Cp142 - 2nd Exam

• Clinical Pharmacy Discipline arose out of dissatisfaction with old practice norms and the pressing need for a health professional with a comprehensive knowledge of the therapeutic use of drugs
• Movement began at the University of Michigan in the early 1960s, but much of the pioneering work was done by David Burkholder, Paul Parker, and Charles Walton at the University of Kentucky in the latter part of the 1960s
• What is the proper degree in pharmacy?

  • Has been debated since at least the 1930s
• Two early developments that shaped clinical pharmacy

  1. Formation of the Doctor of Pharmacy (Pharm.D.) degree
  2. American Association of Colleges of Pharmacy (AACP)’s Millis Commission

  • Federal funding in early 1970s – assisted with greatly expanding clinical pharmacy faculty in Colleges of Pharmacy
• Doctor of Pharmacy (Pharm.D.) degree

  • First formally recommended in 1950

  • 1950 - University of Southern California (USC)

  • 1955 - University of California San Francisco (UCSF)
• Late 1960s – a few other colleges implemented it

  Post-B.S. Pharm.D. – 2 additional years after B.S. Pharmacy degree

  • Year 1 – didactic

  • Year 2 – clinical/experiential

  6 years (straight through from high school)

  • 2 years pre-pharmacy

  • 4 years pharmacy (3 years didactic [include introductory experiential], 1 year advanced

  experiential)

  Some colleges offered both paths
• • 1992 – AACP House of Delegates voted to approve the Pharm.D. degree as the only professional degree in pharmacy, doing away with the B.S. in Pharmacy

  • 1997 – American Council on Pharmaceutical Education (ACPE; sets educational standards and accredits colleges/schools of pharmacy) decreed that it would no longer accredit B.S Pharmacy programs effective 2000; Pharm.D. is the sole professional degree
• 2016 – ACPE (Educational) Standards went into effect; ensures that

  graduating PharmD students are : (RWUAU)

  • Ready to practice in teams and prepared to directly contribute to patient-centered care

  • Work in interprofessional teams

  • Use evidence-based practice

  • Apply quality improvement

  • Utilize informatics
• UCSF – the major pathfinder or one of many trailblazers in the development of the clinical role of the pharmacist
• Problem in the mid-1960s: The profession seemed locked on a slow

  but certain course of extinction

  • Mostly stagnant over the previous 100 years, when stagnation was most

  impossible (technology and change abounded)

  • Deeply infected with apathy, intra- and interprofessional isolationism,

  inferiority complex, and competition
• Result- profession was ignored by:

  • Other health professions

  • Federal policy-setters
• Pharmacy education – suffered similar maladies but was not entirely idle
• A handful of schools had conceptualized new roles for pharmacists, most of which were linked to the dispensing act
• Wishlist – Holy Grail role: the pharmacist as a participant in the drug-prescribing process

  • What would this kind of practitioner do?

  • How should he or she be educated?
• 1950-64

  • Flood of new drugs

  • Almost universally unreliable information regarding their efficacy

  • Increasing expertise/concern in bioavailability
• 1955- Developed a 6-year Doctor of Pharmacy curriculum intense in

  the biological, chemical, and physical sciences

  • Biopharmaceutics

  • Physiology

  • Biochemistry

  • Gross anatomy

  • Microbiology

  • Parasitology

  • Pathology

  • a lecture course entitled “Orientation to Medicine” presented by physicians who exposed students to diagnosis, treatment, and the decision-making of prescribing
• Intended purpose to train students to be knowledgeable in all aspects of the drug product, i.e., from its basic chemical/physical/biological properties to its ultimate formulation in a dosage form
• Be able to assist prescribers in selecting the most effective drug therapy by means of their knowledge of how one agent compared chemically to another
• The influences that the various ingredients constituting the drug product might have upon absorption
• 1966-1969: Clinical pharmacy program is established
• 1966- UCSF experiment – the School of Pharmacy institutes an experimental decentralized pharmacy service in the patient care area of UCSF’s Moffitt Hospital (details in assigned reading)
• The success of this service encourages the faculty to adopt a clinical pharmacy program as a new major educational objective of the curriculum
• 1969- a required clinical clerkship program is instituted, which now encompasses the entire training program of the fourth year for the Doctor of Pharmacy curriculum
• School’s agenda now includes the development of new models of pharmacy patient care in the community and new ways to teach pharmacy students to lead a changing profession
• Millis Commission (1972-1975)
• John S. Millis, a physicist by education; President – National Fund for Medical Education, and Chancellor Emeritus of Case Western Reserve University; had chaired previously successful commissions, including the graduate education of physicians
• Formed in 1972, at the request of the American Association of Colleges of Pharmacy (AACP)
• Finished its work in 1975
• Millis Commission – points of inquiry

  • Education of pharmacists
  • who, how many, how should they be educated
• Starting point for the inquiry:

  • What do pharmacists do?

  • What can pharmacists do?

  • What should pharmacists do?

  • In what settings, organizations, and/or institutions should pharmacists work?

  • How is the work of the pharmacists related to the work of other health professionals?

  • How should the services of pharmacists be valued economically?
• Transitions: 1946-1976 (30 years of change)
• Changes in the medical and pharmacy worlds

  • Advances in technology and practice

  • National events

  • Perceived needs of the public

  • External influences (outside of medicine and pharmacy)
• Changing world - U.S., health care, pharmacy, wars
• Millis Commission Report - 1975

  • Book - “Pharmacists for the Future”
• A significant landmark for pharmacy – it was a citizens’ commission

  • 16 studies up to the 1960s - internally focused – by pharmacists and for pharmacists
• Systems oriented – e.g., the U.S. had a major problem with drug

  abuse and misuse
• Dealing with a health care delivery system, that in addition to pharmacists and pharmacy, included other health care professionals, institutions, and organizations
• What has changed the most since its publication in 1975 - medication use has assumed a more central role in health care at all levels
• Outside of pharmacy, recognition that medication-use specialist, those educated and licensed to practice pharmacy, are essential to the delivery of quality patient care
• Advances in Postgraduate Residency Training

  • Key developments in the 1960s

  • 1962 – first hospital pharmacy residency established – not clinical; focused on developing leadership skills in pharmacy administration and traditional pharmacy operations

  • 1963 – residency standards were published by the American Society of Hospital Pharmacists (ASHP)