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Pharmacy Manpower 2020: Meeting Needs of Patients Implications for Educators, Practitioners and Regulators Slide Library 2003 Today’s Objective Provide insight into the pharmacist shortage and projected growth in prescription use by US population

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Pharmacy Manpower 2020: Meeting Needs of Patients

Implications for

Educators, Practitioners and Regulators

Slide Library

2003

© 2003 Pharmacy Manpower Project, Inc


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Today’s Objective

  • Provide insight into the pharmacist shortage and projected growth in prescription use by US population

  • Describe factors leading to expanded patient care roles as drug therapy managers by pharmacists

  • Present findings of Conference convened to forecast professionally determined need for pharmacists in 2020

  • Discuss implications of the projected, significant shortfall of pharmacists in 2020 to pharmacy education, practice and regulation

© 2003 Pharmacy Manpower Project, Inc


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Section One

Is There a Pharmacist Shortage?, How Are They Currently Deployed?

© 2003 Pharmacy Manpower Project, Inc


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Are We Experiencing a Pharmacist Shortage?

  • Employer perspective:

    • Staffing problems

    • Job vacancies in community and institutional practice, industry, academia and government

    • Escalating salaries

  • Customer/patient perspective:

    • Inconvenience

    • Decreased access

    • Published ADI analysis: 92% US population lived in areas where pharmacist demand exceeded supply 1999-2001

© 2003 Pharmacy Manpower Project, Inc


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US Population and ADIJuly 2001

© 2003 Pharmacy Manpower Project, Inc


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Are We Experiencing a Pharmacist Shortage?

  • Pharmacist perspective:

    • Increased workload/stress

    • Longer working hours

  • Education Perspective:

    • Formation of new pharmacy schools

    • 12 since 1987

  • Government Perspective:

    • HRSA Report

    • Federal legislation on loan forgiveness

    • Bush initiatives to expand 340B eligible clinics and add pharmacy services to address growing number of uninsured

© 2003 Pharmacy Manpower Project, Inc


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So we have a shortage ofpharmacists…

A shortage of pharmacists to do what??

© 2003 Pharmacy Manpower Project, Inc


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Assure Safe & Accurate Medication Distribution

Community Pharmacy, 2001:

3,000,000,000 prescriptions

132,000 community pharmacists

22,727 Rx/pharmacist/year

One prescription every 5 ½ minutes

© 2003 Pharmacy Manpower Project, Inc


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Hospital Pharmacy, 2001:

1,898,000,000 drug orders

50,000 hospital pharmacists

37,960 orders/pharmacist/year

One drug order every 3 minutes

© 2003 Pharmacy Manpower Project, Inc


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What About Tomorrow?

© 2003 Pharmacy Manpower Project, Inc


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Section Two

Common Vision for Pharmacists:

Helping People Make the Best Use of Their Medicines

© 2003 Pharmacy Manpower Project, Inc


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Common vision of pharmacy practice: helping patients make the best use of their medicines.

© 2003 Pharmacy Manpower Project, Inc


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Pharmacists as drug therapy managers the best use of their medicines.

Assessing, counseling and monitoring drug therapy

Dealing with medication misadventures: $177 billion drug morbidity/mortality ErnstF, Grizzle A JAPhA 2001; 192-200.

Overseeing medication management systems

Delivering pharmaceutical care: could save over $105 billion annually if universally available JohnsonJA, Bootman JL AJHP 1997 54: 554-558.

Pharmacists Roles in Patient Care


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These new roles are not just assuring safe and accurate medication distribution….what about tomorrow?

© 2003 Pharmacy Manpower Project, Inc


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2020 Rx and Order Projections medication distribution….what about tomorrow?

Outpatient prescriptions: 7,500,000,000 (+5%/yr)

Hospital drug orders: 3,000,000,000 (+2.5%/yr)

© 2003 Pharmacy Manpower Project, Inc


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Pharmacist Supply medication distribution….what about tomorrow?

2001: 200,000 active pharmacists

2020 projection:

260,000 active pharmacists

  • Based on new graduates, adjusted for those leaving; assumes 20% enrollment growth existing schools and 3 new ones in addition to those slated to open

© 2003 Pharmacy Manpower Project, Inc


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If Nothing Changes….. medication distribution….what about tomorrow?

