Pharmacy Manpower 2020: Meeting Needs of Patients - PowerPoint PPT Presentation

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Pharmacy Manpower 2020: Meeting Needs of Patients

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  1. Pharmacy Manpower 2020: Meeting Needs of Patients Implications for Educators, Practitioners and Regulators Slide Library 2003 © 2003 Pharmacy Manpower Project, Inc

  2. 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

  3. Section One Is There a Pharmacist Shortage?, How Are They Currently Deployed? © 2003 Pharmacy Manpower Project, Inc

  4. 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

  5. US Population and ADIJuly 2001 © 2003 Pharmacy Manpower Project, Inc

  6. 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

  7. So we have a shortage ofpharmacists… A shortage of pharmacists to do what?? © 2003 Pharmacy Manpower Project, Inc

  8. 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

  9. 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

  10. What About Tomorrow? © 2003 Pharmacy Manpower Project, Inc

  11. Section Two Common Vision for Pharmacists: Helping People Make the Best Use of Their Medicines © 2003 Pharmacy Manpower Project, Inc

  12. Common vision of pharmacy practice: helping patients make the best use of their medicines. © 2003 Pharmacy Manpower Project, Inc

  13. 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

  14. These new roles are not just assuring safe and accurate medication distribution….what about tomorrow? © 2003 Pharmacy Manpower Project, Inc

  15. 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

  16. 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

  17. 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

  18. 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

  19. These figures reflect a supply/demand model that only focuses on order fulfillment. Something must change. © 2003 Pharmacy Manpower Project, Inc

  20. How Does Need Fit Into Workforce Projections? • Wants • Demands • Supply • Professionally-determined needs © 2003 Pharmacy Manpower Project, Inc

  21. 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

  22. 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

  23. Their drug use has not yet been factored into the workforce equation… © 2003 Pharmacy Manpower Project, Inc

  24. 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

  25. Section Three Manpower Conference: Why, What, How © 2003 Pharmacy Manpower Project, Inc

  26. 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

  27. 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

  28. 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

  29. 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

  30. 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

  31. 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

  32. 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

  33. 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

  34. 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

  35. Section Four Conference Outcomes, Projections and Assumptions © 2003 Pharmacy Manpower Project, Inc

  36. Current and Projected Need for Pharmacists © 2003 Pharmacy Manpower Project, Inc

  37. 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

  38. 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

  39. 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

  40. 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

  41. 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

  42. 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

  43. 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

  44. 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

  45. 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

  46. 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

  47. 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

  48. 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

  49. 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

  50. 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