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Blazing a New Trail for Pharmacy

Pharmacy Practice Model Initiative Looks to the Future

Apr 09, 2010

TWENTY-FIVE YEARS after the influential Hilton Head conference, ASHP and the ASHP Foundation are once again embarking on a groundbreaking national effort to guide the future of hospital and health-system practice.

The Pharmacy Practice Model Initiative (PPMI), officially launched in 2009, will revisit the hard consensus-building work of Hilton Head and other ASHP-hosted legacy conferences as pharmacists in all practice settings debate what the future of the profession should look like.

“National health care reform, constantly evolving technologies, massive amounts of new drugs entering the market every year, scientific breakthroughs… All of these and more are demanding that we, as pharmacists, really step up and begin to own the medication-use policies and procedures within our institutions,” said ASHP president Lynnae Mahaney, M.B.A., FASHP, chief of pharmacy services at the William S. Middleton Memorial Veterans Hospital in Madison, Wis.

Expectations Versus Actual Opportunities

“We’re in an environment where there is national concern about the future state of health care,” said David Chen, R.Ph., M.B.A., director of ASHP Pharmacy Practice Sections. “Additionally, we’re seeing growing demand for enhanced pharmacy services and increasing pressure to integrate technology advances. We really need a self-critical analysis of the state of pharmacy practice.”

Although the Hilton Head conference and other ones like it successfully laid the groundwork for the all-Pharm.D. degree and many of the professional opportunities that pharmacists now enjoy, there is much more to achieve, according to Doug Scheckelhoff, M.S., ASHP vice president of professional development.

“Hilton Head was focused on the clinical profession of pharmacy and the types of training needed to get there,” Scheckelhoff said. “It was really pivotal in setting a clear direction. The PPMI will be just as important, but in a different way.”

A joint project of ASHP and the ASHP Foundation, the PPMI will comprise three components: an invitational summit this fall, a campaign to promote change, and demonstration projects funded by Foundation grants. At press time, McKesson Corporation had signed on as a Leadership-Level sponsor of the Initiative, and Omnicell, Inc. and CareFusion had signed on as Gold-Level sponsors.

An Unsettling Trend

The Initiative reflects a powerful movement within ASHP’s membership. The need for a new practice paradigm has surfaced again and again during the past several years in ASHP’s policymaking Councils and membership Sections, as well as during strategic planning for the Society’s Leadership Agenda.

“We’ve been monitoring a trend in which professionals other than pharmacists are taking roles that have traditionally been pharmacists’ roles, both by design and by direct competition,” Chen said, adding that the movement is troubling because pharmacists have the knowledge and skills to conduct direct patient care and medication management.

“We need to put our stake in the ground and become the recognized experts among our medical peers on drug therapy and medication-use processes,” he said. “We also have to start taking into consideration external influences that we don’t directly control but that will ultimately affect our opportunities.” 

The issue is particularly stark when one considers the scientific breakthroughs happening today, according to Karl Gumpper, R.Ph., BCPS, director of ASHP’s Section of Pharmacy Informatics and Technology. The Section recently published a Vision Statement on Technology-Enabled Practice, acknowledging many of the challenges and opportunities that lie ahead for pharmacists.

“Medication management eventually will move toward genetics and genomics,” Gumpper noted. “All of that science will go into dosing and even picking a medication. There is no one more qualified than pharmacists to do that job.”

Finding the Right Balance

Ultimately, the best pharmacy practice models are those that find optimal balance, matching the work to the skills of the individual and using automation and technology wherever possible to improve safety and efficiency, according to Scheckelhoff. “What are technicians capable of doing and what should they be doing?” he asked. “How can we use technology to improve our processes? And how can pharmacists directly impact the care of patients?”

Scheckelhoff noted the disparities that currently exist among pharmacy services at different types of hospitals and health systems across the country. ASHP’s National Survey has repeatedly shown that “innovator hospitals” offer high levels of pharmacy services. In contrast, less progressive hospitals still provide the same kinds of  services that they provided 30 to 40 years ago.

“We need to look for ways to close that gap,” Scheckelhoff said. “Our patients need it, and they deserve it.” ASHP created a website just for the Initiative and is encouraging members to disseminate their thoughts on the best practice models via ASHPConnect discussion boards.

The first major activity will be a multidisciplinary invitational summit this fall that will focus on developing a framework of pharmacy practice that takes into consideration the internal and external factors that will affect patient care in the future.

From there, a synopsis of proceedings will help members do their own critical analysis about what types of pharmacy services they are offering. This process will, in turn, drive the development of new practice models.

“To actually change our practice models, we will need leadership at every level of pharmacy…from the pharmacy director, to the clinician at the bedside, to the technician,” said Daniel J. Cobaugh, Pharm.D., FAACT, DABAT, the Foundation’s senior director for research and operations. “It won’t be easy, and it will take time and commitment, but we all need to be engaged in this exciting process.”

Summit Dates Announced
To kick off the PPMIMI, ASHP will host an invitational consensus conference Nov. 7-9, 2010, in Dallas. The conference will bring together thought leaders throughout hospital and health-system pharmacy to reach consensus on optimal practice models.

For more information on ASHP’s Pharmacy Practice Model Inititiave, go to www.ashp.org/ppmi.

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