Community Pharmacy, 2020:

7,500,000,000 prescriptions

172,000 community pharmacists

43,604 Rx/pharmacist/year

One prescription every 2 ¾ minutes

© 2003 Pharmacy Manpower Project, Inc


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If Nothing Changes….. medication distribution….what about tomorrow?

Hospital Pharmacy, 2020:

3,000,000,000 orders

65,000 hospital pharmacists

46,154 Rx/pharmacist/year

One order every 2 minutes

© 2003 Pharmacy Manpower Project, Inc


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These figures reflect a supply/demand model that only focuses on order fulfillment. Something must change.

© 2003 Pharmacy Manpower Project, Inc


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How Does focuses on order fulfillment. Something must change.Need Fit Into Workforce Projections?

  • Wants

  • Demands

  • Supply

  • Professionally-determined needs

© 2003 Pharmacy Manpower Project, Inc


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What We Are Unsure About... focuses on order fulfillment. Something must change.

  • Role of drugs in future health care

  • Role of genomics and biotech as an adjunct, replacement, or addition to current drug therapy

  • Organization and financing of drugs and pharmacy services

  • Extent of adoption of new pharmacist roles

© 2003 Pharmacy Manpower Project, Inc


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What Hasn’t Sunk in Yet... focuses on order fulfillment. Something must change.

  • The baby boomers are not yet 60!--But they will be soon!

  • A boomer will turn 65 every 10 seconds beginning in 2011

  • Everyday in the US, 6000 people reach the age of 65

  • The over-65 population will DOUBLE by 2030—they use 3 times the number of medicines

  • Other special need populations, such as pedicatric patients or chronic disease sufferers, may influence demand


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Their drug use has not yet been factored into the workforce equation…

© 2003 Pharmacy Manpower Project, Inc


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One could already argue we need 150,000 more pharmacists equation…now to help patients with their medication and tackle the $177 billion in annual drug related morbidity and mortality. Barbara Wells2002-2003 AACP President

© 2003 Pharmacy Manpower Project, Inc


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Section Three equation…

Manpower Conference:

Why, What, How

© 2003 Pharmacy Manpower Project, Inc


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Led to: Conference on Professionally Determined Need for Pharmacy Services

Convened by the Pharmacy Manpower Project, Inc.

Held in Baltimore, MD October 29-31, 2001

Carried out by the University of Maryland School of Pharmacy

© 2003 Pharmacy Manpower Project, Inc


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Conference Goals Pharmacy Services

  • Identify the future needfor pharmacy services from a health professional viewpoint

  • Describe “best practice” characteristics for providing these services

  • Suggest the number of pharmacists to meet projected needs in 2020

© 2003 Pharmacy Manpower Project, Inc


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Participants and Process Pharmacy Services

  • Two dozen experts:

    • All segments of pharmacy

    • Medicine

    • Economics

    • Workforce specialists

  • Three days of deliberations – all discussions; no speakers

© 2003 Pharmacy Manpower Project, Inc


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Forecasting Need: Pharmacy ServicesCriteria for Best Practices

IOM’s Quality Chasm Report aims are that practices must be:

  • Safe

  • Effective

  • Patient-centered

  • Timely

  • Efficient

  • Equitable

© 2003 Pharmacy Manpower Project, Inc


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External Trends Examined Pharmacy Services

  • Population

    • 325 million by 2020

    • Older

    • More diverse

  • People

    • Healthier

    • More Internet savvy

  • Therapy

    • More targeted (biotech)

    • More expensive

  • Health care organization

    • Managed care

    • Community pharmacy

    • Institutional pharmacy

  • Reimbursement methods

    • Drug product related

    • Other

  • Technology

© 2003 Pharmacy Manpower Project, Inc


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Technology Changes Influencing Pharmacy Pharmacy Services

  • Electronic data processing and information transfer:

    • Electronic order entry

    • Expert systems to evaluate drug orders

    • Improved electronic communication systems

  • Improvements in automated order fulfillment systems for both outpatient and institutional use

