National Pharmacy Association Research Articles

Analysis of enquiries to the National Pharmacy Association following major changes to controlled drug legislation in the UK

The National Pharmacy Association (NPA) provides an advice service to community pharmacists in the UK, and keeps a database of the enquiries it receives. The aim of this research was to analyse the database for the period of October 2007 to March 2008 to gain an insight into how well pharmacists coped with legislative changes directly affecting pharmacy by identifying which changes generated the most enquiries during these 6 months and ascertaining in which months these queries were at their highest levels. Anonymised telephone enquiries regarding controlled drugs (CDs) received by the NPA from pharmacists during a 6-month period were reviewed and categorised according to the legislative change or other CD issue to which they related. A Poisson model was applied to determine whether there was a significant difference in the total number of CD queries generated each month. Altogether 6082 queries regarding CDs were received, of which 57% related to legislative changes. The three legislative changes that took place during the 6-month period all generated a significant increase in numbers of queries around the time of the change. Queries regarding the new form of CD register comprised the largest single category. Community pharmacists seek information regarding legislative changes when such changes come into force to a greater degree than when the legislation is drafted, consulted upon or enacted. The high number of queries received by the NPA does reflect that there was a difficulty in applying the various legislative changes in practice.

The Mandatory Residency Dilemma: Parallels to Historical Transitions in Pharmacy Education

To review recent literature regarding mandatory residencies in the perspective of the historical entry-level degree debate. Articles were identified through searches of MEDLINE/PubMed, national pharmacy association Web sites, and a review of the references of related literature. Several studies, commentaries, and reviews are examined to discuss viewpoints from both the entry-level degree and mandatory residency debates. Similarities were observed between the 2 debates in regard to objectives and rationale for change, educational issues, pharmaceutical care issues, and economic issues. Fewer than 10 years ago, after many years of debate, colleges of pharmacy made the transition to offering the PharmD degree as the sole entry-level degree for licensure as a pharmacist. Similar debates have taken place over the past several years and continue to take place regarding the necessity for residency training. One key 2006 document by the American College of Clinical Pharmacy calls for mandatory residency training for entry into pharmacy practice by 2020. In parallel with the entry-level degree debate, consensus has yet to be reached among pharmacists and pharmacy organizations, but several have shown support for mandatory residency training for all pharmacists involved in direct patient care. Many questions have yet to be answered regarding the timeline, economics, and feasibility of such a mandate.

Characterizing the American College of Clinical Pharmacy Practice‐Based Research Network

To present the member registry survey methods and characterize the first national clinical pharmacy practice-based research network (PBRN). Cross-sectional online survey. A national clinical pharmacy association. American College of Clinical Pharmacy (ACCP) full and associate members, integrated health system groups of pharmacists, and existing PBRNs were invited to participate in the registry and complete the survey. An association-wide invitation to join the ACCP PBRN was sent to ACCP members who were actively involved in direct patient care or who had access to a patient base for research purposes. Interested pharmacists completed a three-part online survey regarding professional background, practice site, and clinical pharmacy practice. A total of 416 members completed the online registry. These pharmacists practice at 263 distinct clinical sites in 43 states. Forty-six percent of the sites were located within a university hospital, and 30% were within a community hospital setting. Of those working in these two hospital settings, 33% and 40%, respectively, practiced within an outpatient clinic. The ACCP PBRN member pharmacists spent an average of 5 half-days providing clinical pharmacy services and saw a median of 30 patients/week. The most common laboratory tests ordered by member pharmacists were metabolic panels, prothrombin times or international normalized ratios, liver function tests, and blood glucose levels. The most frequently managed conditions or disease states were pharmacotherapy and/or polypharmacy, anticoagulation, diabetes mellitus, and hypertension. Almost two thirds of the pharmacists used an electronic medical record system. Thirty-five percent operated with the use of collaborative practice documents within their sites, whereas 32% had scope of practice agreements. Ninety-five percent did not bill for clinical pharmacy services rendered. The ACCP PBRN is the first national clinical pharmacy PBRN. Its membership has a distinctive profile of primary care and specialty clinical pharmacists who work both within inpatient and outpatient settings. Both internal and external stakeholders are expected to use these ACCP PBRN registry data to support the capabilities and capacity of the ACCP PBRN.

Medication adherence and community pharmacy: a review of education, policy and research in England.

The objective of this narrative review was to identify and describe the current policy, education and research related to community pharmacy and medication adherence in England. Medline, Embase, International Pharmaceutical Abstracts and Pharmline were used to search for relevant research articles. Current policy documents were identified via the websites of the Department of Health in England, the Royal Pharmaceutical Society of Great Britain, the National Pharmacy Association, the Pharmaceutical Services Negotiating Committee and NHS Employers. All pharmacy schools in England were contacted to obtain information about the adherence-related courses they provide to undergraduate and postgraduate pharmacy students. National policies and guidelines in England are conducive to an increasing role for community pharmacists to support patients with medication adherence. Many pharmacy schools cover the issue of adherence in their undergraduate and postgraduate courses. Research in this area has tested the effectiveness of pharmacists providing adherence support in the form of compliance aids, education, involvement in discharge planning, and tailored interventions. In community pharmacy in England, current policy and funding arrangements suggest there is great scope for pharmacists to support patients with medication adherence. Further research is necessary to identify the most useful, cost-effective and sustainable approach in practice.

