with student health and family medicine. After my residency actually stayed on with USC as an ambulatory care pharmacist and our medication therapy management program. Um, and so in that MTM center, we conducted comprehensive medication reviews for Medicare patients located in several States across the Western hemisphere for fairly large, uh, part D provider. Then after working at the MTM clinic for a few years, um, I transitioned into my current role now as faculty. Uh, where I at the school, I teach a lot of our community based, uh, pharmacy practice courses. So I teach courses on health screenings, immunizations, and I oversee the didactic component of our experiential programs with our students ranging from either first to fourth years.

Michelle:

That's, that's extraordinary. Um, and you know, you've taken your whole career into like the clinical pharmacy realm and, um, the, the focus is, is not on the shell bottle and putting those pills into the bottle and pharmacy has shifted so much, like over the years. Um, you know, our reimbursements on, on the prescriptions or dismal, um, you know, pharmacists are now recognized as healthcare providers and you know, for those listeners that don't know, California has an advanced practice pharmacy license now, which, you know, I'm, I'm very proud to have one of those. And um, you have licensed number one, so you, you're the first licensed advanced practice pharmacist in California. And, uh, you know, for our listeners out there, just, I always tell people, but maybe you can also like encourage them to become advanced practice pharmacists and how important we are as healthcare providers and to be able to provide clinical services in that role as an advanced practice pharmacist.

Richard Dang:

Yeah. So, and I think you actually hit the nail on the head. Like our profession has evolved and continues to evolve. Um, and I, I feel like I've seen major changes just over the last decade alone, but for those who have been in the profession for a long time, I think you recognize, you know, the many steps that we've taken to evolve our Preston to where it is now. And I think an introduction of a new licensure in California as a part of that evolution. Um, and I've had a lot of experience in the traditional community practice as well, you know, um, I worked at CVS and Kaiser and the VA, um, clinics and pharmacies, um, in addition to before starting my residency. Um, so it's a, it's an essential foundational part of our profession, but there's also so much more that we can add and to those services and to integrate into those clinical services. And I think that, you know, having that advanced practice pharmacist license or designation really gives you that state authority and recognition as a healthcare provider who provides different kinds of pharmacy services than what is traditionally seen. I think some of the value is really getting when you're talking to patients or when you're talking to physicians, when you present yourself as an advanced practice pharmacist, um, that triggers something different in their heads. They don't immediately think of the product. They don't immediately think of the traditional dispensary role, which is essential to our profession. But they typically tie that to the registered pharmacist license. And when you mentioned you're an advanced practice pharmacist, then you start asking other types of questions. Like what, what do you mean by that? What, what, what, what kind of work do you do? And that presents an opportunity for you to educate them about the evolution that our profession has had and the great amount of involvement that we have in various patient care services.

Michelle:

Oh absolutely. And you know, makes a significant difference. I know for myself in the HIV arena, it's been extraordinary to be able to provide these advanced practice services, especially in tele-health since the pandemic and to be able to provide like rapid HIV rapid stock and prep services. And the outcomes that I've seen in patients that I've worked with have been extraordinary. So it really takes the focus away from the actual product and provides care, which ultimately is going to decrease healthcare costs and decrease the burden on the healthcare system when they recognize that we are less at core provider providing care to the patients.

Richard Dang:

Yeah, absolutely. And I mean during, because of covert 19 we see a lot of, at the very initial stages at least we saw a lot of clinics shut down and close. Um, and so some people were losing access to their primary care providers. And during those very initial stages, the only healthcare units that were open were hospitals and pharmacies. Um, and so a pharmacist played a really important role in making sure that patients who needed that continual care and continuing monitoring were able to receive that.

Michelle:

No, absolutely. And now that you mentioned covert, I think, you know, this, this absolute global devastation and disaster has ultimately been like catapulted pharmacy go ahead and much like at a much more rapid pace than it then it would have without this because I think, um, nationally all the powers that be can see that we really all frontline healthcare providers and that we can do so much more, um, for our patients than just put pills in the bottle. Just, you know, like, like the testing, like the waiver that the governor issued last week for pharmacists to provide testing. Um, could you talk a little bit about that waiver and how does it really impact, um, for every pharmacist out there working in a community pharmacy, I've already had people asking me like, well how do we, how do we start doing this and what do we have to do to do it according to that waiver?