© 2003 Pharmacy Manpower Project, Inc


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Summary Pharmacy Services

  • A 3-day conference of 25 selected participants evaluated the need for pharmacists in 2020

  • Best practice criteria were developed and applied to order fulfillment, drug therapy management (patient care), and other functions

  • Estimates of professionally determined need were made and compared with the estimated supply of pharmacists

  • A shortage of pharmacists with significant magnitude was forecast: 157,000 conservatively

  • Next steps were suggested

© 2003 Pharmacy Manpower Project, Inc


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Strengths of Approach Pharmacy Services

  • Knowledgeable participants

  • Balance of viewpoints

  • Rapid engagement with issues

  • Global perspective

  • Highly focused

  • Substantial pre-meeting preparation

  • Analysis based on “best practice” case examples

© 2003 Pharmacy Manpower Project, Inc


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Weaknesses of Approach Pharmacy Services

  • Short 3-day meeting

  • Small, selected group of participants

  • Broad-brush discussions

  • Quantitative estimates are rough

  • Many assumptions about external environment, health care organization and financing, uptake of technology in communications and dispensing, and regulatory issues

© 2003 Pharmacy Manpower Project, Inc


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Section Four Pharmacy Services

Conference Outcomes, Projections and Assumptions

© 2003 Pharmacy Manpower Project, Inc


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Current and Projected Need for Pharmacists Pharmacy Services

© 2003 Pharmacy Manpower Project, Inc


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Order Fulfillment Functions Will Require 100,000 FTE Pharmacists

  • Defined narrowly to include only order fulfillment functions (“bottling”)

  • Best practices focus solely on assuring that a prescription is completed and delivered precisely as ordered

  • Assumes that drug orders entering the dispensing system have been assessed, clarified and verified

  • Pharmacist need will be to design, implement and oversee order fulfillment systems

  • Pharmacists will not have to inspect every order personally

  • Assumes that post-dispensing pharmacy services such as counseling and monitoring will be accomplished as patient care functions

© 2003 Pharmacy Manpower Project, Inc


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Best Practices for Order Fulfillment Pharmacists

  • Concentration of fulfillment of maximum number of orders in sophisticated central fill facilities

    • Current examples include mail order pharmacy (Merck Medco) and the Veterans Health Administration

  • Increase the efficiency of community pharmacy based order fulfillment:

    • Increase use of qualified pharmacy technicians

    • Increase use of automation

    • Reduce administrative burden of third party programs

  • These are in addition to Quality Chasm criteria.

© 2003 Pharmacy Manpower Project, Inc


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Community Pharmacy Order Fulfillment Pharmacists

  • Conference estimates that 101,400 FTE pharmacists currently dispense about 30,000 prescriptions per pharmacist per year

  • Arthur Anderson report identified major inefficiencies in use of pharmacists in order fulfillment NACDS Education Foundation: Pharmacy Activity Cost and ProductivityStudy, November 1999, www.nacds.org/publications/research&studies

© 2003 Pharmacy Manpower Project, Inc


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Many Initiatives Will Affect The Shortage... Pharmacists

  • Automated dispensing/central fill/pre-packs/unit of use

  • Bar-coding and electronic control of products

  • e-prescribing, electronic record-keeping

    and drug use control

  • Improved use of qualified technicians and other supportive personnel

© 2003 Pharmacy Manpower Project, Inc


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Outpatient Order Fulfillment Forecast Pharmacists

  • 80% of time now spent by pharmacists in the order fulfillment function can be assumed by automation and/or technical personnel

  • Therefore, best practices could increase order fulfillment output/pharmacist five times

  • Conference projects outpatient prescriptions to grow at rate of 5% per year

© 2003 Pharmacy Manpower Project, Inc


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Pharmacists’ Time: PharmacistsActual and Preferred

Percent of Time Pharmacists Devote to Specific Tasks—Preferred

Percent of Time Pharmacists Devote to Specific Tasks—Actual

© 2003 Pharmacy Manpower Project, Inc

Source: Schommer JC et al. Community Pharmacists’ Work Activities in the United States During 2000


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Hospital Order Fulfillment Forecast Pharmacists

