MPA | Pharmacy News

By Michelle Dehoorne-Smith, Pharm.D., patient care services manager, St. John Hospital and Medical Center, Detroit, MSHP Board of Directors

Since the start of 2017, we have taken a critical look at how each of us and our organizations can prepare for the challenge of gearing up for our evolving role in improving patient care through increased access to pharmacists’ healthcare services. As described in the Journal of the American Pharmacists Association’s 2017 pharmacy forecast, there will be a significant shift in the pharmacy work force, and in particular, in our role and training.1  

In addition, as we respond to payment reform, we will be continuously challenged to improve patient outcomes with lower costs and more efficient pharmacy services. Smaller work forces, decreased healthcare spending, improved outcomes and increased demand for high quality experiential education will be some of the future challenges. To assure the necessary skill set for our expanded direct patient care roles, we need to continue to increase the number of sites providing high quality experiential training for students and residents. Providing a greater number of sites with high quality experiential training while requiring less staff and providing expanded services that improve patient outcomes with overall lower cost of care are two of the greatest challenges facing our clinical practice. 

Improved integration of students and residents into our practice model may be a key step in accomplishing these seemingly unbalanced demands with our goals. For example, building interdependent student-pharmacist teams that focus on transitions of care, patient education and decreased readmissions may be a good first step. Integration of students into the practice model traditionally has been resisted as inclusion of students is often seen as an increased workload on supervisors as well as the belief it is a lower quality educational experience. Currently only 20 percent of forecast panelists predict a high likelihood that health-systems will have a formal plan within the next five years of achieving a cost-benefit balance in advanced experiential education and only 38 percent predict this to be somewhat likely.  Without more creative scheduling by organizations and universities and greater student accountability for quantifiable workload, we may be missing the forest amongst the trees. Students value direct patient care and the responsibility for improved patient outcomes. As future practitioners, these increased responsibilities may enhance students’ feeling of ownership for their future patients. 

Healthcare experiential sites need to be willing to forgo models that resist student ownership of workload and provide primarily shadowing and observational training. Rather than be perceived as a drain on the staff, high quality training sites should include greater integration of students and residents into the practice model and greater consistent provision of direct patient care. This will offset pharmacist workload as well as prepare our future practitioners with the appropriate skill set, hands-on experiences and accountability for outcomes.  We know students and residents can provide many benefits to our staff, patients and assist with workloads if we are willing to empower them and change the way we integrate them in our practice models. In turn, we may better prepare our future pharmacy practitioners with the skills to meet the goals of improved services at a lower cost in an efficient practice model. 

1. Zellmer WA, ed. Pharmacy forecast 2017: strategic planning advice for pharmacy departments in hospitals and health systems. Am J Health-Syst Pharm. 2017;74:27-53. 

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