California Women Can Soon Skip the Doctor to Get Their Birth Control
In Los Angeles, How Pharmacists Are Improving Patients' Health
California Pharmacists Providing More Direct Care to Patients
Midwifery, Physical Therapy, Pharmacist Bills Move to Governor's Desk
Debate Over Role of Nurse Practitioners in Primary Care Responsibilities
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She specializes in covering altered states of mind, from postpartum depression to methamphetamine-induced psychosis to the insanity defense. Her investigative series on insurance companies sidestepping mental health laws won multiple awards, including first place in beat reporting from the national Association of Health Care Journalists. She is the recipient of numerous other prizes and fellowships, including a national Edward R. Murrow award for investigative reporting, a Society of Professional Journalists award for long-form storytelling, and a Carter Center Fellowship for Mental Health Journalism.\r\n\r\nDembosky reported and produced \u003cem>Soundtrack of Silence\u003c/em>, an audio documentary about music and memory that is currently being made into a feature film by Paramount Pictures.\r\n\r\nBefore joining KQED in 2013, Dembosky covered technology and Silicon Valley for \u003cem>The Financial Times of London,\u003c/em> and contributed business and arts stories to \u003cem>Marketplace \u003c/em>and \u003cem>The New York Times.\u003c/em> She got her undergraduate degree in philosophy from Smith College and her master's in journalism from the University of California, Berkeley. She is a classically trained violinist and proud alum of the first symphony orchestra at Burning Man.","avatar":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g","twitter":"adembosky","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"arts","roles":["author"]},{"site":"news","roles":["editor"]},{"site":"futureofyou","roles":["author"]},{"site":"stateofhealth","roles":["editor"]},{"site":"science","roles":["editor"]},{"site":"forum","roles":["editor"]}],"headData":{"title":"April Dembosky | KQED","description":"KQED Health Correspondent","ogImgSrc":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/adembosky"},"state-of-health":{"type":"authors","id":"8344","meta":{"index":"authors_1591205172","id":"8344","found":true},"name":"State of Health","firstName":"State of Health","lastName":null,"slug":"state-of-health","email":"stateofhealth@kqed.org","display_author_email":false,"staff_mastheads":[],"title":null,"bio":null,"avatar":"https://secure.gravatar.com/avatar/66de4bf6d331fa7402bba1ffe8135e17?s=600&d=blank&r=g","twitter":null,"facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"arts","roles":["author"]},{"site":"stateofhealth","roles":["editor"]}],"headData":{"title":"State of Health | KQED","description":null,"ogImgSrc":"https://secure.gravatar.com/avatar/66de4bf6d331fa7402bba1ffe8135e17?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/66de4bf6d331fa7402bba1ffe8135e17?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/state-of-health"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"stateofhealth_33190":{"type":"posts","id":"stateofhealth_33190","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"33190","score":null,"sort":[1433401314000]},"guestAuthors":[],"slug":"california-women-can-soon-skip-the-doctor-to-get-their-birth-control","title":"California Women Can Soon Skip the Doctor to Get Their Birth Control","publishDate":1433401314,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Think of how often you stop by Walgreens or CVS. You run in and grab some Band Aids or restock your ibuprofen supply. Maybe get a flu shot on your way to work.\u003c/p>\n\u003cp>Soon, it will be that easy for women to get birth control, too. Under a new law, women will be able to walk in to a pharmacy, get a prescription for contraceptive pills, the ring, or the patch, and get it filled, all at the same time.\u003c/p>\n\u003cp>“For a woman who can’t get in to see their doctor, the pharmacist will be able to furnish that for them now,” says Lisa Kroon, a professor at UC San Francisco’s school of pharmacy who oversees students who work at the Walgreens store on campus.\u003c/p>\n\u003cp>That pharmacy will be one of the first to take advantage of a new law in California allowing pharmacists to prescribe hormonal contraception. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201320140SB493\" target=\"_blank\">SB 493 \u003c/a>was passed in 2013, and state health officials are now in the process of finalizing the regulations for the law to take effect - the board of pharmacy is meeting Thursday to review some of these regulations. The law is expected to be fully implemented later this year.\u003c/p>\n\u003cp>But the law goes beyond birth control pills. It also authorizes pharmacists to prescribe medications for smoking cessation and travel abroad. Pharmacists can administer routine vaccinations to children ages three and older. They can even order lab tests and adjust drug regimens for patients with diabetes, hypertension, or other conditions. Kroon says the idea is to make it easier on patients.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Maybe a working parent can now come after work because the pharmacy is open later,\" she says.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/208770582\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>The law was passed amid growing concern about doctor shortages. As more baby boomers hit age 65, and millions of people get health coverage under the Affordable Care Act, there aren’t enough primary care doctors to go around. Advocates says California is the first state to recognize that pharmacists can help fill the gap.\u003c/p>\n\u003cp>\"The pharmacist is really an untapped resource,\" Kroon says. \"We are graduating students that are ready for this, but the laws just haven’t kept up with what the pharmacist training already is.\"\u003c/p>\n\u003cp>But there's a big drawback for pharmacists. Now they can perform all these services once reserved for the doctor’s office. But, they won’t get paid for the extra time it takes to provide them.\u003c/p>\n\u003cp>The law does not compel insurance companies or Medi-Cal, the state's version of Medicaid, to reimburse these services, says Jon Roth, CEO of the California Pharmacists Association.\u003c/p>\n\u003cp>In the long run, Roth says the law could ultimately save money, because reimbursement rates for pharmacists will inevitably be lower than what doctors charge.\u003c/p>\n\u003cp>“We are working to try and identify where it makes sense to pay pharmacists as opposed to other more expensive providers in the health care delivery system,” he says.\u003c/p>\n\u003cp>Pharmacists' growing power has some physicians bracing for a turf war. The California Medical Association opposed an early version of the law, citing patient safety concerns. It later withdrew its opposition after lawmakers added a special licensing procedure and continuing education requirement for pharmacists.\u003c/p>\n\u003cp>Still, some doctors are concerned that if women don’t come to the clinic for their birth control, they won’t get screened for cervical cancer or tested for sexually transmitted diseases.\u003c/p>\n\u003cp>“Family planning for women is often an access point to assessing other health issues,” says Amy Moy, vice president of public affairs for the California Family Health Council, an advocacy group that does support the law. “Women accessing birth control through the pharmacist would be faster and more convenient. But they will also not have the comprehensive care available in another health care setting.”\u003c/p>\n\u003cp>Studies of women living on the border of Texas and Mexico found that women who get their birth control over-the-counter in Mexican pharmacies are\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22520645\"> less likely to go to the doctor for other preventive care\u003c/a>, compared to women who get contraception at clinics. But women at the clinics were also \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21343757\">more likely to stop using their birth control\u003c/a>, in part because of having to schedule a doctor’s visit to get it.\u003c/p>\n\u003cp>Moy’s group and other women’s advocates say the benefits of improving access to birth control and reducing unintended pregnancies are critical to women's health and outweigh the potential risks.\u003c/p>\n\u003cp>Pharmacy professor Kroon says the plan is for pharmacists to communicate regularly with patients’ doctors. \"We are not a lone ranger out there doing something,\" she says.\u003c/p>\n\u003cp>If things go well with the pharmacists law, it could bode well for efforts to expand the scope of practice for other health care practioners. Sen. Ed Hernandez, who\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml\" target=\"_blank\"> led the effort\u003c/a> on the pharmacist law, has also proposed bills to increase authority for \u003ca href=\"http://www.leginfo.ca.gov/pub/15-16/bill/sen/sb_0301-0350/sb_323_bill_20150422_amended_sen_v97.pdf\" target=\"_blank\">nurse practitioners\u003c/a> and \u003ca href=\"http://www.leginfo.ca.gov/pub/15-16/bill/sen/sb_0601-0650/sb_622_bill_20150504_amended_sen_v97.pdf\" target=\"_blank\">optometrists\u003c/a>. Both are working their way through the legislature.\u003c/p>\n\u003cp>Other states are watching California to see how the pharmacist law plays out. Lawmakers in Oregon and in Congress are considering similar laws.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“They are all watching what happens in California,\" Kroon says.\u003c/p>\n\n","blocks":[],"excerpt":"The new law will also permit pharmacists to prescribe other medications, order lab tests and administer vaccinations.\r\n","status":"publish","parent":0,"modified":1433439445,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":908},"headData":{"title":"California Women Can Soon Skip the Doctor to Get Their Birth Control | KQED","description":"The new law will also permit pharmacists to prescribe other medications, order lab tests and administer vaccinations.\r\n","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"California Women Can Soon Skip the Doctor to Get Their Birth Control","datePublished":"2015-06-04T07:01:54.000Z","dateModified":"2015-06-04T17:37:25.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"33190 http://ww2.kqed.org/stateofhealth/?p=33190","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/06/04/california-women-can-soon-skip-the-doctor-to-get-their-birth-control/","disqusTitle":"California Women Can Soon Skip the Doctor to Get Their Birth Control","path":"/stateofhealth/33190/california-women-can-soon-skip-the-doctor-to-get-their-birth-control","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Think of how often you stop by Walgreens or CVS. You run in and grab some Band Aids or restock your ibuprofen supply. Maybe get a flu shot on your way to work.\u003c/p>\n\u003cp>Soon, it will be that easy for women to get birth control, too. Under a new law, women will be able to walk in to a pharmacy, get a prescription for contraceptive pills, the ring, or the patch, and get it filled, all at the same time.\u003c/p>\n\u003cp>“For a woman who can’t get in to see their doctor, the pharmacist will be able to furnish that for them now,” says Lisa Kroon, a professor at UC San Francisco’s school of pharmacy who oversees students who work at the Walgreens store on campus.\u003c/p>\n\u003cp>That pharmacy will be one of the first to take advantage of a new law in California allowing pharmacists to prescribe hormonal contraception. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201320140SB493\" target=\"_blank\">SB 493 \u003c/a>was passed in 2013, and state health officials are now in the process of finalizing the regulations for the law to take effect - the board of pharmacy is meeting Thursday to review some of these regulations. The law is expected to be fully implemented later this year.