Question about the future of pharmacy

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Swenis

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I know this may sound silly to you guys and gals, but what does everyone foresee for the future of retail pharmacists? Is our field always going to have openings during our lifetime, you think? How do you see the role of the pharmacist changing in the years to come, etc? I was just curious about this as I'm about to begin my two-years of pre-pharmacy coursework, and it just crossed my mind.
 
Man, you are always there for me, South2006. Oh what would I ever do with out you, actually research myself? :laugh:
 
Swenis said:
I know this may sound silly to you guys and gals, but what does everyone foresee for the future of retail pharmacists? Is our field always going to have openings during our lifetime, you think? How do you see the role of the pharmacist changing in the years to come, etc? I was just curious about this as I'm about to begin my two-years of pre-pharmacy coursework, and it just crossed my mind.
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It's a good question, I recommend looking ata Pfizer Pharmacist Career Guide. I am not sure of the link...I am sure some one here may have it. This shows the diversity of the field. You can expect that as technology increases, the amount of medications will increase, the patient populus using meds will increase as baby boomers age, and the pharmacist will be at the center managing technologies, insurance, and helping to develop medications and technologies that will limit side effects. I'd look into a new, important field pharmacogenomics. There is b0ook that looks at all sides of the field Pharmacogenomics: Social, Ethical, and Clinical Dimensions
by Mark A. Rothstein (Editor) . Check it out on a library or just google the subject and you will see the potential for medications and then see the potential for the pharmacist profession.

Good luck!
 
Oneday_9 said:
It's a good question, I recommend looking ata Pfizer Pharmacist Career Guide. I am not sure of the link...I am sure some one here may have it. This shows the diversity of the field. You can expect that as technology increases, the amount of medications will increase, the patient populus using meds will increase as baby boomers age, and the pharmacist will be at the center managing technologies, insurance, and helping to develop medications and technologies that will limit side effects. I'd look into a new, important field pharmacogenomics. There is b0ook that looks at all sides of the field Pharmacogenomics: Social, Ethical, and Clinical Dimensions
by Mark A. Rothstein (Editor) . Check it out on a library or just google the subject and you will see the potential for medications and then see the potential for the pharmacist profession.

Good luck!
Click to expand...


http://www.pfizercareerguides.com/pharmacy.html
 
Hey South! Great links. But I am sort of confused about one thing. The article states that pharmacists now have more decision making power for patients, but more I read the webpage, more it seems like the the closest pharmacist can get to patients is to give them recommendations. It also seems that 99% of the work is done by Doctors and Nurses, and pharmacists just "check" their works. What exactly is the "clinical" role of pharmacists? 😕
 
The role of a pharmacist is increasing in States. The thing is, when you do this type of practice, you have to have a protocol set up. The state of Washington has been the pioneer in this. I'm sure bananaface or baggywrinkle could elaborate more on it. In the state of Georgia, we are slowly becoming more progressive in pharmaceutical care. If you plan on working at Walgreens as a career, you can bet that you will not see much clinical experiance. There are many other things available such as independent pharmacy where you can do whatever you want. You just have to do your homework on the jobs out there available to you. There is a wealth of opportunities out there, you just need to find your niche and proceed from there!
 
I've heard lots of different opinions on the subject matter. From pharmacists being completely replaced by robots to us controlling the world. I'm somewhere in between. Technology seems prime to replace most of the functions of the dispensing pharmacist. From ATM type vending machines for the top 100 med's to robotic filling devices, the technogeeks are ripe with ideas to "assist" us in filling all those empty pharmacist positions. I don't think these will completely replace the dispensing pharmacist, but it will reduce the requirement of us needed to be behind the counter.

Thus, the pundits have advised us we better start making use of our infomation or we may be on the unemployment line. I don't think the demand for this type of pharmacist is ever going to be that large. The money just isn't present in the system for this. Unless we can prove our worth. A difficult task indeed.

Then again, the number of prescriptions are going to keep climbing for at least the forseeable future. So, the demand will be there. But, then again, once we start really focusing on preventative health, the numbers will decline.

There's just so many factors, that it's hard to really tell. The only thing that's for sure is that for at least the next 10 to 20 years, pharmacy is going to be a hot job with continually increasing salaries. Enjoy it while it lasts.
 
South2006 said:
The role of a pharmacist is increasing in States. The thing is, when you do this type of practice, you have to have a protocol set up. The state of Washington has been the pioneer in this. I'm sure bananaface or baggywrinkle could elaborate more on it.
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I have to take this as an opportunity to shamelessly and proudly promote the University of Washington in Seattle since today's emergency contracption and pharmacy based immunization programs would not have been put in place without work by UW pharmacy alumni, faculty, staff, and students.

Some current programs of note to come out of WA state are:

1) Emergency contraception dispensed by pharmacists on a walk-in basis
- Spearheaded by Jackie Gardner a UW School of Pharmacy faculty member
-pharmacist functions as the prescriber
-not all pharmacists participate
-some chains do not allow pharmacists to participate (ie: Wal-Mart)
-requires pharmacist to first attend a seminar and establish a protocol with authorized prescriber
-strict guidelines for dispensing with regards to time from intercourse
-requires referral to counseling for rape victims
-pharmacist (not the company they work for) is paid a $20 counseling fee with each dispensing, in addition to being paid for the drug. Some insurances cover this, including medicaid.
-no lower age limit (heard of it being dispensed to a 12 year old with an 18 year old boyfriend accompanying her)
-potential privacy issue with minors and parent access to medical expense reports for insurance reports

http://www.pharmacist.com/pdf/emer_contra.pdf
http://www.path.org/resources/ec_better_access_to_ecps.htm
http://www.doh.wa.gov/cfh/FPRH/ecproject.htm
http://articles.findarticles.com/p/articles/mi_m3374/is_7_24/ai_86141548

2) Flu Shots AND other immunizations
-A UW Alumni named Beverly Schaefer was the first pharmacist to offer flu shots in a retail setting
-requires a certification class
-pharmacists can give other immunizations (tetanus is prob the most likely to become widespread next)
-few are willing to vaccinate those under 18
-we could potentially become a source of childhood vaccinations
-flu shots covered by medicare for seniors w/o primary insurance
-potential to administer Flu-Mist in coming years (WAY more effective, just as safe as the shot - FDA has bad info on this topic - PM me if you want to know more)
-leading many doctors not to offer flu shots to patients
-doctors enthusiastic abotu the prospect (really!)
-those certified can conduct flu shot/ immunization clinics in the community (UW students do this each year through "Operation Immunization")

