Transcript Slide 1
Beyond Clinical Pharmacy Mary Anne Koda-Kimble, PharmD Professor and Dean School of Pharmacy University of California, San Francisco 5 Goals Examine Clinical Pharmacy Today Identify Gaps Consider Healthcare Trends Propose Future Needs Share UCSF’s Story Clinical Pharmacy Gaps Trends Future Needs Clinical Pharmacy Today UCSF’s Story Clinical Pharmacy Gaps Trends Future Needs UCSF Story Clinical Pharmacy Philosophy Pharmacists are the most highly trained experts on drugs and drug products Best professional to: Promote rational drug prescribing Teach patients to use drugs appropriately Identify and prevent medication problems Silverman, M and Lee, PR: Pills, Profits, and Politics UC Press 1975 Clinical Pharmacy Gaps Trends Future Needs UCSF’s Story Pharmacy 1960’s Clinical Pharmacy 2007 Drug product Therapeutics Pharmacy Bedside Solo Team Dispenser Caregiver Knowledge Information As ordered As best prescribed Clinical Pharmacy Gaps Trends Future Needs How It Began – 1960’s UCSF’s Story Clinical Pharmacy Gaps Trends Future Needs UCSF’s Story Model Works Well in Hospitals Clinical Pharmacy Gaps Trends Future Needs UCSF’s Story Model Works Well in Hospitals Therapeutic advisors Patient education Drug use review and policy Formulary work Medication safety Gaps Clinical Pharmacy Trends Future Needs UCSF’s Story Why the Success in Hospitals? Practice All model originated there practitioners together Access to medical records Complex therapeutics Economics Cost avoidance Safety Captive patient population Clinical Pharmacy Gaps Trends Future Needs UCSF’s Story Pharmacy Benefit Design and Management (PBMs) Pharmaceutical industry Poison control centers Academia Government Other Areas Of Success Clinical Pharmacy Gaps Trends Future Needs UCSF Story Gaps Promote rational drug prescribing Teach patients to use drugs appropriately Identify and prevent medication problems Clinical Pharmacy Gaps Trends Future Needs UCSF Story But We Have Not Yet Achieved Our Vision A Mix of Medicines That Can Be Lethal Study Finds Medicine Misuse Occurs All Too Frequently Firefighter in Deadly Crash was Taking 4 Medications Studies Show Anemia Drugs May Harm Patients Judge Upholds Vioxx Verdict Give Us This Day Our Daily Supplements U.S. Reviewing Safety of Children’s Cough Drugs In The World of Life-Saving Drugs, A Growing Epidemic of Deadly Fakes Clinical Pharmacy Gaps Trends Future Needs UCSF Story New Awareness of Preventable Medication Errors and Adverse Drug Events •Medication errors alone cause more than 7000 deaths annually •Preventable adverse drug events in hospitals cost $2 billion •Side effects cost $20 billion •Pharmacists can reduce errors and minimize side effects Institute of Medicine (IOM) Report 2000 Gaps Clinical Pharmacy Trends Future Needs Drug Therapy Problems Access/Cost Quality Poor/uncoordinated prescribing Adherence Improper use Ongoing assessment and management Safety UCSF Story Clinical Pharmacy Gaps Trends Future Needs UCSF Story Most Drugs Are Used Outside of the Hospital Clinical Pharmacy Gaps Trends Future Needs UCSF Story Community Pharmacy Challenges Isolated practices No access to shared medical records Limited practice scopes Patient expectations Payment policies Environment Time Clinical Pharmacy Gaps Trends Future Needs UCSF Story Overarching Healthcare Concerns Access and cost Quality Safety Misaligned payment systems Episodic vs chronic care Prevention and early screening Political agenda vs health needs Workforce shortages/maldistribution Clinical Pharmacy Gaps Trends Future Needs Confusion and Complexity UCSF Story Clinical Pharmacy Gaps Trends Trends Future Needs UCSF Story Clinical Pharmacy Gaps Healthcare Trends Future Needs UCSF Story is big business Fewer new molecular entities despite increasing R&D spending Revolutionary information and diagnostic technologies Evolutionary practices toward lifetime and personalized care Clinical Pharmacy Gaps Trends Future Needs UCSF Story Science: Biology and Translation Era Whole-istic Biology Chemical Biology Quantitative Biology Bioinformatics Complex Systems Clinical Pharmacy Gaps One Size Fits All Trends Future Needs UCSF Story Clinical Pharmacy Gaps Trends Individualized Therapy Future Needs UCSF Story Clinical