The Next Generation of Pharmacy Practice

FEBRUARY 01, 2009
Bill Schu

Mr. Schu is group editorial director for MJH & Associates

Moderator: David Trang, RPh

"Do you think society is going to be more excited and value a practitioner who waits until someone gets sick before they take care of them or a practitioner who will keep them from getting sick?"

With that provocative question, Lawrence "LB" Brown, PharmD, PhD, assistant professor in the Department of Pharmaceutical Sciences at the University of Tennessee-Memphis, kicked off a recent Pharmacy Times roundtable discussion on the continuing evolution of the pharmacy profession. The roundtable, one of an ongoing series, brought together a distinguished panel of pharmacist leaders, academicians, and community pharmacists. The moderator was David Trang, RPh, assistant professor of pharmacy practice, University of the Incarnate Word, Feik School of Pharmacy in San Antonio, Texas. Entitled Pharmacy Profession in Transition: From Products to Services, the discussion ranged from technology to pharmacist leadership to how patients view pharmacists.


Mike Peerson

One of the first topics the panelists tackled was the lack of leadership training many pharmacist students receive and how that translates later into difficulties managing people or leading a pharmacy team in their community pharmacy. "We clearly see that [today's students] are ready to deliver patient care services to our patients far better than even I was prepared," said Mike Peerson, director of talent services and campus relations, Walmart Stores Inc. "One element that we would like to see is for students to have some leadership development in their curricula, specifically around dealing with conflicts. Many of them do not have that skill set."

Ed Cohen, PharmD

Ed Cohen, PharmD, director of clinical services, Med-Monitor Clinical Program, Clinical Education and Immunization Services at Walgreens Health Services, agreed. "The disconnect between what [students] are learning in colleges of pharmacy and then [what they learn] when they go to the community setting as technicians is huge. In school, their focus is more toward therapeutics. Management classes and business classes are always scheduled right after therapeutics. So the only thing they remember is what they learned in therapeutics, not so much what the business people are teaching them. It is a shame you cannot bring them back 3 or 5 years after they graduate and give them those business classes as an add-on to their education, because that is when that information is pertinent to their career."


Trang then asked a key question that always comes up in regard to pharmacists' ability to provide patient care: "Do they have enough time to do medication therapy management?"

Sean Young, leader of the pharmacy innovations team at Walmart, remarked, "I would argue that the pharmacist wants to deliver patient care, but the customer only wants a product. The real question is: Would that customer trade a 15-minute wait for a 2-hour or even a next-day wait? More importantly, would they trade that next-day pickup so that someone who is a diabetic can get that service from a pharmacist?"

Dr. Brown responded, "Patients think far less of pharmacists than what we think. And I am not saying that as a negative. I am saying that means we need to do a better job of helping them understand what it is that we can do. Because their stereotypical view was, the community pharmacist fills the prescriptions, and anything outside of that was beyond [the patients'] understanding. I have done some research about patients and their views of what pharmacists should and should not do. Pharmacists were willing to get involved in many aspects of patient care, but patients, especially on expanded services, were on the other side of the scale, saying no. That is because they do not know what pharmacists can do."


Daniel A. Hussar, PhD, Remington Professor of Pharmacy in the department of pharmacy practice and pharmacy administration at the Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, raised an interesting point about patient perception. "In some pharmacies that they go into, it is tough to tell the difference between the pharmacist and the technician," he said. "We do not do a good enough job as a profession in calling attention to our professional identity and our services." One irony, said Dr. Hussar, is that pharmacists rarely get credit for one of the most important services they provide: catching a prescription for a patient who is allergic to it or avoiding a major adverse event the patient will never know about. "We are talking quietly on the phone," Dr. Hussar says, "and we do not want to embarrass the physician. We are not going to go out and tell them, wow, I just saved your life."

Asked about how pharmacists can continue to add value in today's information age, Jared Anderson, a student from the University of Minnesota, said, "[Patients] are inundated with information on everything, and they can go to Wikipedia and look up information about amoxicillin, which is much more comprehensive than just what is on the label. But that does not mean anything to them until they have the pharmacist distilling that information down to a few sentences that are really important for you.

"The value of the pharmacist is knowing which interactions are really relevant, what issues really need to be addressed, when the variance from the norm needs attention. That is what pharmacy has to give you."


Lawrence "LB" Brown, PharmD, PhD

Moving to the topic of technology and its ability to help pharmacists curb medical errors, panelist Crystal Lennartz, PharmD, MBA, from the National Association of Chain Drug Stores, talked about how the judgment and knowledge of the pharmacist are the true keys to finding and preventing errors. "The systems are definitely in place, but there needs to be the ownership by the pharmacist and that clinical judgment coming in and the service at the counter. Again, it is crucial to let the patient know our value and what we are doing. We may hear about these highly publicized and often sensationalized medication errors, but the patient has to remember that it is the one case that gets all the attention. Of course, one error is too many, but there are so many that we prevent."

"I will go back to when I first started practicing 30 years ago—we could not talk to patients, we could not give them any information at all," said Dr. Cohen. "Today, we are giving patients all the information they need. We are talking about MTM services and reviewing their therapy. Before their prescriptions are filled, we sit down with them and talk to them. We immunize. So pharmacists have so much value; we have come so far."


"My hope is that, 20 years from now, society would have changed their expectations for why they go to the pharmacy," said Dr. Brown. "Because right now they pretty much go to the pharmacy to pick up their product. But, in 20 years, I am hoping they are not only going there to pick up their medications but to get those medicines managed and to get some counseling on how to use devices. The pharmacy is revolutionized to the point that it is still doing its basic service, but it is so different that it is nothing like it used to be before."

As the panelists closed their discussion, Dr. Hussar offered an inviting look at the future of pharmacy. "I am very optimistic about the opportunities for pharmacy in the future," he said. "I think that right now, and 20 years from now, there has never been a time when there is a greater need for the knowledge and services that pharmacists are able to provide because of the aging of society. And they are the individuals who are using the most medications. I think there is a tremendous opportunity for the profession."

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