Future Pharmacy Research Articles

American Pharmacy: A Profession in the Final Stage of Dividing?

ABSTRACTThe organization and delivery of pharmaceutical services in the United States is undergoing sweeping changes, with implications to the future of pharmacy as a profession. This paper provides an overview of major educational, organizational, and economic changes in pharmacy during the twentieth century. Three main challenges have been faced by the pharmacy profession during the twentieth century: (1) the conflict between commercialism and professionalism in the practice of pharmacy, (2) the isolation of pharmacy education from the practice of pharmacy, (3) the choice between the drug product or the patient as pharmacy's social object. Using the professional dominance, deprofessionalization, and proletarianization theoretical perspectives, the authors conclude that the pharmacy profession is approaching the final stage of dividing into two groups: (1) a new patient-centered profession and (2) a new technical field.

Nursing and residential care for the elderly in Northern Ireland: the contribution of the pharmacist.

To gain more detailed information on the current pharmaceutical service provision in nursing and residential homes in Northern Ireland and to assess the views of care staff on future pharmacy services. A structured questionnaire was developed and mailed to all nursing and residential homes (n = 586) in Northern Ireland on two occasions. A response rate of 68% (n = 396) was obtained. The most frequent services currently provided by community pharmacists were the supply of medication and the collection of unwanted, discontinued or out-of-date medicines. The majority of respondents also reported receiving advice on safe-keeping, correct administration of medicines, advice on more appropriate formulations and advice on patient medication records from the community pharmacist. Over a third of all the respondents received advice on compliance devices. A similar proportion stated that their care staff were trained by the pharmacist on broad medication management issues. Over 90% of all homes strongly supported staff training by pharmacists on the recognition of medication-related problems as a future service. Over 70% of all respondents thought additional guidelines and advice for missed dosages and the use of home remedies would be beneficial. A review of patient medication records to assess drug-drug interactions and possible adverse drug reactions by pharmacists was supported by over 65% of all respondents. This work has demonstrated that those responsible for care in nursing and residential facilities strongly support further involvement by the pharmacist in these care facilities; pharmacy policy makers must ensure that such services are developed to meet the needs of these vulnerable elderly residents.

Political involvement now equals a prosperous pharmacy future

Political involvement now equals a prosperous pharmacy future

From Your Executive Committee: Pharmaceutical care: The future of pharmacy needs your help

From Your Executive Committee: Pharmaceutical care: The future of pharmacy needs your help

Pharmacy Technician Competencies for Practice in an Oncology Pharmacy

Objective: To document the additional competencies that a well-trained pharmacy technician, with no previous oncology pharmacy training or experience, needs to practice effectively in an oncology pharmacy; and to develop a form to document the training of oncology pharmacy technicians at our institution. Design: From September 1, 1997, to November 1, 1997, the oncology pharmacist and the oncology pharmacy technicians developed a list of pharmacy technician competencies that were believed to be unique to pharmacy technician practice in an oncology pharmacy. Information from MEDLINE searches, drug manufacturer materials, and reference books was used to support the competencies identified. Setting: This project was conducted at Brooke Army Medical Center, a 450-bed teaching and research institution of the US Army Medical Department. Results: Twenty-five oncology pharmacy technician competencies were documented. This list was made into a form for inclusion in each oncology pharmacy technician's competency-based assessment folder and for use in training of future oncology pharmacy technicians. Conclusions: There are a significant number of additional competencies that a well-trained pharmacy technician needs in order to practice effectively in our institution's oncology pharmacy. The identification of these additional competencies facilitated the development of a form to document the training of oncology pharmacy technicians.

Pharmacists in the future

Over the next few years, over 40 000 pharmacists in the US will have to make themselves more valuable as the processes of automation and centralisation occur. Otherwise, many pharmacists face the bleak prospect of being replaced by automated technology. The future of pharmacy in the changing healthcare environment may depend on the ability of the discipline to prove the value of pharmaceutical care in the provision of comprehensive healthcare. The future role of the profession was discussed at the 10th Annual Meeting of the National Managed Health Care Congress [Atlanta, US; April 1998].

What are outcomes?