3) The "Take Charge" program (WA state only so far?)
-Don Downing a UW faculty member and owner of an independant pharmacy helped develop this program in coordiantion with many others
-birth contol related items paid for by the state for low income women AND men
-no verification of income performed
-pays for a wellness exam every 10-12 months (for men too!)
-covers various items: condoms, BC pills, spermacide, IUDs if the contain hormones, NuvaRing, etc.
-OTC items are piad by the state with NO RX REQUIRED
-applications can be filled out at a local pharmacy if the pharmacy stocks the apps
-most applicants are referred by planned parenthood

http://fortress.wa.gov/dshs/maa/familyplan/TCclientservices.htm
http://www.fwhc.org/tc-news.htm


A UW project on the table:

Direct access Project (Birth control without a prescription)
-yet another project of Jackie Gardner and Don Downing of UW School of Pharmacy
-denied by the FDA recently (still working towards this though)

http://www.directaccessstudy.info/consent.pdf
http://www.msnbc.msn.com/id/4534244/


Other services offered by progressive pharmacies

1) Osteoporosis screening
-no certification required
-generates cash business
-the machine is expensive ($1200?)
-no significant materials costs per use
-generally we charge about $40 per screening
-takes 5-15 minutes
-usually not covered by insurance

2) Cholesterol screening
-no certification required
-generates cash business
-machine is reasonably priced ($400?)
-requires cartridges costing about $15-25 each depending on the test parameters (HDL, LDL, total cholesterol, glucose, etc)
-generally we charge anywhere from $25 to $60
-takes about 5 minutes to perform, 10 more minutes for counsel
-many insurance companies will cover if patient self-submits
-becoming increasingly common (my store offeres this)


We can never know what the future holds for pharmacy unless we commit ourselves to being the ones pursuing positive professional change. And even then we can't see terribly far ahead.
 
bananaface said:
A UW project on the table:

Direct access Project (Birth control without a prescription)
-yet another project of Jackie Gardner and Don Downing of UW School of Pharmacy
-denied by the FDA recently (still working towards this though)

http://www.directaccessstudy.info/consent.pdf
http://www.msnbc.msn.com/id/4534244/

We can never know what the future holds for pharmacy unless we commit ourselves to being the ones pursuing positive professional change. And even then we can't see terribly far ahead.
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I think that most of those programs are great ideas, but I never liked the idea of this particular one. I wish that we (pharmacists) would concentrate on being able to offer our own, unique services instead of trying to dumb down other people's specialties. The clinic that you mentioned was dispensing BC to anyone who filled out a short questionaire (zero physical exam). It just made me uncomfortable, and for the first time I felt like pharmacists were trying to play doctor. I like to think that we have earned our respect by providing a unique service that nobody else can provide, but dispensing BC just seems like hopping on the bandwagon with everyone else in the healthcare field. Personally, I wish that we would get more training in pharmaceutical sciences and less in pharma policy. Right now, I can tell you every item that must be in a retail pharmacy by law, or recite the objectives of "healthy people 2010", but I have to look up half of the chemicals in a candy bar. I'm hoping that will change with time. 🙄
 
JD, the whole point of ECP and direct access is not to expand the scope of pharmacy per se, but to increase access to contraceptive services. It just to happens that pharmacists are there and willing to step in and provide the extra access points. The idea is that many people who would not otheriwise have access to contraceptive services will stop in to a pharmacy and get what they need. These may be people who do not have a PCP or GYN, who cannot get to their physician because of work conflicts, or who just prefer the convenience and comfort of stopping by a local pharmacy for a brief visit.

ECP is accessed by so many women from so many backgrounds that there is no real demographic to use except to say they are all sexually active.

The direct access program currently requires cash payment, so the patients are fairly well to do. If the project gets off the ground the state will probably pick it up and BC will become another one of those Take Charge items that does not require a prescription from a MD/NP/etc.

A woman does not really need a pelvic exam to be prescribed BC. GYNs like women to get their yearly pap smear. But even if the results are bad they will still prescribe BC for you. So, oral history is really what they as physicians are base their decision to prescribe. Some some women are really uncomfortable with the exam and hate going or refuse to go. For all you guys out there I will spare you the details, but think of how doing a "turn and cough" session makes you feel and then remember we are in there for quite a bit longer. A PCP will prescribe BC without examining a woman, although they will generally (not always) ask the woman if she has had a recent pelvic exam or pap smear. Technically a doctor who prescribes is supposed to have seen for a visit within in the past year. So people who don't visit their doctors regularly won't get BC unless there is a systematic change.

I will write more later. I have to head to work. The company president is touring my pharmacy so I had better not be late!
 
bananaface said:
JD, the whole point of ECP and direct access is not to expand the scope of pharmacy per se, but to increase access to contraceptive services. It just to happens that pharmacists are there and willing to step in and provide the extra access points. The idea is that many people who would not otheriwise have access to contraceptive services will stop in to a pharmacy and get what they need. These may be people who do not have a PCP or GYN, who cannot get to their physician because of work conflicts, or who just prefer the convenience and comfort of stopping by a local pharmacy for a brief visit.
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Isin't that what planned parenthood is for? I feel too with this program that it is jumping scope of practice boundries.
 
bananaface said:
JD, the whole point of ECP and direct access is not to expand the scope of pharmacy per se, but to increase access to contraceptive services. It just to happens that pharmacists are there and willing to step in and provide the extra access points. The idea is that many people who would not otheriwise have access to contraceptive services will stop in to a pharmacy and get what they need. These may be people who do not have a PCP or GYN, who cannot get to their physician because of work conflicts, or who just prefer the convenience and comfort of stopping by a local pharmacy for a brief visit.
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Do you mean Emergency contraception when you say ECP? The point of my post was not emergency contraception, but oral B/C in general. Just because people "prefer the convenience of stopping by a local pharmacy for a brief visit", doesn't mean that it's a good idea. Even if the pt doesn't get a GYN exam for their BC, maybe their PCP will at least check their blood pressure and do a cursory physical exam, which is more than their local pharmacy will offer. I love it when females come in for their "BC and a pack of smokes". 🙄
 
From the little that I have heard(being a guy), it appears as though the pelvic exam has nothing to do with whether or not a women is prescribed birth control by the GYN. I read somewhere that a "questionarre" is more than enough to base a decision on a BC script.

