Lecture 6: Evolution of Pharmacy Practice and Pharmacist’s Roles

Question 1

Describe pharmacist’s roles during the Dispensing Era of pharmacy

Answer 1

Mid-20th century, emergence of manufacturing
* pharmacist role: more restricted than what we see today
* APhA code of ethics 1922-1969: pharmacists no allowed to discuss drug therapy with patients, that was done by physicians
* 1951 Durham-Humphrey amendment to the Food, Drug and cosmetic Act: 2 classes of drug created which were prescription “legend” and OTCs; pharmacist could not make any changes to prescription products without the consent of doctor; This act reduced pharmacy role to dispenser

Question 2

Describe pharmacist’s roles during the Apothecary Era of pharmacy

Answer 2

Apothecary Era (early 1900s)
* prepared and sold medicinal drugs (compounding medications was prominent)
* responsible for ensuring purity of products sold
* provided patients medical advice
* pharmacist trained via apprenticeship just an occupation not a profession

Pharmacists were responsible for ensuring compounds they sold were “pure and uadulterated” and safe for human consumption

Question 3

Describe pharmacist’s roles during the Clinical Eras of pharmacy

Answer 3

late 1900s
* pharmacists getting dissatisfied with the profession thus begun a clinical movement in the 1970s (root in hospital pharmacies) to expand role to dispenser to patient centered care
* **pharmacists were promoted to the role of “therapeutic advisor”
* APhA is revised

Pharmacists in the hospital served as clinical specialists and were responsible for making recommendations and advising other healthcare professionals. They needed to prove they were important part of the healthcare team

Question 4

What was the intent of the 1951 Durham-Humphrey amendment to the Food, Drug, and
Cosmetic Act? What impact did this Act have on pharmacist’s roles during the Dispensing Era of Pharmacy?

Answer 4

• 2 classes of drug created which were prescription “legend” and OTCs; pharmacist could not make any changes to prescription products without the consent of doctor
• This act reduced pharmacy role to dispenser

Question 5

Describe factors that have helped shift community pharmacist’s roles from being product
focused to patient focused.

Answer 5

Moving from dispenser role to patient-centered care role
1. Pharmaceutical Industry/Emergernce of New Prescription Medications: don’t have to compound every medicine, more medicines so very complicated
2. Prescription Drug Insurance Programs (more people have prescription drug insurance, more prescriptions for pharmacies)
3. Roles of Pharmacy Technicians: pharmacist extenders
4. Pharmacy Robotics/Technology: EMR (much faster than paper) reduce medical errors, increase productivity
5. Mail Order Pharmacy: helps with drug distribution, robotics in mail order helps with dispensing, counseling patients call about prescription

Question 6

How did pharmacy technicians, robotics, and mail order pharmacy help shift the pharmacist role?

Answer 6

Changes with techs, robotics and mail order pharmacy helps pharmacists focus less on dispensing role and freeing them up to doing more patient-centered care roles

Question 7

Define and describe Transitions of Care (TOC). Is this an opportunity for the pharmacist
to conduct medication reconciliation?

Answer 7

Shift to more patient centered care
* the movement of a patietn from one setting of care to another (ex/hospital to home)
* Refer to the movement of patients between healthcare practitioners, settings, and home

Question 8

Where is the Pharmacist Profession going? What is the role of the pharmacist?

Answer 8

Moving from product focused to patient focused care
1. Frontline guardian of medication safety: provision of patient care
2. Last ditch guardian of medication safety: pharmacists are often the last healthcare provider the patients interact with before they head home and are managing medication by themselves
3. Agent and healthcare provider: agent meaning you are patients voice, you act on behalf of your patient, giving them the best care, working with health care professionals, talking to insurance, etc.