Understanding the important aspects of measuring outcomes will prepare pharmacists for changes in the marketplace and help them to assess the results of studies that will appear in subsequent issues of the Journal of the American Pharmaceutical Association and the research journals of other health services professions. In any evaluation of quality, all three quality measures (structure, process, and outcomes) must be considered. No one measure, in isolation, can describe the quality of care provided. Thus, the best patient care will come from health care practitioners who document structure, process, and outcomes and who evaluate these measures to provide appropriate care. The pharmacist cannot dispense prescriptions or provide pharmaceutical care without a pharmacy, drug inventory, or patient profiles, all of which are important structural inputs. The pharmacist takes a medication history, monitors the drug regimen, and counsels the patient on the appropriate way to use the treatment, all vital process activities. The objective of these inputs and actions is to improve the health status of the patient. Outcomes, therefore, are the intended endpoints of care, and occasional unintended effects (e.g., adverse drug reactions) as well. The future of pharmacy rests on demonstrating the positive effect of pharmaceutical care on patient outcomes. Pharmacists have always been part of the system of checks and balances in health care delivery. As the provision of health services changes, opportunities to assess the process and structure of care and to document patient outcomes will increase. Pharmacists are well positioned to intervene in patient care, but if they do not demonstrate the value of pharmacy services, they will face competition from alternative providers. Some have even suggested less expensive alternatives to having pharmacists dispense medications. Pharmacists must establish that their role goes beyond dispensing to include cognitive services such as compliance programs, screening services, glucose monitoring, and disease management programs. Pharmacists must document their role and its effects on patient outcomes.

Predictors of organizational and career commitment among Illinois pharmacists.

Illinois pharmacists were surveyed to identify predictors of their work-related attitudes. A survey was mailed in April 1994 to 600 Illinois pharmacists to identify their attitudes about their career, the organization where they work, and the impact of national health care reform and the pharmaceutical care movement on the future of pharmacy. The survey also collected information on the respondents' work site and position; coworkers, family, and friends; and demographic characteristics. The survey was completed by 337 pharmacists. Pharmacists who believed that pharmaceutical care would have a more positive effect on pharmacy were more committed to their employer and to pharmacy as a career. Co-worker support had a positive effect on perceptions about pharmaceutical care, and supervisor support increased career and organizational commitment. Age did not affect career or organizational commitment, but it did negatively affect pharmacists' views of the impact that the call for pharmaceutical care would have on pharmacy. Hospital pharmacists were less committed than community pharmacists to the organizations where they worked. Practice setting, supervisor support, and perceptions about the impact of the pharmaceutical care movement were identified as possible predictors of career and organizational commitment.

Meeting Pharmacy's Future: A Preview of Five Annual Meeting Educational Sessions: The educational sessions at the APhA 1995 Annual Meeting will provide practical, timely information to help you thrive in a changing practice environment.

Meeting Pharmacy's Future: A Preview of Five Annual Meeting Educational Sessions: The educational sessions at the APhA 1995 Annual Meeting will provide practical, timely information to help you thrive in a changing practice environment.

A 12-Step Method for Developing New Pharmacy Programs

Clinical pharmacy service managers are usually responsible for establishing new programs. Many different methods have been used successfully to implement new clinical pharmacy services. These methods vary greatly when services are forced into development during a crisis situation as opposed to having time to employ strategic planning. The 12-step method is ideal for pharmacy leaders who have time to plan the best process for service development. However, individual hospital demographics may dictate the most effective plan for new program development. Teaching versus community hospitals and for-profit versus not-for-profit hospitals have very diverse philosophies. Clinical coordinators must assume a selling role when writing program proposals. The future of pharmacy will depend on the ability of the pharmacy leaders to establish patient-focused services that are also cost-effective.

Creating Pharmacy's Future: This pharmacy school dean calls on all pharmacists to join in creating a future for the profession that is based on pharmaceutical care

Creating Pharmacy's Future: This pharmacy school dean calls on all pharmacists to join in creating a future for the profession that is based on pharmaceutical care

A Review and Analysis of the Medicaid Prudent Pharmaceutical Purchasing Bill and Its Impact on Managed Care Pharmacy

The Medicaid Prudent Pharmaceutical Purchasing Bill is designed to improve Medicaid patients' access to medications in return for signed rebate agreements from pharmaceutical manufacturers. The legislation also recognizes and attempts to develop the potential clinical role of pharmacy through mandates for drug utilization review, patient counseling, and electronic claims processing for Medicaid patients. Managed care pharmacy has a distinct advantage in the achievement of these clinical roles; it has already implemented drug utilization review and has electronic claims capabilities. This article reviews the legislation and describes the potential impact of the law on managed care pharmacy practice. The government is a major player in terms of setting health policy and trends in this country, and managed care pharmacy departments should be keenly aware of the legislative impact on overall future pharmacy trends. The potential exists for other government agencies and eventually the private sector to require and reimburse for provisions similar to those described in the Medicaid legislation. Managed care pharmacists should take a special interest in ensuring that the demonstration projects and studies mandated by the legislation show positive documentation of pharmacists' intervention so that eventually pharmacists will be properly compensated for such services in the public and private sectors.

