It's Time to Renew Your Membership!

There are many benefits to renewing your membership with MSHP/MPA, including:

• Direct access to experts that can answer law and practice questions
• Networking opportunities with pharmacy professionals, such as complimentary membership in our local county associations and practice sections
• Free and discounted CE opportunities such as the MPA Annual Convention and Exposition - the state’s largest pharmacy conference
• Being part of the collective voice advocating for the future of the profession
• MPA Career Connect, a free service for you and other pharmacy professionals looking for job opportunities
• Competitive home, auto and business insurance through MPA’s affiliated PSI Insurance Agency

MPA exists for and is effective because of its members. RENEW today to ensure that your benefits are secured and that MPA has the resources to move the mountains ahead for you, for the profession and for patients.

If you are not renewed by March 30, 2023, you will no longer be considered an MPA member.

ASHP-Accredited Webinar on Pharmacy Tech Shortage

The pharmacy technician shortage remains an issue for many health systems. The American Society of Health-System Pharmacists (ASHP) has developed a comprehensive website, podcasts and expert articles on this issue and now has a live webinar prepared for March 28. ASHP is producing all the content and resources. Chiesi has provided grant support.

Click here for more information on the March 28 webinar. The program offers 1.0 contact hours of free credit. 

Building a Bridge to Meet Patient's Needs

By Shawna Kraft, Pharm.D., BCOP, clinical pharmacist specialist, University of Michigan Rogel Cancer Center; clinical associate professor, University of Michigan College of Pharmacy; immediate past president, MSHP

I have always had the philosophy that to support patients, we need to meet them where they are. But how should we really do that? We know it isn’t enough to simply counsel a patient on how to take their medication with a standardized script applied to all patients. We must think about what it really means for this patient to take their new diabetes medication, or oral oncolytic and all the financial, cultural and lifestyle influences that factor in.

The US Department of Health and Human Services has an information-rich website (https://health.gov/healthypeople/priority-areas/social-determinants-health) that can give you a primer on social determinants of health (SDoH) and how each of these areas can impact a patient’s health. In order for us as health care providers to care for patients, we first need to understand the overall identity of individual patients. 

I think sometimes we might be afraid to ask questions of patients regarding their concerns beyond the medication alone for fear we won’t know the answer, we don’t know how to ask or even that we are worried we could offend. However, what many of us realize is we do have the answers, but the process of incorporating SDoH into our patient care process is about having the patient participate in shared decision-making on their treatment, thus innately incorporating SDOH. Even if we don’t know a specific answer for intervention, there is a plethora of resources out there we can utilize as we support our patients. A recent article, while focusing on SDoH in diabetes care, has an excellent table with resources we can use for our patients.² A basic model for incorporating this process into any type of patient care is the LEARN model. ^{3, 4} 

• L- Listen. What does the patient think might be causing this issue and how is this affecting their life?
• E- Explain. What are your thoughts about what might be the medical issue and your perceptions to the patient.
• A- Acknowledge. Acknowledge the patient’s experience and perceptions of the issue and how this is similar to your perceptions.
• R- Recommend. Recommend treatment that is taking into account what you know as a pharmacist and what the patient has shared with you.
• N- Negotiate. Negotiate a plan that is agreed upon by both the patient and you.



While the LEARN model may seem quite basic, I think we can easily incorporate this in everyday practice and discussion with patients. Whatever tool you use, I believe by simply acknowledging that there isn’t always one right answer for every patient and reaching out and connecting with patients, we can start to optimize medication management for every patient. 

References

1. Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved [date graphic was accessed], from https://health.gov/healthypeople/objectives-and-data/social-determinants-health

2. Pauling EE, et al. Using the Pharmacists’ Patient Care Process to address social determinants of health in patients with diabetes. J APhA 62 (2022); 685-692

3. Diggs AK, Berger BA. Cultural competence. In: Berger BA, ed. Communication Skills for Pharmacists: Building Relationships, Improving Patient Care.3rd ed. American Pharmacists Association; 2009. Available at: https://pharmacylibrary.com/doi/book/10.21019/9781582121321. Accessed March 13, 2023

4. Berlin, E.A., Fowkes Jr., W.C. A teaching framework for cross-cultural health care. Application in family practice (1983) Western Journal of Medicine, 139 (6), pp. 934-938

