Pharmacy Administration Research Articles

Role of Board‐Certified Psychiatric Pharmacists in child and adolescent psychiatry

AbstractIn the context of ongoing workforce shortages, rising symptom severity, and increased rates of psychotropic prescribing, the 2021 declaration of a national emergency in child and adolescent psychiatry (CAP) has highlighted the need for innovative strategies to address access to quality care. As valued members of the interdisciplinary team, Board‐Certified Psychiatric Pharmacists (BCPPs) in CAP are well‐positioned to address these needs as they are integrated across various settings (e.g., ambulatory clinics, and psychiatric hospitals) and have expertise in psychiatric and neurodevelopmental disorders. As educators and advocates for evidence‐based psychotropic medication management, BCPPs in CAP decrease polypharmacy, increase medication adherence and knowledge, and enhance patient outcomes. Given the need for interdisciplinary collaboration among BCPPs, CAP, and primary care providers, it is crucial for pharmacy administrators to respond and recognize the necessity of integrating pharmacy services into CAP and integrating BCPPs into pharmacy departments.

FIP Brisbane 2023: Social and Administrative Pharmacy

Accepted abstracts under the theme: Social and Administrative Pharmacy (n=125)

Corticosteroid Use and Adherence in Patients Treated with Acthar Gel for Advanced Sarcoidosis.

Long-term corticosteroid use in immune-mediated diseases is associated with increased risk of adverse events (AEs) and worsened health-related quality of life (HRQoL). Previous studies report chronic high-dose corticosteroid therapy results in higher rates of healthcare resource use and AE-related medical costs. Recent studies suggest Acthar® Gel (repository corticotropin injection) is an effective steroid-sparing therapy for sarcoidosis. This study compares the corticosteroid-sparing effect between Acthar Gel and comparators and evaluates the impact of Acthar Gel adherence on reduction of corticosteroid burden. A retrospective analysis of a large administrative pharmacy and medical claims database (Symphony Health Solutions) was conducted. Patients were included with confirmed ICD-9/10 diagnosis for sarcoidosis in the study period (2014-2020), followed by ≥ 2 Acthar Gel claims or comparators (janus kinase inhibitor (JAKi)/rituximab), ≥ 18years old, with 12months coverage pre/post index. Outcomes were compared as change from baseline. Acthar Gel adherence was determined by proportion of days covered in the follow-up period. The Acthar Gel (n = 735) and comparator (n = 626) cohorts were mostly female (68-72%) between 55 and 58years old. Compared to the comparator cohort at baseline, Acthar Gel patients had greater any corticosteroid use (80% vs. 56%, p < 0.001), extended use (61% vs. 32%, p < 0.001), and mean average daily dose (6.72 vs. 3.03, p < 0.001). After treatment, Acthar Gel patients had greater reduction from baseline in any corticosteroid use (-9.0% vs. -3.2%) and extended use (-10.0% vs. -3.0%). In the Acthar Gel adherence cohorts, patients with above average adherence had greater reduction in both measures (-11.2% vs. -6.1%; -11.6% vs. -7.6%, respectively) than patients with below average adherence. Acthar Gel patients had greater reduction of extended use at all dose levels. Acthar Gel is associated with reductions in corticosteroid use compared to alternatives. Better adherence is associated with greater reduction in corticosteroid exposure. Key Summary Points.

The Relationship Between Physical Activity And Diet With Nutritional Status In Students At The Iik Strada Indonesia Campus In Kediri City

In Indonesia, the nutritional problem that is being faced is the problem of undernutrition but more nutritional problems are starting to emerge simultaneously (double burden). Generally, adolescent age groups need enough energy to do diverse physical activities, light physical activity such as sitting or lying down, talking, reading, playing games and watching TV is more at risk of causing heart disease and blood vessels. The purpose of this study was to determine the relationship between physical activity and diet with nutritional status in students at the IIK Strada Indonesia campus in Kediri City. The method used is a quantitative method with a cross sectional type of research. The population in this study was all 7th semester fakar faculty students majoring in public health, pharmacy and hospital administration. The sample size was 42 respondents. The results of the study found a relationship between diet and nutritional status in students at the IIK STRADA Indonesia campus in Kediri City where the results of the chi-square test analysis obtained a p-value of 0.002. There is no relationship between physical activity and nutrition ststus in students at the IIK STRADA Indonesia campus in Kediri City where the results of the chi-square test analysis obtained a p-value of 0.757. ). For respondents whose nutritional status is lacking, it is recommended to increase nutritional intake according to needs and do physical activity according to their abilities. Physical activity that is done regularly such as brisk walking or jogging can reduce fat accumulation so as to reduce a person's risk of overweight conditions. Studentswhose diet is lacking and have thin nutritional status, according to the results of the existing questionnaire that this is because respondents in a day their food intake is less because their eating habits are less varied types. In addition, students in terms of eating they are too picky so that they are not controlled what they eat.

