FIP finds pharmacists taking on expanded responsibilities

The changing and increasingly important role of the pharmacist in the healthcare system, whether in the hospital setting, managed care, or community pharmacy, was the focus of much of the recent Federation Internationale Pharmaceutique (FIP) annual meeting in New Orleans. Speakers noted that pharmacists have already become more responsible for pa-tient education, and, in the future, their roles would shift even further from dispensing to collaborating with physicians to ensure optimal patient outcomes through the proper usage of medications.

These goals are based on the concept of concordance, that is, agreement among all the members of the healthcare team, including professionals and the patient, regarding the procedures and medications necessary to achieve disease control.

During a symposium entitled "The Changing Role of the Pharmacist in Medicines Management," Mitchell Medow, M.D., Ph.D., and Christopher Green, R.Ph., Pharm.D., of Ohio State University (OSU) Health Connection, described their collaborative practice. They noted that R.Ph. involvement in medical practice is growing throughout the country, and about 40 states currently regulate collaborative practice. The goal of collaborative practice is to enhance patient care and safety by adding more checks and balances to the system, intervening earlier in the process to ensure that patients understand the importance of taking their medications properly and the nature of their disease.

After the physician makes a diagnosis, the pharmacist is available for consultation regarding appropriate medications or changes in the current drug regimen. The R.Ph. serves as a source of drug information for the physician, screening for potential drug interactions and preventing possible adverse drug reactions. When the therapeutic approach is determined, the pharmacist discusses it with the patient, forming a long-term partnership.

The OSU Health Connection and other collaborative practices have demonstrated their effectiveness by measuring specific end points, such as achievement of target blood pressures for hypertensive patients and glycemic control for diabetics, as well as reduction in medication costs.

In preparation for the new R.Ph. responsibilities, many changes will be necessary in pharmacy education. Peter Vlasses, Pharm.D., executive director of the Accreditation Council for Pharmacy Education (ACPE), noted that as of Jan. 1, 2005, the only degree offered in accredited schools will be the Doctor of Pharmacy (Pharm.D.). Individualized programs will be developed to assist those who wish to convert a bachelor's degree to the Pharm.D.

More emphasis will be placed on maintaining competency for practicing pharmacists. New types of educational programs-referred to as "continuing professional development" rather than continuing education-with more relevance to pharmacy practice, are being developed. Pharmacists can also expect other changes, including the incorporation of active learning techniques such as role playing and problem-based peer discussion. The goal is to develop an attitude of lifelong learning, explained Vlasses.

In a symposium entitled "The New Hospital Pharmacist," Janet Teeters, Pharm.D., director of the accreditation division of ASHP, described the evolution of current U.S. hospital residency training programs from one-year internships in clinical pharmacy to a broader spectrum of two-year programs in specialty areas and even nonhospital residencies.

Much of the rapid growth of these programs has been driven by applicant demand. Residents have recognized the increasing complexity of patient care, the fast pace of the hospital environment, and the need for quick decisions about polypharmacy and they have looked for programs to give them experience and training. Now there are more applicants than residency sites, and some hospitals are discussing whether residencies should be requisite for staff positions. New programs under development are required to look at new training methods designed to develop confident, effective pharmacists with skills to improve services and safety, and to foster a desire for continuing education.

Overall, the FIP meeting, which drew 2,000 participants from 95 countries, painted a picture of the pharmacy profession as one of expanding responsibilities that will ultimately improve patient outcomes.