\u003c/p>\n\u003cp>But the law goes beyond birth control pills. It also authorizes pharmacists to prescribe medications for smoking cessation and travel abroad. Pharmacists can administer routine vaccinations to children ages three and older. They can even order lab tests and adjust drug regimens for patients with diabetes, hypertension, or other conditions. Kroon says the idea is to make it easier on patients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Maybe a working parent can now come after work because the pharmacy is open later,\" she says.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/208770582&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/208770582'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The law was passed amid growing concern about doctor shortages. As more baby boomers hit age 65, and millions of people get health coverage under the Affordable Care Act, there aren’t enough primary care doctors to go around. Advocates says California is the first state to recognize that pharmacists can help fill the gap.\u003c/p>\n\u003cp>\"The pharmacist is really an untapped resource,\" Kroon says. \"We are graduating students that are ready for this, but the laws just haven’t kept up with what the pharmacist training already is.\"\u003c/p>\n\u003cp>But there's a big drawback for pharmacists. Now they can perform all these services once reserved for the doctor’s office. But, they won’t get paid for the extra time it takes to provide them.\u003c/p>\n\u003cp>The law does not compel insurance companies or Medi-Cal, the state's version of Medicaid, to reimburse these services, says Jon Roth, CEO of the California Pharmacists Association.\u003c/p>\n\u003cp>In the long run, Roth says the law could ultimately save money, because reimbursement rates for pharmacists will inevitably be lower than what doctors charge.\u003c/p>\n\u003cp>“We are working to try and identify where it makes sense to pay pharmacists as opposed to other more expensive providers in the health care delivery system,” he says.\u003c/p>\n\u003cp>Pharmacists' growing power has some physicians bracing for a turf war. The California Medical Association opposed an early version of the law, citing patient safety concerns. It later withdrew its opposition after lawmakers added a special licensing procedure and continuing education requirement for pharmacists.\u003c/p>\n\u003cp>Still, some doctors are concerned that if women don’t come to the clinic for their birth control, they won’t get screened for cervical cancer or tested for sexually transmitted diseases.\u003c/p>\n\u003cp>“Family planning for women is often an access point to assessing other health issues,” says Amy Moy, vice president of public affairs for the California Family Health Council, an advocacy group that does support the law. “Women accessing birth control through the pharmacist would be faster and more convenient. But they will also not have the comprehensive care available in another health care setting.”\u003c/p>\n\u003cp>Studies of women living on the border of Texas and Mexico found that women who get their birth control over-the-counter in Mexican pharmacies are\u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22520645\"> less likely to go to the doctor for other preventive care\u003c/a>, compared to women who get contraception at clinics. But women at the clinics were also \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/21343757\">more likely to stop using their birth control\u003c/a>, in part because of having to schedule a doctor’s visit to get it.\u003c/p>\n\u003cp>Moy’s group and other women’s advocates say the benefits of improving access to birth control and reducing unintended pregnancies are critical to women's health and outweigh the potential risks.\u003c/p>\n\u003cp>Pharmacy professor Kroon says the plan is for pharmacists to communicate regularly with patients’ doctors. \"We are not a lone ranger out there doing something,\" she says.\u003c/p>\n\u003cp>If things go well with the pharmacists law, it could bode well for efforts to expand the scope of practice for other health care practioners. Sen. Ed Hernandez, who\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billHistoryClient.xhtml\" target=\"_blank\"> led the effort\u003c/a> on the pharmacist law, has also proposed bills to increase authority for \u003ca href=\"http://www.leginfo.ca.gov/pub/15-16/bill/sen/sb_0301-0350/sb_323_bill_20150422_amended_sen_v97.pdf\" target=\"_blank\">nurse practitioners\u003c/a> and \u003ca href=\"http://www.leginfo.ca.gov/pub/15-16/bill/sen/sb_0601-0650/sb_622_bill_20150504_amended_sen_v97.pdf\" target=\"_blank\">optometrists\u003c/a>. Both are working their way through the legislature.\u003c/p>\n\u003cp>Other states are watching California to see how the pharmacist law plays out. Lawmakers in Oregon and in Congress are considering similar laws.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“They are all watching what happens in California,\" Kroon says.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/33190/california-women-can-soon-skip-the-doctor-to-get-their-birth-control","authors":["3205"],"categories":["stateofhealth_14"],"tags":["stateofhealth_589"],"featImg":"stateofhealth_33207","label":"stateofhealth"},"stateofhealth_18774":{"type":"posts","id":"stateofhealth_18774","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"18774","score":null,"sort":[1398098057000]},"guestAuthors":[],"slug":"in-los-angeles-how-pharmacists-are-improving-underserved-patients-health","title":"In Los Angeles, How Pharmacists Are Improving Patients' Health ","publishDate":1398098057,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cdiv>\n\u003cfigure id=\"attachment_18779\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/140319_pharmacist254_0-e1398097423659.jpg\">\u003cimg class=\"size-large wp-image-18779\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/140319_pharmacist254_0-640x426.jpg\" alt=\"Dr. Sarah Ma goes over medications and dosages with diabetes patient Joe Navarro. (Credit: Anacleto Rapping)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Sarah Ma, a pharmacist with USC, goes over medications with diabetes patient Joe Navarro. (Credit: Anacleto Rapping)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Laurie Udesky,\u003c/strong>\u003ca href=\"http://centerforhealthreporting.org/article/increased-responsibility-pays-health-dividends\" target=\"_blank\"> CHCF Center for Health Reporting\u003c/a>\u003c/p>\n\u003cp>Jose Navarro regularly trekked to the drugstore after being diagnosed as a diabetic seven years ago. In a sign of transformation in the local fight against diabetes, the pharmacist is now coming to him.\u003c/p>\n\u003cp>On a recent day Sarah Ma, a 28-year-old USC clinical pharmacist, set up shop at Navarro’s kitchen table in Santa Ana.\u003c/p>\n\u003cp>She checked Navarro’s blood pressure and blood sugar, examined his feet for cuts or infection, and refilled his monthly pill box. On previous visits she had changed the hour he took some medications, altered some doses, and discontinued others.\u003c/p>\n\u003cp>She inspected the refrigerator. “I see carrots, eggs, beets, cheese and yogurt that I haven’t seen before,” she said, delighted.\u003c/p>\n\u003cp>It wasn’t all great news. Navarro, 78, had told Ma that the pastry he had at breakfast was tiny. Actually, it engulfed half the plate Ma brought with her to illustrate what portions to eat of different food groups.\u003c!--more-->\u003c/p>\n\u003cp>Ma began working closely with Navarro last October. Now, he feels much better, which means he’s not a candidate for an emergency room or expensive hospitalization.\u003c/p>\n\u003cp>It also means an important new tool is emerging in the effort to contain diabetes, which afflicts one in 10 adults in Los Angeles County, one in 14 in Orange County, and can lead to amputations, blindness or death. Direct medical spending on the disease in Los Angeles County alone tops $6 billion annually.\u003c/p>\n\u003cp>More broadly, it also means that pharmacists in California may be on a path to take a much larger role in patient care, and in controlling health care costs.\u003c/p>\n\u003cp>\u003cstrong>Early, Impressive Results\u003c/strong>\u003c/p>\n\u003cp>Ma is part of a three year, $12-million study run by the USC School of Pharmacy and funded by the federal Centers for Medicare and Medicaid Services. Several teams from the school, including professional and student pharmacists, have fanned out to safety net clinics in Los Angeles and Orange counties to test whether patients will benefit if pharmacists’ scope of practice expands into territory normally handled by physicians, including greater autonomy in filling prescriptions and more direct contact with high-risk clients.\u003c/p>\n\u003cp>The early results are impressive:\u003c/p>\n\u003cul>\n\u003cli>Nearly nine of 10 patients who had out-of-control blood pressure saw their readings drop below hypertension levels and remain there within 45 days of working with the pharmacy teams, according to Steve Chen, an associate professor of pharmacy at USC and a developer of the study.\u003c/li>\n\u003cli>Similarly, diabetes patients whose blood sugar levels had been too high were twice as likely to have them under control within six months if they worked with a pharmacist team.\u003c/li>\n\u003cli>In the program’s first 11 months, pharmacists corrected 19,696 medication problems among 1,993 patients, an astonishing nine medication problems per patient.\u003c/li>\n\u003cli>Even more alarming, more than 2,000 of those problems – including excessive dosing, duplication, and drug interactions – were potentially dangerous to patients. In a recent example, a patient with poor kidney function was taking two blood pressure medications that combined could have spiked potassium to a level “that could have literally stopped his heart,” Chen said.\u003c/li>\n\u003cli>Study coordinators project a 25 percent decrease in hospitalizations for the estimated 6,000 patients in the project.\u003c/li>\n\u003c/ul>\n\u003cp>The results are preliminary and unpublished, since the study will continue into next year. When the research is published it is likely to add to the debate over how to contain medical costs.\u003c/p>\n\u003cp>The study began October 1, 2012 at five clinics run by AltaMed Health Services Corp. in underserved neighborhoods in El Monte, West Covina, Boyle Heights, Pico Rivera and Huntington Beach.\u003c/p>\n\u003cp>Three-person USC teams – clinical pharmacist, a pharmacy resident and a pharmacy technician – became primary caregivers for hypertension and blood pressure patients, and others with chronic illnesses. They initiated increased clinic visits, or made house calls as needed. The study has since been expanded to 11 AltaMed clinics in Orange and Los Angeles Counties.\u003c/p>\n\u003cp>Lobbyists for pharmacists in Sacramento pointed to the study as they successfully argued last year for bumping up pharmacists’ authority. A California law that went into effect this January codified a new class of “advanced practice pharmacists” who can enter collaborative agreements with physicians to start, change or discontinue medications, and help manage chronic diseases.\u003c/p>\n\u003cp>\u003cstrong>Initial Resistance from Doctors\u003c/strong>\u003c/p>\n\u003cp>At the outset many AltaMed doctors were rankled by the pharmacy teams.\u003c/p>\n\u003cp>“Quite frankly there was a fair amount of anxiety up front from physicians,” said Dr. Michael Hochman, AltaMed’s director of innovation. The idea that pharmacists could take charge of a drug regimen was a particular concern. “One question I got frequently was ‘Why did I go to medical school?” Hochman said.\u003c/p>\n\u003cp>AltaMed doctors have since been won over, Hochman said, especially after referring perplexing cases to the pharmacists. Hochman says on any given day every AltaMed doctor in the study clinics refers two to three patients to the pharmacist teams.\u003c/p>\n\u003cp>The pharmacists often find that they have to do a lot of educating\u003cstrong>. \u003c/strong>Sarah Ma said she has encountered great resistance to taking insulin among the mostly Latino population the clinics serve.