Analysis of Gender and Race in Pharmacy Faculty and Administrators

ObjectiveThe objective of this report is to identify and characterize the relative likelihood of women and racially minoritized pharmacy faculty being promoted, advancing within leadership roles, and earning comparable salaries. MethodsData from the 2010–2021 American Association of Colleges of Pharmacy Profile of Pharmacy Faculty surveys were analyzed to compare odds ratios for promotion, leadership roles, and salary gaps of pharmacy faculty according to race and gender. Changes in the odds ratios over time were characterized by linear regression and predictions about when and if equality would be achieved according to current trends were calculated. ResultsCompared to White male counterparts, faculty identifying as women, Black, Hispanic, or Asian had a significantly lower odds ratio of promotion to associate or full professor. Women and Asian faculty also had a lower likelihood of promotion from assistant to associate or Chief Executive Officer (CEO) dean. No demographics studied were more likely than White men to advance in rank or attain associate or CEO dean leadership positions. Furthermore, negative salary gaps for women emerge after promotion from assistant professor, becoming significant and continuing to widen at the associate (−$20,419) and CEO dean (−$37,495) level. ConclusionDespite attention to matters of diversity, equity, and inclusion, female and racially minoritized faculty continue to experience lower rates of promotion, leadership advancement, and wages compared to White male colleagues. These results have negative consequences for recruiting and retaining talented faculty and students, and compromise the benefits that a diverse faculty is known to provide on student learning outcomes.

FIP Seville 2022: Social and Administrative Pharmacy

FIP Seville 2022: Social and Administrative Pharmacy

Analysis of Gender Equity in the Salary of Pharmacy Faculty and Administration

Analysis of Gender Equity in the Salary of Pharmacy Faculty and Administration

Economic Considerations and Cost-Saving Strategies for Nonsterile Compounding Education

ObjectiveTo determine the economic considerations, including cost-saving strategies, associated with nonsterile compounding education for students in schools and colleges of pharmacy across the United States. MethodsAn electronic survey was sent to the American Association of Colleges of Pharmacy Pharmaceutics Section and Laboratory Instructor's Special Interest Group members. Quantitative and qualitative data were collected about the institution, student cohorts, compounding courses, equipment, budgets, personnel, and cost-saving measures. Descriptive statistics were calculated using SPSS. Open-ended responses were used by respondents if the primary question could not adequately capture their institution-specific information. These answers were added to the study findings. ResultsOf 555 surveys sent, 46 were completed. Reported annual compounding budgets ranged from $3000 to $96,000. Reported annual equipment maintenance costs ranged from $400 to $18,000. Fifty percent of respondents reported students shared equipment, and 29.6% collected a lab fee from students to offset costs. Approximately half of respondents reported the use of cost-saving measures, including contract pricing, purchasing supplies in bulk, price comparisons, use of simulated drugs, re-use of personal protective equipment, and procurement of donations. Fifty percent of respondents employed laboratory assistants to support nonsterile compounding sessions, with paid positions ranging from $200 to $1000 per semester. ConclusionFindings from this study may assist pharmacy administrators and course directors in evaluating the costs associated with nonsterile compounding education across the Academy and, more importantly, determining ways to reduce such costs while maintaining the intent and quality of these courses.

Qualitative analysis of community pharmacy–based COVID-19 immunization service operations