Pharmacists lend a hand

When I read Douglas Fleming's suggestion (Pharmaceutical Journal 2007; 279: 441) that Britain's pharmacists could “play an extended role in the management of seasonal influenza”, I reacted sceptically. Pharmaceutical chemists do tend to have exaggerated ideas of their own importance. Some years ago, the Royal Pharmaceutical Society tried to restrict the sale of over-the-counter nostrums to places within its own fiefdom. Aspirin, for example, should be banned from filling stations and be made available only through pharmacies with pharmacists “in attendance”. Much more recently, Alison White, Chief Executive of the National Pharmacy Association, was grumbling about her profession being excluded from Lord Darzi's review of the UK National Health Service (The Times, Oct 26, 2007).

Community Pharmacy Services in Portugal

To describe the status and outline the trends of community pharmacy services in the Portuguese healthcare system. The legal framework for Portuguese pharmacies includes geographic and demographic criteria for opening pharmacies and restricting ownership to pharmacists. Since 1975, pharmacy owners have been organized under one association, the Portuguese National Pharmacy Association, which has dealt with pharmacy development over the past 20 years. Securing the economic sustainability of pharmacies was the first milestone. Investing in information software and communication technologies and modernizing the architecture of pharmacies was the next step. Then, professional services such as point-of-care measurements, drug waste management, and needle exchange services were developed. The methadone substitution program was introduced at a later date. Finally, major comprehensive services, including disease management/pharmaceutical care programs, were implemented. All Portuguese pharmacies are independent, which means that the decision to provide different services and the extent to which they are attained vary from pharmacy to pharmacy. Recent political changes seem to reinforce the need to pursue the strategies already defined-to expand the traditional scope of pharmacy business to a wider range of health services. Achievements that have been accomplished and strategies that are in place reflect a high level of organization and unity among Portuguese pharmacies. From a global perspective, pharmacies are reorganizing to be able to compete against other possible agents and are preparing to expand their scope of intervention.

Pharmaceutical Care in Community Pharmacies: Practice and Research in the US

To describe the state of community pharmacy, including patient care services, in the US. Chain pharmacies, including traditional chains, mass merchandisers, and supermarkets, comprise more than 50% of community pharmacies in the US. Dispensing of drugs remains the primary focus, yet the incidence of patients being counseled on medications appears to be increasing. More than 25% of independent community pharmacy owners report providing some patient clinical care services, such as medication counseling and chronic disease management. Most insurance programs pay pharmacists only for dispensing services, yet there are a growing number of public and private initiatives that reimburse pharmacists for cognitive services. Clinical care opportunities exist in the new Medicare prescription drug benefit plan, as it requires medication therapy management services for specific enrollees. The private market approach to healthcare delivery in the US, including pharmacy services, precludes national and statewide strategies to change the basic business model. To date, most pharmacies remain focused on dispensing prescriptions. With lower dispensing fees and higher operating costs, community pharmacies are focused on increasing productivity and efficiency through technology and technicians. Pharmacists remain challenged to establish the value of their nondispensing-related pharmaceutical care services in the private sector. As the cost of suboptimal drug therapy becomes more evident, medication therapy management may become a required pharmacy benefit in private drug insurance plans. Pharmacy school curricula, as well as national and state pharmacy associations, continually work to train and promote community pharmacists for these roles. Practice research is driven primarily by interested academics and, to a lesser degree, by pharmacy associations. Efficient dispensing of prescriptions is the primary focus of community pharmacies in the US. Some well designed practice-based research has been conducted, but there is no national research agenda or infrastructure. Reimbursement for cognitive services remains an infrequent, but growing, activity.

National Pharmacy Associations Unite over Plan to Overhaul Medicaid: APhA brings together pharmacy leaders to discuss pharmacists’ concerns on both the state and federal levels.

National Pharmacy Associations Unite over Plan to Overhaul Medicaid: APhA brings together pharmacy leaders to discuss pharmacists’ concerns on both the state and federal levels.

Rho Chi lecture. Pharmacy in a smaller world.

Health care is a business. Pharmacy is in the health business. The health care delivery system in the U.S. is rapidly becoming a managed system by corporations. Further, these corporations are moving toward international markets where some already have considerable experience. There are many parts of the world not participating in these developments in health care. Some are just off our shores in the Caribbean Basin. A review of activities occurring in recent years by various groups suggests that more could be done. Two modest approaches are presented. Support of the American Association of Colleges of Pharmacy's "Pharmacy School Twinning Project" through which U.S. pharmacy schools would work with pharmacy schools in Central and South America is recommended. Also, national pharmacy associations jointly with pharmaceutical companies would work together using their expertise in continuing pharmacy education to develop new education models for the needy areas of the world.