[e-drug] Pharmacists in Africa and reference to pharmacist shortage in the US

e-drug
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E-DRUG: Pharmacists in Africa and reference to pharmacist shortage in the US
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Hello to all. I feel compelled to respond to a segment of this email (U.S. pharmacist shortage) and the implications assumed regarding the 'shortage' of pharmacists in the U.S. There are many in the U.S. that do not feel that the 'shortage of pharmacists' is a real phenomenon at present, or in the near and long-term future. Analysis of the current situation in the U.S. does reveal a tremendous abundance of qualified pharmacy school applicants to U.S. schools of pharmacy. In response, there are numerous pharmacy schools starting up in the U.S. and many existing programs increasing the number of students accepted into programs. Unfortunately, there is perverse incentive for the accrediting body for pharmacy education in the U.S. (the Accreditation Council for Pharmaceutical Education) when monitoring the quality and quantity of pharmacy programs in the U.S. ACPE reaps economic windfalls when applicant programs seek preaccreditation (precandidate and candidate status) and full accreditation status. As the number of accredited programs have proliferated, ACPE continues to benefit monetarily, sustaining fees for continuing programs continue in perpetuity with increasing charges over time. One need look no further than the state of U.S. pharmacy continuing education (with ACPE oversight) to observe the damaging situation occurring with enhanced incentives for approval and continuing reapproval of CE programs with little impact on patient care and/or improved therapeutic outcomes.

The promise of pharmacy to impact drug morbidity and subsequent mortality remains unfulfilled for the most part in the U.S. Graduating individuals with skills that are underutilized while at the same time maintaining a drug distribution mode at the community pharmacy level that has remained virtually stagnant since the 1970s does neither the new graduates nor the profession anything but a disservice. More importantly, patients continue to suffer. If available technologies: electronic prescription order entry, automated dispensing devices, central prescription fill and refill capabilities are widely used to an extent possible, an enhancement in the more appropriate use of drugs and pharmacists may be a reality. If these time saving, and accuracy improving technologies could be widely used in the U.S., dramatically fewer pharmacists would be needed in a dispensing role. More pharmacists would be able to apply problem solving and patient saving capabilities to a more fully realized professional role. This refocusing of pharmacy practice may in fact result in fewer pharmacists overall being necessary, but more patient care oriented pharmacists being in greater demand. I truly feel that the profession, societies, and patients would benefit in the long run. I frankly hope that the current situation in the U.S. will be attenuated; I certainly do not wish to see certain aspects of the current U.S. model applied elsewhere in the world.

Jack E. Fincham, Ph.D., R.Ph.
A.W. Jowdy Professor of Pharmacy Care
Department of Clinical and Administrative Pharmacy
College of Pharmacy
Adjunct Professor of Public Health
Institute of Gerontology Faculty
Associate Editor, The American Journal of Pharmaceutical Education
The University of Georgia
Room 262 RC Wilson Pharmacy Building
Athens, GA 30602 USA
(706) 542-5311
(706) 583-0034 fax
jfincham@uga.edu
www.takingyourmedicine.com

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E-DRUG: Pharmacists in Africa and USA (2)
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Jack raised an important point about not copying the US curriculum
model without ensuring that the patient outcomes change, and that a
more patient oriented approach could be achieved with the
incoporation of new technologies.

I am sure that other colleagues will confirm that most dispensing in
public sector outlets is usually done by pharmacist assistants,
technicians or nurses whilst the pharmacist supervises, or is
involved with prescription checking and medicine picking. There is
little if any interaction between pharmacist and patients.

If we are to develop a different model of a "pharmacist" that is going
to provide evidence of improved patient outcomes, how long would it
take to train such a person and what would the outcomes of the
degree/ diploma be?

A pharmacist E Drugger contacted me enquiring about doing a
Master in Public Health at my University. I responded as follows:

"I find it particularly interesting that you are seeking to do a Masters
in Public Health. We have many students from outside South Africa
(70% of this years first year class come from many different
countries in Africa.) We have a strong research based postgraduate
programme (nearly 40 PGs) - we graduate about 60 pharmacists a
year. When I my the students what they propose to do after
graduating, many of our foreign students, and an increasing number
of our local students indicate that they would like to do a Masters in
Public Health - which we do not offer at this stage. (We have
however, introduced a Pharm D programme based on the US
model!")

"This suggests to me that the students believe that either:

1. the opportunities for graduate pharmacists (M Pharm, or M Sc
(Pharm) are limited (as opposed to MPH) in Africa.

2. those who do not want to locked into the dispensary rat race see
public health as their best option

3. this is a need that increasingly the pharmacy curriculum should
address (as opposed to the more traditional science based topics).

"Certainly in Africa, the need to focus on improving primary health
care is critical. More pharmacists with MPHs would have better
prospects for developing regional and national policies. So should
we shift the curriculum to take this into account? Could we not
produce someone who is competent to perform basic dispensing
tasks, based on a public health framework?"

"The final question is "could we call that person a pharmacist?"

cheers,

Billy

Billy Futter
Associate Professor
Faculty of Pharmacy
Rhodes University, Grahamstown, South Africa
email B.Futter@ru.ac.za
phone 046 603 8494
fax 046 636 1205