Moving Pharmacists Toward Providing Pharmaceutical Care

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• g a aCI t Toward Providing Pharmaceutical Care

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The American Center for Pharmaceutical Care takes a national approach to helping pharmacists make the transition from dispensing to managing drug therapy. by Kathy A. Stover

ACPC

and many pharmacy experts have long argued that if the pharmacy profession is going to survive, it must accept that the pharmacist ' s future is pharmaceutical care. Despite hearing that message many times during recent rears, most pharmacists are having difficulty making the conI,'ersion to pharmaceutical care practice and continue to focus primarily on drug distribution activities rather than lllanaging drug therapy. To encourage and train pharmacists to make the leap to IPharmaceutical care practice, APhA, in connection with its affiliated state pharmacy associations, has created the American Center for Pharmaceutical Care (ACPC) to help pharmaunderstand pharmaceutical care and provide them with ~e infonnation, skills, and tools they need to practice it.

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Launched in October 1995, ACPC is the result of a twcryear effort between APhA and state associations to develop a re ource center through which pharmacists can learn more about pharmaceutical care and how to provide it within their own practices. Headquartered in Tuc on, Ariz., A P is a free-standing corporation who e mission is to assist pharmacists and phannacies in meeting their patients' drug therapy needs. Specifically, ACPC is design d to provide pharmaceutical care s rvic and educational programs in partnership with tate or r gional centers that want to help pharmacists manage their patients drug therapy. According to Daniel]. Boesen, ACPC chief executive officer, pharmacist, and former executive director of the Arizona Phannacy Association, "ACPC is the result of a statedeveloped plan to increase pharmacists' capacity to deliver phannaceutical care. It is a national partnership organization designed to work with state and national pharmacy associations, schools of pharmacy, pharmaceutical care innovators, manufacturers, wholesalers, and others interested in the development of pharmaceutical care practices. " Boesen, who was chosen because of his broad-based knowledge and experience in pharmacy , health care planning, and managed care, says, "ACPC will serve several Journal of the American Pharmaceutical Association

roles. First, it will provide standardized pharmaceutical care educational and training programs. Second, it will be a clearinghouse of information that pharmacists and pharmacy organizations can tap into. Third, it will serve as a resource for pharmacists and as a vehicle for sharing experiences, discussing problems, and creating new opportunities as they redefme their practice settings. "We're trying to provide a unified system of pharmaceutical care products and services that can be marketed to all practice areas of pharmacy," adds Boesen. ACPC will become "the resource that pharmacists look to and rely on for re-engineering their pharmacies," says John A. Gans, APhA executive vice president. "It will help pharmacists whose resources are inadequate to cope with, or to provide, pharmaceutical care services." Although APhA has provided start-up funding for ACPC and is developing the initial educational and training programs to be offered through ACPC, organizational participation in ACPC will not be limited to APhA. "ACPC is truly designed as a partnership organization. The invitation to participate in this effort goes out to all who share the vision of offering programs, talent, and support to achieve the goal of repositioning pharmacists to be the source of improved pharmaceutical care outcomes," says Boesen. ACPC's initial educational curriculum-based largely on the state-centered model developed by the Iowa Center for Pharmaceutical Care-consists of a series of learning modules providing comprehensive, hands-on instruction in practice reengineering and drug therapy problem solving. Local and national faculty from a wide range of practice settings will provide the "live" seminar portion of the educational program. Boe en estimates that ACPC will offer at least 100 educational programs during 1996, and ACPC is currently scheduling programs with state pharmacy associations and colleges of pharmacy throughout the country.

Teaching Pharmaceutical Care • APhA and its affiliated state pharmacy organizations formed the American Center for Pharmaceutical Care (ACPC) in October 1995 to help pharmacists in the move to become care providers. • ACPC is a partnership organization of national and state organizations working together to provide training, education, products, and services to support pharmaceutical care providers. It will also serve as an information clearinghouse. • APhA's own Office of Pharmaceutical Care is developing pharmaceutical care educational programs for use by ACPe. • ACPC is launching the first of its pharmaceutical care programs in 1996, with programs scheduled in Connecticut, Iowa, and Oregon.