Question 9

3 things you need to remember by pharmaceutical care definition

Answer 9

1. being responsible
2. definite outcomes
3. improve quality of life

Question 10

What is “responsible provision” of Drug Therapy? (pharmaceutical care)

Answer 10

1. Indication: taking the right drug (s) at the right dose
2. Efficacy: Receiving the outcomes desired
3. Safety: Adverse drug events and drug interactions
4. Adherence: making sure patient is taking medication the way they are suppose to be

Question 11

Give
patient outcomes a pharmacist can focus on. (pharmaceutical care)

Answer 11

1. cure of a disease
2. elimination or reduction of a patient’s symptoms
3. arresting or slowing of a disease process
4. preventing a disease or symptoms=vaccines

Question 12

Provide examples of things that can go wrong when patients take medications (“unintended consequences”).(pharmaceutical care)

Answer 12

1. Side effects and/or drug interactions
2. Decreased quality of life
3. death
4. prescription drug abuse
5. financial burden

Question 13

What was the impact of OBRA ’90 on pharmacy practice?

Answer 13

requires DUR and allows pharmacist to counsel patients
* * Required DUR (is the medication appropriate for the patient)
* Offer to counsel the patient (started the “do you have a question for the pharmacist)
* note: provides a “snapshot” in time for a specific medication (without the knowledge of all medications and treatments)

Practiced on medicaid patients first, then profession expanded to all patients

Question 14

What are examples of Medication Therapy Management (MTM) activities that
pharmacists can provide?

Answer 14

broad range of activities (optimize therapeutic outcomes and direct interaction of pharmacist with patient)
1. Performing patient health assessments
2. formulating a medication treatment plan
3. selecting, initiating, modifying or adminstering med therapy
4. monitoring and evaluating the patient’s response to thearpy
5. Performing a comprehensive medication review (CMR)
6. Documenting the care delivered and communicating information to other providers
7. Providing verbal education and training
8. Providing information designed to enhance patient adherence with therapeutic regimens
9. Coordinating and integrating MTM services within the broader health-care management services being provided to the patient

Question 15

What did the Joint Commission of Pharmacy Practitioners (JCPP) include? Whatis at the core of the process?

Answer 15

• includes responsibility for safe medication, distribution and optimal medication outcomes
• patient-centered care is key: establishment of pharmacist-patient relationship
• Core of process: collaboration, communication and documentation

Question 16

In what year was the PharmD degree mandated to be the entry level degree for the
pharmacy profession?

Answer 16

Mandated in year 2000

Question 17

Define and describe Medication Reconciliation.

Answer 17

can happen in any healthcare setting and be equally important in ambulatory care but we see it alot in hospitals
* process to avoid inconsistencies across transitions in care by reviewing the patient’s complete medication regimen at the time of admission, **transfer **and **discharge **

includes ALL meds not just prescription (prescriptions + OTC)
formularies in the hospital can be difference than formularies in outpatient setting

Question 18

Define Collaborative Practice and where do you see it?

Answer 18

• Health care providers practicing together to solve a patient’s problem
• See it in: clinical teams in hospitals, ambulatory care clinics, employer-based clinics and networks, physician offices, and health plans

Question 19

Define and describe Collaborative Practice Agreements.

Answer 19

It is voluntary written agreement between a physician and a pharmacist outlining cooperative practice for drug therapy management and that the care falls within the scope of practice of both the physician and the pharmacist

Question 20

What is the purpose of collaborative practice agreements?

Answer 20

1. optimize patient’s drug therapy
2. allow pharmacist to provide drug therapy management
3. allow physicians to enter a protocol-style agreement with pharmacists

**Oversight by State Boards of Pharmacy

Question 21

Provide examples of barriers to pharmacists’ expanding roles.

Answer 21

1. Recognition and acceptance from stakeholders (physicians, nurses, government, insurance companies) in the health care system: they have to be willing ot work with pharmacist
2. Recognition and acceptance from patients: are patients willing to work with pharmacists
3. Lack of reimbursement for patient care services: pharmacist only being paid for dispenser role
4. Resistance with the pharmacy profession: some pharmacists want to still be focused on the dispensing

Question 22

Pharmacists practing at the top of their license

Answer 22

1. Collaborative Practice
2. MTMs
3. Joint Commision of Pharmacy Practitioners (JCCP)
4. Medication Reconcillition