Should women get regular exams? yes. To often in medicine, something that should be simple and cheap to get can become expensive and time consuming (considering the waits to see a GYN these days. Not that I know personally 🙂 ). This is done for outwardly altruistic reasons( women should get exams, so let's keep giving them a reason to) and inwardly self-serving ( I get to charge A LOT for the exam). Should someone who can't afford an exam go without BC for that reason. I would argue that is exactly who we want to make it easiest for to get BC.

In my slightly sarcastic opinion, it makes about as much sense to require a pelvic exam to get BC, as it would to require a Dental checkup to buy a toothbrush(which would help all of us get those teeth checked every 4 months, OR would have us buying less toothbrushes)
 
Yes, ECP stands for Emergency Contraception Protocol. Canada and the UK have made levonorgestrol over the counter for emergency contraceptive purposes. Legislation is being pursued in the US to get Plan B (levonorgestrol) OTC status. The FDA is ok with making EC OTC for those 16 and older, since they have been determined to be capable of using it safely. The problem is that approving the drug for just that age group would require age checks which would require identification. So they denied the proposal to make it OTC until the details were worked out.

So JD, how is it that we jump boundaries with BC but not by giving flu shots?Pharmacists do check blood pressure as a part of the Direct Access program and cover topics like smoking in their screening process. We are certainly capable of taking on these tasks. And unless someone steps up to the plate and brings in new strategies, access to needed services will not improve. The goal is not to steal patients from other provders, but to bring services to patients who do not currently access them but want to.

Planned Parenthood does provide access to contraceptive services for some. But, by allowing pharmacists to dispense EC and BC without a prescription, access to services is made quicker and closer. This increases the proportion of people wanting services who end up recieving them.

I'm sorry if I don't separate the topics too well. They are just not all that different to me.

This brings up another issue. BC is alot safer for the general population than many other medications which are currently available OTC. If you consider the large scale use of minimally regulated nutritional supplements, the drug interactions possible with antacids, and the potential for liver damage due to acetominophen overuse/overdose you should realize that not everything available over the counter is without risks.
 
bananaface said:
So JD, how is it that we jump boundaries with BC but not by giving flu shots?Pharmacists do check blood pressure as a part of the Direct Access program and cover topics like smoking in their screening process. We are certainly capable of taking on these tasks. And unless someone steps up to the plate and brings in new strategies, access to needed services will not improve.

This brings up another issue. BC is alot safer for the general population than many other medications which are currently available OTC. If you consider the large scale use of minimally regulated nutritional supplements, the drug interactions possible with antacids, and the potential for liver damage due to acetominophen overuse/overdose you should realize that not everything available over the counter is without risks.
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I don't agree with flu shots either. Why not hire an LPN to jab those people for $14/hr instead of taking a pharmacist away from his/her normal job. The pharmacist has less experience jabbing people, but bills for 3-4 times as much money. =not efficient use of resources, especially if you would like to consider those insured by the state. Pharmacists have enough to do on a daily basis, why play nurse for a day? Pharmacists measure blood pressure, they don't initiate therapy based on a short questionaire.

BC is also a lot safer than other OTC products like turpentine, iodine, isoproyl alcohol, propylene glycol.. depending on how such products are used. Prescribing and dispensing BC just seems like those internet pharmcies that know you "need" viagra, and are not only willing to sell it to you, they will also have a doctor review your email to make sure it's "safe for you to take". 🙄 Just wait until the insurance companies get wind of being able to essentially prescribe BC for yourself... it will be OTC claritin all over again (=non-payment by insurance). 👎
 
Pharmacists are healthcare professionals who initiate therapy after interviewing patients on a daily basis. It can be in the form of a referral to another medical professional, a recommendation about how to treat a condition using over the counter products, or by exercising a protocol established with a physician. Being the most accessible healthcare professionals gives us opportunities for patient care that others do not enjoy in theor practice. If we refuse to embrace opportunities to provide increased levels of care, we effectively decide for a whole demographic that they will continue not to access care. If we decide to provide additional services, we may reach those who are unreachable by other means.

I found out that some insurances are now covering the BC dispensed as a part of the Direct Access project. http://depts.washington.edu/pha/news-events/news-birthcontrol.html

There are alot of good things to consider about pharmacist administered flu shots. Alot of pharmacists enjoy giving flu shots because it gives them a chance to build relationships with their patients. Some things are just nice to do as a service to the community. And without pharmacist administered flu shots we would not have nearly the influenza vaccination rate that we do. And physicians like not having to schedule flu shots in the office.

If you don't like where things are headed in pharmacy, where you you like to see the profession go, JD?
 
bananaface said:
It can be in the form of a referral to another medical professional, a recommendation about how to treat a condition using over the counter products, or by exercising a protocol established with a physician. Being the most accessible healthcare professionals gives us opportunities for patient care that others do not enjoy in theor practice.
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A referral to another medical professional (a doctor) is not the same as diagnosing, prescribing, and dispensing BC to patients at the pharmacy. Nor is suggesting an OTC product. OTC products, and the conditions they are intended to treat, are OTC for a reason. Your arguements are apples and oranges.. Patients would also like access to narcotics, sleeping pills, diet drugs, viagra, etc. Would it be proper for us to honor those requests because we're the most accessible professional, or because we recommend OTC products to other patients? (No) Should we perform (minor) surgery in our pharmacies as well? 🙄

bananaface said:
There are alot of good things to consider about pharmacist administered flu shots. Alot of pharmacists enjoy giving flu shots because it gives them a chance to build relationships with their patients. Some things are just nice to do as a service to the community. And without pharmacist administered flu shots we would not have nearly the influenza vaccination rate that we do. And physicians like not having to schedule flu shots in the office.