  • 35,000 FTE pharmacists currently fill about 1.9 million drug orders per year in hospitals

  • Inpatient drug orders to grow at 5% per year, assuming that patient population stays about the same size with increased acuity

  • Best practices could double order fulfillment output/pharmacist

© 2003 Pharmacy Manpower Project, Inc


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Long Term Care Order Fulfillment Pharmacists

  • Conference estimated at 196 million prescriptions in 2001

  • Orders for assisted living, home care and hospice not estimated separately

  • Conference forecasts assume these orders included in outpatient and inpatient totals

© 2003 Pharmacy Manpower Project, Inc


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Order Fulfillment Needs Forecast: Summary Pharmacists

  • Assuming all conference projections hold, about 100,000 pharmacists will be needed in 2020 for the order fulfillment function.

  • This assumes that utilization rises 5% annually, mail order and hospital productivity double, and community practice productivity improves by a factor of five

© 2003 Pharmacy Manpower Project, Inc


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Order Fulfillment Projection Assumes: Pharmacists

  • Increased use of information technology and automation, with safety assurances

  • Changes in regulatory environment

  • Successful adaptation to HIPAA

  • Changes in pharmacist attitudes and culture

© 2003 Pharmacy Manpower Project, Inc


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Patient Care Functions Will Require Nearly 300,000 FTE Pharmacists

Expanded need will be due to:

  • Population demographics & special need populations

  • More drugs, increased potency, higher cost

  • Emergence of personalized drug therapy through gene therapy and biotechnology

  • Requirements of specialized drug therapy management for high-risk treatments

  • Increased need for communication among patients and providers

© 2003 Pharmacy Manpower Project, Inc


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Patient PharmacistsCare: Drug Therapy Management

  • A core function of pharmacy: drug therapy management, and other aspects of pharmaceutical care

  • Patient care needs were assessed in all settings

  • Mechanisms for paying pharmacists for these services is prerequisite and assumed

© 2003 Pharmacy Manpower Project, Inc


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Ambulatory Drug Therapy Management Forecast Pharmacists

  • Two best practices models were discussed: a highly-organized HMO (Kaiser Permanente-Denver) and community pharmacy

  • Estimates of pharmacists needed based on two methods resulting in range of 165,000 to 358,000 pharmacists; used the more conservative number

  • Agreed not all patients require same level of primary care

© 2003 Pharmacy Manpower Project, Inc


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Ambulatory Drug Therapy Management Forecast Pharmacists

  • 2/3rds of population get at least 1 Rx/year while 40% receive 4 or more Rx/year

  • Latter group requires complex primary care at best practice estimate of 1 FTE pharmacist per 1000 patients; while remaining population receives services at a ratio of 1 FTE pharmacist per 5,500 patients

© 2003 Pharmacy Manpower Project, Inc


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Hospital-Based Drug Therapy Management Pharmacists

  • About 5,000 hospitals in the U.S.

  • About one pharmacist per hospital performs population-based patient care: safety, policy, etc.

  • Best practice estimate doubles this number

© 2003 Pharmacy Manpower Project, Inc


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Hospital-Based Drug Therapy Management Pharmacists

  • 10,000 FTE pharmacists currently provide this service

  • ASHP surveys find that only about 10% of best practice services are now routinely provided

  • Conference estimates that 100,000 FTE pharmacists needed for this function

© 2003 Pharmacy Manpower Project, Inc


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Drug Therapy Management in LTC and Related Settings Pharmacists

  • 3,000 FTE pharmacists currently provide this service

  • Although over-65 population will be much larger in 2020, it will also be healthier

  • Best practice estimate is 18,750 FTE pharmacists in 2020

© 2003 Pharmacy Manpower Project, Inc


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Drug Therapy Management Needs Forecast: Summary Pharmacists

  • Conference forecasts a need for almost 300,000 pharmacists to meet drug therapy management needs of patients in 2020.