Richard Dang:

Sorry, which I think you cut out a little bit, so I'm not sure if you want to repeat the question. I think I heard what you, what the question was.

Michelle:

Oh yeah, yeah. With the waiver that um, Gavin Newsome issued, um, last week, um, granting pharmacists the, the, the right to, um, order covert 19 tests and to provide the testing. A lot of pharmacists have been asking me, well, what do they do? How do they get the tests? Do they have to be certified to administer the tests? And you know, what PPE or what requirements are necessary to do it? Cause I know the waiver was only granted for like 60 days.

Richard Dang:

Yeah, absolutely. I mean I'm one of the right size of covert 1980. You can even use that term is that pharmacy has never received as much attention as it has now. It's, I've been on almost every person, every legislator's tongue, both in the state and in the federal level. And we saw some really great recognition for the work that pharmacists can do in the era of coven 19 come from the federal government. They first issued that, um, the department of health and human services first issued, um, an order in early April announcing that pharmacists have the authority to order and administer Kobe 19 tests and they recognize the great role that pharmacists can play in helping the nation scale up its availability of Kobe 19 tests. Um, you also mentioned the governor's order. Yeah. So in California last early last week, governor Newsome, um, announced an order, um, pretty much in line with the vision of what HHS had mentioned. Uh, it's, I think we're seeing some really great, uh, recognition of the work that pharmacists can do. Um, and so I think with the governor's order and with the order from HHS, we've been hearing from a lot of pharmacists that they are very motivated and interested in providing these services. And of course there are some steps in regulatory, I think hurdles that still have to be uh, um, taken care of. Um, it's a mixture of a variety of different issues. I think the reality of the situation is that this is a really new, this is a really new situation for everybody. And I'm not just referring to COBIT, I'm also referring to recognizing pharmacists as essential health care providers who can provide these services at who should ultimately get paid for these services. So I think some of the challenges we're seeing is that even with the order from the federal government and from the state, that a lot of the different health plans or other entities may not yet be as familiar with what it means for a pharmacist to order or administer Cobra 19 tests. And as an association, CPHI is working towards navigating all of the different issues, meeting with the stakeholders, educating them about what it means. So that we can facilitate this process and really, um, have our members offer these tests as quickly as safely and as efficiently as possible.

Michelle:

Oh, absolutely. Well that, that'll make a huge difference. And you know, once we are able to start providing those tests, hopefully tests will be available because that seems to be like the challenge. Um, I know like in LA County for instance, um, you guys, if, if you're a frontline healthcare worker can just go get a test here in orange County, it's not like that. You still have to, um, fit the CDC criteria and have symptoms in order to go get a test. So, you know, each jurisdiction has their own criteria that they following. So I think so many people just get confused as to who can get a test, how they can get tested and you know, what's next. So I think if CPHI has guidance and there's like a step by step process that people can follow to be able to not only like order the tests but get the tests and provide them, that will be huge.

Richard Dang:

Absolutely. And I think right now is recognizing that there's different types of tests that are available. And generally when we talk to people about Colby 19 tests, um, they might have different things in mind. So kind of breaking it down. There are two main types of Cobra, 19 tests. There's the diagnostic which are used to recognize the virus. So identify the Brit if you have the disease. And then second is the serology tests or the antibody tests to see if you potentially have any markers of immunity. So those are the two tests that are currently on the market. Where are, um, and where the greatest need currently exists is with the diagnostic test. That's where our local governments need great assistance in terms of increasing the number of people who are going to be tested in the community. Um, projecting forward at some point in the future, the serology tests may play an important role. We don't have a lot of information yet as to what it means to have antibodies. You know, theoretically that means that you've been infected, that you are, uh, that you have some immunity from the disease and that you can't get the disease again. But that may not be the case. Um, and, and we don't know how long that immunity will last. So I think in the meantime we're seeing a lot of people who are very interested in the serology tests, but we're not quite sure what role that will play just yet. Uh, but once that's clarified, that's going to be a really, um, important test for pharmacists to be able to offer because a lot of the serology tests that may be available are going to be utilizing simple finger sticks. And those are procedures that pharmacists have been doing for decades using blood glucose meters and cholesterol meters.