\u003c/p>\n\u003cp>“Patients will come in and say insulin can cause blindness, amputations, it can cause me to go to the hospital. They’ll say my neighbor or my uncle or son or somebody started insulin and they died,” said Ma. “You have to ask them a lot of questions and try to elicit answers to help them connect the dots.”\u003c/p>\n\u003cp>Michelle Lee, a USC clinical pharmacist at AltaMed’s Boyle Heights clinic, recently asked Alfredo Perez, a 46-year-old diabetes patient, if he’d taken his insulin as prescribed.\u003c/p>\n\u003cp>“I did but I stopped because my vision became blurry for two days,” he responded.\u003c/p>\n\u003cp>“I’m scared to take insulin,” he told a reporter. “I’m afraid that once I start, I’ll never be off of it.”\u003c/p>\n\u003cp>Lee had spent months trying to gently coax Perez to take insulin. Each time he resisted, she asked him to try a lower dose. On this day she noted that his blood sugar was 93, more than 63 points above what it should be for the time of day, and she tried a more direct strategy.\u003c/p>\n\u003cp>“You’ve had high sugars for a long time. It’s going to damage your eyes, you’re going to lose your eyesight,” she said with authority. Instead of waiting two weeks for the next appointment, Lee asked Perez to return in a week and try a very small dose of insulin, and he agreed to do so.\u003c/p>\n\u003cp>\u003cstrong>Likely Cost Savings\u003c/strong>\u003c/p>\n\u003cp>Although such patient encounters are time consuming, many studies suggest that when clinical pharmacists work on primary care teams, overall healthcare costs plummet.\u003c/p>\n\u003cp>A recent report by the U.S. Public Health Service found that every dollar invested in clinical pharmacy services saved about 10 dollars in health spending, as patients better understood how to manage their illnesses and avoid expensive treatments that result from missed or misapplied medications\u003cstrong>.\u003c/strong>\u003c/p>\n\u003cp>Although the USC/AltaMed study is still 17 months from completion, there has already been interest in duplicating the project.\u003c/p>\n\u003cp>Robert Beltran, the chief medical officer for Brand New Day, a Medicare Specialty Health Plan that serves 6,000 members in Los Angeles, Orange, Riverside, San Bernardino and Kings Counties, said he plans to start a pharmacist team program in Orange County and the Inland Empire in late spring or this summer.\u003c/p>\n\u003cp>When asked about whether AltaMed will continue the pharmacist program after the grant runs out, Altamed’s Hochman said, “That’s the million dollar question. We have proven to ourselves beyond a reasonable doubt that the (USC-led pharmacist teams) are a very high-value service to patients.”\u003c/p>\n\u003cp>But typically, clinics like AltaMed don’t get reimbursed by Medi-Cal, Medicare, or private insurance for pharmacist services. “We are hopeful it will become a reimbursed service for us in the near future,” he said.\u003c/p>\n\u003cdiv>\u003c/div>\n\u003c/div>\n\u003cp>[contextly_auto_sidebar id=\"uPCv7ELLO6PmiIKvr6zeDyDCdW31Nw02\"]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>[ad floatright]\u003c/p>\n","blocks":[],"excerpt":"Pharmacists from USC are fanning out to safety net clinics in Los Angeles as part of 3 year study.","status":"publish","parent":0,"modified":1398098057,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":37,"wordCount":1403},"headData":{"title":"In Los Angeles, How Pharmacists Are Improving Patients' Health | KQED","description":"Pharmacists from USC are fanning out to safety net clinics in Los Angeles as part of 3 year study.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"In Los Angeles, How Pharmacists Are Improving Patients' Health ","datePublished":"2014-04-21T16:34:17.000Z","dateModified":"2014-04-21T16:34:17.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"18774 http://blogs.kqed.org/stateofhealth/?p=18774","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/04/21/in-los-angeles-how-pharmacists-are-improving-underserved-patients-health/","disqusTitle":"In Los Angeles, How Pharmacists Are Improving Patients' Health ","path":"/stateofhealth/18774/in-los-angeles-how-pharmacists-are-improving-underserved-patients-health","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cdiv>\n\u003cfigure id=\"attachment_18779\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/140319_pharmacist254_0-e1398097423659.jpg\">\u003cimg class=\"size-large wp-image-18779\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/140319_pharmacist254_0-640x426.jpg\" alt=\"Dr. Sarah Ma goes over medications and dosages with diabetes patient Joe Navarro. (Credit: Anacleto Rapping)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Sarah Ma, a pharmacist with USC, goes over medications with diabetes patient Joe Navarro. (Credit: Anacleto Rapping)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Laurie Udesky,\u003c/strong>\u003ca href=\"http://centerforhealthreporting.org/article/increased-responsibility-pays-health-dividends\" target=\"_blank\"> CHCF Center for Health Reporting\u003c/a>\u003c/p>\n\u003cp>Jose Navarro regularly trekked to the drugstore after being diagnosed as a diabetic seven years ago. In a sign of transformation in the local fight against diabetes, the pharmacist is now coming to him.\u003c/p>\n\u003cp>On a recent day Sarah Ma, a 28-year-old USC clinical pharmacist, set up shop at Navarro’s kitchen table in Santa Ana.\u003c/p>\n\u003cp>She checked Navarro’s blood pressure and blood sugar, examined his feet for cuts or infection, and refilled his monthly pill box. On previous visits she had changed the hour he took some medications, altered some doses, and discontinued others.\u003c/p>\n\u003cp>She inspected the refrigerator. “I see carrots, eggs, beets, cheese and yogurt that I haven’t seen before,” she said, delighted.\u003c/p>\n\u003cp>It wasn’t all great news. Navarro, 78, had told Ma that the pastry he had at breakfast was tiny. Actually, it engulfed half the plate Ma brought with her to illustrate what portions to eat of different food groups.\u003c!--more-->\u003c/p>\n\u003cp>Ma began working closely with Navarro last October. Now, he feels much better, which means he’s not a candidate for an emergency room or expensive hospitalization.\u003c/p>\n\u003cp>It also means an important new tool is emerging in the effort to contain diabetes, which afflicts one in 10 adults in Los Angeles County, one in 14 in Orange County, and can lead to amputations, blindness or death. Direct medical spending on the disease in Los Angeles County alone tops $6 billion annually.\u003c/p>\n\u003cp>More broadly, it also means that pharmacists in California may be on a path to take a much larger role in patient care, and in controlling health care costs.\u003c/p>\n\u003cp>\u003cstrong>Early, Impressive Results\u003c/strong>\u003c/p>\n\u003cp>Ma is part of a three year, $12-million study run by the USC School of Pharmacy and funded by the federal Centers for Medicare and Medicaid Services. Several teams from the school, including professional and student pharmacists, have fanned out to safety net clinics in Los Angeles and Orange counties to test whether patients will benefit if pharmacists’ scope of practice expands into territory normally handled by physicians, including greater autonomy in filling prescriptions and more direct contact with high-risk clients.\u003c/p>\n\u003cp>The early results are impressive:\u003c/p>\n\u003cul>\n\u003cli>Nearly nine of 10 patients who had out-of-control blood pressure saw their readings drop below hypertension levels and remain there within 45 days of working with the pharmacy teams, according to Steve Chen, an associate professor of pharmacy at USC and a developer of the study.\u003c/li>\n\u003cli>Similarly, diabetes patients whose blood sugar levels had been too high were twice as likely to have them under control within six months if they worked with a pharmacist team.\u003c/li>\n\u003cli>In the program’s first 11 months, pharmacists corrected 19,696 medication problems among 1,993 patients, an astonishing nine medication problems per patient.\u003c/li>\n\u003cli>Even more alarming, more than 2,000 of those problems – including excessive dosing, duplication, and drug interactions – were potentially dangerous to patients. In a recent example, a patient with poor kidney function was taking two blood pressure medications that combined could have spiked potassium to a level “that could have literally stopped his heart,” Chen said.\u003c/li>\n\u003cli>Study coordinators project a 25 percent decrease in hospitalizations for the estimated 6,000 patients in the project.\u003c/li>\n\u003c/ul>\n\u003cp>The results are preliminary and unpublished, since the study will continue into next year. When the research is published it is likely to add to the debate over how to contain medical costs.\u003c/p>\n\u003cp>The study began October 1, 2012 at five clinics run by AltaMed Health Services Corp. in underserved neighborhoods in El Monte, West Covina, Boyle Heights, Pico Rivera and Huntington Beach.\u003c/p>\n\u003cp>Three-person USC teams – clinical pharmacist, a pharmacy resident and a pharmacy technician – became primary caregivers for hypertension and blood pressure patients, and others with chronic illnesses. They initiated increased clinic visits, or made house calls as needed. The study has since been expanded to 11 AltaMed clinics in Orange and Los Angeles Counties.\u003c/p>\n\u003cp>Lobbyists for pharmacists in Sacramento pointed to the study as they successfully argued last year for bumping up pharmacists’ authority. A California law that went into effect this January codified a new class of “advanced practice pharmacists” who can enter collaborative agreements with physicians to start, change or discontinue medications, and help manage chronic diseases.\u003c/p>\n\u003cp>\u003cstrong>Initial Resistance from Doctors\u003c/strong>\u003c/p>\n\u003cp>At the outset many AltaMed doctors were rankled by the pharmacy teams.\u003c/p>\n\u003cp>“Quite frankly there was a fair amount of anxiety up front from physicians,” said Dr. Michael Hochman, AltaMed’s director of innovation. The idea that pharmacists could take charge of a drug regimen was a particular concern. “One question I got frequently was ‘Why did I go to medical school?” Hochman said.\u003c/p>\n\u003cp>AltaMed doctors have since been won over, Hochman said, especially after referring perplexing cases to the pharmacists. Hochman says on any given day every AltaMed doctor in the study clinics refers two to three patients to the pharmacist teams.\u003c/p>\n\u003cp>The pharmacists often find that they have to do a lot of educating\u003cstrong>. \u003c/strong>Sarah Ma said she has encountered great resistance to taking insulin among the mostly Latino population the clinics serve.\u003c/p>\n\u003cp>“Patients will come in and say insulin can cause blindness, amputations, it can cause me to go to the hospital. They’ll say my neighbor or my uncle or son or somebody started insulin and they died,” said Ma. “You have to ask them a lot of questions and try to elicit answers to help them connect the dots.”\u003c/p>\n\u003cp>Michelle Lee, a USC clinical pharmacist at AltaMed’s Boyle Heights clinic, recently asked Alfredo Perez, a 46-year-old diabetes patient, if he’d taken his insulin as prescribed.\u003c/p>\n\u003cp>“I did but I stopped because my vision became blurry for two days,” he responded.\u003c/p>\n\u003cp>“I’m scared to take insulin,” he told a reporter. “I’m afraid that once I start, I’ll never be off of it.”\u003c/p>\n\u003cp>Lee had spent months trying to gently coax Perez to take insulin. Each time he resisted, she asked him to try a lower dose. On this day she noted that his blood sugar was 93, more than 63 points above what it should be for the time of day, and she tried a more direct strategy.\u003c/p>\n\u003cp>“You’ve had high sugars for a long time. It’s going to damage your eyes, you’re going to lose your eyesight,” she said with authority. Instead of waiting two weeks for the next appointment, Lee asked Perez to return in a week and try a very small dose of insulin, and he agreed to do so.