How Will Pharmacists Practice in 2015: A 2017 Response

SEPTEMBER 21, 2017
Raven Jackson, PharmD, Candace Hopgood, PharmD, Vy Nguyen, PharmD
In 2005, Carol Ukens wrote an article titled "How will Pharmacists Practice in 2015?" It is now 2017, and as an accompaniment, this article will look to both answer that question and hypothesize the future of the profession.

Patient-Centered Care
Based on statements from the Joint Commission of Pharmacy Practitioners (JCPP), Ukens foreshadowed
that pharmacists would be responsible for the:
●  Rational use of medications, including the measurement and assurance of medication therapy outcomes
●  Promotion of wellness, health improvement, and disease prevention
●  Design and oversight of safe, accurate, and timely medication distribution systems.1

On May 29, 2014, the JCPP developed a resource titled the "Pharmacists’ Patient Care Process" (PPCP). The process includes 5 key steps that pharmacists should consider when providing patient care: collect information, assess for medication (and non-medication) related problems, develop plans to meet and address these problems, implement the plan that is agreed upon by both the patient and the pharmacist, and lastly, follow-up to evaluate the efficacy of the implemented plan. This resource has been implemented to promote the need for a consistent, streamlined process of pharmacist provided patient care services. 2

Ukens stated that by the year 2015, pharmacists would be the health care professionals responsible for providing patient care that ensures optimal medication therapy outcomes, according to the JCPP.1 With the implementation of the PPCP, it would be appropriate to state that the profession is definitely working to accept that challenge.

Patient-Centered Medical Home
Ukens also mentioned that the JCPP vision foresaw pharmacists working cooperatively with practitioners of other disciplines to care for patients. In this relationship, pharmacists would be the most trusted and accessible source of medications, related devices, and supplies. They would also be the primary source for unbiased information and advice regarding the safe, appropriate, and cost-effective use of medications, and they will be the patient care providers that health care systems and payers recognize as being responsible for ensuring desired medication use outcomes.1

The concept that Ukens spoke of relates to the current model of the Patient Centered Medical Home (PCMH). In March of 2007, the primary care professional societies endorsed a set of joint principles for the PCMH. The approach is intended to provide a guideline for the comprehensive care of children, youth, and adults. The PCMH looks to facilitate a relationship between the primary care provider and the patient/family while also providing a continuum of care. 3

Pharmacists are able to contribute to the PCMH through the provision of Medication Therapy Management (MTM).4 In 2003, the Centers for Medicaid and Medicare Services (CMS) elicited an expectation that insurance companies would provide services that would enhance a patient’s understanding of their medications, increase medication adherence, and decrease the risk of adverse events.

In 2004, 11 national pharmacy organizations defined the term “MTM” in the MTM Core Elements 1.0 that included steps to effectively implement MTM services in a community pharmacy setting. Three years later, a second version was released (MTM Core Elements 2.0). In contrast to version 1.0, this document included elements of patient involvement in decision making and also included input from pharmacy professionals outside of community pharmacy to increase the generalizability of the document. Since 2008, MTM has continued to be on the rise.  Most community pharmacies now provide MTM services through a relationship with insurance companies.5 The American Pharmacist’s Association also provides an MTM certification, which allows pharmacists to specialize in the provision of these services and further expand their professional portfolio.6

The current wave of MTM ties in perfectly with Ukens’ hypothesis that pharmacists would make medication therapy management services readily available to all patients.

Pharmacy Education
The last portion of Ukens’ article addressed the role of pharmacy education. The author stated that pharmacy educators would need to prepare pharmacists to provide patient-centered and population-based care; to manage resources to improve therapeutic outcomes; and to promote health improvement, wellness, and disease prevention.

Pharmacy education has made a commitment to this challenge through the provision and continued expansion of pharmacy residency programs.7 Pharmacy residencies provide pharmacists with additional clinical training to prepare them for unique career opportunities where they can provide high level medication management for a variety of disease states.8 In 2005, there were 415 programs offering 1091 positions.9 The number of programs and positions has now nearly quadrupled, reflected in 2016 data from the American Society of Health-Systems Pharmacy (ASHP). There are 1833 programs and 3954 available positions, and that number is steadily growing with the integration of new programs and new colleges of pharmacy.10

The Future of Pharmacy
Ukens, in 2005, saw a health care field that was budding toward a more pharmacist-inclusive patient centered care approach. In 2017, pharmacists and pharmacy organizations have worked to meet and exceed those expectations, but there is still more work to be done. To continue on this positive trajectory, pharmacists must continue to evolve to the needs of their patients and always remain a key player in health care decisions.


References
  1. Ukens, C. How Will Pharmacists Practice in 2015? Drug Topics: Community Pharmacy. 12 Sept 2005.Accessed on September 18, 2017 at http://drugtopics.modernmedicine.com/drug-topics/news/clinical/community-pharmacy/how-will-pharmacists-practice-2015
  2. The Pharmacists’ Patient Care Process. Joint Commission of Pharmacy Practitioners. 2017. Accessed on September 18, 2017 at https://jcpp.net/patient-care-process/
  3. Joint Principles of the Patient Centered Medical Home. March 2007. Accessed on September 18, 2017 at http://www.aafp.org/dam/AAFP/documents/practice_management/pcmh/initiatives/PCMHJoint.pdf
  4. Smith M. The Patient Centered Medical Home. Science and Practice of Pharmacotherapy. ACCP Pharmacotherapy Self-Assessment Program. Accessed on September 18, 2017 at https://www.accp.com/docs/bookstore/psap/p7b08.sample02.pdf
  5. Medication Therapy Management in Pharmacy Practice: Core Elements of an MTM Service Model. Version 2.0. March 2008. Accessed on September 18, 2017 at https://www.pharmacist.com/sites/default/files/files/core_elements_of_an_mtm_practice.pdf
  6. Delivering Medication Therapy Management Services. American Pharmacists’ Association. Accessed on September 18, 2017 at http://www.pharmacist.com/delivering-medication-therapy-management-services
  7. A Vision of Pharmacy’s Future Roles, Responsibilities, and Manpower Needs in the United States. American College of Clinical Pharmacy White Paper. Pharmacotherapy. 2000;20(8)991–1020). Accessed on September 18, 2017 at http://onlinelibrary.wiley.com/doi/10.1592/phco.20.11.991.35270/pdf
  8. What is a Residency and How Do I Get One? Residency Programs. American College of Clinical Pharmacy. Accessed on September 18, 2017 at https://www.accp.com/stunet/compass/residency.aspx
  9. Sommer K. Backtracking: Pursuing Residency Training after Working. New Practitioners Forum. Am J Health-Syst Pharm—Vol 63 Feb 15, 2006. Accessed on September 18, 2017 at http://www.tustudentlife.com/clubfiles/pls/Phi%20Lambda%20Sigma%20-%20Residency%20Pan el%20/Residency%20After%20Working%20First.pdf
  10. Summary Results of the Match for Positions Beginning in 2016. American Society of Health-System Pharmacists. National Matching Services Inc. Copyright National Matching Services Inc., 2016. Accessed on September 18, 2017 at https://natmatch.com/ashprmp//stats/2016progstats.pdf


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