Pharmacy Gaps Trends Future Needs UCSF Story Small World •Internet •Manufacturing •Healthcare •Education •Research •Infectious diseases Clinical’ Pharmacy Gaps Trends Future Needs Future Needs UCSF Story Gaps Clinical Pharmacy Trends Future Needs UCSF Story What is Needed? Virtual teams Post-marketing surveillance Leadership with, not of Translational research Blended roles Systems thinkers Preventive care Safety officers Integrated/continuous care Drug use policy Clinical Pharmacy Gaps Trends Future Needs UCSF Story …And More Health services researchers Drug benefit designers Global leaders Clinical scientists Drug therapy managers Drug information specialists Medical informaticists Pharmacogeneticists Clinical Pharmacy Gaps Trends Future Needs UCSF Story Next Steps Create virtual health care teams - EMRs Blend and expand roles Conduct postmarketing surveillance Apply technology Telepharmacy Electronic medical records Educate visionary, collaborative practitioners Learn from colleagues internationally Partner: business, industry, government, community And more….. Clinical Pharmacy Gaps Trends Future Needs UCSF Story Look at Who Needs Our Care Clinical Pharmacy Gaps Trends Future Needs UCSF Story UCSF School of Pharmacy Story Clinical Pharmacy Gaps Trends Future Needs Our Mission: Mastering medicines to maximize health UCSF Story Clinical Pharmacy Gaps Trends Future Needs Our Plan Create a new framework for drug discovery and science Ensure that more patients get the best results from their drugs Shape the future of pharmacy science, policy, education and patient care by working in fresh and collaborative ways UCSF Story Gaps Clinical Pharmacy Trends Future Needs UCSF Story Some of our Tactics Make the promise of personalized medicines a reality for patients Help consumers take a central part in caring for their own health Minimize Prepare medication errors and adverse events more clinical scientists Advance interprofessional learning and practice among student pharmacists, physicians, nurses, and dentists. Clinical Pharmacy Gaps Trends Future Needs UCSF Story Safer and More Effective, Targeted Therapies Pharmacogenomics Clinical Pharmacy Gaps Trends Future Needs UCSF Story Lung Adipose In Liver Out Other Tissues (Nonmetabolizing, nonaccumulating) IF (OD<0.6) EXPRESS Antigen IF (OD>0.6 AND Tumor-Specific Signal) ADHERE to Cell Surface RELEASE Therapeutic Target Target Target Target UCSF Story Education for a Pharm.D. Degree K 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 Primary - Middle - Upper School College or University Pharmacy School >95% have degrees ( 4 years) at UCSF ~ 60-75% UCSF graduates pursue postgraduate training: residencies, fellowships, degrees Clinical Pharmacy Gaps Trends Future Needs UCSF Story UCSF Pathway Curriculum Core Curriculum UCSF PharmD Curriculum 132 Units Pharmaceutical Care Pathway 58 Units Pharmaceutical Policy and Management Pathway 58 Units PharmD 190 Units Pharmaceutical Sciences Pathway 58 Units Clinical Pharmacy Gaps Trends Future Needs UCSF Story Guiding Goals and Principles A more “nimble” curriculum Opportunities to pursue personal interests All graduates will be: Board eligible for licensure High level, competent pharmacists Adaptable to change Common to all pathways Research project APPEs: acute care, ambulatory care, community Clinical Pharmacy Gaps Trends Future Needs Students Reaching Out UCSF Story Clinical Pharmacy Gaps Our Approach Interdisciplinary Entrepreneurial Partnership based Physically integrated Patient centered Trends Future Needs UCSF Story Clinical Pharmacy Gaps Trends Future Needs UCSF Story Why Do We Care? Clinical Pharmacy Gaps My Mother Trends Future Needs UCSF Story Adverse effects Bleeding, fatigue, dizziness Wrong drug Calcium channel blocker Long-acting nitroglycerin Wrong dose Drug interactions NTG + BP meds Aspirin + Fosamax Adherence – Iron Clinical Pharmacy Gaps Trends Future Needs UCSF Story Clinical Pharmacy Philosophy Pharmacists are the most highly trained experts on drugs and drug products Best professional to: Promote rational drug prescribing Teach patients to use drugs appropriately Identify and prevent medication problems Silverman, M and Lee, PR: Pills, Profits, and Politics UC Press 1975