9/30/2018 FUNCTIONAL MEDICINE IN PHARMACY PRACTICE Suzanne Keyes, PharmD, FACA, IFMCP Keyes’ Compounding & 180 Wellness Elk City, OK 1
9/30/2018 DISCLOSURES it’s about transparency I, Suzanne Keyes, declare no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. LEARNING OBJECTIVES it’s about education Discuss an appointment- Discuss the functional medicine Identify target patient based model for market and the health care populations and outline functional medicine, professions involved who are marketing strategies pharmacy workflow & add-on potential partners for pharmacy. and themes for expansion into revenue opportunities. functional medicine. 2
9/30/2018 DID YOU KNOW? it’s about the facts • Independent community pharmacy represent 36% of U.S. retail pharmacies and are capturing $80 billion dollars in the current marketplace BUT • Below-cost reimbursements, exacerbated by DIR fees in Medicare Part D, contribute to gross margins falling by 5% over the past five years AND • 52% of total prescriptions are covered by the Medicare Part D and Medicaid programs. ( 10,000 people a day are turning 65 years old) 3
9/30/2018 TOP 5 MEDICINES IN THE U.S. based on number of monthly prescriptions written in millions CRESTOR NEXIUM 15.2 15.2 13.7 13.7 21.5 21.5 21.4 21.4 18.2 18.2 ADVAIR SYNTHROID VENTOLIN https://www.webmd.com/drug-medication/news/20150508/most-prescribed-top-selling-drugs THE PHARMACIST’S ROLE NOW it’s about change • The Role of the Pharmacist as Part of a Multidisciplinary Cancer Care Team https://www.specialtypharmacytimes.com/publications/specialty-pharmacy-times/2018/may-2018/the-role-of-the-pharmacist-as-part-of-a-multidisciplinary-cancer-care-team • The Pharmacist's Role in Educating Patients on Medical Cannabis Use https://www.pharmacytimes.com/conferences/ashp-summer-2018/the-pharmacists-role-in-educating-patients-on-medical-cannabis-use • Use of Pharmacogenomics Data within Pharmacy Practice https://pharmacist.com/2018-apha-policy-topics • The Pharmacist’s Role in Educating the Health-Care Team About Adverse Effects of Immune Checkpoint Inhibitors http://www.ascopost.com/issues/may-25-2018/pharmacist-role-in-educating-the-health-care-team/ Pharmacists called to take lead in pharmacogenomics—the bridge to personalized • medicine https://www.pharmacist.com/article/pharmacists-called-take-lead-pharmacogenomics-bridge-personalized-medicine 4
9/30/2018 TECH CHECK TECH (TCT) it’s about trust • The results of 11 studies published since 1978 indicate that technicians' accuracy in performing final dispensing checks is very comparable to pharmacists' accuracy Adams AJ, Martin SJ, Stolpe SF. "Tech-check-tech": a review of the evidence on its safety and benefits. Am J Health Syst Pharm. 2011;68(19):1824-1833. • California, Colorado, Idaho, Iowa, Kansas, Kentucky, Michigan, Minnesota, Montana, North Dakota, South Carolina, Washington, Maryland, North Carolina, and Oregon 5
9/30/2018 RANDOM PIECES it’s about creating a picture The Standard American Diet 01 Environmental Exposures 02 Chronic Stress 03 Nutrient Depletion 04 6