BackgroundThe unprecedented coronavirus disease 2019 (COVID-19) pandemic has generated worldwide impacts while positioning community pharmacies as easily accessible immunizers to rollout the COVID-19 vaccine. ObjectivesThis study describes community pharmacists’ experiences, success stories, and lessons learned from providing COVID-19 immunization services. MethodsThis study was conducted in February to March 2022 using semistructured interviews with licensed pharmacists practicing full-time in Alabama community pharmacies. Transcribed interviews’ content analysis was conducted by 2 independent coders in ATLAS.ti software. ResultsNineteen interviews were completed. Pharmacists’ experiences in the implementation of COVID-19 immunization services are described across 4 themes: (1) on-site and off-site immunization locations, (2) roles and responsibilities of pharmacy personnel, (3) vaccine storage and administration, and (4) vaccine waste reduction and immunization uptake strategies. This study found that pharmacists’ ability to adapt is vital to maintaining their ability to offer immunization services and other services. Pharmacists’ capacity for adapting is exemplified through their ability to acclimate to becoming a primary hub of outpatient health care services, accommodating to COVID-19 social distancing and vaccine guidelines, and disseminating a novel vaccine with varying supply and demand. In addition, pharmacies gathered and maintained waitlists of patients and adopted an appointment-based model as to predict, plan, and provide for patients. Pharmacists also used reactive techniques and workflow aspects to dissuade COVID-19 vaccine waste such as in contacting interested patients on waitlists or switching to a walk-in acceptance model. The COVID-19 pandemic elicited unprecedented alterations to the legal, health care responsibilities granted to pharmacy staff with participants describing pharmacy technicians as making a considerable impact to pharmacies’ workflow. ConclusionsPharmacists stepped up as frontline providers during a time of public health emergency with their diverse experiences granting policy makers and researchers much to learn from as, in their communities, pharmacists have continued to increase access to care during a national health crisis.

Atención farmacéutica en la bibliografía nacional e internacional

Healthcare Utilisation and Clinical Outcomes in Older Cardiovascular Patients Receiving Comprehensive Medication Management Services: A Nonrandomised Clinical Study Brajkovic A, Bosnar L, Int. J. Environ, Ramalho de Oliveira D, et al. Res. Public Health. 2022; 19(5): 2781. https://doi.org/10.3390/ijerph19052781 Are pharmacists’ knowledge and practice the key to promoting deprescribing of potentially inappropriate medication: a missing link between treatment and outcomes. Faris El-Dahiyat, Ammar Abdulrahman Jairoun, et al. International Journal of Pharmacy Practice, 2023; riad027 https://doi.org/10.1093/ijpp/riad027 A photovoice study on community pharmacists’ roles and lived experiences during the COVID-19 pandemic Kaitlyn E. Watson, Theresa J. Schindel, et al. Research in Social and Administrative Pharmacy. 2023; 19(6):944-955. https://doi.org/10.1016/j.sapharm.2023.03.005

Medication use optimization in critical care through a pharmacy morbidity, mortality, and improvement program

AbstractPharmacy‐led morbidity, mortality, and improvement (MMI) programs enhance practitioner education and improve patient‐safety culture. The impact of MMI programs on process improvement (PI) outcomes is lacking, particularly within critical care. The purpose of this retrospective report was to describe PI interventions from critical care medication errors evaluated through a pharmacy MMI program. Medication errors reported between June 2013 and August 2022 that occurred in an intensive care unit, emergency department, or procedural area were included. Error severity and potential were assessed using the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Medication Error Index and Harm Associated with Medication Error Classification (HAMEC), respectively. The primary outcome of PI interventions was classified as clinical update, operations change, pharmacy or hospital administration change, and/or informatics and technology (IT) updates. Electronic medical record (EMR) were further classified as best practice advisory, medication order build/change, order set build/change, dose limit/alert, or infusion smart pump change. Institute for Healthcare Improvement (IHI) reliability level was evaluated as a secondary outcome. A total of 54 errors were included. Most errors were classified as NCC MERP category D (13 [24.1%]) and C (12 [22.2%]) with severe harm potential (HAMEC 4, 26 [48.1%]; median score 3 [interquartile range, IQR, 3–4]) error potential. A total of 88 PI interventions were identified (median 1.5 [IQR 1–2] per error); clinical (30 [34.1%]) and IT (26 [29.5%]) updates were the most common. Order set build or change (20 [45.5%]) was the most common EMR enhancement. PI interventions were a median IHI level 1 reliability (IQR, 1–2). EMR enhancements had a median IHI level of reliability of 2 (IQR, 1–2). Critical care medication errors addressed through a formal Pharmacy MMI program have high harm potential and often involve multiple PI interventions. EMR interventions generally had higher levels of empiric reliability.

Development and Validation of a Prediction Model for Incident Hypothyroidism in a National Chronic Kidney Disease Cohort.