If you don't like where things are headed in pharmacy, where you you like to see the profession go, JD?
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I could go either way on flu shots, but the truth is that we're catering to people's laziness by offering them at the pharmacy. You do NOT need to see a physician for a flu shot, and the office or free clinic can have you in and out in a matter of minutes. Medical clinics also have the advantage of a dr. on staff, proper ACLS training, protocol for allergic reaction, etc.

I don't want to see pharmacy headed in the direction of (insert low/mid-level practicioner here)'s turf. We are not LPNs, RNs, PAs, NPs, etc. They all have a great niche, and they do their job well. We don't need to do it half-as well for twice as much money. Personally, I think that the whole patient care thing is a joke, unless our education is substantially changed. I advocate compounding, sterile products, law, manufacturing, education, research, etc. The best part of being a pharmacist is knowing UNIQUE things that others do not. That is what produces value in our knowledge. Becoming a true drug expert is desirable for many reasons, and that position cannot be replaced by anyone or a robot. I see these attempts at patient care as watering down an important curriculum for the most part. Sure, it might be appropriate to provide flu shots in a small town, or disaster relief when necessary, but that's not our true niche.

We are recieving far too much education with regard to pharmacy practice issues, and not nearly enough education in the basic phamaceutical sciences that make pharmacists so valuable. I will trade all of my "clinical" or "diversity/empathy" classes for one more semester of pharmaceutics, compounding, chemistry, or anatomy. :meanie:
 
Wow, JD. Well said. I think I agree.
 
jdpharmd? said:
A referral to another medical professional (a doctor) is not the same as diagnosing, prescribing, and dispensing BC to patients at the pharmacy.
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I gave you examples of how we initiate therapy, because you said that we didn't. BC pills do not require a diagnosis in the same way that other ailments do. The need for contraception is self-identified and not questioned by the prescriber in any case. I see your arguments comparing narcotics and BC as apples and oranges since I think that the only reason BC pills shouls not be OTC is that they need a good counsel and someone there to answer follow-up questions.

jdpharmd? said:
I could go either way on flu shots, but the truth is that we're catering to people's laziness by offering them at the pharmacy. You do NOT need to see a physician for a flu shot, and the office or free clinic can have you in and out in a matter of minutes. Medical clinics also have the advantage of a dr. on staff, proper ACLS training, protocol for allergic reaction, etc.
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The big reson that pharmacies draw the crowds when it comes to flu shots is that we are there as educators to distill myths about the flu shot, emphasize its importance, and provide it in an already visited location.

When it comes to seniors you have to keep in mind that not all of them are very mobile. They are often unaware of where immunization resources are in the community. And those who get out often limit themselves to familiar areas. For example, my grandmother does not know where the free clinic is, would not go there is she knew for fear of being mugged, and would be too proud to go anywhere for charity treatment. I suspect that 85% of seniors are in the same boat as she is. If you consider transit time and waiting time to get to an outside facility, an extra 5 minutes at someplace you already are is a significant advantage. Especially for people who do not drive themselves anymore.

Seniors often decide not to recieve a flu shot because they have misconceptions (the shot will make you sick, the shot doesn't work, the shot has side effects). When we, who often have established relationships with patients (seniors and otherwise) offer a service such as flu shots, people start asking questions and we get a chance to dispell their misconceptions. We also see alot of people who came in for a flu shot come to us when they have prescriptions, because they built a relationship of trust with us.

I wonder if many of us as professionals realize the significance of the influenza virus in our society. From a public health standpoint getting everyone flu shots is one of the best thing we can do. After influenza infection, which most people get 3-4 times a year (including non-symptomatic infections), the damage to nasal mucosa lasts about 2 months. Immunization to influenza blocks the route of entry for other pathogens and severely reduces the incidence of other illness.

I should say somewhere in here that FluMist, while more expensive, is the best thing out there. It is currently only approved for the 5-49 crowd and costs about $50 a dose. The manufacturer is working on getting it approved for kids then they will work towards seniors. The benefit of mucosal immunity is overwhelming. It has been shown in studies to be 80% effective in reducing the incidence of death when administered in a nursing home environment and brings the incidence rate of ear infections in small children to near zero. I would love to see this administered in pharmacies in the future.

Pharmacists who do the certification for immunizations will also have an allergic reaction protocol.

jdpharmd? said:
I don't want to see pharmacy headed in the direction of (insert low/mid-level practicioner here)'s turf. We are not LPNs, RNs, PAs, NPs, etc. They all have a great niche, and they do their job well. We don't need to do it half-as well for twice as much money.
Click to expand...

Personally, I think you are treading on very thin ice when you say that pharmacists are not as competent to perform these task like flu-shots as other healthcare professionals. There are a great number of practicing pharmacists who would be offended at being told that they are sub-standard providers of care.

jdpharmd? said:
Personally, I think that the whole patient care thing is a joke, unless our education is substantially changed. ....

We are recieving far too much education with regard to pharmacy practice issues, and not nearly enough education in the basic phamaceutical sciences that make pharmacists so valuable. I will trade all of my "clinical" or "diversity/empathy" classes for one more semester of pharmaceutics, compounding, chemistry, or anatomy. :meanie:
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Acquisition of pharmaceutical knowledge is great but it takes people like you and I to educate our patients about what we know. If we do not study those skills, how will be remain valuable to the public in the retail setting where most of our jobs are?

jdpharmd? said:
I advocate compounding, sterile products, law, manufacturing, education, research, etc. The best part of being a pharmacist is knowing UNIQUE things that others do not. That is what produces value in our knowledge. Becoming a true drug expert is desirable for many reasons, and that position cannot be replaced by anyone or a robot.
Click to expand...

Does your school not offer this? My school offers all of this to people who want it. Your Pharm.D. degree should be able to provide the basis for whatever career you want.
 
Im not even a pharmacist and I agree with you.

jdpharmd? said:
A referral to another medical professional (a doctor) is not the same as diagnosing, prescribing, and dispensing BC to patients at the pharmacy. Nor is suggesting an OTC product. OTC products, and the conditions they are intended to treat, are OTC for a reason. Your arguements are apples and oranges.. Patients would also like access to narcotics, sleeping pills, diet drugs, viagra, etc. Would it be proper for us to honor those requests because we're the most accessible professional, or because we recommend OTC products to other patients? (No) Should we perform (minor) surgery in our pharmacies as well? 🙄



I could go either way on flu shots, but the truth is that we're catering to people's laziness by offering them at the pharmacy. You do NOT need to see a physician for a flu shot, and the office or free clinic can have you in and out in a matter of minutes. Medical clinics also have the advantage of a dr. on staff, proper ACLS training, protocol for allergic reaction, etc.