\u003c/p>\n\u003cp>\u003cstrong>Likely Cost Savings\u003c/strong>\u003c/p>\n\u003cp>Although such patient encounters are time consuming, many studies suggest that when clinical pharmacists work on primary care teams, overall healthcare costs plummet.\u003c/p>\n\u003cp>A recent report by the U.S. Public Health Service found that every dollar invested in clinical pharmacy services saved about 10 dollars in health spending, as patients better understood how to manage their illnesses and avoid expensive treatments that result from missed or misapplied medications\u003cstrong>.\u003c/strong>\u003c/p>\n\u003cp>Although the USC/AltaMed study is still 17 months from completion, there has already been interest in duplicating the project.\u003c/p>\n\u003cp>Robert Beltran, the chief medical officer for Brand New Day, a Medicare Specialty Health Plan that serves 6,000 members in Los Angeles, Orange, Riverside, San Bernardino and Kings Counties, said he plans to start a pharmacist team program in Orange County and the Inland Empire in late spring or this summer.\u003c/p>\n\u003cp>When asked about whether AltaMed will continue the pharmacist program after the grant runs out, Altamed’s Hochman said, “That’s the million dollar question. We have proven to ourselves beyond a reasonable doubt that the (USC-led pharmacist teams) are a very high-value service to patients.”\u003c/p>\n\u003cp>But typically, clinics like AltaMed don’t get reimbursed by Medi-Cal, Medicare, or private insurance for pharmacist services. “We are hopeful it will become a reimbursed service for us in the near future,” he said.\u003c/p>\n\u003cdiv>\u003c/div>\n\u003c/div>\n\u003cp>[contextly_auto_sidebar id=\"uPCv7ELLO6PmiIKvr6zeDyDCdW31Nw02\"]\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/18774/in-los-angeles-how-pharmacists-are-improving-underserved-patients-health","authors":["8344"],"categories":["stateofhealth_11","stateofhealth_14"],"tags":["stateofhealth_589"],"featImg":"stateofhealth_18779","label":"stateofhealth"},"stateofhealth_17617":{"type":"posts","id":"stateofhealth_17617","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"17617","score":null,"sort":[1392141366000]},"guestAuthors":[],"slug":"california-pharmacists-providing-more-direct-care-to-patients-thanks-to-new-law","title":"California Pharmacists Providing More Direct Care to Patients","publishDate":1392141366,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_17619\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/pharmacy-2-e1392140738356.jpg\">\u003cimg class=\"size-large wp-image-17619\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/pharmacy-2-640x427.jpg\" alt=\"Clinical pharmacist Diana Arouchanova worked with patient Diana Freedman’s physician to switch one of the medications that helped lower her blood pressure (Heidi de Marco/KHN)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Clinical pharmacist Diana Arouchanova worked with patient Diana Freedman’s physician to switch one of the medications that helped lower her blood pressure (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Anna Gorman,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/February/11/pharmacists-see-clinical-role-expand.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Jill Freedman felt like her heart was jumping out of her chest. She knew her blood pressure was too high and feared having a heart attack or a stroke.\u003c/p>\n\u003cp>\"I was freaking out,\" said Freedman, 55. \"You get very emotional when you think you could drop dead at any moment.\"\u003c/p>\n\u003cp>Her doctor doubled one of her medications, she said, but that only made her feel worse. So Freedman turned to the one person she knew she could count on -- her pharmacist.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"We are the most overeducated and underutilized healthcare professional in the U.S.\" \u003c/aside>\n\u003cp>\"It was Diana who figured out what the problem was,\" said Freedman, referring to her longtime pharmacist Diana Arouchanova. \"Had she not been on top of what I’m going through, God knows how many more weeks this could have potentially gone on.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Arouchanova, who owns Clinicare Pharmacy in Northridge, reviewed Freedman's medications and realized that her problem stemmed from the dangerous combination of two prescriptions. She got the physician to change the medications and started checking Freedman's blood pressure daily. Soon, it began to drop.\u003c!--more-->\u003c/p>\n\u003cp>Once limited to filling and dispensing drugs, pharmacists are increasingly providing direct care to patients. Across the country, they are working with doctors to give immunizations and help patients safely manage medications. In some places, they can even write prescriptions after a physician's diagnosis.\u003c/p>\n\u003cp>California is among the states to give pharmacists the greatest flexibility, thanks in part to a law that took effect this year. Other states, including New Mexico and North Carolina, have also allowed pharmacists to take on more clinical responsibilities.\u003c/p>\n\u003cp>It's all part of a push by druggists and pharmacies to take a greater role in guiding patients and promoting good health. One prominent example is CVS Caremark's recent announcement that it will stop selling tobacco products to help customers become healthier.\u003c/p>\n\u003cp>At the same time, health officials are looking for ways to ease the strain on overloaded doctors, improve care and contain costs. With millions of people gaining coverage under the nation's health law, experts say pharmacists can fill gaps in primary care and help avoid unnecessary hospital admissions.\u003c/p>\n\u003cp>Pharmacists, who are required to\u003cstrong> \u003c/strong>have a doctorate in pharmacy, say technicians can fill prescriptions and that their training and education can be put to better use.\u003c/p>\n\u003cp>\"We are the most overeducated and underutilized healthcare professional in the U.S.,\" said R. Pete Vanderveen, dean of the USC School of Pharmacy. \"It doesn't take eight years of education and a professional doctorate to fill a bottle with pills.\"\u003c/p>\n\u003cp>The new California law designates pharmacists as health care providers and allows them to give routine vaccinations and provide some travel and birth-control medications. The law also creates a new class of provider known as an \"advanced practice pharmacist.\" With additional training and experience, such as a residency program, advanced practice pharmacists will be able to collaborate with doctors in assessing and referring patients, starting and stopping medications and managing patients' diseases.\u003c/p>\n\u003cp>Some physicians, however, are wary of pharmacists doing too much on their own. The American Medical Association supports physician-led teams that include pharmacists, but opposes giving pharmacists prescription privileges without a doctor's supervision. The California Medical Association initially opposed the state law but withdrew the opposition after amendments were added, including one that limited the type of medications they could provide.\u003c/p>\n\u003cp>Pharmacist organizations are quick to point out they don't want to take over the physician's job.\u003c/p>\n\u003cp>\"We are not looking to become the primary care provider for all patients,\" said Stacie Maass, a senior vice president at the American Pharmacists Association. \"We want to be part of the team.\"\u003c/p>\n\u003cp>Research has shown that pairing pharmacists and physicians can save money and improve health outcomes. Other studies are under way.\u003c/p>\n\u003cp>Clinical pharmacist Michelle Lee is funded by a federal grant to the USC School of Pharmacy and AltaMed Health Services to determine whether pharmacists can help high-risk patients control chronic diseases take their medications as prescribed and avoid hospitalization.\u003c/p>\n\u003cp>On a recent day at an AltaMed clinic in Boyle Heights, a primarily Latino neighborhood in Los Angeles, Lee stopped the medications of a liver disease patient whose condition might have worsened if he took what a local hospital just prescribed him. Then she ordered another check of his liver.\u003c/p>\n\u003cp>Lee also saw 57-year-old Maria Flores, who has uncontrolled diabetes, noticing that both her blood sugar and her blood pressure were higher than normal.\u003c/p>\n\u003cp>\"Have you been under any stress?\" Lee asked through a Spanish-language translator.\u003c/p>\n\u003cp>The woman started to tear up. She responded that there had been a death in the family and that she hadn't been able to sleep or eat. Lee ordered a shot of insulin and adjusted her blood-pressure medication. She reminded Flores to check her blood sugar every day.\u003c/p>\n\u003cp>\"It's important for us to know if the insulin is at a good dose,\" she said. \"We might need to make adjustments.\"\u003c/p>\n\u003cp>As a student, Lee worked at Walgreens and customers frequently came in with questions. Lee said she wanted to do more for them. Now, Lee said she believes she is doing that.\u003c/p>\n\u003cp>\"It's a little role but I think it's making a big difference,\" she said.\u003c/p>\n\u003cp>Freedman appreciates the difference. She discovered Clinicare Pharmacy about seven years ago. In contrast to the chain drug store she'd been using, which she felt was impersonal, Arouchanova and her staff regularly called to see how she was feeling and to check on any side effects.\u003c/p>\n\u003cp>Now Arouchanova, 36, helps her track the more than a dozen medications she takes for hypertension, Crohn’s disease and ulcerative colitis.\u003c/p>\n\u003cp>Freedman stops by a couple times a week, sometimes just to say hello. She considers her pharmacist a friend and brings her birthday presents. \"I can walk in here any time of the day,\" she said. \"There is somebody who greets me with a smile.\"\u003c/p>\n\u003cp>Arouchanova, an Armenian immigrant with a bob of short blond hair, said she tries to go \"above and beyond the call of duty.\"\u003c/p>\n\u003cp>\"I take care of each of my patients as if they were my only patients,\" she said. That means working up to 12 hours a day and only seeing her young son briefly in the morning and evening.\u003c/p>\n\u003cp>One day a week, a physician, Hanriet Minasian, works out of an office in the pharmacy. She and Minasian have an agreement that allows Arouchanova to order labs and to start, stop and adjust medications. They refer patients to one another and together review their patients' charts.\u003c/p>\n\u003cp>Erika Pappas, 34, who lives in nearby Reseda, sees both Arouchanova and Minasian for her diabetes and hypertension.\u003c/p>\n\u003cp>\"I don't have to worry about my pharmacist or my doctor not being on the same page,\" she said during a recent visit. \"Everything is very clear.\"\u003c/p>\n\u003cp>Minasian said Arouchanova is another set of eyes on complex cases -- patients with multiple chronic diseases who receive numerous prescriptions.\u003c/p>\n\u003cp>\"It's like a checks and balances system,\" Minasian said. \"The more heads you put together, the better care we can provide for our patients.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"z7rb1W1ynPsKeajzYwtkWOoP3QcHE5NL\"]\u003c/p>\n\n","blocks":[],"excerpt":"Her doctor doubled one of her medications, she said, but that only made her feel worse. So Freedman turned to the one person she knew she could count on -- her pharmacist.","status":"publish","parent":0,"modified":1392158455,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":38,"wordCount":1246},"headData":{"title":"California Pharmacists Providing More Direct Care to Patients | KQED","description":"Her doctor doubled one of her medications, she said, but that only made her feel worse. So Freedman turned to the one person she knew she could count on -- her pharmacist.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"California Pharmacists Providing More Direct Care to Patients","datePublished":"2014-02-11T17:56:06.000Z","dateModified":"2014-02-11T22:40:55.