9/30/2018 CONVENTIONAL FUNCTIONAL MEDICINE MEDICINE LOOKS AT: LOOKS AT: Nutrient deficiencies; food sensitivities; IRRITABLE BOWEL Biologics; increase fiber; inflammation; underlying SYNDROME stress reduction parasitic/fungal/bacterial infections; hormone imbalances NT pathways; inflammation; nutrient Anti-depressants; deficiencies ; hormone imbalances DEPRESSION/ANXIETY anxiolytics; counseling (including sex steroids, insulin and thyroid) ; gut microbiome Hormone imbalances; thyroid; food MIGRAINE HEADACHES Medications; rest sensitivities ; toxic exposure; nutrient deficiencies Stress management; rest; Mold/fungal exposures; nutrient CHRONIC FATIGUE medications for deficiencies ; thyroid; hormone 13 SYNDROME symptoms imbalances 7
9/30/2018 MEDICATION / CLASS OF DEPLETES CAUSING MEDICATION Dybiosis, neurotransmitter Lactobacillus acidophilus, imbalance , weight gain, Bifidobacterium AMOXICILLIN restlessness, ADHD, anxiety, sleep bifidum, biotin, folic acid, inositol, disturbance, fatigue, thyroid vitamins B1, B2, B3, B6, B12, and K dysfunction Depression, Type II diabetes, ADHD, PMS, Asthma , Epilepsy, Sleep Magnesium METHYLPHENIDATE disturbances, Migraines, Angina, HTN, Arrhythmias, Osteoporosis Amino acids, A (beta-carotene) B6, Neurotransmitter imbalance, blood ORAL / INHALED B12, C, calcium, chromium, D, DHEA, sugar dysregulation, restlessness, CORTICOSTEROIDS Folate, magnesium, melatonin, anxiety, sleep disturbance, fatigue, protein, potassium, selenium, zinc dysbiosis, thyroid dysfunction Irritability; restlessness, sleep Melatonin SSRIs disturbance , thyroid imbalances Iodine Irritability; restlessness, sleep CLONIDINE Melatonin disturbance KEYES’ COMPOUNDING& 180 WELLNESS it’s about differentiation 8
9/30/2018 CHANGE PHARMACY HEIRRARCHY it’s about reinventing yourself • FIELDS PHONE CALLS 25% • DIRECTS CONSULT & TEST KIT SALES • UPDATES EDUCATIONAL PAMPHLETS 50% • DIRECTS NUTRITIONAL SALES • EDUCATES PATIENTS ON FOOD CLERK PLANS, CBD, DIND TECHNICIAN PHARMACIST • COUNSELS PATIENTS • CONDUCTS CONSULTS 25% • EDUCATES PRACTITIONERS SHELF POSITIONING it’s about creating the need for education GUT HEALTH NEURO ADRENALS THYROID Probiotics Glandulars Herbals Sleep Betaine/Pepsin Adaptogens Glandulars Mood Boosters Digestive Enzymes Cofactors Cofactors 9
9/30/2018 COUNSELING OR CONSULTING? it’s about assigning value THE PARRATA RULE it’s about discernment 10
9/30/2018 A FEW OF MY MENTORS it’s about who you know Jeffrey Bland, MD www.jeffreybland.com Jill Carnahan, MD www.flatironmedicine.com Chris Kresser, Lac www.chriskresser.com Mark Hyman, MD www.drhyman.com Will Cole, DC www.drwillcole.com Westin Childs, DO www.restartmed.com Jolene Brighten, ND www.drbrighten.com Kelly Brogan, MD www.kellybroganmd.com Steven Gundry, MD www.gundrymd.com Ben Lynch, ND www.mthfr.net www.drbenlynch.com : WHAT’S INVOLVED? it’s about what you know Know the condition Know the questions to ask Know the studies, statistics & evidence Know the pathway Know the triggers/exposures/food Know the labs/biomarkers Know optimal ranges Know genetic SNPs exist Know the supplements 11
9/30/2018 BUT ABOVE ALL ELSE it’s about what you know KNOW YOUR WORTH WHERE DO I FIND OUT MORE? it’s about your resources https://www.ifm.org https://kalishinstitute.com/blog/become-functional-medicine-practitioner/ https://www.schoolafm.com https://www.functionalmedicineuniversity.com https://www.functionalmedicinecoaching.org https://www.uws.edu/human-nutrition-functional-medicine/ https://smhs.gwu.edu/integrative-medicine/ https://www.a4m.com https://www.integrativenutrition.com 12
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