I don't want to see pharmacy headed in the direction of (insert low/mid-level practicioner here)'s turf. We are not LPNs, RNs, PAs, NPs, etc. They all have a great niche, and they do their job well. We don't need to do it half-as well for twice as much money. Personally, I think that the whole patient care thing is a joke, unless our education is substantially changed. I advocate compounding, sterile products, law, manufacturing, education, research, etc. The best part of being a pharmacist is knowing UNIQUE things that others do not. That is what produces value in our knowledge. Becoming a true drug expert is desirable for many reasons, and that position cannot be replaced by anyone or a robot. I see these attempts at patient care as watering down an important curriculum for the most part. Sure, it might be appropriate to provide flu shots in a small town, or disaster relief when necessary, but that's not our true niche.

We are recieving far too much education with regard to pharmacy practice issues, and not nearly enough education in the basic phamaceutical sciences that make pharmacists so valuable. I will trade all of my "clinical" or "diversity/empathy" classes for one more semester of pharmaceutics, compounding, chemistry, or anatomy. :meanie:
Click to expand...
 
bananaface said:
Personally, I think you are treading on very thin ice when you say that pharmacists are not as competent to perform these task like flu-shots as other healthcare professionals. There are a great number of practicing pharmacists who would be offended at being told that they are sub-standard providers of care.
Click to expand...

I don't think JD intended that pharmacists are sub-standard providers of care; but simply that, there are other health care professionals that are specifically trained for these services that you feel pharmacists should offer. Our position in the healthcare system framework is NOT to be pseudo-docs/nurses. Although the pharmacy has become an easy access point for early treatment and care, that is not our primary goal/service. There is no problem offering vaccines at the pharmacy, but an LPN being paid $12/hour is much more economical than paying a RPh $40/hour (and I think your grandmother might appreciate the possible cheaper cost of the vaccine).
 
bananaface said:
BC pills do not require a diagnosis in the same way that other ailments do. The need for contraception is self-identified and not questioned by the prescriber in any case. I see your arguments comparing narcotics and BC as apples and oranges since I think that the only reason BC pills shouls not be OTC is that they need a good counsel and someone there to answer follow-up questions.
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I would expect that the need for pain meds is also self identified. Would the planned course of action change if pathology was discovered upon physical examination? PID, endometriosis, weeping wounds, warts, etc... Wouldn't you encourage routine health screenings to all your patients?

bananaface said:
The big reson that pharmacies draw the crowds when it comes to flu shots is that we are there as educators to distill myths about the flu shot, emphasize its importance, and provide it in an already visited location.
Click to expand...
I'm always happy to educate. That doesn't mean that I have to be the one poking people. I'm working on a presentation that could be done at a senior center regarding drug costs and the new medicare program. That doesn't mean that I have to actually enroll them or pay their bills. I can just arm them with their most powerful weapon: information.
bananaface said:
I wonder if many of us as professionals realize the significance of the influenza virus in our society. From a public health standpoint getting everyone flu shots is one of the best thing we can do.
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...but only if the CDC predicts the correct flu strains.
bananaface said:
Personally, I think you are treading on very thin ice when you say that pharmacists are not as competent to perform these task like flu-shots as other healthcare professionals. There are a great number of practicing pharmacists who would be offended at being told that they are sub-standard providers of care.
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I didn't call anyone a sub-standard provider of care.
bananaface said:
Acquisition of pharmaceutical knowledge is great but it takes people like you and I to educate our patients about what we know. If we do not study those skills, how will be remain valuable to the public in the retail setting where most of our jobs are?
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Agreed 😎 , however it is not necessary to physically perform the technical aspects required, when there are more important tasks at hand. You don't have to physically put the drugs in every bottle, because you know that your technician can perform that while you supervise and concentrate on amino-glycoside dosing for a patient in the ICU. Anyone else can vaccinate these patients. Use professional extenders for their intended purpose (ie nurses, rad techs, pt aids).

bananaface said:
Does your school not offer this? My school offers all of this to people who want it. Your Pharm.D. degree should be able to provide the basis for whatever career you want.
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Offer what? Unfortunately, I can't ditch my "duhh" classes 😴 for the interesting ones, but I am looking forward to my electives. I feel confident that my degree will prepare me for what I need to do. I wish that I could say the same for everybody (nobody specific in mind).
 
AmandaRxs said:
I don't think JD intended that pharmacists are sub-standard providers of care; but simply that, there are other health care professionals that are specifically trained for these services that you feel pharmacists should offer. Our position in the healthcare system framework is NOT to be pseudo-docs/nurses. Although the pharmacy has become an easy access point for early treatment and care, that is not our primary goal/service.
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I think that Amanda picked up on my general theme. We can play Dr. by prescribing BC, and our local Dr. can play Pharmacist by ordering a few 500-count bottles of Amoxil and PenVK to hand out for URT infections. Boom, we've both got our hands in each other's pockets and on each other's patients, and you can bet that neither patient is getting the quality of care that they deserve. After work, I can dress up like a cop and go shoot some bad guys! :meanie:
 
why can't we live in the world where phsycians can only prescribe and pharmacist only dispense and consult? wouldn't that be better? not stepping anyone's line, and clearly defines the job description. JD didnt you say once that doctors should dignose and call pharmacist for medication? i kinda like that idea, but i know it would never happen (by law i mean).
 
kwakster928 said:
why can't we live in the world where phsycians can only prescribe and pharmacist only dispense and consult? wouldn't that be better? not stepping anyone's line, and clearly defines the job description. JD didnt you say once that doctors should dignose and call pharmacist for medication? i kinda like that idea, but i know it would never happen (by law i mean).
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I've actually seen instances similar to what you described. I've seen scripts for three or four drugs, with directions to talk to the patient about which one they would like to select. Usually the motive is driven by cost, and I doubt that it's legal, but it was refreshing.