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"17617 http://blogs.kqed.org/stateofhealth/?p=17617","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/02/11/california-pharmacists-providing-more-direct-care-to-patients-thanks-to-new-law/","disqusTitle":"California Pharmacists Providing More Direct Care to Patients","path":"/stateofhealth/17617/california-pharmacists-providing-more-direct-care-to-patients-thanks-to-new-law","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_17619\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/pharmacy-2-e1392140738356.jpg\">\u003cimg class=\"size-large wp-image-17619\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/pharmacy-2-640x427.jpg\" alt=\"Clinical pharmacist Diana Arouchanova worked with patient Diana Freedman’s physician to switch one of the medications that helped lower her blood pressure (Heidi de Marco/KHN)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Clinical pharmacist Diana Arouchanova worked with patient Diana Freedman’s physician to switch one of the medications that helped lower her blood pressure (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Anna Gorman,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/February/11/pharmacists-see-clinical-role-expand.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Jill Freedman felt like her heart was jumping out of her chest. She knew her blood pressure was too high and feared having a heart attack or a stroke.\u003c/p>\n\u003cp>\"I was freaking out,\" said Freedman, 55. \"You get very emotional when you think you could drop dead at any moment.\"\u003c/p>\n\u003cp>Her doctor doubled one of her medications, she said, but that only made her feel worse. So Freedman turned to the one person she knew she could count on -- her pharmacist.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"We are the most overeducated and underutilized healthcare professional in the U.S.\" \u003c/aside>\n\u003cp>\"It was Diana who figured out what the problem was,\" said Freedman, referring to her longtime pharmacist Diana Arouchanova. \"Had she not been on top of what I’m going through, God knows how many more weeks this could have potentially gone on.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Arouchanova, who owns Clinicare Pharmacy in Northridge, reviewed Freedman's medications and realized that her problem stemmed from the dangerous combination of two prescriptions. She got the physician to change the medications and started checking Freedman's blood pressure daily. Soon, it began to drop.\u003c!--more-->\u003c/p>\n\u003cp>Once limited to filling and dispensing drugs, pharmacists are increasingly providing direct care to patients. Across the country, they are working with doctors to give immunizations and help patients safely manage medications. In some places, they can even write prescriptions after a physician's diagnosis.\u003c/p>\n\u003cp>California is among the states to give pharmacists the greatest flexibility, thanks in part to a law that took effect this year. Other states, including New Mexico and North Carolina, have also allowed pharmacists to take on more clinical responsibilities.\u003c/p>\n\u003cp>It's all part of a push by druggists and pharmacies to take a greater role in guiding patients and promoting good health. One prominent example is CVS Caremark's recent announcement that it will stop selling tobacco products to help customers become healthier.\u003c/p>\n\u003cp>At the same time, health officials are looking for ways to ease the strain on overloaded doctors, improve care and contain costs. With millions of people gaining coverage under the nation's health law, experts say pharmacists can fill gaps in primary care and help avoid unnecessary hospital admissions.\u003c/p>\n\u003cp>Pharmacists, who are required to\u003cstrong> \u003c/strong>have a doctorate in pharmacy, say technicians can fill prescriptions and that their training and education can be put to better use.\u003c/p>\n\u003cp>\"We are the most overeducated and underutilized healthcare professional in the U.S.,\" said R. Pete Vanderveen, dean of the USC School of Pharmacy. \"It doesn't take eight years of education and a professional doctorate to fill a bottle with pills.\"\u003c/p>\n\u003cp>The new California law designates pharmacists as health care providers and allows them to give routine vaccinations and provide some travel and birth-control medications. The law also creates a new class of provider known as an \"advanced practice pharmacist.\" With additional training and experience, such as a residency program, advanced practice pharmacists will be able to collaborate with doctors in assessing and referring patients, starting and stopping medications and managing patients' diseases.\u003c/p>\n\u003cp>Some physicians, however, are wary of pharmacists doing too much on their own. The American Medical Association supports physician-led teams that include pharmacists, but opposes giving pharmacists prescription privileges without a doctor's supervision. The California Medical Association initially opposed the state law but withdrew the opposition after amendments were added, including one that limited the type of medications they could provide.\u003c/p>\n\u003cp>Pharmacist organizations are quick to point out they don't want to take over the physician's job.\u003c/p>\n\u003cp>\"We are not looking to become the primary care provider for all patients,\" said Stacie Maass, a senior vice president at the American Pharmacists Association. \"We want to be part of the team.\"\u003c/p>\n\u003cp>Research has shown that pairing pharmacists and physicians can save money and improve health outcomes. Other studies are under way.\u003c/p>\n\u003cp>Clinical pharmacist Michelle Lee is funded by a federal grant to the USC School of Pharmacy and AltaMed Health Services to determine whether pharmacists can help high-risk patients control chronic diseases take their medications as prescribed and avoid hospitalization.\u003c/p>\n\u003cp>On a recent day at an AltaMed clinic in Boyle Heights, a primarily Latino neighborhood in Los Angeles, Lee stopped the medications of a liver disease patient whose condition might have worsened if he took what a local hospital just prescribed him. Then she ordered another check of his liver.\u003c/p>\n\u003cp>Lee also saw 57-year-old Maria Flores, who has uncontrolled diabetes, noticing that both her blood sugar and her blood pressure were higher than normal.\u003c/p>\n\u003cp>\"Have you been under any stress?\" Lee asked through a Spanish-language translator.\u003c/p>\n\u003cp>The woman started to tear up. She responded that there had been a death in the family and that she hadn't been able to sleep or eat. Lee ordered a shot of insulin and adjusted her blood-pressure medication. She reminded Flores to check her blood sugar every day.\u003c/p>\n\u003cp>\"It's important for us to know if the insulin is at a good dose,\" she said. \"We might need to make adjustments.\"\u003c/p>\n\u003cp>As a student, Lee worked at Walgreens and customers frequently came in with questions. Lee said she wanted to do more for them. Now, Lee said she believes she is doing that.\u003c/p>\n\u003cp>\"It's a little role but I think it's making a big difference,\" she said.\u003c/p>\n\u003cp>Freedman appreciates the difference. She discovered Clinicare Pharmacy about seven years ago. In contrast to the chain drug store she'd been using, which she felt was impersonal, Arouchanova and her staff regularly called to see how she was feeling and to check on any side effects.\u003c/p>\n\u003cp>Now Arouchanova, 36, helps her track the more than a dozen medications she takes for hypertension, Crohn’s disease and ulcerative colitis.\u003c/p>\n\u003cp>Freedman stops by a couple times a week, sometimes just to say hello. She considers her pharmacist a friend and brings her birthday presents. \"I can walk in here any time of the day,\" she said. \"There is somebody who greets me with a smile.\"\u003c/p>\n\u003cp>Arouchanova, an Armenian immigrant with a bob of short blond hair, said she tries to go \"above and beyond the call of duty.\"\u003c/p>\n\u003cp>\"I take care of each of my patients as if they were my only patients,\" she said. That means working up to 12 hours a day and only seeing her young son briefly in the morning and evening.\u003c/p>\n\u003cp>One day a week, a physician, Hanriet Minasian, works out of an office in the pharmacy. She and Minasian have an agreement that allows Arouchanova to order labs and to start, stop and adjust medications. They refer patients to one another and together review their patients' charts.\u003c/p>\n\u003cp>Erika Pappas, 34, who lives in nearby Reseda, sees both Arouchanova and Minasian for her diabetes and hypertension.\u003c/p>\n\u003cp>\"I don't have to worry about my pharmacist or my doctor not being on the same page,\" she said during a recent visit. \"Everything is very clear.\"\u003c/p>\n\u003cp>Minasian said Arouchanova is another set of eyes on complex cases -- patients with multiple chronic diseases who receive numerous prescriptions.\u003c/p>\n\u003cp>\"It's like a checks and balances system,\" Minasian said. \"The more heads you put together, the better care we can provide for our patients.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"z7rb1W1ynPsKeajzYwtkWOoP3QcHE5NL\"]\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/17617/california-pharmacists-providing-more-direct-care-to-patients-thanks-to-new-law","authors":["8344"],"categories":["stateofhealth_11","stateofhealth_14"],"tags":["stateofhealth_589"],"featImg":"stateofhealth_17619","label":"stateofhealth"},"stateofhealth_15004":{"type":"posts","id":"stateofhealth_15004","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"15004","score":null,"sort":[1379094752000]},"guestAuthors":[],"slug":"midwifery-physical-therapy-pharmacists-bills-move-to-governors-desk-scope-of-practice","title":"Midwifery, Physical Therapy, Pharmacist Bills Move to Governor's Desk","publishDate":1379094752,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_15016\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/115011610-e1379100622408.jpg\">\u003cimg class=\"size-large wp-image-15016\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/115011610-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>California's legislators introduced a suite of bills during the legislative session that ended Thursday with an eye toward helping to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/09/12/the-primary-care-crunch-not-enough-doctors-and-more-patients-coming-engaged-patient/\" target=\"_blank\">expand access to primary care\u003c/a>. These \"scope-of-practice\" bills have sometimes been the subject of hot debate in Sacramento, but three of them survived and have moved to Gov. Brown's desk.\u003c/p>\n\u003cp>Here's a recap of some of the bills and where they stand now:\u003c/p>\n\u003cp>\u003cstrong>Midwifery Bill (\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billVotesClient.xhtml\" target=\"_blank\">AB 1308\u003c/a>) -- headed to governor's desk\u003c/strong>\u003c/p>\n\u003cp>The \u003ca href=\"http://centerforhealthreporting.org/blog/update-midwifery-bill-moves-governor%E2%80%99s-desk1175\" target=\"_blank\">Center for Health Reporting writes\u003c/a> that the bill passed unanimously Thursday night and is now on the governor's desk. From the Center:\u003c/p>\n\u003cblockquote>\n\u003cp dir=\"ltr\">(L)icensed midwives were legally obligated to be supervised by physicians. If a doctor supervised a licensed midwife, however, the doctor ran the risk of losing liability insurance. So, collaboration was unattainable and advocates said this put women and babies at risk.\u003c/p>\n\u003cp dir=\"ltr\">The bill removes the requirement for licensed midwives to be supervised by a physician.\u003c/p>\n\u003cp dir=\"ltr\">“Because physician supervision was required but not available, the midwives often had to operate in the shadows,” said Shannon Smith-Crowley, a lobbyist for the American Congress of Obstetricians and Gynecologists (ACOG), a group representing OB/GYNs and the bill’s sponsor. “Midwives can be out in the open, helping them develop better relationships, warmer reception and protocols for transfer, ideally leading to earlier transfers in less dire circumstances.”