- TRANSITIONS OF CARE -

Michiganians, Michiganders: This Is Not Mishigas

To Crush or Not to Crush; Reduction of a Compounded Risk in the New Era

By Rob Accetta, RPh, BCGP, FASCP

FDA, CDC, USP, OSHA, NIOSH.¹ The members of the Michigan Pharmacists Association (MPA) are no doubt familiar with the acronyms and the agencies they represent. These regulatory bodies are focused on patient and healthcare worker safety. Should pharmacists and health care providers be concerned whenever a provider orders a patient’s medications to be crushed? What are the concerns about crushing or compounding a drug, which may create hazard risks for the pharmacist compounder, nurse or patient? How should that information be shared and become actionable by pharmacy providers and decision-makers? Pharmacists should be aware that United States Pharmacopeia (USP) Chapter <800> standards for handling hazardous drugs in healthcare settings, while not currently compendial, provide guidance for healthcare providers for all aspects related to safety and risk mitigation.²

Crushing and Compounding Medications: True or False?

1. Concerns in this new era are due to standards and risks associated with medication administration. 
2. Concerns should be addressed as a part of an overall strategy of reducing risk, including using commercially-available, FDA-approved liquids or suspensions rather than compounding. 
3. Crushing and compounding adds an additional burden to providers and staff due to safety concerns and the need for use of personal protective equipment (PPE)

If you answered “True” for the statements above, you are on track!

Swallowing Medications: A Clinical Concern for Patients with Dysphagia

The diagnosis of dysphagia is a reality for many patients, especially those who transition from a hospital to a short-term stay or another rehabilitation facility. Thirty-three percent of these patients are more likely to need nursing home care; two times more are likely to die while in the hospital. They spend 3.8 days longer in the hospital on average, their hospital bills are on average $6,243 more expensive and 69% of older patients miss doses due to difficulties swallowing.³ Complications include concerns about nutrition, chewing, swallowing and compliance to medication regimens. Altered food consistencies (puree, chopped) or the need for thickened liquids serve as prompting clues to assess for proper swallowing of medications; NPO orders and enteral feeding tubes may be in use; compliance to med regimens may require a “crush and mix with food” strategy. A nurse decides to do so to encourage speed and efficiency but maybe add risks of exposure to hazardous drugs at the same time.

Hazards in the Medication Compounding or Administration Process

USP has announced that standards <795> and <797> will become compendial effective Nov. 1, 2023.⁴ The standards around <800> and the handling of medications are tied in with that compendial date. Handling medications includes all steps in the process from receiving a package through pouring, counting, compounding, dispensing and delivering to the patient. Institutions and pharmacies should already have procedures in place to protect employees from the hazards of medications on the National Institute for Occupational Safety and Health (NIOSH) hazardous drug lists.⁵

NIOSH considers a drug to be hazardous if it exhibits one or more of the following characteristics in humans or animals: carcinogenicity; teratogenicity or developmental toxicity; reproductive toxicity; organ toxicity at low doses; and genotoxicity structure and toxicity profiles of new drugs that mimic existing hazardous drugs. 

What does the FDA think about the compounding of drugs that are essentially a copy of an existing product? Former FDA commissioner and highly visible consultant Scott Gottlieb, MD said, “Compounded drugs should only be distributed to meet the needs of patients whose medical needs cannot be met by an FDA-approved drug.”

If there is an FDA-approved liquid alternative, crushing and compounding should be avoided altogether. FDA-approved liquid products, which are manufactured in GMP facilities to meet standards of quality and mitigate risks, provide a safer option to those who need medications in an alternative dosage form to tablets and capsules. For example, manufacturer CMP Pharma has FDA-approved liquid products for spironolactone, amlodipine, and tadalafil. Websites of manufacturers like this are helpful resources for more information.

References

1. FDA: Food & Drug Administration; CDC: Centers for Disease Control and Prevention; USP: United States Pharmacopeia; OSHA: Occupational Safety and Health Administration; NIOSH: National Institute for Occupational Safety and Health

2. USP Chapters <795>, <797> and <800> are to become compendial on November 1, 2023.

3. "Swallowing Problems Increase Risk of Death, Nursing Home Admissions." UW School of Medicine and Public Health. Accessed January 4, 2023. https://www.med.wisc.edu/news-and-events/2017/november/swallowing-problems-following-stroke/

4. USP and its standards may be found at: https://www.usp.org

5. NIOSH list may be found at https://www.cdc.gov/niosh/docs/2016-161/default.html

Mike Kraft, University of Michigan

Mike Kraft is a clinical professor in the Department of Clinical Pharmacy at the University of Michigan College of Pharmacy. He is also the assistant director of Education and Professional development at Michigan Medicine

Describe Your Role/Day in the Life: As many members may also express, I never envisioned that I would be in this role when I started my career. After graduating, I completed a specialty residency in critical care and nutrition support, then returned to U-M as a clinical faculty member and a clinical specialist in surgical intensive care/nutrition support. I really enjoyed the work, but my interests in education and professional development grew over the first several years of my career. I ultimately pursued opportunities that incorporated more responsibilities related to education and professional development and that’s how I ended up in my current role, which I have been in for approximately 10 years.

