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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

Pharmacy Manpower 2020: Meeting Needs of Patients

Implications for

Educators, Practitioners and Regulators

Slide Library

2003

© 2003 Pharmacy Manpower Project, Inc

today s objective
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

section one

Section One

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

© 2003 Pharmacy Manpower Project, Inc

are we experiencing a pharmacist shortage
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

us population and adi july 2001
US Population and ADIJuly 2001

© 2003 Pharmacy Manpower Project, Inc

are we experiencing a pharmacist shortage6
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

so we have a shortage of pharmacists

So we have a shortage ofpharmacists…

A shortage of pharmacists to do what??

© 2003 Pharmacy Manpower Project, Inc

assure safe accurate medication distribution
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

slide9
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

what about tomorrow
What About Tomorrow?

© 2003 Pharmacy Manpower Project, Inc

slide11

Section Two

Common Vision for Pharmacists:

Helping People Make the Best Use of Their Medicines

© 2003 Pharmacy Manpower Project, Inc

slide12

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

© 2003 Pharmacy Manpower Project, Inc

pharmacists roles in patient care
Pharmacists as drug therapy managers

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
these new roles are not just assuring safe and accurate medication distribution what about tomorrow

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

© 2003 Pharmacy Manpower Project, Inc

2020 rx and order projections
2020 Rx and Order Projections

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

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

© 2003 Pharmacy Manpower Project, Inc

slide16

Pharmacist Supply

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

if nothing changes
If Nothing Changes…..

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

slide18

If Nothing Changes…..

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

slide19
These figures reflect a supply/demand model that only focuses on order fulfillment. Something must change.

© 2003 Pharmacy Manpower Project, Inc

how does need fit into workforce projections
How Does Need Fit Into Workforce Projections?
  • Wants
  • Demands
  • Supply
  • Professionally-determined needs

© 2003 Pharmacy Manpower Project, Inc

slide21

What We Are Unsure About...

  • 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

slide22

What Hasn’t Sunk in Yet...

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

© 2003 Pharmacy Manpower Project, Inc

slide24

One could already argue we need 150,000 more pharmacists 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

section three

Section Three

Manpower Conference:

Why, What, How

© 2003 Pharmacy Manpower Project, Inc

led to conference on professionally determined need for pharmacy services
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

conference goals
Conference Goals
  • 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

participants and process
Participants and Process
  • Two dozen experts:
    • All segments of pharmacy
    • Medicine
    • Economics
    • Workforce specialists
  • Three days of deliberations – all discussions; no speakers

© 2003 Pharmacy Manpower Project, Inc

forecasting need criteria for best practices
Forecasting Need: Criteria 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

slide30

External Trends Examined

  • 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

slide31

Technology Changes Influencing Pharmacy

  • 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

slide32

Summary

  • 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

slide33

Strengths of Approach

  • 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

slide34

Weaknesses of Approach

  • 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

section four

Section Four

Conference Outcomes, Projections and Assumptions

© 2003 Pharmacy Manpower Project, Inc

current and projected need for pharmacists
Current and Projected Need for Pharmacists

© 2003 Pharmacy Manpower Project, Inc

slide37

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

slide38

Best Practices for Order Fulfillment

  • 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

slide39

Community Pharmacy Order Fulfillment

  • 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

slide40

Many Initiatives Will Affect The Shortage...

  • 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

slide41

Outpatient Order Fulfillment Forecast

  • 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

slide42

Pharmacists’ Time:Actual 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

slide43

Hospital Order Fulfillment Forecast

  • 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

slide44

Long Term Care Order Fulfillment

  • 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

slide45

Order Fulfillment Needs Forecast: Summary

  • 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

order fulfillment projection assumes
Order Fulfillment Projection Assumes:
  • 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

patient care functions will require nearly 300 000 fte pharmacists
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

slide48

Patient Care: 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

slide49

Ambulatory Drug Therapy Management Forecast

  • 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

slide50

Ambulatory Drug Therapy Management Forecast

  • 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

slide51

Hospital-Based Drug Therapy Management

  • 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

slide52

Hospital-Based Drug Therapy Management

  • 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

slide53

Drug Therapy Management in LTC and Related Settings

  • 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

slide54

Drug Therapy Management Needs Forecast: Summary

  • 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
non patient care needs forecast
Non-Patient Care Needs Forecast
  • 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

slide56

Variables and Assumptions: Order Fulfillment

  • 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

slide57

Variables and Assumptions: Drug Therapy Management

  • 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

slide58

Variables and Assumptions:Other 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

assumptions underlying conference projections
Assumptions Underlying Conference Projections
  • 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

slide60

Manpower 2020: Conclusions

  • 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

slide61

Additional Conclusions

  • 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

section five

Section Five:

Actions Needed by Profession

© 2003 Pharmacy Manpower Project, Inc

actions required by the profession
Actions Required By The Profession
  • 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
slide64

Even If You Disagree with the Details…

  • 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

slide65

…You Will Agree at a High-Level

  • 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

what does 2020 look like
What Does 2020 Look Like…
  • If we don’t move ahead?
  • Open discussion
  • Top 10 Issues Summary

© 2003 Pharmacy Manpower Project, Inc

section six

Section Six

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

© 2003 Pharmacy Manpower Project, Inc

implications for educators how to expand the profession
Implications for Educators: How to Expand the Profession?
  • 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

implications for educators
Implications for Educators

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

entry level pharmacy graduates
Entry-Level Pharmacy Graduates

© 2003 Pharmacy Manpower Project, Inc

projected entry level graduates
Projected Entry-Level Graduates

© 2003 Pharmacy Manpower Project, Inc

implications for educators72
Implications for Educators

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

  • Accessible
  • Affordable
  • Flexible
  • Partnerships with practice organizations

© 2003 Pharmacy Manpower Project, Inc

slide73

Challenges for Educators

  • 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

challenges for educators practice
Challenges for Educators/Practice

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

implications for practice how to accelerate change
Implications for Practice: How to Accelerate Change?

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

© 2003 Pharmacy Manpower Project, Inc

slide76

Implications for Practice: How to Accelerate Change?

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

slide77

Stepping Stone Summit: Technology Recommendations

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

slide78

2003 Hot Technologies: ASAP Survey 2-2003

  • 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)

chain use of technology july 2002

Chains using IVR

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

hospital use of technology
Hospital Use of Technology
  • 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

slide82

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

© 2003 Pharmacy Manpower Project, Inc

and ratios are changing
And Ratios are Changing...

Puerto Rico

Alaska

Greater than 2:1

2:1

1:1

No Established Ratios

No Data

Hawaii

slide84

Implications for Community Practice

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

challenges for practice
Challenges for Practice
  • 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

challenges for practice regulators
Challenges For Practice/Regulators
  • 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

implications for regulators technologically facilitated care
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

implications for regulators
Implications for Regulators
  • Focus on outcomes vs. structure, process
  • How to ensure continuing competence among a changing workforce

© 2003 Pharmacy Manpower Project, Inc

slide89

Implications for All

  • 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

slide90

Implications for All

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

© 2003 Pharmacy Manpower Project, Inc

implications for all
Implications for All

They are not a no-risk proposition and

must be actively managed

© 2003 Pharmacy Manpower Project, Inc

slide92

What if This Was Your Mom?

  • 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

what if this was your child
What If This Was Your Child?
  • 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

how are you spending your time
How Are You Spending Your Time?
  • 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

how are you spending your time95
How Are You Spending Your Time?

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

where to go from here
Where To Go From Here?
  • Open Discussion: what are top 5 issues for Educators, Practitioners, Regulators?

© 2003 Pharmacy Manpower Project, Inc