\u003c/p>\n\u003c/blockquote>\n\u003cp>\u003cstrong>Physical Therapy (\u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/asm/ab_0951-1000/ab_1000_bill_20130906_amended_sen_v91.pdf\" target=\"_blank\">AB 1000\u003c/a>) -- headed to governor's desk\u003c!--more-->\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>This bill would eliminate the need for patients to have a physician's diagnosis to receive physical therapy. Under the bill, patients could access physical therapy directly. But as \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2013/9/physical-therapist-bill-headed-to-governor\" target=\"_blank\">California Healthline \u003c/a>reports, the bill is both supported and opposed by physical therapists, some of whom want the governor to veto the bill:\u003c/p>\n\u003cblockquote>\u003cp>Paul Gaspar, president of the Independent Physical Therapists of California, said the bill wasn't really about direct patient access to therapy as much as it was about changing the financial relationship between physicians and physical therapists.\u003c/p>\n\u003cp>\"People who own [physical therapy] businesses are very concerned about this,\" Gaspar said. \"We feel threatened that people are going to take advantage of us.\"\u003c/p>\n\u003cp>Physician groups now will be able to directly hire physical therapists, and Gaspar said that means they'll be able to make money on the work of other providers. That bucks a national trend, he said, that goes against referral-for-profit plans.\u003c/p>\n\u003cp>Gaspar said his group will talk to the governor's office about the possibility of a veto, based in part on national legislation (\u003ca href=\"http://thomas.loc.gov/cgi-bin/bdquery/z?d113:hr.2914:\" target=\"_blank\">HR 2914\u003c/a>) by Rep. Jackie Speier (D-San Mateo) that may conflict with the state law.\u003c/p>\n\u003cp>Wieckowski said direct access to physical therapists can only be good for consumers.\u003c/p>\n\u003cp>\"This bill helps streamline health care delivery in California and will help patients get the access they need,\" he said, \"rather than losing valuable time with unnecessary and costly delays.\"\u003c/p>\u003c/blockquote>\n\u003cp>\u003cstrong> Pharmacists (\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml\" target=\"_blank\">SB 493\u003c/a>) -- headed to governor's desk\u003c/strong>\u003c/p>\n\u003cp>This bill allows pharmacists to order some lab tests and prescribe smoking cessation drugs. From \u003ca href=\"http://www.sacbee.com/2013/09/11/5728426/bill-would-expand-role-of-pharmacists.html#storylink=cpy\" target=\"_blank\">The Sacramento Bee\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>The legislation is part of what had been a package from Democratic Sen. Ed Hernandez of \u003ca href=\"http://topics.sacbee.com/West+Covina/\" rel=\"nofollow\">West Covina\u003c/a> intended to help address the state's expected shortage of primary care physicians. ...\u003c/p>\n\u003cp>Supporters, which include pharmacy schools and \u003ca href=\"http://topics.sacbee.com/Blue+Shield/\" rel=\"nofollow\">Blue Shield\u003c/a> of California, say the legislation would allow pharmacists to better use their training and could help control \u003ca href=\"http://topics.sacbee.com/health+care+costs/\" rel=\"nofollow\">health care costs.\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cdiv>\u003cstrong>Nurse Practitioners (\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB491\" target=\"_blank\">SB 491\u003c/a>) -- stuck in committee\u003c/strong>\u003c/div>\n\u003cdiv>This bill was \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/09/debate-over-role-of-nurse-practitioners-in-primary-care-responsibilities/\" target=\"_blank\">one of the most hotly contested\u003c/a> of all the scope-of-practice bills. On August 30, it failed to move out of committee. The Los Angeles Times\u003ca href=\"http://www.latimes.com/local/la-me-healthcare-20130902,0,3526045.story\" target=\"_blank\"> captured the mood\u003c/a>:\u003c/div>\n\u003cdiv>\n\u003cblockquote>\u003cp>The proposal failed in a committee Friday, under fire from the California Medical Assn., the powerful lobbying arm for the state's physicians. The organization teamed with some specialists and labor unions to mobilize lobbyists, engage doctors across the state and even dedicate Twitter accounts as it waged its campaign against the bill. ...\u003c/p>\n\u003cp>Jockeying over the scope of medical professionals' practice has intensified this year as California prepares for full implementation of the new national healthcare law, which will bring an influx of newly insured patients.\u003c/p>\n\u003cp>But \"the sticking point for the nurse practitioner bill [was] the word 'independent,'\" said Hernandez, who chairs the Senate health committee. \"For organized medicine, that's the … line in the sand.\"\u003c/p>\u003c/blockquote>\n\u003c/div>\n\u003cp>\u003cstrong> Optometrists (\u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_0451-0500/sb_492_bill_20130508_amended_sen_v95.html\" target=\"_blank\">SB 492\u003c/a>) -- pulled from consideration by bill's author\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The bill would have allowed optometrists to prescribe more drugs and treat certain diseases. But Sen. Ed Hernandez (D-West Covina) opted to hold the bill to the next session, as the\u003ca href=\"http://blogs.sacbee.com/capitolalertlatest/2013/08/bill-expanding-optometrists-authority-on-hold-til-next-year.html\" target=\"_blank\"> Sacramento Bee\u003c/a> reported:\u003c/p>\n\u003cblockquote>\u003cp>\"We turned that into a two-year bill just to make sure we can continue working on it in committee, continue to work with the opposition,\" Hernandez told The Bee.\u003c/p>\n\u003cp>\"What we wanted to achieve we felt needed a little more conversation, and we felt it would just be better to work over the break on it.\" ...\u003c/p>\n\u003cp>Molly Weedn, a spokeswoman for the California Medical Association, said doctors hoped to reach compromise with Hernandez on the optometry bill the way they had on the bill regarding pharmacists.\u003c/p>\n\u003cp>\"We're glad there is extra time to work out what some of those difference are,\" she said. \"Our biggest concern has been and remains that patients are being treated by qualified health care professionals.\"\u003c/p>\n\u003cp>Hernandez said it's too soon to say what kind of compromise is in order:\u003c/p>\n\u003cp>\"We're not willing to give up on anything because we haven't had that conversation yet with the opposition.\"\u003c/p>\u003c/blockquote>\n\u003cdiv>And, as has been\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/09/06/bill-to-increase-abortion-providers-on-governors-desk/\" target=\"_blank\"> widely reported\u003c/a>,\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB154\" target=\"_blank\"> AB 154\u003c/a>, which would permit specially trained clinicians to conduct aspiration abortions, went to the governor's desk earlier this month.\u003c/div>\n\n","blocks":[],"excerpt":"California's legislators introduced a suite of bills during the legislative session that ended Thursday with an eye toward helping to expand access to primary care. These \"scope-of-practice\" bills have sometimes been the subject of hot debate in Sacramento, but three of them survived and have moved to Gov. Brown's desk.","status":"publish","parent":0,"modified":1379365592,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":27,"wordCount":966},"headData":{"title":"Midwifery, Physical Therapy, Pharmacist Bills Move to Governor's Desk | KQED","description":"California's legislators introduced a suite of bills during the legislative session that ended Thursday with an eye toward helping to expand access to primary care. These "scope-of-practice" bills have sometimes been the subject of hot debate in Sacramento, but three of them survived and have moved to Gov. Brown's desk.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Midwifery, Physical Therapy, Pharmacist Bills Move to Governor's Desk","datePublished":"2013-09-13T17:52:32.000Z","dateModified":"2013-09-16T21:06:32.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"15004 http://blogs.kqed.org/stateofhealth/?p=15004","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/09/13/midwifery-physical-therapy-pharmacists-bills-move-to-governors-desk-scope-of-practice/","disqusTitle":"Midwifery, Physical Therapy, Pharmacist Bills Move to Governor's Desk","WpOldSlug":"midwifery-physical-therapy-pharmacists-bills-move-to-governors-desk","path":"/stateofhealth/15004/midwifery-physical-therapy-pharmacists-bills-move-to-governors-desk-scope-of-practice","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_15016\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/115011610-e1379100622408.jpg\">\u003cimg class=\"size-large wp-image-15016\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/09/115011610-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>California's legislators introduced a suite of bills during the legislative session that ended Thursday with an eye toward helping to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/09/12/the-primary-care-crunch-not-enough-doctors-and-more-patients-coming-engaged-patient/\" target=\"_blank\">expand access to primary care\u003c/a>. These \"scope-of-practice\" bills have sometimes been the subject of hot debate in Sacramento, but three of them survived and have moved to Gov. Brown's desk.\u003c/p>\n\u003cp>Here's a recap of some of the bills and where they stand now:\u003c/p>\n\u003cp>\u003cstrong>Midwifery Bill (\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billVotesClient.xhtml\" target=\"_blank\">AB 1308\u003c/a>) -- headed to governor's desk\u003c/strong>\u003c/p>\n\u003cp>The \u003ca href=\"http://centerforhealthreporting.org/blog/update-midwifery-bill-moves-governor%E2%80%99s-desk1175\" target=\"_blank\">Center for Health Reporting writes\u003c/a> that the bill passed unanimously Thursday night and is now on the governor's desk. From the Center:\u003c/p>\n\u003cblockquote>\n\u003cp dir=\"ltr\">(L)icensed midwives were legally obligated to be supervised by physicians. If a doctor supervised a licensed midwife, however, the doctor ran the risk of losing liability insurance. So, collaboration was unattainable and advocates said this put women and babies at risk.\u003c/p>\n\u003cp dir=\"ltr\">The bill removes the requirement for licensed midwives to be supervised by a physician.\u003c/p>\n\u003cp dir=\"ltr\">“Because physician supervision was required but not available, the midwives often had to operate in the shadows,” said Shannon Smith-Crowley, a lobbyist for the American Congress of Obstetricians and Gynecologists (ACOG), a group representing OB/GYNs and the bill’s sponsor. “Midwives can be out in the open, helping them develop better relationships, warmer reception and protocols for transfer, ideally leading to earlier transfers in less dire circumstances.”\u003c/p>\n\u003c/blockquote>\n\u003cp>\u003cstrong>Physical Therapy (\u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/asm/ab_0951-1000/ab_1000_bill_20130906_amended_sen_v91.pdf\" target=\"_blank\">AB 1000\u003c/a>) -- headed to governor's desk\u003c!--more-->\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This bill would eliminate the need for patients to have a physician's diagnosis to receive physical therapy. Under the bill, patients could access physical therapy directly. But as \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2013/9/physical-therapist-bill-headed-to-governor\" target=\"_blank\">California Healthline \u003c/a>reports, the bill is both supported and opposed by physical therapists, some of whom want the governor to veto the bill:\u003c/p>\n\u003cblockquote>\u003cp>Paul Gaspar, president of the Independent Physical Therapists of California, said the bill wasn't really about direct patient access to therapy as much as it was about changing the financial relationship between physicians and physical therapists.\u003c/p>\n\u003cp>\"People who own [physical therapy] businesses are very concerned about this,\" Gaspar said. \"We feel threatened that people are going to take advantage of us.