    • Ambulatory patient care: 165,000

    • Hospital-based patient safety, policy: 10,000

    • Hospital-based patient care: 100,000

    • Long term patient care settings: 18,750


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Non-Patient Care Needs Forecast Pharmacists

  • Estimated at 22,000 in 2020

  • Relatively small but critical area

  • Specialty and leadership positions in

    • Profession

    • Industry

    • Academia

    • Government

© 2003 Pharmacy Manpower Project, Inc


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Variables and Assumptions: Order Fulfillment Pharmacists

  • Outpatient Order Fulfillment

    • 2001 prescription number: confident

    • Growth rate (5%): conservative

    • Mail order growth (10%): conservative, given low base

    • Dispensing productivity increases: liberal

  • Hospital, LTC Order Fulfillment

    • 2001 drug order numbers: unknown (extrapolated from orders/patient/day)

    • Hospital growth rate: liberal (5%)

    • LTC orders: conservative

© 2003 Pharmacy Manpower Project, Inc


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Variables and Assumptions: Drug Therapy Management Pharmacists

  • Ambulatory:

    • Highly-managed setting (HMO)(one pharmacists/1000 patients): confident/liberal

    • Community setting (1/1000): unknown/liberal

  • Institutional:

    • Hospital patient safety/policy: confident

    • Hospital patient care: survey-based/confident

    • LTC patient care: conservative

© 2003 Pharmacy Manpower Project, Inc


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Variables and Assumptions: PharmacistsOther Needs; Pharmacist Supply

  • Pharmacist Supply

    • Enrollment growth in existing schools (10% total): conservative

    • New schools (class size 100; 3 new 2010-2020): moderate

  • Other Needs:

    • Category by category assessment: conservative

© 2003 Pharmacy Manpower Project, Inc


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Assumptions Underlying Conference Projections Pharmacists

  • Improved and compatible IT systems will be implemented throughout health care

  • Patient data and reference information will be available to practitioners at the point of service in real time

  • Health care teams will really work

  • Quality and safety systems will be in place

  • Financial incentives will be appropriate

© 2003 Pharmacy Manpower Project, Inc


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Manpower 2020: Conclusions Pharmacists

  • A large shortage of pharmacists is forecasted in 2020

  • The supply of pharmacists needs to increase substantially

  • Productivity of pharmacists needs to increase even more than projected

  • Or services will remain unmet or be provided by others

© 2003 Pharmacy Manpower Project, Inc


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Additional Conclusions Pharmacists

  • Conference forecasts demonstrate that professionally determined needs for order fulfillment services and for drug therapy management services are inextricably intertwined

  • Unless an even more dramatic solution is adopted to meet the forecasted demand for dispensing, the expansion of direct patient drug therapy management by pharmacists will fall far short of need

© 2003 Pharmacy Manpower Project, Inc


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Section Five: Pharmacists

Actions Needed by Profession

© 2003 Pharmacy Manpower Project, Inc


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Actions Required By The Profession Pharmacists

  • Embrace responsibility for drug therapy management

  • Commit to obtaining and maintaining the knowledge, skills and abilities required by patient care

  • Achieve provider status for pharmacists under Medicare

  • Obtain a supporting payment mechanism

  • Expand the size of the profession in order to meet unmet societal needs

  • Fully utilize technology & technicians for order fulfillment


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Even If You Disagree with the Details… Pharmacists

  • Each person will filter the forecasted numbers through their unique perspective and experience

  • Where you find you might reduce the needed number of pharmacists in one area, you will find you raise it in others

© 2003 Pharmacy Manpower Project, Inc


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…You Will Agree at a High-Level Pharmacists

  • Your revised forecasts compared against pharmacist supply estimates will show a significant shortfall of practitioners

  • Findings should be used and challenged within the profession’s practices, educational and regulatory arenas and other stakeholder groups to assist in their long-term planning efforts

© 2003 Pharmacy Manpower Project, Inc


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What Does 2020 Look Like… Pharmacists

  • If we don’t move ahead?