Journal of the American Pharmaceutical Association

Iowa's Key Role Both ACPC, in its state-centered approach to pharmaceutical care training, and APhA's own Office of Pharmaceutic~ Care, in its educational initiative, are fashioned after a relative. ly new but successful model: the Iowa Center for Phannaceu. tical Care (lCPC). Established in May 1994, ICPC works with the Iowa Pharo macists Association and two Iowa colleges of pharmacy to help the state's community and chain pharmacists convert their practices from traditional dispensing to managing drug therapy. To date, some 85 Iowa pharmacies (including about 220 pharmacists and 100 pharmacy technicians) have enrolled in ICPC's pharmaceutical care training program, says Jenelle Sobotka, Iowa Pharmacists Association vice president of public and professional affairs. The program was launched in collaboration with the Col· leges of Pharmacy at Drake University and the University of Iowa, a step described by Sobotka as a "win-win-win situa· tion." ICPC helps pharmacists-ranging from recent gradu· ates to those nearing retirement, in both independent and small chain settings-who are struggling to convert to pharo maceutical care, she says. The center also provides the col· leges of pharmacy with community sites for pharmaceutical care clerkships and coordinates diverse pharmaceutical care research projects. ICPC's 16-week program entails classroom sessions, region· al work-group meetings, on-site visits, and follow-up support. The first part of the training involves the pharmacy's entire staff and covers practical aspects of changing the work envi· ronment-remodeling the pharmacy, redesigning workflow, and realigning responsibilities of the technical staff. After an introductory classroom session, pharmacists and their staffs implement the necessary changes with on-site help from a member of the training faculty. (Costs vary from as little as $500 to as much as $40,000 for pharmacies making more extensive physical renovations, says Sobotka.) Another class· room session follows, which covers patient care plans, mar· keting techniques, and communications skills. ICPC also provides support after the conversion has taken place. The ICPC program "is not a cookie-cutter approach," says Randy McDonough, clinical instructor at the University of Iowa College of Pharmacy and one of the program's four faculty members. Rather, each pharmacy makes its own conversion to pharmaceutical care in its own way, depending on its commitment, time, and budget. "We [the faculty] are the facilitator, and they [the pharmacists] are the problem solvers, " McDonough says. The easy part is making the required physical changes in the pharmacy; it is changing the practice itself that pharmacistS often struggle with, he says. He notes that pharmacists are often their own biggest barriers-when they lack the confidence to make needed changes and fall back on old practice habits. February 1996

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One of the program' goal . for pharmac' by the 16th week of the program, two pati nt ar day, says McDonough. A patient care plan in Iud d urn nration of the patient's problem, a medical and m di ation history, and the phannacist's interventions, often ing a OAP (subjective data, objective data, asses ment, plan f car ) £ rmat. In some pharmacies, this goal is realistic , but oth r require more time. On the whole, McDonough consider th program successful-if success is measured by the change that have occurred in pharmacists' practices. Attitudes definitely have changed, he adds. Pharmacists are asking, not how they can dispense 200 prescriptions per day, but how they can provide optimal patient care. Key to a phannacy's implementation is ICPC's flexibility in providing training for a pharmaceutical care program that is within that pharmacy's commitment, time, and budget constraints (see sidebar, below).

APhA and Pharmaceutical Care

minar and phaana utica! ary kills t provide uch ervice in th ir own practic . In 1996, ACPC will offer Pha I- "R - ngin ring Your Pharmacy Practice " -of it educational curriculum. During this phase, pharmacist will partiCipate in a two-day minar designed to provide an intensive hands-on 1 aming appr ach to pharmaceutical care in truction.

Implenlenting Pharl11aceutical Care in lo""a by Ma ureen E. Flanagan

For Carl V. Chalstrom, manager of The Pharmacy on Main, in Anamosa, Iowa, the physical changes made to his rural community pharmacy to implement pharmaceutical care were inexpensive. Chalstrom put up office partitions, used existing counter space, and adapted his one computer system to document the new services. He is now producing a brochure to market his new services. "I'm designing it myself, based on what I feel is important to get across ... nothing too tec,h nical," he says. Chalstrom's patients have been receptive to the new level of service he provides. Some have offered to pay him, although he is encouraging them to go through their third party insurers, who "need to be aware of what's happening" in the profession and to begin to develop some mechanism for compensation. His I goal is to be "out in front " working ~ith patients and not tied up with dIspensing activities. Dennis Jorgensen, owner of Panora