\"\u003c/p>\n\u003cp>Physician groups now will be able to directly hire physical therapists, and Gaspar said that means they'll be able to make money on the work of other providers. That bucks a national trend, he said, that goes against referral-for-profit plans.\u003c/p>\n\u003cp>Gaspar said his group will talk to the governor's office about the possibility of a veto, based in part on national legislation (\u003ca href=\"http://thomas.loc.gov/cgi-bin/bdquery/z?d113:hr.2914:\" target=\"_blank\">HR 2914\u003c/a>) by Rep. Jackie Speier (D-San Mateo) that may conflict with the state law.\u003c/p>\n\u003cp>Wieckowski said direct access to physical therapists can only be good for consumers.\u003c/p>\n\u003cp>\"This bill helps streamline health care delivery in California and will help patients get the access they need,\" he said, \"rather than losing valuable time with unnecessary and costly delays.\"\u003c/p>\u003c/blockquote>\n\u003cp>\u003cstrong> Pharmacists (\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml\" target=\"_blank\">SB 493\u003c/a>) -- headed to governor's desk\u003c/strong>\u003c/p>\n\u003cp>This bill allows pharmacists to order some lab tests and prescribe smoking cessation drugs. From \u003ca href=\"http://www.sacbee.com/2013/09/11/5728426/bill-would-expand-role-of-pharmacists.html#storylink=cpy\" target=\"_blank\">The Sacramento Bee\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>The legislation is part of what had been a package from Democratic Sen. Ed Hernandez of \u003ca href=\"http://topics.sacbee.com/West+Covina/\" rel=\"nofollow\">West Covina\u003c/a> intended to help address the state's expected shortage of primary care physicians. ...\u003c/p>\n\u003cp>Supporters, which include pharmacy schools and \u003ca href=\"http://topics.sacbee.com/Blue+Shield/\" rel=\"nofollow\">Blue Shield\u003c/a> of California, say the legislation would allow pharmacists to better use their training and could help control \u003ca href=\"http://topics.sacbee.com/health+care+costs/\" rel=\"nofollow\">health care costs.\u003c/a>\u003c/p>\u003c/blockquote>\n\u003cdiv>\u003cstrong>Nurse Practitioners (\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB491\" target=\"_blank\">SB 491\u003c/a>) -- stuck in committee\u003c/strong>\u003c/div>\n\u003cdiv>This bill was \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/08/09/debate-over-role-of-nurse-practitioners-in-primary-care-responsibilities/\" target=\"_blank\">one of the most hotly contested\u003c/a> of all the scope-of-practice bills. On August 30, it failed to move out of committee. The Los Angeles Times\u003ca href=\"http://www.latimes.com/local/la-me-healthcare-20130902,0,3526045.story\" target=\"_blank\"> captured the mood\u003c/a>:\u003c/div>\n\u003cdiv>\n\u003cblockquote>\u003cp>The proposal failed in a committee Friday, under fire from the California Medical Assn., the powerful lobbying arm for the state's physicians. The organization teamed with some specialists and labor unions to mobilize lobbyists, engage doctors across the state and even dedicate Twitter accounts as it waged its campaign against the bill. ...\u003c/p>\n\u003cp>Jockeying over the scope of medical professionals' practice has intensified this year as California prepares for full implementation of the new national healthcare law, which will bring an influx of newly insured patients.\u003c/p>\n\u003cp>But \"the sticking point for the nurse practitioner bill [was] the word 'independent,'\" said Hernandez, who chairs the Senate health committee. \"For organized medicine, that's the … line in the sand.\"\u003c/p>\u003c/blockquote>\n\u003c/div>\n\u003cp>\u003cstrong> Optometrists (\u003ca href=\"http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_0451-0500/sb_492_bill_20130508_amended_sen_v95.html\" target=\"_blank\">SB 492\u003c/a>) -- pulled from consideration by bill's author\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The bill would have allowed optometrists to prescribe more drugs and treat certain diseases. But Sen. Ed Hernandez (D-West Covina) opted to hold the bill to the next session, as the\u003ca href=\"http://blogs.sacbee.com/capitolalertlatest/2013/08/bill-expanding-optometrists-authority-on-hold-til-next-year.html\" target=\"_blank\"> Sacramento Bee\u003c/a> reported:\u003c/p>\n\u003cblockquote>\u003cp>\"We turned that into a two-year bill just to make sure we can continue working on it in committee, continue to work with the opposition,\" Hernandez told The Bee.\u003c/p>\n\u003cp>\"What we wanted to achieve we felt needed a little more conversation, and we felt it would just be better to work over the break on it.\" ...\u003c/p>\n\u003cp>Molly Weedn, a spokeswoman for the California Medical Association, said doctors hoped to reach compromise with Hernandez on the optometry bill the way they had on the bill regarding pharmacists.\u003c/p>\n\u003cp>\"We're glad there is extra time to work out what some of those difference are,\" she said. \"Our biggest concern has been and remains that patients are being treated by qualified health care professionals.\"\u003c/p>\n\u003cp>Hernandez said it's too soon to say what kind of compromise is in order:\u003c/p>\n\u003cp>\"We're not willing to give up on anything because we haven't had that conversation yet with the opposition.\"\u003c/p>\u003c/blockquote>\n\u003cdiv>And, as has been\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/09/06/bill-to-increase-abortion-providers-on-governors-desk/\" target=\"_blank\"> widely reported\u003c/a>,\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB154\" target=\"_blank\"> AB 154\u003c/a>, which would permit specially trained clinicians to conduct aspiration abortions, went to the governor's desk earlier this month.\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/15004/midwifery-physical-therapy-pharmacists-bills-move-to-governors-desk-scope-of-practice","authors":["240"],"categories":["stateofhealth_14"],"tags":["stateofhealth_37","stateofhealth_589"],"featImg":"stateofhealth_15016","label":"stateofhealth"},"stateofhealth_14238":{"type":"posts","id":"stateofhealth_14238","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"14238","score":null,"sort":[1376077034000]},"guestAuthors":[],"slug":"debate-over-role-of-nurse-practitioners-in-primary-care-responsibilities","title":"Debate Over Role of Nurse Practitioners in Primary Care Responsibilities","publishDate":1376077034,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_14252\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-14252\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/RS4667_WellnessCenter_ChrisRichard-scr-640x480.jpg\" alt=\"Pediatric Nurse Practitioner examines toddler. (Chris Richard/KQED)\" width=\"640\" height=\"480\">\u003cfigcaption class=\"wp-caption-text\">A pediatric nurse practitioner examines a toddler. (Chris Richard/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>An estimated 6 million Californians will be eligible for insurance under Obamacare -- about 5 million through the Covered California marketplace and more than a million people via the Medi-Cal expansion.\u003c/p>\n\u003cp>Yet, just 16 of California's 58 counties have enough primary care doctors\u003ca href=\"http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/F/PDF%20FewerAndMoreSpecializedMDSupplyInCA.pdf\" target=\"_blank\"> right now\u003c/a>. To try to improve access, California legislators are moving bills to expand \"scope of practice\" for such midlevel health providers as pharmacists and nurse practitioners. In general, such bills would allow certain health providers to practice more independently. Right now, in many cases, they must be overseen by physicians. More autonomy could open access for underserved groups.\u003c/p>\n\u003cp>But some of those ideas are being hotly debated in Sacramento.\u003c/p>\n\u003cp>The toughest scope-of-practice sell right now seems to be nurse practitioners. Earlier this week, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB491\" target=\"_blank\">SB 491,\u003c/a> which would expand nurse practitioner duties, failed to get out of committee. It will be up for a vote again next week. State Sen. Ed Hernandez (D-West Covina), an optometrist himself, joined \u003ca href=\"http://www.kqed.org/a/forum/R201308090900\">KQED Forum\u003c/a> Friday to discuss the bill. He said California needs to \"utilize providers within their training\" to help ease this \"huge access problem in primary care.\"\u003c!--more-->\u003c/p>\n\u003cp>California, as it turns out, is among only a \u003ca href=\"http://www.californiahealthline.org/insight/2013/california-behind-national-scopeofpractice-curve-according-to-nurse-practitioners\" target=\"_blank\">handful of states with the most restrictive policies\u003c/a> (see map) around nurse practitioners and patient care. Paul Phinney, a pediatrician and president of the California Medical Association, said \"allowing nurse practitioners to practice independently fragments care.\" He agreed there is tremendous primary care need, but said a better way to address the problem would be to \"have physicians and nurse practitioners work collaboratively in teams.\"\u003c/p>\n\u003cfigure id=\"attachment_14244\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://www.aanp.org/legislation-regulation/state-practice-environment\">\u003cimg class=\"size-medium wp-image-14244\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/Screen-Shot-2013-08-09-at-12.20.25-PM-300x189.png\" alt=\"Map of state practice environment for nurse practitioners. California has some of the most restrictive policies. (Map: American Association of Nurse Practitioners)\" width=\"300\" height=\"189\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Map of state practice environment for nurse practitioners. California has some of the most restrictive policies. (Map: American Association of Nurse Practitioners)\u003c/figcaption>\u003c/figure>\n\u003cp>Hernandez agreed a team approach is best, but pointed to many studies (he didn't say specifically, but \u003ca href=\"http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health/Recommendations.aspx\" target=\"_blank\">this one\u003c/a> from the Institute of Medicine is a good start) that have found nurse practitioners are \"just as qualified\" to provide safe primary care as physicians are. Right now, 17 states currently allow independent practice for nurse practitioners.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Of course, that means 33 states do not allow fully independent practice, countered Phinney.\u003c/p>\n\u003cp>Debra Bakerjian, senior director of clinical education at the UC Davis School of Nursing, talked about structural barriers that further limit the practice of nurse practitioners. For example, Medi-Cal recipients face not only a primary care shortage but also a shortage of physicians who will accept Medi-Cal. Since nurse practitioners must be aligned with a physician, if the physician does not accept Medi-Cal, neither can the NP. With changes in regulations, like SB 491, \"We could expand and provide access to care to people who don't have it already,\" she explained.\u003c/p>\n\u003cp>Bakerjian stressed that NPs want to be part of a health care team, but argued that \"physicians should be required to be part of a team as well.\"\u003c/p>\n\u003cp>Forum is a call-in discussion program, and a call from a woman who identified herself as Aurora was especially pointed. She said that she is a psychiatric mental health nurse practitioner who works with severely mentally ill adults and children in an urban area.\u003c/p>\n\u003cp>We have a \"huge waiting list,\" she said, adding that severely mentally ill children might face a one-year wait to get into a clinic. \"We cannot get physicians to collaborate with us,\" Aurora said. \"Often there are no physicians available to do that.\"\u003c/p>\n\u003cp>SB 493 -- which would permit more practice options for pharmacists -- has already passed out of committee. A third scope-of-practice bill, also by Hernandez, would \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB492\" target=\"_blank\">permit optometrists\u003c/a> to diagnose and treat more conditions. Like the NP bill, it will be heard next week as well.