  • Open discussion

  • Top 10 Issues Summary

© 2003 Pharmacy Manpower Project, Inc


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Section Six Pharmacists

Implications for Various Stakeholder Groups: Educators, Practitioners, Regulators, All

© 2003 Pharmacy Manpower Project, Inc


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Implications for Educators: How to Expand the Profession? Pharmacists

  • Good news: today’s graduates are being educated at level consistent with profession’s long-term patient care vision

  • Many new opportunities for pharmacists, especially with doctoral level training

© 2003 Pharmacy Manpower Project, Inc


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Implications for Educators Pharmacists

Producing more graduates:

  • Enrollments rising; impact of PharmD transition closing

  • 12 new schools since 1987

  • Decade trend numbers show sizable increase

  • Role of foreign graduates?

Foreign Pharmacy Graduate Equivalency Examination™ (FPGEE®).

© 2003 Pharmacy Manpower Project, Inc


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Entry-Level Pharmacy Graduates Pharmacists

© 2003 Pharmacy Manpower Project, Inc


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Projected Entry-Level Graduates Pharmacists

© 2003 Pharmacy Manpower Project, Inc


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Implications for Educators Pharmacists

Expansion of programs that support current practitioner’s transition to new roles:

  • Accessible

  • Affordable

  • Flexible

  • Partnerships with practice organizations

© 2003 Pharmacy Manpower Project, Inc


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Challenges for Educators Pharmacists

  • Faculty needs: new models & partnerships with practice; more residency trained faculty needed

  • Training sites: new models, residencies

  • Curriculum to address distributive/patient care roles

  • Technology application to both: e.g. distance education

  • Sharing resources across institutions: curricular resources, faculty?

  • Financing for expansion in era of state budget issues

  • Research enterprise: where will growing funding be secured?

© 2003 Pharmacy Manpower Project, Inc


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Challenges for Educators/Practice Pharmacists

Determining how many practitioners will need to make the transition?

  • Decrease of 25,000 for order fulfillment (dispensing) over 20 years vs. need for 295,000 in drug therapy management services

  • Create tools to identify best practitioners to target?

© 2003 Pharmacy Manpower Project, Inc


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Implications for Practice: How to Accelerate Change? Pharmacists

Continued, rapid implementation of technology and qualified pharmacy technicians to improve order fulfillment efficiency, patient safety and patient services

© 2003 Pharmacy Manpower Project, Inc


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Implications for Practice: How to Accelerate Change? Pharmacists

Increase residency trained practitioners

As of May 2003 *

  • 383 Accredited pharmacy practice programs

  • 242 Accredited specialized residencies

  • 1,077 Residents/year

    *Programs that have been accredited or have applied for accreditation

© 2003 Pharmacy Manpower Project, Inc


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Stepping Stone Summit: Technology Recommendations Pharmacists

APhA/NCPA/NACDS in 2/2002:

#1 – Bar code verification

#2 – e-prescribing systems & interface

#3 – In pharmacy dispensing automation

& central fill

#4 – Broadband Internet connectivity

#5 – Reduce regulatory barriers

© 2003 Pharmacy Manpower Project, Inc


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2003 Hot Technologies: ASAP Survey 2-2003 Pharmacists

  • E-signatures, primarily HIPAA driven

  • E-prescribing will grow

  • Continued system integration: IVR, dispensing, POS

  • High-speed Internet connectivity

© 2003 Pharmacy Manpower Project, IncFrom American Society of Automation in Pharmacy (ASAP)


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Chains using IVR Pharmacists

Stores in chain withIVR installed

Using IVR to route refills to doctors

Chains evaluatingrobotic solutions

Chains using scanners in the pharmacy

Stores in chain using scanners

Central fill on the agenda

Central processingon the agenda

Chains that applied for HIPAA extension

Will be applying forHIPAA extension

Want continuedsupport of 3.2

Chain Use of Technology: July 2002

© 2003 Pharmacy Manpower Project, IncAdapted from July/August 2002 ComputerTalk



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Hospital Use of Technology Pharmacists

  • Computerized Prescriber Order Entry (CPOE)

    • 3.5% of hospitals use CPOE

  • Use of Automated Storage and Distribution Devices (ASDDs)

    • 58% have some ASDDs

  • Bar Code Point-of-Care Technology

    • 1.3% verify medication, patient id, and nurse at the bedside

  • Pharmacy Robots

    • 8% use robot filling devices

Source: 2002 ASHP National Survey of Pharmacy Practice in Hospitals

© 2003 Pharmacy Manpower Project, Inc


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Adding Pharmacy Technicians to the Mix: 131,000++ (12-02) Pharmacists

