Editorial: ACPE Requests Curriculum Content Input: Practicing Pharmacists Should Be Involved In Establishing Accreditation and Curriculum Standards, Part III
This is the last week for this topic but it is very, very important for compounding pharmacists to respond. Following is a short discussion of a few of the factors involved in pharmacy practice today as it has evolved and their relationship to the educational process.
As I look back at my undergraduate pharmacy days back in the 60s, the complaint was that there was not enough drug store management-type courses in the curriculum. This was soon corrected. Later, it was a lack of hospital-oriented courses. This, too, was soon corrected. Colleges of pharmacy were influenced by practitioners in developing and maintaining the curriculum. The goal was to provide a background in pharmacy so the students would have the basic background to go into almost any type of practice setting. In addition, the students were very well prepared scientifically to go into graduate work to assume a position in the pharmaceutical industry or academia.
Following that was the big change that started in the 70's to orient the curriculum more towards clinical pharmacy (patients) and move away from pharmaceuticals (products and preparations) so others could handle the distribution process; part of the basis for the universal PharmD degree. The emphasis then was to remove product and preparation distribution from the realm of pharmacy practice and just deliver clinical pharmacy/therapeutic drug management services. The hope was to be reimbursed for these activities. This move was largely initiated via academia but was "bought into" by pharmacy associations and it seemed plausible and beneficial to many at the time. As a result, there have been major changes in the curriculum, including drastically scaling back most of the "science-based" courses such as pharmaceutics, medicinal chemistry, natural products chemistry, etc. while incorporating additional social and administrative sciences and clinical pharmacy courses, related to the patient and drug therapy management. Colleges of Pharmacy are taught by excellent PharmD faculty and are graduating very well trained students in the clinical aspects of pharmacy; but not in sufficient detail in the scientific aspects of pharmacy.
The practice of pharmacy, however, has not necessarily followed suit with the changes in the curriculum initiated in the 70s. The product is still with us and the practice of pharmacy is still oriented primarily towards dispensing, since that is where most of the income is derived, whether in ambulatory care or in institutional settings. Without the product or preparation, we may have ceased to exist as a profession as the product and preparation is still our lifeblood. Dispensed prescriptions may be commercially available products or compounded preparations. The majority of full time clinical practitioners appear to be in institutions with very few, if any, ambulatory practice settings being devoted solely to clinical pharmacy activities (no dispensing) on a fee-for-service basis. Many ambulatory care clinical practitioners incorporate the clinical aspects of pharmacy with the distributive aspects, however, the income is still primarily derived from the dispensing and compounding activities.
The practice scenarios of dispensing, compounding and clinical pharmacy need not be mutually exclusive, but should compliment each other. For example, many pharmacies incorporate patient counseling in the dispensing process very effectively but really need to receive some level of reimbursement for this activity. Third party reimbursement is based on the product and does not include clinical pharmacy activities except for selected examples, such as diabetes education if one is a Certified Diabetes Educator. With the salary of a pharmacist approaching $1 per minute and a minimum of 3-5 minutes ($3 to $5 additional per prescription) to prepare for and deliver the service for each prescription if there are no complicating factors, the clinical services need to be reflected in the price of the prescription or the service may need to be delivered by some alternative, more cost-effective means, including technology or other health professionals.
It is very difficult to give away your time and to stay in business, unless someone else is paying the bills. In fact, I have often wondered why many claimed "victory" years ago when some states "mandated" patient counseling but did not provide for financial consideration for providing these services. I think some felt that our services were finally being recognized. No doubt, our services are vitally important; but, if physicians, attorneys, etc. get paid for their services, pharmacists should also get paid for their services. I'm not sure if it is a "victory" if one is willing to give away valuable services for nothing. I think most institutions/states would agree to providing their clients excellent patient counseling services if it doesn't cost the institution/state anything. But���have we proven our value if we still don't receive compensation for these services after all these years? I do believe that patient care is much, much better but I do believe that pharmacists should be compensated for their time if these services are to continue.
Some of the most active clinical pharmacists are also compounding pharmacists. After all, the goal of compounding pharmacy is to "individualize patient care", which is the same goal of clinical pharmacy. Compounding pharmacy is a means of achieving the goal by actually preparing compounded medications to meet the unique and individual needs of patients when commercial products are not available or not appropriate. As the shift continues and more and more pharmacies, including large mail-order pharmacies, are providing compounding services, we still have a lack of educational resources in the colleges of pharmacy to address this expanding function. Pharmaceutical compounding is heavily dependent upon training in the sciences, including pharmaceutics, chemistry, medicinal chemistry, natural products chemistry, etc. Along with the classroom, laboratory exercises are of utmost importance. Practical laboratory experience in compounding expands clinical pharmacy not only in providing individual prescriptions, but provides additional background for the clinical pharmacist to dispense and better discuss dosage forms with patients, as well as the physiological and pharmacological aspects of therapy.
In addition, pharmacy graduates are often not adequately prepared in the sciences to pursue graduate work without taking additional coursework. This is definitely not a reflection on the faculty, as we have excellent dedicated science faculty in the colleges; but this has resulted because of the reduced number of hours in the sciences in the curriculum. Now, when a pharmacy student is contemplating graduate school and realizes that additional coursework must be done in their graduate program to make up these deficiencies, it can result in the student turning away from pursuing a graduate degree (M.S., Ph.D.). This is one factor that has led to a decline in the number of US-trained pharmacists going into graduate programs. Where are our scientists for industry and faculty for colleges of pharmacy coming from and going to continue to come from in the future? Many, if not most, do not now have a primary degree in pharmacy.
Where is all this going? In looking at the STANDARDS FOR CURRICULUM for the entry-level, 5-6 year, professional PharmD degree, as mentioned last week, let's turn our attention to the Pharmaceutical Sciences section, which has 495 contact hours suggested. Sounds okay until you look at all the topics that must be included in that area. For example, "Pharmaceutical Sciences" includes (1) Medicinal Chemistry, (2) Pharmacology, (3) Pharmacognosy and Alternative and Complementary Treatments, (4) Toxicology, (5) Bioanalysis/Clinical Chemistry, (6) Pharmaceutics, (7) Pharmacokinetics, (8) Pharmacogenomics/genetics, and (9) Extemporaneous Compounding/Parenteral/Enteral. There are a lot of "heavy topics" but not really sufficient time to cover them all adequately to meet the needs of today's new pharmacists. It may be time for a curriculum "adjustment" to more appropriately reflect the activities of today's pharmacist practitioner.
Please take a few minutes and either contact ACPE (www.acpe-accredit.org) or IACP (1-281-933-8400) and let your voice be heard before the November 1 deadline concerning the curriculum of the U.S. colleges of pharmacy and the growing practice of pharmaceutical compounding. Maybe it's time that colleges of pharmacy again listened to pharmacist practitioners�..but, it's up to you.
Loyd V. Allen, Jr., Ph.D., R.Ph
Editor-in-Chief |