It would be helpful if med students had a few classes taught by pharmacy faculty. We have a PharmD, BCBS teaching us infectious disease treatment. A PharmD, 2-year residency, ID fellowship, and board certification makes him a pretty interesting guy. Even with all that, he says that he experiences some resistance when he tells the docs that it's time to D/C vanco, et al. Perhaps resistant pathogens will raise our status in the food chain. "Where is the pharmacist?! What the heck will kill THIS??!" :meanie:
 
JD, when you said "We don't need to do it half-as well for twice as much money." I interpreted that as you saying that pharmacists are not as qualified as LPNs to give flu-shots. I have gotten a flu shot from nurses before and generally they won't tell you anything outside of the information sheet the FDA provides. And the FDA info is somewhat dated. So I would personally prefer flu shots to be given by a pharmacist who can answer specific questions and give more accurate information. Giving the shot itself is a basic competency. But the counseling that comes with the shot is our specialty.

My grandmother would get the vaccine for free anyway since she has Medicare and no other insurance coverage.

Pharmacies do have to enroll patients in the pharmacy discount card programs, according to the FDA. Not that I like it. That is just how they set it up. We do more work, we get paid less. Yay. 😡

There is diagnosis that is needed with pain meds, because the source of the pain should be identified and ideally the pain should be prevented. Again, contraception does not have that need for diagnosis.

I can say from experience that even if you have a bad pap smear indicating possible endometriosis a GYN will continue to prescribe contraceptives but require you to recieve a biopsy. The other problems mentioned would require further diagnosis but not contraindicate contraception. (And I woild hope they would be noticed by the patient before the visit!) The only contraindication for BC which would be discovered at the office visit would be pregnancy. And that would not be from the exam itself but from the urine test, which can be evaluated with a home pregnancy test kit. If it turned out someone started BC while pregnant they would figure it out and discontinue use before birth defects became an issue.

Under the Direct Access project, all patients enrolling are encouraged to recieve pelvic exams and pointed to providers offering exams which are affordable or free to the patient. Direct access should allow women who previously did not access a BC or a pelvic exam to at least get BC and find out why a pelvic exam is important and how/where to get one. I am all for encouraging these women to get pelvic exams during the consultation process. Our hopes are that many more women will get exams because of the project then will skip the exams because of it.

Interestingly, even though the Flu-Mist spray and the shot contain the same antigens, the mucosal immunity conferred by the spray is more potent and can protect against more remote strains than the shot. (You can't get information like that out of an LPN. They just tell you to read the fact sheet, sign the release, and roll up your sleeve.) The duration of immunity from any strain you are innoculated against is lifelong whether it be by recieving the shot or spray. The mutations (aka "antigenic drifts") in flu strain from year to year are why shots are needed yearly. The mucosal immunity from Flu-Mist is so much broader that protection should last 2-3 flu seasons even with mutating strains. It even offers limited immunity to strains of the flu whose antigens are quite different than those contained in the vaccine. The flu shot cannot offer those benefits.

I don't know about everyone else, but I don't want to live in a world where physicians take no responsibility for drug consults. They need to keep up on the meds they prescribe and be open to answering questions during office visits. If doctors do not adequately explain why medication is needed and address patient concerns, a larger proportion of needed prescriptions will end up written by unfilled.

Are the classes relating to pharmaceutical care the "duh" classes you are referring to, JD? Alot of times they seem stupid while you are taking them. But even though the class may seem obvious you still learned some things. Then, if you are like me, you get mad and wonder why you allowed yourself to be coerced and enlightened by such stupid material. 😀
 
bananaface said:
I can say from experience that even if you have a bad pap smear indicating possible endometriosis a GYN will continue to prescribe contraceptives but require you to recieve a biopsy. The other problems mentioned would require further diagnosis but not contraindicate contraception. (And I woild hope they would be noticed by the patient before the visit!) The only contraindication for BC which would be discovered at the office visit would be pregnancy. And that would not be from the exam itself but from the urine test, which can be evaluated with a home pregnancy test kit. If it turned out someone started BC while pregnant they would figure it out and discontinue use before birth defects became an issue.

Under the Direct Access project, all patients enrolling are encouraged to recieve pelvic exams and pointed to providers offering exams which are affordable or free to the patient. Direct access should allow women who previously did not access a BC or a pelvic exam to at least get BC and find out why a pelvic exam is important and how/where to get one. I am all for encouraging these women to get pelvic exams during the consultation process. Our hopes are that many more women will get exams because of the project then will skip the exams because of it.
Click to expand...

So how would a pharmacist prevent the bad pap smear or detect it? Also, as a BC dispensing pharmacist, you are going to trust the patient about her home health care results for the pregnancy test. I do not agree with that. There are too many dumb people out there that can not do this right. Patients are encouraged to see the doctor but are not required to see the doctor under this project. I just dont care for that line of thought because it tells me that it's OK not to see a doctor!
 
I do trust that most people could pee on a stick and check it in 5 minutes. However, that is not necessary before starting BC. It is pretty easy to figure out that something is up when the monthly cycle quits.

If you think ladies need to see the doctor before using contraception, why not advocate making condoms by RX only?
 
bananaface said:
I do trust that most people could pee on a stick and check it in 5 minutes.
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You obviously have not met some of my "favorite" patients. 😀
 
bananaface said:
I do trust that most people could pee on a stick and check it in 5 minutes. However, that is not necessary before starting BC. It is pretty easy to figure out that something is up when the monthly cycle quits.

If you think ladies need to see the doctor before using contraception, why not advocate making condoms by RX only?
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Condoms are a device, not a drug! 🙂
 
I have my favorite patients too. I hope they are on Depo-Provera! That does not mean the general public is comprised of idiots who cannot figure out a home pregnancy test. They are OTC because they are so simple.

Devil's advocate says, "Some medical devices require a presription, why not condoms? Also, nonoxynol-9 could be made an Rx. Men need to get a pelvic exam so we should withold condoms and spermicide from them so they get the regular medical care they need! They MUST be seen!"

Really, how many men get their prostate checked yearly?
 
The problem I see with Direct Access birth control is that pharmacists are not versed in all aspects of medicine; our area of expertise is drugs. There are many factors that should go into selecting a BCP. Medical history is only one part of an examination.