Hypothyroidism is a common yet under-recognized condition in patients with chronic kidney disease (CKD), which may lead to end-organ complications if left untreated. We developed a prediction tool to identify CKD patients at risk for incident hypothyroidism. Among 15 642 patients with stages 4 to 5 CKD without evidence of pre-existing thyroid disease, we developed and validated a risk prediction tool for the development of incident hypothyroidism (defined as thyrotropin [TSH] > 5.0 mIU/L) using the Optum Labs Data Warehouse, which contains de-identified administrative claims, including medical and pharmacy claims and enrollment records for commercial and Medicare Advantage enrollees as well as electronic health record data. Patients were divided into a two-thirds development set and a one-third validation set. Prediction models were developed using Cox models to estimate probability of incident hypothyroidism. There were 1650 (11%) cases of incident hypothyroidism during a median follow-up of 3.4 years. Characteristics associated with hypothyroidism included older age, White race, higher body mass index, low serum albumin, higher baseline TSH, hypertension, congestive heart failure, exposure to iodinated contrast via angiogram or computed tomography scan, and amiodarone use. Model discrimination was good with similar C-statistics in the development and validation datasets: 0.77 (95% CI 0.75-0.78) and 0.76 (95% CI 0.74-0.78), respectively. Model goodness-of-fit tests showed adequate fit in the overall cohort (P = .47) as well as in a subcohort of patients with stage 5 CKD (P = .33). In a national cohort of CKD patients, we developed a clinical prediction tool identifying those at risk for incident hypothyroidism to inform prioritized screening, monitoring, and treatment in this population.

116 A Performance Testing Protocol for Closed System Transfer Devices Used During Pharmacy Compounding and Administration of Hazardous Drugs

Abstract Cytotoxic and other hazardous drugs, whilst potentially therapeutic to patients, pose an occupational exposure hazard to healthcare workers during compounding and administration. However, occupational exposure to these drug compounds can be reduced with the use of closed system transfer devices (CSTDs) designed to prevent the escape of aerosol, liquid or vapour from a hazardous drug vial. In 2015 NIOSH developed a test procedure to assess the containment performance of CSTDs using an isopropanol-water challenge agent and infra-red detection. However, this protocol could not be used to assess devices using air filtration technology. HSE and BSTL therefore developed a modified procedure, using less volatile challenge agents and measurement using thermal desorption (TD) and gas chromatography-mass spectrometry (GC-MS), which could be used to assess all CSTD types. Unlike the NIOSH procedure this approach does not give a ‘real-time’ result but shows significantly greater sensitivity with the challenge agents used; typically being able to detect an airborne concentration of less than 1 part per billion (ppb). Testing carried out using a solution of 2-phenoxyethanol as the challenge agent showed no evidence of release with three of the four CSTDs tested; two barrier devices and one using air filtration. The tests also showed limits of detection to be dependent not only on the analytical procedure but on the effectiveness of the cleaning regime used to decontaminate the exposure chamber between tests.

Economic Considerations and Cost-Saving Strategies for Sterile Compounding Education

ObjectiveTo determine economic considerations associated with the facilitation of sterile compounding education for students in schools and colleges of pharmacy across the United States. MethodsAn online survey was sent to members of the American Association of Colleges of Pharmacy Pharmaceutics Section and Laboratory Instructor’s Special Interest Group. Quantitative and qualitative data were collected on general information about the institution, student cohorts, compounding courses, types of compounds prepared, equipment, budgets, personnel, and cost-saving measures. Descriptive statistics were calculated using SPSS. Open-ended responses were used by respondents if the primary question could not adequately capture their institution-specific information. These answers were added to the study findings. ResultsOf 555 surveys sent, 40 were completed. Reported annual sterile compounding budgets ranged from $500 to $95,500. Twenty-two percent of respondents reported collecting a lab fee from students to offset associated costs. Seventy percent of respondents specified cost-saving measures, including the use of expired drugs, reusing supplies or personal protective equipment, price comparisons, simulated drugs, and donations. ConclusionFindings from this study may assist pharmacy administrators and faculty in evaluating the costs associated with sterile compounding education and determining ways to reduce costs while maintaining the intent and quality of these courses.

The Role of a Pharmacy Administration and Leadership Rotation within Postgraduate Year Two Critical Care Residency Training.

