ROUNDTABLE DISCUSSION: "THE FUTURE OF PHARMACY"

EARLIER THIS YEAR, PHARMACY Times held a roundtable discussion about ?The Future of the Pharmacy? at the American Pharmacists Association convention in Atlanta, Ga, where students and executives discussed the varying issues affecting the field of pharmacy today and how those issues may impact the future. Stephen Eckel, PharmD, assistant director of pharmacy at University of North Carolina Hospitals Department, hosted the lively discussion that covered a wide range of topics?Medicare Part D, medication therapy management (MTM), pharmacist education, and the role of technicians. Not surprisingly, the focus was squarely on patient care and the value of building trust between patients and pharmacists. Medicare Part D and MTM have provided a springboard for pharmacists who are eager to delegate pill dispensing and to become part of a whole health care team.

MEDICARE PART D

Participants agreed that while Medicare Part D has in many ways been quite positive for patients, notably improving compliance, many challenges still remain.

?There needs to be more communication and education for those people [patients] so they can understand [Medicare Part D].... Many seniors do not understand, and they lose trust,? said Rhonda Garner, a University of Tennessee-Memphis student. Megan Barnes, a student at <?xml:namespace prefix = st1 />

Duquesne

University

, agreed and added, ?I also agree that it is a major problem of seniors not understanding the plan. I think it is very important that pharmacists get involved and make sure that every senior citizen who comes in and is eligible for a Medicare Part D plan is counseled and understands their options.? Pharmacists were encouraged by the improved communication with patients throughout the year and were relieved that patients were not pill splitting or rationing their medications.

?There really is an improvement in the system?, [including] Compliance to medications as well as an increase in the interaction, and the opportunity for the interaction with the pharmacist and the patients...,? said Papatya Tankut, vice president of pharmacy professional services, CVS Corp.

PREPARING PHARMACISTS

Throughout the discussion of Medicare Part D, concerns were raised about the pressure that pharmacists have been under to help patients understand their drug benefits and how to make good choices.

Making sure pharmacists are prepared to help patients on an ongoing basis was a high priority for both students and executives on the panel. A common recognition was voiced that earning and keeping patients? trust will not be easy. While the education of pharmacists is critical, all pharmacists will be learning some of their most important new skills on the job.

?It is incumbent upon us to help our pharmacists so that they are prepared to answer those questions [regarding Medicare Part D from patients],? according to Susanne Hiland, PharmD, director of professional services and government relations at Wal-Mart Stores Inc.

David Trang, RPh, assistant professor in pharmacy practice at the University of the Incarnate Word, Feik School of Pharmacy, feels that students are very well trained via curriculum but may benefit from additional training in business and management. He said, ?It surprises me the immense amount of training that students get?. But, the one thing that I see that they do not get particularly enough of, which we are incorporating into our program, is that management and that business training?the skills that they do not necessarily get.?

MTM

MTM is a very positive extension of patient relationships established in the first year of Medicare Part D, according to the panelists. Although the response to MTM has been quite encouraging, it is important to establish industry-wide standards, so that all pharmacists can be trained within a common framework. Generally, participants also agreed that MTM standards help patients, and decision-makers can all become familiar with what MTM is and what it can accomplish. Multiple approaches, however, may confuse pharmacists as well as other stakeholders that pharmacists who eager to reach.

?One of the things that has been mentioned many times is that there are so many different plans out there that offer their own type of MTM, which makes it very difficult for training, especially in large partners. But eventually, as more standardization comes out, it is something we are all going to have to do in order to make this happen,? according to Scott A. Miller, PharmD, director of clinical education and medication services at Walgreens Health Services.

The student panelists felt prepared and were excited about the prospect of providing MTM to patients. ?I think we are [ready], and I think we are also getting very excited about it,? said Cristina Gonzalez, a student from

Palm Beach

Atlantic

University

. ?I think the issue is that there are a lot of minds that need to be changed. We need to provide a lot more education to patients and physicians,? she said.

PHARMACY EDUCATION

While there is some appreciation for PharmDs and individuals trained with other advanced degrees, panelists also were keen to point out that patient care is not something students will learn in a classroom. Participants agreed that more work needs to be done to help prepare students for the demands of providing direct patient care, particularly to our aging population.

?Clinical and face-to-face interaction can be done by PharmDs, bachelor?s degrees, and others as long as we are all committed?and passionate about?quality interactions with our customers,? said Wal-Mart?s Hiland. ?As the profession changes from pill dispensing to patient care, schools should provide on-the-job training for students to participate in these changes without driving up the cost of health care.?

USE OF TECHNICIANS

Pharmacy chains employ tens of thousands of technicians who free up pharmacists to spend more time counseling and interacting with patients at every level.

?We employ over 40,000 pharmacy technicians,? said CVS? Tankut. ?I believe that the correct utilization and training for technicians provides and affords the pharmacist the opportunity to be able to do the things they are trained to do and spend more time counseling and interacting with the patients.?

Delegating pharmacists? tasks can be tough, however, because of an issue of trust between pharmacists and the technicians they team with. If a technician makes a dispensing error, the pharmacist is accountable, for example. Participants agreed that one way to help establish trust and demonstrate competence may be to require every technician to be certified in each pharmacy he/she works.

?The pharmacist is not familiar with those technicians?. Maybe require every technician to be certified in that pharmacy?, then [the pharmacist] may see the technician as trustworthy,? said Carlisha Colbert, a student at

Howard

University

.

Pharmacy chain executives agreed that trust has to be earned, and certification is a good step in that direction. Delegating more tasks to technicians was seen important to moving the profession forward as well.

?They [technicians] are the pharmacist?s right hand,? said Walgreens? Miller. ?I think there is a timeframe where trust is earned. So, where at first a practitioner [pharmacist] might try to do everything themselves and not fully utilize their technician because they are concerned that ?this is my license?. I have just spent the last 6 years of my life getting this,?? Miller said. ?But, that symbiotic relationship develops rather quickly when the pharmacist is saying, ?Alright, I just cannot do everything.??

FUTURE OF THE PROFESSION

At the end of the roundtable, participants were enthusiastic though realistic about the future of pharmacy and pharmacists? roles in direct patient care. Common goals included establishing ways to regularly collaborate with other health care professionals, delegating more duties to technicians, and improving direct patient care through MTM and other approaches. Giving students more exposure to patient care and learning to adapt to dynamic changes in health care policy also were key areas of concern among participants. At the same time, the uncertain future of Medicare, health care costs, and the other unspoken challenges remain.

Janet Strain, a student from Midwestern University, Chicago College of Pharmacy, concluded, ?I think pharmacy is headed more towards being an integrated part of the health care team...through collaborative practice and working with physicians.?

?We have to find a way as a profession to impact the cost of health care and make ourselves a valuable part of the health care team that can reduce costs and provide ultimate patient safety and improved health outcomes,? said