In my current position, I rarely have two days that look the same. However, this is also one aspect of my position that I really enjoy. My primary responsibilities are with U-M Health, where I lead the Education and Professional Development team for our department. This is a team of six individuals, and we have oversight of a number of important activities for our department of approximately 700 team members:

• Recruiting, on-boarding and training for new employees
• Leading pharmacy technician interviews
• Education, competencies and professional development for the entire department
• Pharmacy technician training program
• Pharmacy student experiential education
• Job shadowing opportunities with local partners
• Oversight and management of our 17 accredited pharmacy residency programs and 34 pharmacy residents

Our responsibilities span our entire department, which means we have an opportunity to work with a broad range of team members on a wide variety of initiatives. This is one of the best aspects of my position. My workdays typically include a lot of meetings, working on various projects related to our responsibilities and supporting team members who report to me. However, on any given day, I may be meeting about and/or working on projects related to recruiting team members, improving onboarding and training, student education, pharmacy residency programs, department education, professional development initiatives and more. I enjoy and appreciate that I have an opportunity to be involved in so many important initiatives for our team.

As a faculty member at the U-M College of Pharmacy, I have the opportunity to prepare future pharmacists to be successful. Most of my didactic teaching is related to career and professional development and I am co-advisor for one of the student professional organizations. The most rewarding part of my job is that we help our current team members and learners provide better care to patients in some way, and we help them to be better prepared for their future careers. This ultimately will lead to improving patient care on a level far beyond what I could do as an individual pharmacist.  

Why You’re an MSHP/MPA/MSPT Member: Like many pharmacists, my involvement in professional organizations started when I was a student. However, after I graduated, I didn’t fully appreciate the importance of remaining involved and the opportunities this could provide. I had several mentors who pushed me to get involved and give back to the profession, and that wise advice and “encouragement” has been extremely valuable throughout my career. Early in my career I became more involved in MPA, and eventually served as the chair of the Professional Affairs Committee. Not only did it align with my professional interests, but it was an opportunity to give back to the profession and to help others. It also allowed me to expand my professional network and connect with other colleagues, which is not only rewarding but can be helpful in many ways – remaining current on practice trends, confirming current practices, identifying opportunities, providing other ways to contribute to the profession, other leadership opportunities and more. As a member of MPA and MSHP, it provides opportunities to give back to the profession in my local community and across the state.

Recent Accomplishments: We have a number of recent accomplishments that were cause for celebration:



• Celebrated the one-year anniversary of establishing our Pharmacy Technician Training Program
• Completed recruiting for our next class of pharmacy interns and pharmacy residents
• Supported implementation of a new Learning Management System for our institution and department
• Significantly reduced our time from candidates applying to being hired and we have onboarded a record number of new employees over the past two years
• As a personal accomplishment, I was recently named as the 2023 recipient of the American Society for Parenteral and Enteral Nutrition (ASPEN) Stanley Serlick Award

How MSHP/MPA/MSPT Has Helped You Achieve Any Accomplishments: My involvement in MPA has played a key role in developing my professional network and my leadership skills and it has allowed me to give back to the profession and support my local communities. These have been important in my daily work and they have contributed to my involvement at the national level as well. For those professionals who are early in their career or even those who are further along but have not been involved in professional organizations, getting involved in a state organization like MPA, MSHP or MSPT can provide some great opportunities to give back to the profession. Some may be hesitant, but I have always found the experience to be rewarding and you work with great people. Giving back and pursuing leadership opportunities doesn’t mean you have to aim to be president of a national organization – there are great opportunities right in your backyard. These opportunities can help you develop your leadership skills and expand your professional network, all while giving back to the profession in your local communities.

- RESIDENT'S CORNER -

American Diabetes Association 2023 Guideline Updates on the Management of Comorbidities in Patients with Type 2 Diabetes

By Margaret Crosley, Pharm.D.; Cassandra Falk, Pharm.D., MPH; Destiny Hughson, Pharm.D.; Aidan Yetsko, Pharm.D., PGY-1 Resident, Trinity Health Grand Rapids

As we continue to age, so do our guidelines. It’s time for an update.