The job of a critical care pharmacy specialist has evolved to include quality improvement and administrative tasks. As such, the American Society of Health-System Pharmacists (ASHP) highlights specific goals and objectives to ensure post-graduate year two (PGY2) critical care residents are sufficiently trained to perform these tasks. The PGY2 critical care pharmacy residency leadership at the University of Kentucky sought to develop a four-week learning experience entitled, "Critical Care Administration / Medication Use Quality & Outcomes," as a unique rotation to capture these requirements and activities. The focus of this commentary is to serve as a guide for other residency programs to develop such a rotation, highlight resulting resident contributions to the department, describe perceived benefits of this rotation for residents, and highlight how this rotation impacted graduated residents' early years as practitioners. This learning experience is pivotal to providing a more balanced view of the entire medication use process and the healthcare ecosystem during a specialty residency. PGY2 critical care residents can gain valuable experiences away from the bedside that better prepare them for future tasks in addition to patient care that will be expected of them as clinical pharmacists.

National Amoxicillin-Clavulanate Formulation Use Pattern: A Survey.

Five commercially available amoxicillin-clavulanate (AMC) ratio formulations contribute to ratio selection variability with efficacy and toxicity implications. The objective of this survey was to determine AMC formulation use patterns across the United States. A multicenter practitioner survey was distributed to multiple listservs (American College of Clinical Pharmacy pediatrics, infectious diseases, ambulatory care, pharmacy administration; American Society of Health-System Pharmacists; Pediatric Pharmacy Association members), and selected pediatric Vizient members in June 2019. Responses were screened for multiples within institutions. Repeated organization responses were identified (n = 37) and excluded if the duplicate matched another response from the same organization exactly (n = 0). One hundred ninety independent responses were received. Nearly 62% of respondents represented a children's hospital within an acute care hospital; remainder being from stand-alone children's hospitals. Around 55% of respondents indicated prescribers were responsible for choosing the patient-specific formulation for inpatients. Nearly 70% of respondents indicated multiple formulations were available due to clinical need (efficacy, toxicity, measurable volume), whereas over 40% responded that the number of liquid formulations were limited to decrease the potential for error. Variability was demonstrated among institutions using ≥ 2 different formulations for acute otitis media (AOM), sinusitis, lower respiratory tract infection, skin and soft tissue infection, and urinary tract infection (33.6%, 37.3%, 41.5%, 35.8%, and 35.8%, respectively). The 14:1 formulation was the most common, but not exclusive, for AOM, sinusitis, and lower respiratory tract infections with 2.1%, 2.1%, and 2.6% of respondents indicating use of the 2:1 formulation and 10.9%, 15%, and 16.6% of respondents indicating use of the 4:1 formulation. Significant AMC formulation selection variability exists across the United States.

Healthcare Resource Utilization and Costs in Patients with EGFR-Mutated Advanced Non-Small Cell Lung Cancer Receiving First-Line Treatment in the United States: An Insurance Claims-Based Descriptive Analysis.

An estimated 10-15% of non-small cell lung cancer (NSCLC) cases present with epidermal growth factor receptor mutation (EGFRm). While EGFR tyrosine kinase inhibitors (EGFR-TKIs) such as osimertinib have become first-line (1L) standard of care for these patients, limited chemotherapy use still occurs in real-world practice. Studies of healthcare resource use (HRU) and cost of care provide a means by which the value of various treatment regimens, healthcare efficiency, and disease burden can be assessed. These studies are important for population health decision makers and health systems that prioritize value-based care to drive population health. The aim of this study was to descriptively assess HRU and costs among patients with EGFRm advanced NSCLC initiating 1L therapy in the United States. IBM MarketScan Research Databases (January 1, 2017 to April 30, 2020) were used to identify adult patients with advanced NSCLC, based on a diagnosis for lung cancer (LC) and initiation of 1L therapy or diagnosis of metastases within 30 days of the first LC diagnosis. All patients had ≥ 12 months of continuous insurance eligibility prior to the first LC diagnosis and initiated (in 2018 or after) an EGFR-TKI during any line of therapy to proxy EGFRm status. Per-patient-per-month all-cause HRU and costs were described during 1L for patients initiating 1L osimertinib or chemotherapy. A total of 213 patients with advanced EGFRm NSCLC were identified (mean age at 1L initiation: 60.9 years; 69.0% female). In 1L, 66.2% initiated osimertinib, 21.1% chemotherapy, and 12.7% another regimen. Mean 1L therapy duration was 8.8 months (osimertinib) and 7.6 months (chemotherapy), respectively. Among osimertinib recipients, 28% had an inpatient admission, 40% an emergency room (ER) visit, and 99% an outpatient visit. Among chemotherapy recipients, these proportions were 22%, 31%, and 100%. Mean monthly all-cause healthcare costs among osimertinib and chemotherapy patients were US$27,174 and US$23,343, respectively. Among osimertinib recipients, drug-related costs (including pharmacy and outpatient antineoplastic drug and administration costs) made up 61% (US$16,673) of total costs, inpatient costs 20% (US$5462), and other outpatient costs 16% (US$4432). In chemotherapy recipients, 59% (US$13,883) of total costs were drug-related, 5% (US$1166) were inpatient costs, and 33% (US$7734) other outpatient costs. Higher mean total cost of care was observed among patients receiving 1L TKI (osimertinib) than 1L chemotherapy in EGFRm advanced NSCLC. However, descriptive differences in type of spending and HRU were identified: higher inpatient costs and inpatient days for osimertinib versus higher outpatient costs for chemotherapy. Findings suggest that significant unmet needs may remain for 1L treatment of EGFRm NSCLC, and despite significant advances in targeted care, further individualized therapies are needed to balance benefits, risks, and total cost of care. Furthermore, observed descriptive differences in inpatient admissions may have implications for quality of care and patient quality of life, for which additional research is warranted.