PCOS (Polycystic Ovarian Syndrome) is sometimes not even properly diagnosed by a GYN unless he/she is really on the ball. It is not something that can be diagnosed simply by asking questions. But, if you prescribe the wrong type of BCP you could wreak havoc.
 
I have heard of combination oral contraceptives being used to treat PCOS. What havoc is going to be wreaked by estrogen only pills? (Not that they are used for much more than breastfeeding moms.) Do you have a reference?


According to UpToDate: (www.uptodate.com)

Screening requirements ? Hormonal contraception can be safely provided after a careful medical history and blood pressure measurement. While breast exams, pap smears, and screening for sexually transmitted diseases are important, most groups, including the American College of Obstetricians, the World Health Organization, and the Royal College of Obstetricians and Gynecologists agree that these procedures are not necessary before a first prescription for OCs [7].

7. Stewart, FH, Harper, CC, Ellertson, CE, et al. Clinical breast and pelvic examination requirements for hormonal contraception: current practice vs evidence. JAMA 2001; 285:2232.
 
bananaface said:
I have heard of combination oral contraceptives being used to treat PCOS. What havoc is going to be wreaked by estrogen only pills? (Not that they are used for much more than breastfeeding moms.) Do you have a reference?


According to UpToDate: (www.uptodate.com)

Screening requirements ? Hormonal contraception can be safely provided after a careful medical history and blood pressure measurement. While breast exams, pap smears, and screening for sexually transmitted diseases are important, most groups, including the American College of Obstetricians, the World Health Organization, and the Royal College of Obstetricians and Gynecologists agree that these procedures are not necessary before a first prescription for OCs [7].

7. Stewart, FH, Harper, CC, Ellertson, CE, et al. Clinical breast and pelvic examination requirements for hormonal contraception: current practice vs evidence. JAMA 2001; 285:2232.
Click to expand...

Only certain types of combination pills can be used. According to Thatcher in PCOS: The Hidden Epidemic:

" Presently the most distinguicshing characteristic between OCs is the type of progestin each contains. The first generationprogestin, norethindrone, is the standard by which other agents are measured. The second generation progestin levonorgestrel, is the most potent progestin and is the most androgenic.... PCOS patients should, in general, avoid the more androgenic OCs. The third generation progestational agents such as desogestrel and norgestimate are the least andrgenic and most estrogenic of the progestational agents."

He further states that, "even low doses of levonorgestrel may adversely alter glucose tolerance and increase insulin resistance. For this reason some have avoided use of levonorgestrel."

He does not make much reference to Estrogen only outside of HRT.
 
The underlying point of those opposed to pharmacists prescribing BCs is the decreased likelihood of getting a GYN exam. I know that if I had the option to just get the pill without the exam, I probably would. And I'm a healthcare person who knows how important it is to get yearly checkups; imagine the people out there who don't know the value of the exam.

Banana, you're right, it's not necessary to have an exam to prescribe BCs; but it sure is a nice safety catch for those of us who dread going but will manage to drag their assess to the clinic to get the pill.
 
That passage does not seem to me to indicate that havoc would be wreaked with use of levonorgestrel contailing oral contraceptives in PCOS diagnosed patients.

Even levonorgestrel containing BC pills will help by providing regular menses. They are just pointing out that the ideal use would be 3rd gen then 1st gen then 2nd gen.

Generally overweight women with PCOS are the ones with insulin sensitivity and glucose tolerance problems. They are advised to lose weight to avoid/reverse these issues. The problem would exist outside the BC issue.
 
I think it's dangerous to say it's alright to dispense BC pills without a Rx. Apart from a potential ethical dilemma, e.g. encourage early sexual activities, people obtaining it for minors, etc., BC pills can have some serious side effects (hey all you smart pharmacists out there)! You better document you've consult your patients regarding smoking and DVTs, depression, etc. Somebody who is taking seizure medications, Coumadin...... sorry, maybe you should start preparing your testimony for your date in court!..... It's hard to imagine you guys are advocating the practice.

Regarding vaccinations and flu shots, I can train a 10 year old to give shots, no need for your guys to have years of professional education to do it. It is a waste of the resource. You may argue that it is more convenient for people to get a shot in a pharmacy, but if someone get a severe allergic reaction while you are giving the shot, what are you going to do?

There is a difference between prescribing and dispensing and that's why it takes 4 years to get your degree and it takes 4 years to get mine + many years of clinical training to be board certified!

Pharmacists are drug specialists, prepare, dispense and provide drug information, I prefer to leave it as is.
 
I believe that the Direct Access Project requires that the hormonal contraceptives (pills/patch/ring) be dispensed through a patient profile and go through the same DURs as a prescription written by an outside prescriber. I think one of my classmates works at a pilot store, so I will verify when I have the chance. I do not advocate OTC hormonal contraceptives, but programs like Direct Access that involve the screening protocol. Drug interactions and risk factors should be addressed by these systems.

The side effects of hormonal contraceptives are not serious for those without risk factors. Some women may experience tenderness in the breasts, or "PMS" type symptoms like mood swings, nausea, and bloating. If one regimen does not work out, another often will. Sometimes women experience breakthrough bleeding or amenorrhea (no period) while using hormonal contraceptives. Depending on the symptoms and circumstances a change in drug, referral for diagnosis, or monitoring of pregnancy status would be warranted.

As mentioned before, there are protocols in place for adverse reactions to flu shots. In the case of a serious reaction we call 911 and take appropriate measures. This includes administration of epinephrine if needed. These programs are not put into place without forethought.

Until other healthcare providers find a way to improve access to services such as flu shots, you will find people like myself in the field of pharmacy who are willing to step up to the plate in the name of public health. The same is true for access to EC and hormonal contraceptives.

I have no ethical dilemma with giving minors birth control. If they want to have sex at age 14 they can at least go somewhere like a Direct Access pharmacy that encourages them to access other wellness resources. Group Health draws a line at age 12 and permits those 12 and older to access services as if they were an adult. They are the first healthcare entity to recognize that people who make adult decisions need access to adult resources. And, I applaud them for their philosophy. I am not advocating that people have sex at a young age. I am recognizing that it happens and that we as healthcare providers cannot ignore it. Services need to be there for everyone, not just the people who meet our moral expectations.
 