Diabetes continues to be one of the most prevalent disease states, with diagnoses having more than doubled in the American population in the last 20 years.¹ Unfortunately, of those with diagnosed diabetes, 48.8% are uncontrolled (HbA1c greater than 7%) which can lead to detrimental ramifications. These can include progressive kidney disease, retinopathy, and hypercholesterolemia, with the more serious consequences being threats to limbs and life.² As medicine continues to evolve, best practices for treating diabetes as a whole can be best accomplished through appropriate management of contributing comorbid disease states.

In “Standards of Care in Diabetes – 2023,” the section with the most updates was “Cardiovascular Disease and Risk Management.” For primary prevention, guidelines recommend diabetic patients with high cardiovascular risk who are 40 to 75 years old achieve a low-density lipoprotein cholesterol (LDL) goal of less than 70 mg/dL. Patients started on therapy should also have at least a 50% LDL reduction from baseline. For diabetics with atherosclerotic cardiovascular disease (ASCVD) history, an LDL reduction of greater than 50% is recommended, but the secondary prevention goal for LDL is reduced even further to less than 55 mg/dL.

If patients are not reaching these new goals through maximized statin therapy, providers should consider the addition of ezetimibe or a PCSK9 inhibitor.³ Multiple randomized controlled trials support these goals and approaches to lipid-lowering therapy for cardioprotection. One example is the Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT). This study identified a significant decrease in a composite endpoint of cardiovascular events when ezetimibe was added to a statin versus a statin alone, and the median LDL in the combination group was 53.7 mg/dL.⁴

This guideline section also focuses on the management of hypertension in diabetic patients. Previously, the 2022 guidelines defined hypertension as sustained blood pressure greater than 140/90 mmHg. The American Diabetes Association (ADA) 2023 update defines hypertension as a systolic blood pressure greater than 130 mmHg or a diastolic blood pressure greater than 80 mmHg to align with the American College of Cardiology and American Heart Association definition. Therefore, pharmacologic treatment in patients with diabetes and confirmed hypertension should now target a blood pressure goal of less than 130/80 mmHg.⁴ The Strategy of Blood Pressure Intervention in Elderly Hypertensive Patients (STEP) and Action to Control Cardiovascular Risk in Diabetes (ACCORD) trials supported this update. STEP trial results specifically showed a lowered incidence of cardiovascular events in the treatment group with an SBP target of 110 to 130 mmHg compared to a target of 130 to 150 mmHg.5 ACCORD did not confirm a link between SBP less than 120 mmHg and a decrease in CV events in DM patients, but there was a higher rate of adverse events with this intensive treatment arm.⁶

^

Finally, there were also considerable changes in the “Standards of Care in Diabetes – 2023” section on chronic kidney disease and risk management. The ADA now recommends the addition of finerenone, a selective non-steroidal mineralocorticoid antagonist, for patients with diabetes, chronic kidney disease (CKD), and albuminuria currently treated with an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker. The medication was approved by the Food and Drug Administration in 2021 and has been shown to reduce the risk of CKD progression and improve cardiovascular outcomes.⁷ Key studies involved in this change were Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) and Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease (FIDELIO-DKD) trials. The hazard ratio of a composite CV endpoint was reduced by 13% in patients treated with finerenone vs placebo.^8,9

Overall, most updates in this year’s ADA guidelines focused specifically on the management of hyperlipidemia, hypertension, and chronic kidney disease in diabetic patients. This differs from previous guideline modifications, which tended to be heavier on changes in therapy recommendations to achieve glycemic control. As current medications and approaches to managing diabetes continue to be maximized, emphasis should be given to comorbidity management. Considering all patient conditions, rather than just diabetes as a single condition, will help place patients on a path toward achieving optimal diabetes care.

References

1) Centers for Disease Control and Prevention. Diabetes Fast Facts. Diabetes. Retrieved from https://www.cdc.gov/diabetes/basics/quick-facts.html

2) Najafipour H, Farjami M, Sanjari M, Amirzadeh R, Shadkam Farokhi M, Mirzazadeh A. Prevalence and Incidence Rate of Diabetes, Pre-diabetes, Uncontrolled Diabetes, and Their Predictors in the Adult Population in Southeastern Iran: Findings From KERCADR Study. Front Public Health. 2021;9:611652. Published 2021 Nov 1. doi:10.3389/fpubh.2021.611652

3) ElSayed NA, Aleppo G, Aroda VR, et al. Cardiovascular disease and risk management: Standards of care in diabetes—2023. Diabetes Care. 2022;46(Supplement 1):S158-S190. 

