Transcript The Pharmacy Workforce Numbers, Scope and Effective Utilization

The Pharmacy Workforce:
Numbers, Scope, and
Effective Utilization
Lucinda L. Maine, PhD, RPh
Executive Vice President and CEO
American Association of Colleges of Pharmacy
C. Edwin Webb, PharmD, MPH, FNAP
Associate Executive Director
American College of Clinical Pharmacy
Session Objectives
• Describe the characteristics of the current
pharmacy workforce (pharmacists and techs)
• Outline current and emerging services
encompassed in pharmacists’ scope of
practice
• Identify changes in pharmacy education and
the significance for health service delivery
• Relate changes in pharmacy to broader health
care delivery trends and priorities
Societal Imperative for Enhanced
Medication Management and Use
• Number of prescription medications has increased
from approximately 600 in 1960 to over 15,000 today
• 75% of health care costs are chronic disease-related
and medication use is the primary modality of
treatment
• Drug-related morbidity and mortality is estimated to
exceed $250 billion annually
How Did We Get There?
American Pharmaceutical Association
Code of Ethics (1922-69)
“Pharmacists should never discuss the therapeutic
effect of a physician’s prescription with a patron or
disclose details of composition which the physician
has withheld”
The Starting Point for Important Change
American Pharmacists Association
Code of Ethics 1969
“A pharmacist should always strive to perfect and
enlarge his knowledge. He should utilize and make
available this knowledge as may be required in
accordance with his best judgment.”
American Pharmacists Association
Code of Ethics Current (1994)
I. A pharmacist respects the covenantal relationship between
the patient and pharmacist.
Considering the patient-pharmacist relationship as a covenant
means that a pharmacist has moral obligations in response to
the gift of trust received from society. In return for this gift, a
pharmacist promises to help individuals achieve optimum
benefit from their medications, to be committed to their
welfare, and to maintain their trust.
Evolution to the Doctoral Level of Education
The 60 year debate that ended just in
time
From 4 to 5 Years of Pharmacy Education for
BPharm Graduates
Pre-1960’s*
• 4 years total with no therapeutics
or practice coursework
Change to 5-year
curriculum*
• Primarily added an additional
year of pre-pharmacy coursework
(earliest PharmD emerges)
“Capitation Era” of Clinical
Pharmacy
• Schools hired PharmD-educated
clinical faculty to teach
therapeutics to B.S. students and
develop post-BS PharmD
*6 to 12 months of post-graduate internship
was supervised by the Board of Pharmacy
The Revolution to PharmD Only
(from 5 to 6 or 8 years)
• AACP Commission to Implement Change in Pharmacy
Education
– Critical examination of societal need for medication
management services
• Declaration by accrediting body that dual accreditation
(BS and PharmD) was not likely to continue
• Agreement by leading practitioner organizations that 21st
century pharmacists needed doctoral level preparation
The US PharmD Program
ACPE Standards 2016
Pre-pharmacy
• 2-year minimum but
practically 3-4 years
Didactic Curriculum
• Very systems focused,
integrating science and
therapeutic content
Experiential Education
• 30% of curriculum with
both early and advanced
experiences
Core Competencies for the PharmD Graduate
• From Institute of Medicine
– Need a patient-centered professional equipped
for team-based care that is evidence-based with
QI and HIT competence
• From AACP 2013 CAPE Competencies
– Foundational Knowledge
– Essentials for Practice and Care
– Approach to Practice and Care
– Personal and Professional Development
Four competency domains with 38 sub-competencies:
Values and ethics
Roles and
responsibilities
Interprofessional
communications
Teams and teamwork
The Pharmacy Workforce
The Pharmacy Workforce Today
Pharmacists (HRSA)
Year
Licensees
2011
255,001
2013
265,416
PharmD (%)
115,596 (45.3)
135,576 (51.1)
Pharmacy Technicians/Aides (BLS)
2008
381,200
140
Number of Colleges and Schools of
Pharmacy with ACPE-Accredited
Degree Programs*
135
Schools With No Degrees Conferred
120
Schools Conferring Degrees
100
80
74
75
60
40
20
* Inclusive of June 2015 ACPE Board Actions
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2002
2000
1995
1990
1985
1980
1975
1970
0
Pharmacy School Graduation Trends
(1990 – 2016)
16000
14000
12719
Number of Graduates
12000
10000
8000
6956
6000
4000
2000
0
Source: AACP Fall 2012 Data and ACPE May 2013 Estimates
Pharmacy school graduates for 2013–2016
projected based on current enrollment and
ACPE-estimated attrition
14923
CPhTs: Integral Members of the
Pharmacy Team
• Work together with pharmacists to ensure
optimal and safe medication use
• Help promote successful health outcomes
• Synergistic application of knowledge, skills,
abilities, and roles
• Allows engagement, expansion, and
sustaining high-level services
• Improves job satisfaction and professional
growth