Personally i do not have problem with any of the things has been said by other posts. I do not care if we dispence BC or give flu shot. I would do it, but not enjoy it.

As many of you said there are a lot of other people in health care can provide such a role. nurse are qulified, PAs are qualified, best of all they are in constant supervision under MD. i do not want to say that we as pharmacist are not qualified to perform such tasks. However, i believe that rather than adding responsiblity that has been performed by others, strength the area we are expert in. Meaning, lets us not worry about giving flu shots and having prescription privilages. but let us worry about how we can view as drug experts rather than pill counters. I personally belive that everyone in healthcare field has specific tasks and niche. we should concentrate about keeping our niche, and strengthening our borders. what happens when others try to take over our job. there has been a lot of talks about robots and computers taking over our job already. giving flu shots and giving out BC is not answer to those questions.

WE ARE DRUG EXPERTS. not flu shot givers not prescribers. we should rather concentrate on preventing ADRs or dispencing wrong meds. how we going to accomplish this? now this is somehting we should be debating and putting our brains together about. these are my thoughts. please please put some input. i will love to hear what others think. thanks.
 
kwakster928 said:
WE ARE DRUG EXPERTS. not flu shot givers not prescribers. we should rather concentrate on preventing ADRs or dispencing wrong meds. how we going to accomplish this? now this is somehting we should be debating and putting our brains together about. these are my thoughts. please please put some input. i will love to hear what others think. thanks.
Click to expand...

I am interested in seeing what your opinion is after your first semester of school. Im sure Temple will shed some light on to what a pharmacist is.
 
south,

who knows... that's why i am going to school for i guess. but i am sticking with my point for now...
 
bananaface said:
That passage does not seem to me to indicate that havoc would be wreaked with use of levonorgestrel contailing oral contraceptives in PCOS diagnosed patients.

Even levonorgestrel containing BC pills will help by providing regular menses. They are just pointing out that the ideal use would be 3rd gen then 1st gen then 2nd gen.

Generally overweight women with PCOS are the ones with insulin sensitivity and glucose tolerance problems. They are advised to lose weight to avoid/reverse these issues. The problem would exist outside the BC issue.
Click to expand...


This shows how uneducated even health professionals are to the disease, if I can call it a disease. It's perfectly acceptable to not know everything there is to know about every disease, syndrome, etc; but then don't pretend that you DO (this goes for MD/DOs too)!
Those that tell PCOs patients to lose weight to avoid insulin resistance have it the other way around. Insulin resistance is thought to be the cause of the weight issues as well as other symptoms. Furthermore, not all people with PCOS are overweight, yet recent "talk" is that perhaps all those with PCOS also have insulin resistance. Therefore there has been a big push lately in the use of Metformin and Avandia to treat those with PCOS.

In addition, those with PCOS already have an elevated androgen level. By prescribing a BCP that is considered to be more androgenic you will cause that person a lot more "symptoms....hirsutism, brown skin patches, skin tags, etc.

Granted Direct Access may be beneficial once you have been on a BCP for an extended length of time to get a refill of sorts, but initial prescriptions should be after a thorough medical examination (and even THAT doesn't catch everything.)
 
The fundamental issue that the pro-script pharmas dont understand is that knowing EVERYTHING about a drug is NOT enough information to be able to prescribe it.

There is nothing wrong with the status quo. If you want to write scripts, go to medical school. And if medical students want to run a pharmacy, they can go to pharm school.
 
I'm not pretending to know everything. But I think I know more than you are giving me credit for, off2skl. I was trying to confine my answer to the question at hand. Since when do I need to give a dissertation on PCOS to answer a couple of points? From what I read losing weight is supposed to be the first recommended course of action for those with insulin resistance and glucose tolerance problems, since losing the weight can supposedly eliminate the problems. If you have further information, I would be glad to read your reference.

If a lady starts exhibiting noticeable PCOS symptoms after starting say a levonorgestrel containing contraceptive, we can refer her for treatment.

So are you going to give out drug samples from your office without a pharmacist's screening, MacGyver?
 
Oh great. Here we go. Too bad we couldn't have limited this discussion to pharm students and pharmacists. (and pre-pharms)
 
We will hear their input sooner or later. We have to respond to it at some point.

Maybe I should start protesting the "keep off my turf" hypocracy by threatening to make my law class project one on the prohibition of dispensing samples and prescriptions out of medical offices unless they are a part of an approved clinical trial. 🙄

There is not diagnosis needed for hormonal contraceptives, so the whole concept of needing to have them prescribed by a physician seems strange to me. I think of physicians as diagnostic experts whereas pharmacists are drug experts. Where there is no diagnosis, there is no need for a physician. I am open to rational discussion on this point.
 
bananaface said:
I'm not pretending to know everything. But I think I know more than you are giving me credit for, off2skl. I was trying to confine my answer to the question at hand. Since when do I need to give a dissertation on PCOS to answer a couple of points? From what I read losing weight is supposed to be the first recommended course of action for those with insulin resistance and glucose tolerance problems, since losing the weight can supposedly eliminate the problems. If you have further information, I would be glad to read your reference.
Click to expand...


Try soulcysters.com for a compilation of many articles on the subject (some contradictory, but we know how that is). PCOS affects 5-15% of women, but frankly since so many are undiagnosed, that figure may be off. Several articles point out that weight is easy to gain and difficult to lose.

Now, I'll step down from my soapbox. My point is there are a lot of factors that go into prescribing BCP and I think a patient/doctor relationship is important when selecting a medication.
 
wow... *shakes head*.. i'm in utter shock..

jd.. i'm curious to know what your school provides in training.. would there be a link with course curriculum i could take a look at?

as another advocate from the UW in Seattle, I'm starting to realize how advanced our curriculum is. We ARE provided with extensive pharmacology, medicinal chemistry and anatomy classes. We ARE given the opportunity through an elective to be certififed in immunizations and CPR/first aid (required course) as well (so if someone goes into shock, yes we can be certified to assist in that as well.)

so i'm really interested in how the schools differ.. when i come back from lunch i'm going to start a new thread on that topic.....

and why shouldnt we "expand" our scope of practice?

lunch.. but i'll elaborate more later
 
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