4) Cannon CP, Blazing MA, Giugliano RP, et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med. 2015;372(25):2387-2397.

5) Zhang W, Zhang S, Deng Y, et al. Trial of intensive blood-pressure control in older patients with hypertension. N Engl J Med. 2021;385(14):1268-1279

6) Cushman WC, Evans GW, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362(17):1575-1585.

7) ElSayed NA, Aleppo G, Aroda VR, et al. Chronic kidney disease and risk management: Standards of care in diabetes—2023. Diabetes Care. 2022;46(Supplement 1):S191-S202.

8) Pitt B, Filippatos G, Agarwal R, et al. Cardiovascular events with finerenone in kidney disease and type 2 diabetes. N Engl J Med. 2021;385(24):2252-2263.

9) Agarwal R, Filippatos G, Pitt B, et al. Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis [published correction appears in Eur Heart J. 2022 May 21;43(20):1989]. Eur Heart J. 2022;43(6):474-484.

- ANTIMICROBIAL STEWARDSHIP -

The Status of Expedited Partner Therapy in Michigan 

By Hollyann Holmquist, Pharm.D. candidate; Kayla Backus Pharm.D., MBA candidate; Andrew de Voest, Pharm.D. candidate; Bianca C. Clarke RN, BSN;

and Michael Klepser, Pharm.D., FCCP, FIDP

In response to rising rates of sexually transmitted infections (STI) in Michigan, clinicians have turned to a new patient care strategy. Expedited Partner Therapy (EPT) is a means of providing an antibiotic for an STI anonymously and quickly to a patient diagnosed with an STI for their partners who might not otherwise seek care.

What Does EPT Look Like in Michigan?

The amendment to Public Act 525 of 2014 authorized the use of EPT in Michigan in January 2015.² EPT in Michigan targets three STIs: chlamydia, gonorrhea and trichomonas. EPT typically works by having the index patient give a written prescription to their partners, which can be covered by insurance if the partner presents the prescription to the pharmacy with their insurance information. Payment for the antibiotic is typically the responsibility of the partner and if the partner is not insured, they are able to pay out of pocket for the EPT medication. Pharmacies can fill these prescriptions even though they may not know the actual partner’s name or date of birth. For unnamed partners, pharmacies often input the prescription under a profile with the name “expedited partner therapy” and use Jan. 1 of the current year as the date of birth. If the partner is unable to pay for the prescription or does not have insurance that will cover the cost of the EPT medication, the partner should be referred to the local health department for free or low-cost STI treatment. There is no limit on how many courses of EPT a patient can request.

Treatment Regimens in Michigan

Michigan currently utilizes the 2021 Centers for Disease Control (CDC) STI Treatment Guidelines for EPT for both gonorrhea and chlamydia.¹ Although, EPT for trichomonas is not outlined in the CDC guidelines, the Michigan Department of Health and Human Services (MDHHS) has included it in their EPT guidelines due to the high prevalence among sexually active women.² If a partner is known to have allergies or contraindications to oral EPT, they must seek in-person treatment through a provider. 

Following are the current EPT regimens approved for use in Michigan:

Trichomonas

EPT regimens for partners of patients diagnosed with trichomonas infections are based on gender. For male partners, the EPT is metronidazole 2 g orally once as one single dose. For female partners, the EPT is metronidazole 500 mg twice daily for seven days. 

Gonorrhea

The EPT regimen for partners of patients diagnosed with gonococcal infections is cefixime 800 mg orally as a single dose. 

Chlamydia

The EPT regimen for partners of patients diagnosed with chlamydial infections is doxycycline 100 mg twice daily for seven days. 

When prescribing or dispensing EPT for chlamydia, azithromycin 1 g orally should be substituted for doxycycline when the partner is, or maybe, pregnant; or if the partner is unlikely to adhere to a seven-day regimen.

Chlamydia and Gonorrhea

Providers may write EPT prescriptions for both chlamydia and gonorrhea if there is a high suspicion of co-infection, if there are positive results for both STIs, or if a chlamydia result is not available at the time of treatment.  

