Lesson 1 Professionalism and Health Care Professionals 2024-2.pptx

Professionalism and Health Care Professionals Plake KS, Schafermeyer KW, and McCarthy RL (2017). Health Care Deliver y– A Primer for Pharmacists, 6th edition, Jones and Bartlett, Chapter 2 & 3. Hammer DP, Berger BA, Beardsley RS, Easton MR. “Student Professionalism,” AJPE 2003; 67(3), Article 96. Am...

Professionalism and Health Care Professionals Plake KS, Schafermeyer KW, and McCarthy RL (2017). Health Care Deliver y– A Primer for Pharmacists, 6th edition, Jones and Bartlett, Chapter 2 & 3. Hammer DP, Berger BA, Beardsley RS, Easton MR. “Student Professionalism,” AJPE 2003; 67(3), Article 96. American College of Clinical Pharmacy, “Tenets of Professionalism for pharmacy Students,” Pharmacotherapy 2009; 29(6):757-759. Objectives  Summarize characteristics of a health care professional  Describe and understand the tenets of professionalism for pharmacy students  Define and understand professional behaviors that should be demonstrated by all pharmacy students  Describe major changes in the pharmacy profession starting in the early 20th century up through today Objectives  Outline the educational requirements and prescribing privileges and restrictions of the various health care professionals  Summarize the pharmaceutical care model of practice and identify roadblocks to its adoption  List the major pharmacy associations and organizations and describe benefits they offer to their members  Actively participate in a group and class discussion on professionalism What is a Professional?  Self-regulatory and policing  Altruism--putting the needs of the patient first  Specialized technical knowledge--exercising judgment in daily duties  Licensed to practice by an accepted credentialing body (or state) The professions enjoy more status in our society than an occupation and can be considered a step-up on the socioeconomic ladder. In this view of professionalism, Wertheimer has pointed out that there is an implicit agreement between the person and society involved. That agreement is that the person gains access to a field of study which limits access. Limited access to the field increases the chances of success. In exchange for entrance to this exclusive group, society expects an accountability of that person. The points of accountability are Definition of Professionalism  The active demonstration of the traits of a professional  Described as the advocacy of a set of attitudes and behaviors believed to be appropriate to a particular occupation Tenets of Professionalism  Altruism  Honesty and Integrity  Respect for Others  Professional Presence  Professional Stewardship  Dedication and Commitment to Excellence  Duty  Accountability Professional behaviors for pharmacy students  Takes responsibility for actions  Volunteering  Acts of service  Continued learning  Self-instruction  Fair treatment of all people regardless of demographic characteristics Professional behaviors for pharmacy students  Behaviors that demonstrate honesty and trustworthiness  Increased receptiveness to new ideas  Dresses appropriately  Punctual  Maintains confidentiality  Comes to class prepared Professional behaviors for pharmacy students  Actively participates in class activities, such as engages in discussion  Engages in constructive peer assessment  Accepts and applies constructive critique  Desire to seek out and take on new challenges History—Three Phases  Pre-1940 period  1940-1970 period  Post 1970s Pre-1940 Pharmacy  Since the founding of America, pharmacy had been an occupation based on the apprenticeship model ♦ One became a pharmacist by working under a practicing pharmacist ♦ No formal training in many cases    There were NO laws requiring most drugs have a physician’s prescription prior to dispensing Patients did not need to see a physician to get medication Pharmacists actually had considerable status in the community ♦ Power to “counter prescribe” medications ♦ Pharmacists were de facto treating patients Pre-1940 Pharmacy  Professionalism movement in America in early 1900s ♦ Begun by medicine ♦ Abraham Flexner studied medical education and produced a seminal report (1910) What prompted this movement?? Profession of Pharmacy  Flexner said pharmacy was not a profession  U.S. War Department wouldn’t commission pharmacists as officers in the military (1915)  1928—AACP* adopted 4 year B.S. in Pharmacy as minimum (went into effect in 1932) *AACP= American Association of Colleges of Pharmacy Abraham Flexner was hired by the American Medical Association in the early 1900’s to study the medical school curriculums across the United States. In his report Flexner stated that pharmacy was not a profession. This did not cause a great deal of trouble until the war department refused