Michelle:

No, absolutely. I mean it's, it's huge. And you know, I, I see so many parallels between like covert 19 and like the HIV epidemic, like from the early days. And it seems that people want a quick fix, like so quickly. It's only been like five months, you know. And with, with HIV it's been like 40 years and we're still waiting for a vaccine. So I always try to tell people just we've got to be patient, you know, and see where the science takes us. And you know, this whole business of like in unity as well. Like, like you said, like do people have antibodies and if so will they hold and will they be immune for what period of time? Like nobody knows this is just a new virus. So people really have to be mindful of like the science and the process to understand what's going on because I mean it's been, what, five months, which is nothing really in the big scheme of things.

Richard Dang:

Yeah. There's a lot of fear and anxiety associated with the unknown. I and not also just highlights the important role that pharmacists and healthcare providers can play to reassure their patients, reassure their community and to provide accurate information as to what is currently known regarding, um, the virus and its implications.

Michelle:

Oh, absolutely. And the information changes like all the time. And we just have to, you know, stay abreast of it.

Richard Dang:

I feel like it changes every hour sometimes.

Michelle:

I know, Oh my goodness. But you know, the work that you've done with the task force and everything, I mean, you know, as a, as a California pharmacist, I appreciate that so much. And you know, I, I'm a big proponent of pharmacists, athlete belonging to the state and national associations because, um, you know, CPHI has been extraordinary. I mean, we wouldn't be where we are today without the work of CPHI and the work that the organizations do going to bet for pharmacists like every minute of every day. I mean, we just said the governor's budget revision last week and now there's the whole thing about three 40 B going and you know, not paying for pharmacist services. So the work is never, ever, ever done.

Richard Dang:

You're still right, Michelle. Thank you for that recognition. And I mean, I hope that the last few months I've really highlighted for people the importance of their local, their local state associations. Um, with CPHI. I mean we've had some really great leadership that recognized the potential dangers and locations of the disease and they assembled a task force right away. So I was honored to be asked to serve as the chair and we compiled a great group of experts in infectious disease hospital and community pharmacy practice and regulatory affairs of who we've been working almost every every day. We had meetings at least two to three days a week. I'm constantly thinking about Kobe as at the, especially at the very initial stages and our work has really evolved, but our primary mission has been to serve our profession and to make sure that everyone who's working and providing pharmacy services in California, pharmacists, pharmacy technicians, student pharmacists, delivery drivers, that they're all equipped with the best information possible. I mean, when Kobe first came out, there were a lot of concern about workplace and personnel safety. We had a lot of unknowns about how this disease was spread, what our risk is as health care providers, as other businesses were ordered to shut down. Pharmacists and pharmacies were one of the few places that remained open and we didn't know what that meant for pharma, for our pharmacy workers, how do we protect them, what protective measures do we need to put in place? And really grateful to the work of our task force that we were able to put out a comprehensive set of recommendations for employers and workers on infection prevention. Um, I'm actually pretty proud of the fact that we were able to push, put out some information about providing pharmacists as well. One recognizing pharmacists as essential frontline workers who need access to personal protective equipment. We were one of the first groups to recommend widely, uh, universal masking, um, engineering physical barriers like sneeze guards, giving access to masking gloves to our pharmacy workers. Um, and just a host of other recommendations even a few days before the CDC recommended their recommendations for all pharmacies. So we're really proud of the work that we've done and that evolved from looking at the safety of our pharmacy workforce and it's now transitioned into really putting pharmacy at the forefront of all Kobe related items. And that includes Kobe related testing. And as you mentioned, Michelle, there's some considerations with the budget cut as well that might impact various pharmacy services. And we're at the forefront of those discussions with the governor's office and with state legislators to ensure that pharmacies can continue to serve their communities with the necessary resources.