Professional ownership
Organizational commitment
Occupation commitment
17
Record-Breaking Year
550,000 pharmacy technicians nationwide have
earned the PTCB CPhT credential since 1995
53,5000 candidates sat for the PTCE in
2014
18
State Regulations
According to the NABP Survey of Pharmacy Law,
45 states regulate pharmacy technicians. States may
choose to require:
• Certification
• Registration
• Licensure
• Ratios
• Training
• Continuing Education
19
U.S. Pharmacist Segments in 2009
90%
Proportion of 2009 Workforce
80%
% time Dispensing
70%
% time in Patient Care
60%
50%
41%
40%
30%
25%
16%
20%
12%
6%
10%
0%
Dispenser
Dispenser who also
provides Patient
Care
Other Activity
Pharmacist
Patient Care
Provider who
Dispenses
Patient Care
Provider
Proportion of U.S. Pharmacists by Segment in
Descending Size
(2009 data in lighter tone and 2014 data in darker tone)
45%
41% 40%
40%
35%
30%
25%
25%
22%
18%
20%
16%
15%
12%
13%
10%
6%
7%
5%
0%
Medication
Provider
Medication Other Activity Patient Care
Provider who Pharmacist
Provider who
also Provides
also Provides
Patient Care
Medication
Patient Care
Provider
U.S. Pharmacist Segments in 2009
Community Practice Setting
80%
Hospital Practice Setting
70%
Other, Licensed Pharmacy
Other, Non-Licensed Pharmacy Setting
60%
50%
40%
30%
20%
10%
0%
Dispenser
Dispenser who also
provides Patient
Care
Other Activity
Pharmacist
Patient Care
Provider who
Dispenses
Patient Care
Provider
% in Clusters 1&2 (Dispensers) by
Year of Licensure Cohort
100%
94%
91%
90%
80%
71%
70%
69%
70%
64%
64%
67%
58%
60%
55%
56%
50%
40%
30%
20%
10%
0%
Pre1960
1960 to
1964
1965 to 1970 to 1975 to
1969
1974
1979
1980 to 1985 to
1984
1989
1990 to
1994
1995 to 2000 to 2005 to
1999
2004
2006
Postgraduate Residency
Training in Pharmacy
March 18, 2016
4,609 applicants match day
3041 PGY1 matched
580 PGY2 match & 319 Early Commit = 899 PGY2
1,817 applicants unmatched
1,569 PGY1 & 248 PGY2
Pharmacist Board Certification
and Specialization
Board of Pharmacy Specialties
•
•
•
•
•
•
•
•
Ambulatory Care
Critical Care
Nuclear Pharmacy
Nutrition Support
Oncology
Pediatrics
Pharmacotherapy
Psychiatric Pharmacy
•
In development (currently “added qualifications” in pharmacotherapy):
– Cardiology
– Infectious Diseases
•
•
Ambulatory Care Pharmacy
Critical Care Pharmacy
557
287
25000
2349
1956
1990
1539
1773
903
537
1648
845
556
20000
1000
15000
518
1247
684
482
10000
5000
0
557
463
348
655
490
358
757
509
382
860
548
410
956
582
423
1421
758
523
824
569
1083
627
457
17771
15897
13961
11608
9445
7766
344
423
391
409
461
360
473
493
339
2228
2631
3191
3688
2003
475
468
463
495
501
507
515
496
513
524
552
575
533
463
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Nuclear
Pharm
Nutrition Support
4523
5567
Psychiatric
6657
Oncology
Amb Care
Pediatrics
Critical Care
Scope of Practice Section
A Framework for Credentialing and Scope of Practice
in Pharmacy
BREADTH OF PATIENT/PRACTICE FOCUS
Narrow
Entry-Level
A
B
Advanced
C
D
LEVEL OF KNOWLEDGE, SKILLS, &
EXPERIENCE
Broad
Practice/Competency Area 1: Patient Care
“Provision of patient-centered and population-based care”
BREADTH OF PATIENT/PRACTICE FOCUS
Professional
degree in
pharmacy &
license
Broad
A
Generalist
practitioner
Advanced
generalist
practitioner
Wide variety of diseases in a
unique setting or population,
or a narrow disease focus
Entry-Level
B
Focused
practitioner
Advanced
focused
practitioner
Advanced
Wide variety of patients and
diseases; complex healthcare
issues
C
Focused patient populations;
medically complex patients,
therapies, and/or technology
D
LEVEL OF KNOWLEDGE,
SKILLS, & EXPERIENCE
Wide variety of patients
and diseases; minor
ailments to more complex
conditions
Narrow
Practice/Competency Area 1: Patient Care
Provision of patient-centered and population-based care
BREADTH OF PATIENT/PRACTICE FOCUS
Narrow
A
B
Continuing
education
activities
PGY1
Post-licensure
continuing
education and
training offered
to pharmacists
Certificate
training
programs
Entry-Level
Continuing
education
activities
Traineeships
PGY2
Continuing
education
activities
C
Continuing
education
activities
D
Advanced
LEVEL OF KNOWLEDGE, SKILLS, &
EXPERIENCE
Broad
Practice/Competency Area 1: Patient Care
“Provision of patient-centered and population-based care”
BREADTH OF PATIENT/PRACTICE FOCUS
A
Narrow
CDM
Postlicensure
certifications
offered to
pharmacists
B
Entry-Level
CDE
CGP
BCPS
C
BCADM
BCNP
BCNSP
+ Added
Qualifications BCOP
BCPP
BCPS
D
Advanced
LEVEL OF KNOWLEDGE, SKILLS, &
EXPERIENCE
Broad
Medication Management in Patient-Centered
Team-Based Care
“Getting the Medications Right”
PCPCC defines comprehensive
medication management (CMM)
•
•
•
The PCPCC guide defines
comprehensive medication
management in the PCMH
Included in AHRQ’s Innovation Center
- Quality Toolkit
2nd Revision with Appendix AGuidelines for Practice and
Guidelines for Documentation
PCPCC Resource Guide: Integrating Comprehensive Medication Management to Optimize Patient
Outcomes
http://www.pcpcc.net/files/medmanagement.pdf
Discussion