to commission pharmacists in the army. This got pharmacists active!! Pharmacists’ activity led to upgrading the professional education. This was the beginning of a period of elevation in the profession of pharmacy Pharmacy History—1940-1970     Era of expansion in health care The Hill-Burton Act of 1946 provided grants to build and renovate hospitals Laws had already been passed to protect the public from adulterated, toxic and mislabeled drugs 1965 saw the establishment of Medicare and Medicaid ♦ Increased coverage and increased utilization of drugs and other medical services  Pharmacy saw decreased scope of practice and diminished status ♦ Why???????? Pharmacy History—1940-1970 Diminished Role  Compounding had diminished ♦ Most medications were prefabricated by manufacturers ♦ Pharmacists technical expertise played lesser role  The Humphrey-Durham amendment (1951) to the Food, Drug and Cosmetic Act of 1938 created the “prescription only” class of drugs ♦ Pharmacists could no longer “counter prescribe” (i.e., could not dispense without Rx) ♦ Pharmacists became more dependent on the physician Pharmacy History—1940-1970 Diminished Role  Ethics statement of the American Pharmaceutical Association (now American Pharmacists Association) prohibited pharmacists from discussing medications or therapeutic effects with patients ♦ When the patient asked “What is this drug for?”, “What will this drug do to me?”, “What is in this drug?” Pharmacist was ethically bound to say – “You’ll have to ask your physician” Pharmacy History—1940-1970 Educational Requirements  Pharmacy schools responded to the diminished role by increasing the B.S. degree to 5 years with more emphasis on science ♦ Attempt to elevate the profession   Criticisms of this increase in education at the time was that pharmacists were overeducated and underutilized Next steps occurred in the 3rd wave in pharmacy history 1970s to Today Pharmacy History—1970s-Today  The clinical pharmacy movement was created in response to the diminished role perceived in the profession  The late 1960s saw the first 6 year PharmD only programs in California ♦ Greater emphasis on therapeutics  In 1992 the 6 year PharmD was recommended as the entry level degree  Last Bachelors of Science in Pharmacy degree in 2004 Pharmacy History—1970s-Today  Report commissioned by APhA found that the public perceived pharmacists as business persons and not professionals ♦ Stimulated a change in pharmacy academia  Pharmacy educator (Brodie, 1967) began building the case in the literature by stating the value of the pharmacist was ♦ Drug use control  Later literature (Hepler,1987) propelled the awareness of the pharmacist’s capacity to be a drug therapy advisor Pharmacy History—1970s-Today  Additional academic publishing advocated for a more professional role for pharmacists ♦ Manasse (1989) described “drug misadventuring” Adverse reactions Hospitalizations Death ♦ Due to increasing medication use and the lack of proper guidance for the patient These events led to the current mission and philosophy of pharmacy practice Pharmacy Mission and Philosophy of Practice Pharmaceutical Care—pharmacy’s mandate for the 21st century Pharmaceutical care is the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life. These outcomes are (i) cure of a disease; (ii) elimination or reduction of a patient's symptomatology;(iii) arresting or slowing of a disease process; or (iv) preventing a disease or symptomatology. Pharmaceutical care involves the process through which a pharmacist cooperates with a patient and other professionals in designing, implementing, and monitoring a therapeutic plan that will produce specific therapeutic outcomes for the patient. This in turn involves three major functions: (i) identifying potential and actual drug-related problems; (ii) resolving actual drug-related problems; and (iii) preventing drug-related problems. Pharmaceutical Care—pharmacy’s mandate for the 21st century Pharmaceutical care is a necessary element of health care and should be integrated with other elements. Pharmaceutical care is, however, provided for the direct benefit of the patient, and the pharmacist is responsible directly to the patient for the quality of that care. The fundamental relationship in pharmaceutical care is a mutually beneficial exchange in which the patient grants authority to the provider, and the provider gives competence and commitment (accept responsibility) to the patient. The fundamental goals, processes, and relationships of pharmaceutical care exist regardless of practice setting. Reference: Hepler, D.D. & Strand, L.M., Opportunities and Responsibilities in Pharmaceutical Care, Am J Pharm Educ, 53, 7S-15S(1989). Pharmaceutical Care American Pharmacists Association, 2000 A patient-centered, outcomes-oriented pharmacy practice that requires the pharmacist to work in concert with the patient and the patient’s other health care providers to promote health, to prevent disease, and to assess, monitor, initiate, and modify medication use to assure that drug therapy regimens are safe and effective. Where is all the Pharmaceutical Care??  