Experts | University of the Sciences

Priorities for our Profession - Pharmacy

By Daniel A. Hussar is the Remington Professor of Pharmacy at University of the Sciences' Philadelphia College of Pharmacy. He serves as the author and editor of The Pharmacist Activist newsletter (http://www.pharmacistactivist.com) from which this editorial was taken.

Choosing the topic for this month's issue of The Pharmacist Activist was more of a challenge than usual. Not because there are not enough important issues to address, but rather because there are so many. Indeed, pharmacy faces so many challenges that identifying the degree of priority with which they should be addressed is an important decision in and of itself. Therefore, the purpose of this editorial is to identify the issues that, in my opinion, require our profession's highest priority attention.

1. Commitment, passion, and activism
Many pharmacists are apathetic or even negative about pharmacy and their individual responsibilities, and it is no consolation that this situation exists in every profession and area of employment. Tens of thousands of pharmacists are not members of even one professional association. Some would contend that the wide availability of employment opportunities (at least until recently) and high salaries have contributed to the apathy and complacency that is so widespread. Pharmacy has provided a good livelihood for the vast majority of pharmacists and every pharmacist should recognize a responsibility to give something back to our profession. This should be motivated by our enthusiasm for and pride in our profession, and demonstrated through a commitment to and passion for what we represent and can do individually and collectively for our patients and profession. We need thousands more activists within pharmacy. The colleges of pharmacy have an extremely important responsibility in encouraging these attitudes, qualities, and involvement among student pharmacists that will be continued through their professional careers. Our professional organizations must be more innovative and effective in increasing membership and active participation in professional initiatives.


2. More effective professional organizations
Our profession needs an organizational structure at the national, state/regional, and local levels that will serve and advance the interests of pharmacy in a more effective manner than is being accomplished through our current system (please see the editorial in the January 2011 issue [www.pharmacistactivist.com] for possible national organizational structure options). Leaders of the national pharmacy organizations should meet to actively consider these options in the context of what is best for the profession, and not just what is best for individual organizations. Many state/regional pharmacy organizations are struggling financially and have limited effectiveness. In my opinion, the profession is best served by having one organization of pharmacists in each state, and the leaders of the multiple pharmacy organizations within a state should be encouraged to develop and approve such a structure.


3. Independent pharmacies must thrive
Notwithstanding the importance of the roles and accomplishments of pharmacists in all areas of professional responsibility, it is the independent pharmacists who are the "face" of our profession with the public and who have the most prominent identity that is responsible for the reputation for trust and integrity that our profession enjoys. It is also the independent pharmacists who are the most likely to have the personal interaction with the largest number of patients who receive the medications and services around which the expanding roles of pharmacists are based. As the number of chain/corporate and mail-order pharmacies has increased in recent years and the number of independent pharmacies has declined, some have predicted the disappearance of independent pharmacies. However, we must not let that happen! A number of years ago I voiced the opinion that the future roles and success of the profession of pharmacy are inextricably linked to the extent that independent pharmacists can be successful in their professional responsibilities. My conviction regarding the validity and importance of this opinion is even stronger today. Our entire profession must be strongly supportive of efforts that will enable independent pharmacies to not only survive, but thrive.


4. Tightening of the job market
The economic challenges of the last several years coupled with the large increase in the numbers of colleges of pharmacy and pharmacy graduates have resulted in a significant tightening of the employment opportunities for pharmacists and student pharmacists. This situation has many extremely important implications that are as positive as a much larger number of opportunities in which the abilities and skills of pharmacists can be utilized in providing optimal drug therapy for many more patients, and as negative as widespread pharmacist unemployment. We must not be content to sit back and watch how this situation evolves. Our profession must be actively engaged in developing plans and strategies that will result in the assimilation of a much larger number of pharmacists in the provision of more comprehensive services of documented value to an increasingly elderly patient population with greater needs for optimal drug therapy. The alternative would be the worst possible contradiction - a country with millions of people who have a great need for the expertise possessed by pharmacists who can not provide it because of the failure of a healthcare system that does not recognize and pay for that expertise.


5. "Walking the talk"
As much as many of us extol the expertise of pharmacists and the value of our advice and services, optimal services are not the norm and, indeed, for many, are not evident at all. We must provide to a much greater extent what we claim as the value of our role and responsibilities. We must do much better in providing even the most basic information and services, and develop programs that will provide pharmacists with the information and confidence necessary to extend their services. As a profession we have the potential to assume "ownership" of important challenges such as the prevention of medication/dispensing errors and increasing patient compliance with the instructions for using medications. If pharmacists do not respond to these opportunities that can be viewed as such a natural part of our domain of responsibilities, it will only be a matter of time before other health professionals will.


6. Prescription benefit programs
The inequitable compensation and conditions of most prescription benefit programs are continuing important concerns for pharmacists. Pharmacists must document the value of their services and the cost of dispensing a prescription so that they are well positioned to demonstrate inequities in programs in which they are asked to participate. Pharmacists should not reduce the scope and quality of their services to try to adjust for the inadequacies of the program but rather should decline to participate in programs in which the compensation or other conditions are not equitable. Notwithstanding the need to avoid specifics of compensation issues because of antitrust implications, the profession should develop a model prescription benefit program that would effectively address the drug therapy needs of patients, and encourage and recognize the value of the information and services provided by pharmacists.


7. Legislative influence
Pharmacists and our professional associations must have much more extensive and effective communication with our legislators. The geographical distribution of pharmacists provides an excellent opportunity for legislative influence. However, we are not even close to reaching our potential in this regard. In addition to having pharmacy's interests and services considered in new and revised national health insurance legislation (e.g., Obamacare), other issues require the attention of the profession. Examples include legislative changes that would permit pharmacists and our organizations to collectively negotiate for equitable compensation for the services we provide, and changes that would prevent mandated participation of patients in mail-order pharmacy programs.