Is a Third Class of Drugs in Pharmacy's Future?

Is a Third Class of Drugs in Pharmacy's Future?

Utah Society looks at pharmacy's future at annual meeting

Utah Society looks at pharmacy's future at annual meeting

Specialization and Pharmacy's Future

This paper briefly reviews the development of the Board of Pharmaceutical Specialties (BPS) and the specialty certification process. The importance of performing a role delineation in the preparation of a certification examination is discussed. Additionally, the relevance of role delineation of current clinical specialties to the future structure of recognition and certification procedures is outlined. Broad-based discussion of issues important to specialization such as manpower, academic preparation, postgraduate training, interprofessional relationships, and reimbursement is encouraged. The purpose and intent of the BPS self-study is described and participation by the profession in this examination is requested.

Workshop 2: Training future pharmacy leaders

Workshop 2: Training future pharmacy leaders

Office-Based Medication Dispensing: Another Consideration

We read with interest the American Academy of Pediatrics' recommendation concerning dispensing of medications by physicians (Pediatrics. 1989;83:143-144). In 1987, dispensing of prepackaged prescriptions was a consideration at the Pocatello Children & Adolescent Clinic. A pharmacy that shared the same building as the clinic had closed in 1982. Despite the loss of the pharmacy, the need for patient convenience in obtaining medications continued. The decision was made not to purchase prepackaged prescriptions for dispensing by physicians. Instead, a community pharmacy (Future Generation Pharmacy) owned by the pediatricians was constructed.

Drug Usage Evaluation (DUE) Activity in PSAOs

Summary To describe PSAO drug usage evaluation (DUE) activity during DUE's developmental stages, the authors surveyed 44 state PSAOs and one independent DUE program. Of those surveyed, 23 were operating DUE programs, 16 of which had been operational for less than 3years. All identified their most important goal to be that of reducing costs. This was closely followed by the goal of reducing and preventing inappropriate prescribing and dispensing. AU programs reported intervening when potential problems are identified. The DUE programs provide extensive information on drug use and provider behavior which is expected to have a profound impact on future pharmacy practice. It is likely that mnst PSAOs will eitheradd such a program or revise the current one.

Leadership in a Clinical Profession

The contributions of residency training programs to pharmacy's development into a clinical profession are described. Residency programs supply institutional pharmacy with mature, highly skilled clinical and managerial practitioners, and ASHP's accreditation process ensures the programs' quality. Residents develop values, philosophy, and vision that breed innovation and advancement of the profession. As pharmacy departments strive to meet the standards set by the accreditation program, the level of services rises; subsequently, higher standards are established and practice advances accordingly. Future residency training for community practice and the movement toward the Pharm.D. as the sole entry-level degree for practitioners must be evaluated in terms of effect on patient care and on pharmacy school and hospital resources. Planning for future pharmacy education and manpower needs should involve the whole profession, but the needs of community and hospital pharmacy may differ. A goal for the future is entry-level residency training for all hospital pharmacists, with the Pharm.D. degree as a prerequisite. Such a residency program would focus on clinical practice and provide experience in all pharmaceutical services and the overall management of a pharmacy department; it would be a prerequisite for advanced specialized residency programs. Managers of departments providing clinical services will need an entry-level clinical residency followed by a specialized residency in administration. In their 25-year history, residency programs have contributed greatly to the profession. Efforts to develop quality residency training sites and promote them to pharmacy graduates should continue.

Unresolved Issues in the Future of Pharmacy

The effect of the major forces shaping pharmacy's future--technology, economics, and social values--is discussed. Pharmacy can best respond to these forces by expanding the informational component of pharmacy practice and by returning to its fundamental relationship with society--that is, by accepting responsibility for drug-use control. To accomplish this, pharmacy must go through a process of occupational reconstruction and self-renewal. Technological forces shaping pharmacy practice include computers and robotics, communications, and therapeutics. Regarding economic changes, medical-care decisions are shifting away from individuals toward "third parties." This factor, combined with output-based payment systems, may lead to a consolidation of service providers. Marketing pharmaceutical services and organizing pharmacy's internal structure will become important. Some of the social forces affecting pharmacy's future include the aging population, the weakening of professional authority, and pharmacy's public image. Just as society goes through the "information revolution," pharmacy will need to undergo a "reprofessionalization." Pharmacy's societal function should involve "pharmaceutical care," a concept that includes both drug-product control and clinical pharmacy services. Pharmacy should return to its preindustrial origins in valued, complex, specific, and committed public service if it wishes a happy postindustrial future.