Are the stars aligning?

American Journal of Pharmaceutical Education,  Winter 2000  by Penna, Richard P

• E-mail
• Print
• Link

Recent events within the Health Resources and Services Administration (HRSA) give us in pharmacy cause for substantial hope. Last year, HRSA awarded a contract to AACP to evaluate the level of pharmaceutical care delivered in the more than 1000 community and migrant health centers supported in part by the agency. AACP retained Dr. Marvin Shepherd (Texas at Austin) to conduct the study. Results will be available in January 2001. Moreover, at last February's AACP Interim Meeting, HRSA representative Dr. Donald Weaver announced that the agency would devote funds to support demonstration projects involving pharmaceutical care in various health centers. The $2.3 million demonstration program is funding 10 (and perhaps more) projects from the 26 submitted. Most exciting of all is that each migrant or community health center project funded will be linked with a college or school of pharmacy. Why link with the schools? Because our schools will provide technical assistance to existing pharmacy programs at the centers and faculty and/or residents for newly established programs at some of the health centers. In addition, our faculty will bring their research and analytical expertise.

While we are naturally elated that ten or more of our colleges and schools are participating in these projects, that HRSA even considered devoting its funds to them represents a significant change in HRSA's view of pharmacy. Pharmacy and pharmaceutical care are now on HRSA's radar screen. Please note the following statement from HRSA's background statement accompanying the grant announcement:

"In addition to the dispensing of drugs, clinical pharmacy services include patient education and consultation, checking for potential drug interactions, methods to make sure that patients adhere to the prescribed drug therapy, regular monitoring of health outcomes, and a network-wide core formulary. The purpose of this clinical pharmacy demonstration is to show the impact these services can have on improved health with a modest initial budget that, in a relatively short time, can more than pay for itself at full implementation. In these demonstration projects, the clinical pharmacist provides these services as a key member of the health delivery team. By preventing problems caused by drug interactions, inappropriate doses, and failure to adhere to prescribed therapy, the cost of outpatient care and inpatient medical care to deal with such problems can be avoided while restoring and maintaining the patient's wellbeing."

In these days of discussions about including prescription drugs under Medicare or other federal programs and compensating pharmacists for providing pharmaceutical care services, having a major federal agency recognize that pharmacists are critical to the efficient delivery of health care offers the profession a significant advantage.

AACP began visiting with HRSA several years ago to discuss general issues related to pharmaceutical education and HRSA's mission. We found an agency that was deeply concerned about the rapidly rising costs of pharmaceuticals and the escalating costs of drugrelated illness. Of course data that AACP presented showing the enormous amount of money that Medicaid was spending on drugrelated illness only solidified our contention that pharmacy had some answers and colleges and schools of pharmacy could assist local community and migrant health centers in resolving their difficulties.

The message that pharmacy is an integral component of the delivery of efficient and effective primary health care is finally being echoed from halls other than those within the profession. In the past, discussions of who should be involved in the delivery of primary care quickly degenerated into turf battles with or between medicine and nursing as to who should be designated as primary health care providers. That there were federal dollars attached to supporting primary care educational, research, and demonstration programs only fueled the turf issues.

We must now move away from the argument of who is a primary care provider and concentrate on the premise that primary care cannot be delivered - indeed cannot exist - without pharmaceutical care. The demonstrations now being conducted will greatly assist us in making that case. Significantly, the demonstration grant program is housed in the Office of Pharmacy Affairs (OPA) within the Health Resources and Services Administration's (HRSA) Bureau of Primary Health Care (BPHC). That this program is in the Bureau of Primary Health Care should not be lost on our analysis of the politics of Washington's health care dealings.

The projects being conducted by our colleges and schools of pharmacy will have other results. They will provide practice opportunities for faculty, especially ambulatory care faculty. They will offer research opportunities. Faculty will have new practice environments through which to rotate students. Finally, creating residency training opportunities will assure the preparation of a cadre of practitioners who will find professionally fulfilling practices in community and migrant health centers and other primary health care facilities. Moreover, while the demonstration projects are in progress, we look for more community and migrant health centers to seek out similar arrangements with colleges and schools of pharmacy in their areas. These arrangements will not be demonstrations but applications of what they learned from the ten projects that were funded.