8. Taking a stand
The profession of pharmacy, primarily through its professional organizations, must demonstrate the courage to address situations that place patients at risk and/or are potentially damaging to the profession, even if they may be controversial or sensitive. For example, excessively busy and stressful working conditions that increase the risk of dispensing errors must not be tolerated. Employers who persist with policies that place patient safety in jeopardy must be challenged. Likewise, prescription benefit programs that require or provide financial incentives for patients to obtain medications from a mail-order pharmacy and decrease personal communication between patients and pharmacists must be challenged. The continuing establishment of new colleges of pharmacy in the face of a saturated marketplace for pharmacists is another situation that must be questioned.


9. Developing leaders
The urgent attention that is needed to address the numerous current issues can easily obscure the importance of developing the future leaders for the profession. The identification and development of new leaders is a critical component of plans to position pharmacy for success in the future.
 
10. Expanded and new opportunities
At the same time that current challenges demand priority attention, there must be a vision for expanding some existing opportunities and developing new ones. The manner in which some pharmacists have developed practices that focus on compounding prescriptions to meet individualized needs of patients is one such example. Other examples include expanded roles in medication therapy management (MTM) programs, immunization programs, the self-care of patients with nonprescription products, the provision of durable medical equipment products and services, and the provision of specialty pharmaceuticals.

Agreeing with FDA Actions on Acetaminophen

In June 2009 the FDA convened 37 health professionals who serve on three of its advisory committees to address concerns regarding acetaminophen. My editorial in the July 2009 issue of The Pharmacist Activist identifies many of the recommendations of the advisory committees, and also includes my responses/observations. The advisory committee statements are recommendations and do not become policy until the FDA approves them, which it has not done.

Interestingly, the action that the FDA just announced addresses just one component of a much larger picture. The recommendation applies only to prescription products that contain acetaminophen in combination with other medications (almost always a narcotic [also known as an opioid]).  The recommendation does not pertain to nonprescription (OTC) products such as those available under the Tylenol brand name.

I fully agree with the action that the FDA has just taken. At the present time prescription combination products that contain a narcotic and acetaminophen may contain widely varying amounts of acetaminophen (e.g., 325 mg, 500 mg, 650 mg, 750 mg). The narcotic component of the combination is a much more potent pain killer than acetaminophen and is also associated with a greater number of risks.

As a result, many may overlook the inclusion of acetaminophen in the product or not be attentive to its quantity in each tablet or capsule.  This could result in the use of an excessive dosage/quantity of acetaminophen, even when the amount of the narcotic may be appropriate.  The use of excessive amounts of acetaminophen may result in serious liver toxicity and even death.

By limiting the amount of acetaminophen (to 325 mg) that may be included in prescription combination products that also contain a narcotic, the FDA will be providing greater clarity and safety with respect to the use of these products.

Daniel A. Hussar is the Remington Professor of Pharmacy at University of the Sciences' Philadelphia College of Pharmacy.

 

 

Unique partnership will promote sustainability training for pharmacists

The issue of pharmaceuticals in the environment is multifaceted—ranging from the excretion of animal and human waste, to improper disposal like flushing, to residues transferred from skin (e.g., sunscreens, ointments).

Pharmacists serving in the role of public health advisor are in a unique position to educate patients and providers on strategies to decrease the amount that gets into the environment. This partnership couples Practice Greenhealth’s known expertise in this area with the knowledge and expertise of the nation’s first college of pharmacy to provide outstanding educational opportunities for pharmacists to learn themselves and how to educate others. 

The partnership is designed to develop educational modules for pharmacists working in community/retail settings, hospital settings and long term care settings. Further, the intent of the partnership is to develop educational programming for students in colleges of pharmacy and public health programs to learn about this important issue.

-- Andrew Peterson is dean of Mayes College of Healthcare Business and Policy

Research Day Showcases Faculty and Student Research

From metabolic engineering to computational chemistry and from structural prediction of proteins to rational design of new therapeutics, University of the Sciences in Philadelphia showcased the diversity and growth of research pursuits on campus during its 7th Annual Research Day starting on Thursday, April 2, 2009. Posters representing approximately 120 topics were on display.

Research Day recognizes undergraduate and graduate student research efforts, and highlights aspects of faculty scholarly activity to encourage and promote communication and collaboration among investigators. The University is distinctive in that most undergraduate students conduct research with faculty early in their academic careers.

The diverse research activity on display spans several aspects of the University’s scholarly pursuits, including:

• Biological Sciences: Dr. Jennifer Anthony’s research involving the metabolic engineering of E. coli for the production of vitamin A.
  • Chemistry: Dr. Randy Zauhar’s use of computer-aided drug design to identify new antimicrobial lead compounds.
• Pharmaceutical Sciences: Dr. Bin Chen’s evaluation of the effects of vascular-targeting photodynamic therapy on prostate cancer metastasis.
• Physical Therapy: Dr. Therese Johnston’s usage of treadmill training for children with cerebral palsy.
• Social Sciences: Psychology major Mark Paullin’s (Philadelphia, Pa.) study of mild cognitive impairment in Alzheimer’s disease.
• Health Policy: Master in public health major Sekinat Kekere-Ekun’s (Deptford, N.J.) work on the descriptive epidemiology of viral hepatitis in methadone maintenance clients.
• Pharmacy Practice: Doctor of pharmacy students Neha Patel (Fairless Hills, Pa.), Puja Patel (Hillsborough, N.J.), and Isha Shah’s (Bensalem, Pa.) analysis of the usage of ondansetron in non-chemotherapy patients at a community teaching hospital.