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Pharmacy, in Panora, Iowa, says that he had been "out of the dispensing mode" and practicing aspects of pharmaceutical care for three years before enrolling in the Iowa Center for Pharmaceutical Care (lCPC) program. The program, however, made it easier for him to make effective changes and helped him with planning the pharmacy's remodeling, documenting patient care plans, and communicating with patients and physicians. "It has provided me with a better approach to getting my program up and rolling and given me the push I needed," Jorgensen says. Leman E. Olson, owner of Forest Park Pharmacy, in Mason City, Iowa, was one of the pioneers of Iowa's pharmaceutical care conversion process. His pharmacy, located in a medical building, was one of 12 involved in the pilot training program-taught in cooperation with the Peters' Institute of Pharmaceutical Care, University of Minnesota, Minneapolis, under Mary Ann Tomechko, linda Strand, andJohn Loch-during ICPC's start-up period.

In implementing phannaceutical care, Olson added two technicians, a private consultation area, and a small room with a computer for documentation. He now provides pharmaceutical care service to "those who want it and need it," such as patients with a chronic disease and those taking multiple medications. He has 50 patients enrolled in the program and, by th middle of 1996, hope to have added 150 to his pharmaceutical care ro ter. Olson, for one, i optimi tic about payment for the e ervice . This fall, he expects to become a credentialed pharmaceutical care provider through the PCA Iowa network, and he hope eventually to receive payment for care of a limited patient population through PCA Iowa's marketing efforts to third party providers. Except for a few pilot projects, "it's the first time in real practice someone has come forward" with the possibility of compensation, he notes.

Maureen E. Flanagan is a freelance writer in Washington, D. C

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February 1996

Journal of the American Pharmaceutical Association

According to Knapp, "The Phase I seminar gives pharmacists a step-by-step approach to adopting pharmaceutical care. It begins with some philosophy about pharmaceutical care, and then gives the nuts and bolts of how pharmacists can reengineer their workflow, make any needed changes to their pharmacies, and begin to assume new types of duties." Once Phase I is completed, participants will have four to six weeks in which they must complete home study materials before Phase II begins. The assignments will reaffirm what was learned and prepare them for topics that will be addressed in Phase II. During Phase II, pharmacists will participate in a three-day seminar on "Identifying and Solving Drug Therapy Problems. " During this phase, pharmacists will progress from the fundamentals to a more focused area of pharmaceutical care-managing drug therapy. Participants will learn how to assess drug therapy, gather patient information, create an individualized care plan, evaluate outcomes, communicate effectively with patients and prescribers, and integrate caregiving activities with routine workflow. Once participants complete both phases, they will receive a certificate of achievement in pharmaceutical care. In addition to educating pharmacists on the fundamentals of pharmaceutical care, APhA-OPC expects to offer training programs for diseases such as asthma and diabetes later in 1996.

Bringing Instruction to You As APhA-OPC continues its development of phannaceutical care training programs, and ACPC, in partnership with other national and state organizations, offers those programs nation. wide, pharmacists across the country will have the perfed opportunity to learn how to become pharmaceutical care· givers. And if the predictions for the pharmacy profession are correct, pharmacists should take advantage of this opportu· nity to embrace the future direction of pharmacy: phannaceu· tical care. Kathy A. Stover is staff writer, Journal of the American Phannaceutical Association.

pharmacy For More Information American Center for Pharmaceutical Care (ACPC)

5620 N. Kolb Rd. Suite 287 Tucson, AZ 85750 Phone: (520) 529-6715 Contact: Daniel J. Boesen, ACPC executive vice president Iowa Center for Pharmaceutical Care (lCPC)

Find out today how QARx®for WindowsTM, Version 4.0 can tum your ordinary PC into a turnkey patient care documentation system.

8515 Douglas, Suite 16 Des Moines, IA 50322 Phone: (515) 270-0713 Contact: Jenelle Sobotka, vice president of public and professional affairs, Iowa Pharmacists Association

Call 1·800·878·0729

APhA Office of Pharmaceutical Care

2215 Constitution Ave., NW Washington, DC 20037 Phone: (202) 628-4410 Contact: Cynthia Knapp, Director, APhA Office of Pharmaceutical Care

Journal of the American pharmaceutical Association

APhA

for a free brochure or to order a trial disk

APhA Publication Sales • P.O. Box 571 , Williston, VT 05495-0571 96AP2

February 1996

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