Michelle:

No, absolutely. The work is absolutely critical. And if we come, I have, uh, you know, interactions with pharmacists and uh, a lot of pharmacists are complaining about reimbursement and the reimbursements are going down and everything. My first question to them always is, are you a member of CPHI? And when they say no, it's like you have to join, you have to become a member because the work is extraordinary and we would never be where we are today without, you know, the advocacy and the tireless work that not only the people that work at CPHI but you know, you and all the pharmacists that are involved in this advocacy like literally on a daily basis, it's all, it's almost like we surface tsunami every day and you know, CPH and the work that you do on the taskforce, that's, that's what helps guide us down the way if you want, if you will.

Richard Dang:

Absolutely. And I also liked that when, when I had this conversation with what likes to add on, think of all the accomplishments that we were able to do with our limited resources and with the membership members that we have now. Can only imagine what else we could accomplish if we had every single pharmacist join as a part of the association, that that would increase our Howard, that would increase our size, that would increase our presence and just think of what new Heights we could achieve with the added support of every single pharmacy professional in the state.

Michelle:

Oh, it would, it would be massive. And I challenge every California pharmacist that's listening to this podcast today. I challenge you to join CPHI and with your membership to CPHI. You get membership to your local association as well. And you know, I, I've been, I've been a member for CPHI for a really long time now, ever since I graduated, um, as a pharmacist and got my license. So, um, the work is extraordinary. I mean just yesterday, um, we all got a vis the Orex alert that, you know, the pharmacist association is now like a trusted partner for um, the California emergencies office of emergency services and we're able to get PPE for every pharmacy, um, through the emergency management office. I mean, that's like extraordinary work in my opinion.

Richard Dang:

Absolutely. I mean, as you can see the associations really delivering on, it's a task that has taken on. And like I mentioned earlier, PP was one of our primary priorities and we're so proud of the fact that we're able to partner with the governor's office and the office of emergency services to be able to offer access to the state supply PPE to pharmacies all across the state.

Michelle:

Yeah. And it just goes to show that, you know, the powers that be in the administration that we have, which we've had such great leadership and everything has, has really taken this, this light that pharmacists are actually frontline healthcare workers. I mean, we have people come in sick people coming into the pharmacies every single day. Of course we're on the front lines and we should all be protected. So we can take care of our patients every day.

Richard Dang:

Yeah. And that's, that's especially more true with Cobra, especially with the unknown amount of asymptomatic carriers who may be walking around.

Michelle:

No, absolutely. Well, you know, um, so listen, there's no out there. Um, you know, Richard's running for president of CPHI as well this year. Um, your work has been just absolutely, you know, extraordinary. Not only in your Renae at USC, but everything that you've done, um, you know, for the association. And, um, if anybody out there wants to, um, get in touch with you, what's the best way, I mean, in the resources, I've put all these links to CPHI and all the covert 19 resources, but if anyone wants to get in touch with you, what's the best way?

Richard Dang:

Absolutely. I'll start out with a shout out to our COBIT 19 webpage on the CPA website. If you're looking for any resources, please visit[inaudible] dot com slash COBIT 19 you'll find a of resources and documents and videos that we posted up there for the public and for pharmacy professionals and to contact me personally. I'm very active on a variety of social media platforms, Twitter, LinkedIn, Facebook, Instagram, whatever it might be. But the best way to reach me directly would probably be through contacting you by email. And my email address is R D a N g@usc.edu.

Michelle:

Fantastic. Well thank you so much for taking time out of your busy day to be a guest on the show and you know, to all the pharmacists out there, stay tuned. Um, see what CPHI has every day. There's new information out there so that we can better take care of our patients. And again, Richard, thank you so much for being on the show.

Richard Dang:

Thank you for having me. Michelle was such a pleasure speaking with you.

Michelle:

No, absolutely. And remember to all the pharmacists out there, remember you are the change.

Speaker 1:

Thanks for listening to the conscious pharmacist podcast. We hope you subscribe to our podcast so you never miss an episode. If you miss something, you can listen again or just read the transcript of the show on our website@mishrxconsulting.com forward slash podcast. If you have a spare minute, don't forget to give us a review or rating on iTunes. Remember to practice on purpose your rock star pharmacist and healthcare provider, and in the words of Mahatma Gandhi, be the change you wish to see in the world. The conscious pharmacist podcast is a production of mish RX pharmacists consulting services, your HIV pharmacists and pharmacy experts.