Being a pharmacist today is a very different proposition than it was two decades ago. Sometimes the expectations seem to shift on a monthly … if not daily … basis. To help practicing pharmacists and students keep up with their ever-expanding roles, the Tennessee Pharmacists Association (TPA) has put advocacy, education and professional awareness at the top of the priority list.

 

"One particular area that really benefits every pharmacist, no matter what the practice setting, is the advocacy the association provides to the profession," said Thomas Campbell, PharmD, 2009/10 president of the TPA and associate dean for academic affairs at Lipscomb University College of Pharmacy. "The association networks with legislators and other professional organizations. Advocacy is a critical component."

 

This point is driven home daily, Campbell noted, as pharmacists have moved far beyond simply filling prescriptions and into the realm of medication therapy management, patient education, disease state management, collaboration with providers on targeted therapies and advocacy on behalf of patients who cannot afford needed medications. All of this must be accomplished in the face of increasing regulations with decreasing reimbursements and a looming professional shortage. And did we mention today's pharmacist must also be part detective and keep a watchful eye out for fraud and abuse?

 

"We were the impetus behind setting up the controlled substance database," noted Baeteena Black, DPh, executive director of the TPA. Black, on behalf of the association, worked with political representatives to enact legislation in 2003 that would make it easier to determine treatment history and flag potential abuse by patients or prescribers when it comes to schedule II-V drugs. Although program funding took additional time to be approved, the database has now been fully operational for three years.

 

"After advocacy, we also provide extraordinary information on general changes in practice," Black continued. "We have an electronic list serve where I can reach members almost immediately." This service, she continued, is crucial to keep pharmacists updated on federal and state regulatory changes, drug recalls and other breaking news. "One area we've been incredibly involved in is pandemic preparedness and planning," she said, adding the membership has worked together to form networks to best distribute resources and address shortages such as with Tamiflu (oseltamivir phosphate).

 

Another service expansion many pharmacists have undertaken is becoming the "go to" person for medication management and patient education. Two years ago, the TPA adopted a Universal Medication List (UML) as a first step to more accurately record and assess all the medications an individual is taking. Campbell said the UML is an important safety tool across the continuum of care. "In today's world of specialists, we're making sure that patients, when they are seeing multiple physicians, have a detailed list of medications so prescribers have a comprehensive medication profile."

 

Black said the paper document, which all patients are encouraged to carry with them, is an interim step while the organization continues to work with other provider associations towards full implementation of eHealth records.

 

Pharmacists have also been tasked by Medicare Part D to ensure seniors not only receive their prescribed medications but receive optimized care through patient education regarding dosing, interaction with other medications, and possible side effects. Similarly, Black said pharmacists are in a position, particularly as more patients stay in the homecare environment, to serve as a liaison between patients and providers, which has led to another role expansion in terms of disease state management.

 

"We can avoid huge, very costly hospitalizations by adopting a collaborative practice model," said Black.

 

She added the accessibility of pharmacists encourages patients to ask questions. Using the example of a newly-diagnosed diabetic, Black pointed out the pharmacist could play a key role in helping that patient understand their medications and monitor and manage their blood sugars. "There is a cost savings (to the healthcare system) … but more importantly, the quality of life for these diabetic patients has been improved significantly," she said.

 

As complex as these tasks already are, Black and Campbell said they will become even more so as medicine moves toward genetically targeted therapies.

 

"Pharmacists are going to play a very critical role in working with physicians to target the right therapy for the right patient, but then also in providing education to patients about the complex medication regimens they'll be receiving," said Campbell.

 

"One of the areas we know is emerging and that we're already discussing and preparing for is how to educate the practitioner of tomorrow," added Black.

 

"The expanding role of the pharmacist in the provision of care to the patient has necessitated having more pharmacists to provide that care," Campbell pointed out. Black said workforce studies have predicted shortages based on growth of an aging population coupled with the age of existing pharmacists and projected retirement dates. Campbell added the shortfall was predicted to be upwards of 125,000 by the year 2020 not too long ago. "That was one of the primary drivers for the addition of pharmacy schools," he noted.

 

To help meet the need, Black said Tennessee has launched four new programs … three in the past two years. The state now has a total of five pharmacy programs with locations spanning east to west. The University of Tennessee College of Pharmacy, located in Memphis, has been in operation for more than a century. Four years ago, East Tennessee State University rolled out their new program in Johnson City. Belmont and Lipscomb Universities in Nashville and Union University in Jackson have just recently welcomed their second class of students.

 

The addition of educational opportunities isn't unique to Tennessee. Black said she has seen a national trend that has increased the number of accredited pharmacy schools from somewhere in the mid-70's to more than 110 programs today. Still, Tennessee accounts for nearly 10 percent of these new programs. Even with the influx of new pharmacists who will soon graduate, the nation must still brace for a shortage. Revised workforce figures now predict a shortfall of approximately 75,000 pharmacists by 2020.

 

The number of schools recently opened in Tennessee is even more impressive in light of the very complex accreditation specifications for new schools of pharmacy. Campbell is all too aware of what it takes to get a program off the ground as Lipscomb University just completed the process two years ago. One key area is making sure there are effective clinical sites available to students.

 

"There's a very specific process to make sure each college has the necessary practice sites to make sure students are trained appropriately," Campbell said. He added Lipscomb University College of Pharmacy focuses on three general areas: the community pharmacy setting, the institutional — or hospital — setting, and the specialty pharmacy setting such as a long term care facility or home infusion specialist. Having willing sites isn't enough, Campbell continued. It's important that each site understand the hands-on objectives that must be met by student pharmacists.

 

"That has entailed a collaborative effort among all the colleges of pharmacy to train preceptors to meet the curricular objectives associated with advance practice experiences," explained Campbell. Black added clinical sites are meant to be experiential rather than observational. "Sites have to deliver," said Campbell. "We have to make sure when the student leaves that site, they have achieved the curricular competencies set forth."

 

Both in the classroom and in the practice setting, it's critical the next generation of pharmacists be trained to face the challenges of their expanded role and meet whatever new demands are on the horizon.