\u003c/p>\n\u003cp>Still, California Healthline reported that California, a trendsetter in so many ways, is \u003ca href=\"http://www.californiahealthline.org/insight/2013/california-behind-national-scopeofpractice-curve-according-to-nurse-practitioners\" target=\"_blank\">behind the curve\u003c/a> on the scope-of-practice issue for nurse practitioners, according to Tay Kopanos of the American Association of Nurse Practitioners:\u003c/p>\n\u003cblockquote>\u003cp>\"In Oregon, a nurse practitioner can manage care completely from diagnosis to prescribing treatment, but step over the border into California and barriers are thrown up that prevent care,\" Kopanos said. \"We are concerned that when legislators begin setting up state-based requirements for team care, they might be shortchanging everyone by requiring a physician to be the head of every team.\"\u003c/p>\n\u003cp>\"We're not sure that's the best way to do it,\" Kopanos said. \"We can see circumstances in many states from Kentucky to California, where having somebody other than a physician -- maybe a nurse practitioner or maybe some other provider -- heading teams in underserved areas would be best for patients.\"\u003c/p>\n\u003cp>\"That's what we think should be the driving force behind states' decisions -- what's best for patients,\" Kopanos said.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Listen to the Forum discussion:\u003c/strong>\u003cbr>\n\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201308090900.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201308090900.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n","blocks":[],"excerpt":"An estimated 6 million Californians will be eligible for insurance under Obamacare -- about 5 million through the Covered California marketplace and more than a million people via the Medi-Cal expansion.\r\n\r\nYet, just 16 of California's 58 counties have enough primary care doctors right now. To try to improve access, California legislators are moving bills to expand \"scope-of-practice\" for such mid-level health providers as pharmacists and nurse practitioners.","status":"publish","parent":0,"modified":1376598292,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":19,"wordCount":806},"headData":{"title":"Debate Over Role of Nurse Practitioners in Primary Care Responsibilities | KQED","description":"An estimated 6 million Californians will be eligible for insurance under Obamacare -- about 5 million through the Covered California marketplace and more than a million people via the Medi-Cal expansion.\r\n\r\nYet, just 16 of California's 58 counties have enough primary care doctors right now. To try to improve access, California legislators are moving bills to expand "scope-of-practice" for such mid-level health providers as pharmacists and nurse practitioners.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Debate Over Role of Nurse Practitioners in Primary Care Responsibilities","datePublished":"2013-08-09T19:37:14.000Z","dateModified":"2013-08-15T20:24:52.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"14238 http://blogs.kqed.org/stateofhealth/?p=14238","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/08/09/debate-over-role-of-nurse-practitioners-in-primary-care-responsibilities/","disqusTitle":"Debate Over Role of Nurse Practitioners in Primary Care Responsibilities","path":"/stateofhealth/14238/debate-over-role-of-nurse-practitioners-in-primary-care-responsibilities","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_14252\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-14252\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/RS4667_WellnessCenter_ChrisRichard-scr-640x480.jpg\" alt=\"Pediatric Nurse Practitioner examines toddler. (Chris Richard/KQED)\" width=\"640\" height=\"480\">\u003cfigcaption class=\"wp-caption-text\">A pediatric nurse practitioner examines a toddler. (Chris Richard/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>An estimated 6 million Californians will be eligible for insurance under Obamacare -- about 5 million through the Covered California marketplace and more than a million people via the Medi-Cal expansion.\u003c/p>\n\u003cp>Yet, just 16 of California's 58 counties have enough primary care doctors\u003ca href=\"http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/F/PDF%20FewerAndMoreSpecializedMDSupplyInCA.pdf\" target=\"_blank\"> right now\u003c/a>. To try to improve access, California legislators are moving bills to expand \"scope of practice\" for such midlevel health providers as pharmacists and nurse practitioners. In general, such bills would allow certain health providers to practice more independently. Right now, in many cases, they must be overseen by physicians. More autonomy could open access for underserved groups.\u003c/p>\n\u003cp>But some of those ideas are being hotly debated in Sacramento.\u003c/p>\n\u003cp>The toughest scope-of-practice sell right now seems to be nurse practitioners. Earlier this week, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB491\" target=\"_blank\">SB 491,\u003c/a> which would expand nurse practitioner duties, failed to get out of committee. It will be up for a vote again next week. State Sen. Ed Hernandez (D-West Covina), an optometrist himself, joined \u003ca href=\"http://www.kqed.org/a/forum/R201308090900\">KQED Forum\u003c/a> Friday to discuss the bill. He said California needs to \"utilize providers within their training\" to help ease this \"huge access problem in primary care.\"\u003c!--more-->\u003c/p>\n\u003cp>California, as it turns out, is among only a \u003ca href=\"http://www.californiahealthline.org/insight/2013/california-behind-national-scopeofpractice-curve-according-to-nurse-practitioners\" target=\"_blank\">handful of states with the most restrictive policies\u003c/a> (see map) around nurse practitioners and patient care. Paul Phinney, a pediatrician and president of the California Medical Association, said \"allowing nurse practitioners to practice independently fragments care.\" He agreed there is tremendous primary care need, but said a better way to address the problem would be to \"have physicians and nurse practitioners work collaboratively in teams.\"\u003c/p>\n\u003cfigure id=\"attachment_14244\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://www.aanp.org/legislation-regulation/state-practice-environment\">\u003cimg class=\"size-medium wp-image-14244\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/Screen-Shot-2013-08-09-at-12.20.25-PM-300x189.png\" alt=\"Map of state practice environment for nurse practitioners. California has some of the most restrictive policies. (Map: American Association of Nurse Practitioners)\" width=\"300\" height=\"189\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Map of state practice environment for nurse practitioners. California has some of the most restrictive policies. (Map: American Association of Nurse Practitioners)\u003c/figcaption>\u003c/figure>\n\u003cp>Hernandez agreed a team approach is best, but pointed to many studies (he didn't say specifically, but \u003ca href=\"http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health/Recommendations.aspx\" target=\"_blank\">this one\u003c/a> from the Institute of Medicine is a good start) that have found nurse practitioners are \"just as qualified\" to provide safe primary care as physicians are. Right now, 17 states currently allow independent practice for nurse practitioners.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Of course, that means 33 states do not allow fully independent practice, countered Phinney.\u003c/p>\n\u003cp>Debra Bakerjian, senior director of clinical education at the UC Davis School of Nursing, talked about structural barriers that further limit the practice of nurse practitioners. For example, Medi-Cal recipients face not only a primary care shortage but also a shortage of physicians who will accept Medi-Cal. Since nurse practitioners must be aligned with a physician, if the physician does not accept Medi-Cal, neither can the NP. With changes in regulations, like SB 491, \"We could expand and provide access to care to people who don't have it already,\" she explained.\u003c/p>\n\u003cp>Bakerjian stressed that NPs want to be part of a health care team, but argued that \"physicians should be required to be part of a team as well.\"\u003c/p>\n\u003cp>Forum is a call-in discussion program, and a call from a woman who identified herself as Aurora was especially pointed. She said that she is a psychiatric mental health nurse practitioner who works with severely mentally ill adults and children in an urban area.\u003c/p>\n\u003cp>We have a \"huge waiting list,\" she said, adding that severely mentally ill children might face a one-year wait to get into a clinic. \"We cannot get physicians to collaborate with us,\" Aurora said. \"Often there are no physicians available to do that.\"\u003c/p>\n\u003cp>SB 493 -- which would permit more practice options for pharmacists -- has already passed out of committee. A third scope-of-practice bill, also by Hernandez, would \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB492\" target=\"_blank\">permit optometrists\u003c/a> to diagnose and treat more conditions. Like the NP bill, it will be heard next week as well.\u003c/p>\n\u003cp>Still, California Healthline reported that California, a trendsetter in so many ways, is \u003ca href=\"http://www.californiahealthline.org/insight/2013/california-behind-national-scopeofpractice-curve-according-to-nurse-practitioners\" target=\"_blank\">behind the curve\u003c/a> on the scope-of-practice issue for nurse practitioners, according to Tay Kopanos of the American Association of Nurse Practitioners:\u003c/p>\n\u003cblockquote>\u003cp>\"In Oregon, a nurse practitioner can manage care completely from diagnosis to prescribing treatment, but step over the border into California and barriers are thrown up that prevent care,\" Kopanos said. \"We are concerned that when legislators begin setting up state-based requirements for team care, they might be shortchanging everyone by requiring a physician to be the head of every team.\"\u003c/p>\n\u003cp>\"We're not sure that's the best way to do it,\" Kopanos said. \"We can see circumstances in many states from Kentucky to California, where having somebody other than a physician -- maybe a nurse practitioner or maybe some other provider -- heading teams in underserved areas would be best for patients.\"\u003c/p>\n\u003cp>\"That's what we think should be the driving force behind states' decisions -- what's best for patients,\" Kopanos said.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Listen to the Forum discussion:\u003c/strong>\u003cbr>\n\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201308090900.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201308090900.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/14238/debate-over-role-of-nurse-practitioners-in-primary-care-responsibilities","authors":["240"],"categories":["stateofhealth_11","stateofhealth_14"],"tags":["stateofhealth_589"],"featImg":"stateofhealth_14252","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. 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On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg","imageAlt":"On Our Watch from NPR and KQED","officialWebsiteLink":"/podcasts/onourwatch","meta":{"site":"news","source":"kqed","order":"1"},"link":"/podcasts/onourwatch","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1567098962","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw","npr":"https://rpb3r.app.goo.gl/onourwatch","spotify":"https://open.spotify.com/show/0OLWoyizopu6tY1XiuX70x","tuneIn":"https://tunein.com/radio/On-Our-Watch-p1436229/","stitcher":"https://www.stitcher.com/show/on-our-watch","rss":"https://feeds.npr.org/510360/podcast.xml"}},"on-the-media":{"id":"on-the-media","title":"On The Media","info":"Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. 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