Reliability and Validity Evidence for an Academic Gender Equity Questionnaire

Objective. The majority of practicing pharmacists and student pharmacists are women. However, instruments to assess perceptions of gender equity within pharmacy academia are not available. The objective of this research was to describe the psychometric analysis of a questionnaire developed to assess gender equity by a Gender Equity Task Force and to report reliability and validity evidence.Methods. A questionnaire with 21 items addressing the teaching, research, service, advancement, mentoring, recruitment, and gender of college leaders was created. The survey was distributed via email in December 2020 to all social and administrative science section members of two professional associations. Rasch analysis was performed to evaluate the reliability and validity evidence for the questionnaire.Results. After reverse coding, all items met parameters for unidimensionality necessary for Rasch analysis. Once adjacent categories were merged to create a 3-point scale, the scale and items met parameters for appropriate functionality. Items were ordered hierarchically in order of difficulty. The modified instrument and scale can be treated as interval level data for future use.Conclusion. This analysis provides reliability and validity evidence supporting use of the gender equity questionnaire in the social and administrative academic pharmacy population if recommended edits such as the 3-point scale are used. Future research on gender equity can benefit from use of a psychometrically sound questionnaire for data collection.

Rewards, recognition, and advancement for clinical pharmacists

AbstractClinical pharmacy has continually evolved, with significant expansion in clinical pharmacists' qualifications and roles. However, this growth has not necessarily correlated with improved job satisfaction among clinical pharmacists. A survey of practicing clinical pharmacists performed by the American College of Clinical Pharmacy (ACCP) Clinical Practice Affairs Committee A identified low satisfaction with the time allocated for clinical activities, quality improvement, research and scholarship, and teaching and mentorship. There was also low satisfaction with the recognition provided, despite a high desire for recognition and strong agreement that recognition affects job satisfaction. Rewards for workplace successes and advancement pathways are also not commonly provided. This white paper provides an update to the previous ACCP publications from 1995 and 2010 on the current state of rewards, recognition, and advancement for clinical pharmacists. Suggestions for the pharmacy profession and administrators on how to improve job satisfaction and retention and reduce burnout were developed by the committee and are provided as best practice recommendations.

Navigating the Path to Careers in Academic Pharmacy Administration

The purpose of this commentary is to discuss the qualifications, responsibilities, and keys to success for pharmacy faculty considering a department (or division) chair (head) or dean (including assistant or associate dean) position. The perspectives are those of a department chair, vice dean, and past dean of colleges of pharmacy with extensive experience in pharmacy administration. The qualifications for these administrative positions vary by institution, particularly with respect to the institution’s focus on research. Because the dean is the chief executive officer of a college of pharmacy, previous administrative experience is almost always a basic requirement for the position. For associate/assistant deans and department chairs, previous experience as a faculty member is a typical minimum requirement and may include experience as a department vice chair or director of a unit within the department or division. The dean has a fiduciary duty to university administration, as well as to other external and internal stakeholders, to educate and graduate competent pharmacists and to operate within budget. Associate/assistant deans often have responsibility for specific functions of the college, such as student or professional affairs, and it is common for deans to delegate authority, responsibility, and accountability to associate/assistant deans. Department chairs have a unique perspective with respect to college activities because they must not only think about the “big picture” when considering issues with other college administrators but must oversee the implementation and monitoring of strategic initiatives through the faculty and staff who report to them.