The EPT regimen for partners of patients with suspected co-infection of chlamydia and gonorrhea is cefixime 800 mg orally as a single dose, plus doxycycline 100 mg twice daily for seven days.

Azithromycin 1 g orally should be substituted for doxycycline when the partner is, or maybe, pregnant; or if the partner is unlikely to adhere to a seven-day regimen.

Conclusion

It is important for healthcare professionals and members of the community to be aware of the public health resources that are available for the management of STIs. EPT is an innovative approach to combating the rise of STIs in Michigan.

Since 2012, the average gonorrhea rates have been on the rise while the average chlamydia rates have stayed the same. Michigan’s gonorrhea rate is rising similar to the national average [3].

References:

1. CDC. STI Treatment Guidelines. 29 June 2021, https://www.cdc.gov/std/treatment-guidelines/toc.htm. 

2. Michigan Department of Health and Human Services. Guidance for Health Care Providers: Expedited Partner Therapy (EPT) for Chlamydia, Gonorrhea, and Trichomoniasis, 2021. https://www.michigan.gov/-/media/Project/Websites/mdhhs/Folder4/Folder32/Folder3/Folder132/Folder2/Folder232/Folder1/Folder332/Expedited_Partner_Therapy_Guidance_for_Health_Care_Providers.pdf?rev=56ab4e1a513b4fab803eafa823d24edd

3. Michigan Department of Health and Human Services. STI Trends in Michigan, 2012 - 2021. https://www.michigan.gov/-/media/Project/Websites/mdhhs/Folder4/Folder32/Folder3/Folder132/Folder2/Folder232/Folder1/Folder332/Expedited_Partner_Therapy_Guidance_for_Health_Care_Providers.pdf?rev=56ab4e1a513b4fab803eafa823d24edd

- REGIONAL UPDATE -

Northern Michigan Society of Health-System Pharmacists Update

By Miranda Maitland, Pharm.D., BCPS, assistant director of pharmacy,

MyMichigan Medical Center Sault; NMSHP president 

The Northern Michigan Society of Health Systems Pharmacists (NMSHP) will be gathering for a virtual meeting May 9. From the pandemic we have learned remote and virtual options are effective methods of gathering our members spread across northern Michigan in a convenient matter. The meeting will consist of two hours of live continuing education for pharmacists and pharmacy technicians. NMSHP is excited to have Nathan Richards, Courtney Vanhouzen, Tony Huizenga, Brianna Brian, Carley Dubbert, and Genevieve Bates, the current PGY1 residents of Munson Medical Center, present their residency research projects. 

NMSHP is happy to share we had two members represent NMSHP at the House of Delegates at the Michigan Pharmacists Association Annual Convention and Exhibition (ACE). NMSHP would like to extend sincere gratitude to the entire MPA team for hosting an excellent ACE. 



For more information on upcoming meetings, please contact NMSHP president Miranda Maitland at mirandapmaitland@gmail.com.

OFFICERS

PRESIDENT | Michelle Dehoorne | (313) 343-6381 | Ascension, Detroit

PRESIDENT-ELECT | Kyle Schmidt | (616) 685-6675 | Mercy Health St. Mary's, Grand Rapids

IMMEDIATE PAST PRESIDENT | Shawna Kraft | (734) 232-6667 | Michigan Medicine, Ann Arbor

TREASURER | Marc Guzzardo | (810) 606-6095 | Ascension, Detroit

EXECUTIVE VICE PRESIDENT | Edward Szandzik | (313) 587-6279 | Detroit

DIRECTORS

Stacy Brousseau | (269) 341-7407 | Bronson Methodist Hospital, Kalamazoo

Diana Kostoff | (313) 725-7925 | Henry Ford, Detroit

Nada Farhat | nmhammou@med.umich.edu | Michigan Medicine, Ann Arbor

Julie Schmidt | (989) 450-6695 | Bronson Methodist Hospital, Kalamazoo

REGIONAL SOCIETY REPRESENTATIVES 

CENTRAL | Tim Ekola | (734) 845-3418 | VA Ann Arbor Healthcare System

NORTHERN | Miranda Maitland | mirandapmaitland@gmail.com | My Michigan Medical Center, Sault Ste. Marie

SOUTHEASTERN | Jessica Jones | (313) 982-5737 | Beaumont Health, Detroit

WESTERN | Shelby Kelsh | shelbyKelsh@ferris.edu | Ferris State University, Big Rapids

MANAGING EDITOR | Ryan Weiss | (517) 377-0232 | Michigan Pharmacists Association, Lansing