The Growing Influence of Health-System Pharmacy

Introducing

Stephen F. Eckel, PharmD, MHA, BCPS, FASHP, FAPhA

Stephen F. Eckel received his bachelor of science degree in pharmacy from the University of North Carolina (UNC) at Chapel Hill and received his doctor of pharmacy degree, also from UNC. Following completion of a pharmacy practice residency at Duke University Medical Center, he began as a clinical pharmacist at UNC Hospitals. He completed a masters of health care administration at the UNC School of Public Health.

Currently, Dr. Eckel is the assistant director of pharmacy and residency program director of UNC Hospitals. In addition, he is director of graduate studies in the Division of Pharmacy Practice and Experiential Education at UNC Eshelman School of Pharmacy and is in charge of the 2-year masters of science in hospital pharmacy administration. This degree is hosted in multiple sites across the state of North Carolina. Dr. Eckel is also board certified as a pharmacotherapy specialist.

Dr. Eckel is a passionate supporter of the unique role the pharmacist plays in patient care. He has dedicated his time to utilizing pharmacy technicians and technology to free up pharmacists to practice. He conducts research in this area and is a frequent speaker around the world on these issues.

Dr. Eckel leads a dynamic group of patient care providers at UNC Hospitals. He has also worked with numerous residents over the years, giving them the passion to practice and the desire to be involved in the profession of pharmacy. He is very active in the North Carolina Association of Pharmacists and has been elected both as the chair of the Acute Care Practice Forum and as a board member. He has served for many years in the American Society of Health-System Pharmacists (ASHP) House of Delegates. He was also the chair of the ASHP Council of Pharmacy Practice from 2009 to 2010. Dr. Eckel has been recognized as a fellow of ASHP and the American Pharmacists Association.

With this special edition, Pharmacy Times is launching a new section specifically focused on Health-System Pharmacy. The intent is to provide content and useful information targeted to practitioners working in this setting. While this is exciting and might make sense to some, others might not understand why it is needed. To address some of these questions, I thought it would be important to highlight a few of the emerging opportunities for pharmacists practicing in health-system pharmacy and the growing influence these pharmacy departments have in today’s health care scene.

As health care reform continues to be discussed and health systems evaluate whether to become accountable care organizations, a need emerges for alignment between acute care activities (ie, inpatient) and the ambulatory care setting (ie, physician offices). The traditional hospital has placed the majority of pharmacy resources on the inpatient side and has not invested much in pharmacy practice in the outpatient setting, except for the retail pharmacy.

With the recognition that reimbursement is being limited for readmissions— and these events commonly arise due to hasty discharges or medication issues upon hand-offs to home—these transitions of care between the 2 settings have become critical. It has been demonstrated that when a patient is discharged and there is an appropriate hand-off to the ambulatory care setting (medications are appropriate and understood), readmissions are less likely to occur.¹

Aside from the emerging focus on transitions of care in the health-system pharmacy and the growing opportunities for pharmacists to take a leading role, the pharmacy departments are also receiving increased attention from hospital administration. Over the last few years, accreditation agencies and the federal government have placed a large focus on quality standards and the appropriate utilization of medications. Compliance with these National Patient Safety Goals and Core Measures has required pharmacy departments to restructure and add resources in order to ensure success.

As these pharmacy departments take accountability and responsibility for the medication use process, pharmacy leadership is provided a very influential opportunity. Many organizations have identified the need for a chief pharmacy officer, which is someone who has broad responsibility for the utilization of medications across the entire organization. These individuals are usually located in the executive suite and exert influence on the strategic direction of the organization. These positions have become essential and necessary because of the following characteristics of hospitals2:

• Drug budgets account for 30% of the organization’s total supply expense

• Technology and information systems dedicated to pharmacy cost at least 15% of the organization’s total budget

• Pharmacy is responsible for 25% of gross operating revenue

Because of the increasing costs associated with the pharmacy department, it is critical for leadership to manage these well. The most effective manner to do this is having pharmacy knowledgeable about and influential on the direction of the organization.

The complexity and influence of health systems has provided the pharmacy department and individual pharmacist with a great deal of influence. Having tools that allow these pharmacists to be successful can only benefit patient care. This is why Pharmacy Times has developed a unique section for health-system pharmacy, and I know it will be both informative and useful to the health-system pharmacy community. As we evolve this growing section, please let me know if there are any sections or content areas that can help you be more impactful to the well-being of your patients. PTHS

Dr. Eckel is assistant director of pharmacy at the University of North Carolina Hospitals and clinical assistant professor at the University of North Carolina Eshelman School of Pharmacy.