Hospital Pharmacy Leadership Conference - June 1 - 3, 2007
of Pharmacy Practice - What Will the Future Look Like?
A Discussion of the Role of Pharmacy
in the Health Care System of the Future
Moderator: Kevin Hall
Editorial Advisory Board
Hospital Pharmacy in Canada Report
In the course of discussion, participants returned repeatedly
to one central challenge in achieving advanced pharmacy practice:
designing a system that is flexible enough to accommodate all
practitioners. Some spoke of the need to facilitate the work of
“overachievers” in the profession, while also accommodating
the traditional community pharmacist who may be content to stay
behind the drugstore counter. Presenters and participants demonstrated
broad agreement that success in doing so will require more consistent
and coherent credentialing, national standards, and initiatives;
more comprehensive education and practice philosophies; and extensive
work across disciplines.
While credentialing was generally recognized as a necessary component
in expanding scope of practice, there were different ideas for
the appropriate structure of a credentialing system and for the
educational and training components needed to support the structure.
Dr. Gomori stressed the importance of tailoring education and
training closely to the particular practice area, to ensure that
inter-professional teams blend well and function successfully.
Several participants noted that credentialing is only a first
step in the process of advancing practice scope. A residency pharmacy
graduate summarized this line of thinking: “A credential
gets you in the door, but it’s the relationships you form
that move you and your professional practice forward.” When
professionals have the right skills, their background is respected,
witnessed, and assessed by their peers—this can be “as
important a measure as anything that can be accomplished in a
formal training structure.”
Koshman and Syme both stressed the need to increase residency
training programs as an integral part of the education and credentialing
system. Koshman referred to her own undergraduate experience to
illustrate the importance of integrating longer and more residencies
into basic pharmacy education to help guide students as they make
decisions about their future practice. She called for strong formal
relationships between hospital pharmacy and undergraduate programs,
so that programs are less centred on traditional community practice.
Syme recommended that in light of contemporary issues, efforts
to advance practice be strategic. Pharmacists should take advantage
of current trends in health care to position themselves to take
over roles for which they have the expertise in both hospital
and community settings.
Syme underscored the comments of several others in noting that
formal curriculum changes must be accompanied by practical “common
sense” changes. For example, pharmacology is taught to nurses
by nurses and to doctors by doctors. A good first step in building
inter-professional cooperation, understanding, and respect would
be for pharmacists to teach their discipline to other professionals.
She recommended increasing inter-professional education opportunities
overall, both in field placements and within the academic curriculum.
The need for flexibility again asserted itself. Dr. Gomori observed
that not all pharmacists might be interested in residencies that
prepare them for hospital or inter-professional practice. He suggested
screening pharmacy students to help select those who might want
or be suited to a residency program.
A mechanism for advanced training would allow the system to “grow”
practitioners and offer them opportunities suited to their level
of expertise, ability, and willingness, Koshman countered. The
inability of everyone to do a particular thing should not hold
back those who are willing and able.
Group members used the metaphor of “ceiling and floor”
to further explore the tensions in creating a system that fits
those who want to expand their scope of practice and those who
do not. Some group members expressed concern that the “floor
effect” is as problematic as the “ceiling effect,”
which is known to discourage advancement. A system of regulatory
authority will not function if it is built for the “stars”
of the profession; it must be built for the basic level. One participant
called it the responsibility of hospital pharmacy leaders and
administrators to create a system that recognizes and uses the
talents of the “stars” while simultaneously moving
forward the whole profession.
Others disagreed. Several participants said community pharmacists
are “holding back” the advancement of practice. They
argued that other disciplines view hospital pharmacists differently
from their community colleagues. They recommended leveraging the
reputation of hospital pharmacists, Doctors of Pharmacy, and hospital/community
residency programs to expand opportunities for advanced practice.
One participant stressed the need to proceed “without getting
stuck in the mud waiting for our community colleagues to catch
up.” Another recommended acknowledging the important role
of community pharmacists by enabling practice in that area to
move forward differently.
Syme said a truly national representative organization to parallel
the Canadian Nurses Association would be useful. The organization
could take responsibility for aligning activities across provinces
and for using best practice evidence-based models to help advance
practice across the country. Participants said such a body does
not exist for pharmacists. The Canadian Pharmacists Association
(CPhA) is voluntary and the National Association of Pharmacy Regulatory
Authorities (NAPRA) does not include Quebec and Ontario. A participant
called for the creation of a leadership body to help bridge the
gap for advancing inter-professional advanced pharmacy practice
without alienating broader pharmacy associations or leaving anyone
out of the process.
The issue of job title was revisited. Dr. Gomori echoed the sentiments
of participants when he noted that “words are important
and small details like titles matter.” He expressed his
support for changing the name of advanced practice pharmacists
at his Winnipeg clinic to reflect the actual scope of their contributions.
Finally, participants expressed agreement on the importance of
clearly defining the roles for advanced practice across disciplines
to ensure that overlapping roles are understood and do not become
a source of contention. They called for the establishment of appropriate
structures to ensure that expertise is used efficiently and effectively
in as broad a range of settings as possible.