© 2003 Pharmacy Manpower Project, Inc


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And Ratios are Changing... Pharmacists

Puerto Rico

Alaska

Greater than 2:1

2:1

1:1

No Established Ratios

No Data

Hawaii


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Implications for Community Practice Pharmacists

Continued creation of opportunities for new service development in the community:

  • Residency programs in community practice: 65 programs with 32 that are accredited or have applied for accreditation

  • Participation in demonstration projects, e.g. Patient Self-Management: Diabetes

  • Partnerships with education and practice organizations

    Seeking payment mechanisms and provider status

© 2003 Pharmacy Manpower Project, Inc


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Challenges for Practice Pharmacists

  • Generating sufficient capital to support practice transition

  • Maintaining practitioner knowledge and skills: Does CE enterprise need to be different?

  • Addressing attitudes and culture among practitioners to embrace new technologies and roles

© 2003 Pharmacy Manpower Project, Inc


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Challenges For Practice/Regulators Pharmacists

  • Changing regulatory environment to embrace rapid practice change

  • Securing collaborative practice authority

  • Securing ability to immunize

Immunizations Bill Passes in House

© 2003 Pharmacy Manpower Project, Inc


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Implications for Regulators: “Technologically Facilitated Care”

  • How to regulate “technologically facilitated care”

  • Remove impediments to change that can improve dispensing efficiency and patient care:

    • Qualified pharmacy technicians

    • Automation

    • information sharing: HIPAA concerns and security

© 2003 Pharmacy Manpower Project, Inc


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Implications for Regulators Care”

  • Focus on outcomes vs. structure, process

  • How to ensure continuing competence among a changing workforce

© 2003 Pharmacy Manpower Project, Inc


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Implications for All Care”

  • How to implement services that people don’t know they need

    • Physicians, public not overly concerned about medical errors NEJM 2002: 347:19330194

    • Public not aware of health professional shortage AmerisourceBergen Poll 7/2002

  • Continued learning from those successfully implementing among patients

  • Publicizing outcomes from practices widely

© 2003 Pharmacy Manpower Project, Inc


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Implications for All Care”

  • People outside the profession care about drugs and believe they are:

    • Expensive

    • Toxic

    • Complex

© 2003 Pharmacy Manpower Project, Inc


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Implications for All Care”

They are not a no-risk proposition and

must be actively managed

© 2003 Pharmacy Manpower Project, Inc


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What if This Was Your Mom? Care”

  • Elderly consume 34% of all Rx’s

  • Many have issues related to medication access and coverage

  • Adverse drug reactions (ADRs) are among the top 5 threats to senior’s health

What Will You Do When You Leave?

© 2003 Pharmacy Manpower Project, Inc


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What If This Was Your Child? Care”

  • Little known about ADR’s in children

  • Pediatric ADR Reporting System--Pediatric Pharmacy Advocacy Group

  • 2 to 17% of children admitted to hospitals were admitted due to ADRs Mitchell et al AmJEpid: 1979: 196-204.

  • 65-75% of FDA-approved meds not approved for use in children Yaffe et.al Ped. Pharmacology 1992: 3-9.

What Will You Do When You Leave?

© 2003 Pharmacy Manpower Project, Inc


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How Are You Spending Your Time? Care”

  • I’ll get to that project tomorrow?

  • My colleagues are tackling that issue

  • That issue is the responsibility of X, Y and Z?

  • What can I do?

Or…

© 2003 Pharmacy Manpower Project, Inc


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How Are You Spending Your Time? Care”

Are you moving ahead to:

  • Implement new programs?

  • Implement technology?

  • Use qualified support personnel?

  • Collaborate with colleagues?

  • Stay current with new developments?

Or taking other steps to help patients?

© 2003 Pharmacy Manpower Project, Inc


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Where To Go From Here? Care”

  • Open Discussion: what are top 5 issues for Educators, Practitioners, Regulators?

© 2003 Pharmacy Manpower Project, Inc


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