All would agree that this care model would benefit the patient and the profession  What is happening?? ♦ We do not see pharmaceutical care practiced as much as it should be  Considerable barriers to the practice of pharmaceutical care  Transition to Medication Therapy Management (MTM) with Medicare Part D Barriers to Pharmaceutical Care 1. Drug product focus—dispensing drugs has historically been the paradigm 2. Service to the patient (DUR, dosing calculations) occurs distant from the patient and (potentially) without regard for outcomes 3. Turf battles Other professions (e.g., nurses & physicians) may view pharmaceutical care as their role Barriers to Pharmaceutical Care 4. Lack of financial incentives—most reimbursement incentives still focused on dispensing and NOT care provided 5. Pharmacies may lack facilities for consulting, monitoring physiologic parameters 6. Greatest barrier is ourselves. Comfort with the status quo. LAZINESS Pharmaceutical Care—the good news  Legislation is expanding pharmacists scope of practice ♦ Medicare Part D MTM – In 2024, patients had to incur expenses of $5,330 to be eligible for this service, thus only about 25% of Part D recipients are eligible for this service. ♦ Vaccinations –since mid to late 2000’s Seasonal influenza vaccine COVID-19 Herpes Zoster T-dAP RSV ♦ Home care services  National pharmacy chains starting to commit more resources Keys to Elevating Pharmaceutical Care  Talk to your patients—get to know them  Advocate for the patient’s health  Document your services  Take an active interest in the patient  Take an active role in pharmacy organizations and political issues Pharmacist Organizations  Pharmacy Organizations (Clubs) exist to: ♦ Disseminate information ♦ Maintain members competency CE, Codes of Ethics and standards of practice ♦ Career development/career planning assistance ♦ Financial benefits Member discounts on books, CE and subscriptions ♦ Governance Hard work, but YOU get the opportunity to make policy Committee work forces one to be current on the issues & actively engaged—connections count!!! ♦ NETWORK WITH COLLEAGUES Pharmacy Organizations  American Pharmacists Association (APhA) ♦ Oldest—founded in 1852 to establish standards for drugs and chemicals ♦ Physicians had threatened to regulate us Pharmacists formed APhA to avoid physician interference ♦ Student organization is the Academy of Student Pharmacists (ASP) ♦ Annual Meeting and Exposition March 22 – 25, 2024 in Orlando, FL Journal of the American Pharmacists Association (JAPhA) – Premier academic journal in pharmacy Pharmacy Today Pharmacy Organizations  American Society of Health-System Pharmacists (ASHP) ♦ Established in 1942 ♦ Accredit residencies ♦ Annual Midyear Clinical Meeting Early December Residency Showcase Personnel Placement Service ♦ Publications American Journal of Health-System Pharmacy (ASHP) AHFS Drug Information Handbook on Injectable Drugs Pharmacy Organizations  National Community Pharmacist Association (NCPA) ♦ Voice of independent pharmacy in America ♦ Publishes America’s Pharmacist ♦ Publishes NCPA-Pfizer Digest Financial indicators of independent pharmacy ♦ ValuRite purchasing cooperative for independent pharmacy Pharmacy Organizations       American Association of Colleges of Pharmacy (AACP) American College of Clinical Pharmacy (ACCP) Academy of Managed Care Pharmacy (AMCP) American Society of Consultant Pharmacists (ASCP) International Academy of Compounding Pharmacists (IACP) National Alliance of State Pharmacy Associations (NASPA) Pharmacists Education and Training  Pharmacy school expansion ♦ 2004 – 89 programs offer PharmD ♦ 2010 – 118 programs offer PharmD ♦ 2017 – 140 programs offer PharmD ♦ 2018 – 143 programs offer PharmD ♦ 2020 – 144 programs offer PharmD ♦ 2022 – 142 programs offer PharmD  Demographics ♦ Class of 2022– 64.4% female ♦ 45,261 total enrolled in PharmD program in fall 2022 (down 11.1% from 50,897 in fall 2021) ♦ 13,323 PharmD degrees conferred in 2022 (down from 14,223 in 2021) ♦ PhD and Masters degrees offered: Med Chem, Pharmacology, Pharmaceutics, Social and Administrative Sciences Pharmacists Specializations  Ambulatory care  Pharmacy administration  Drug information  Community practice  Industry  Geriatrics  Nuclear medicine* * Certification available  Managed care  Long-term care  Internal medicine  Psychiatry*  Oncology*  Nutrition support*  Pharmacotherapy* Pharmacy by the numbers  Number ♦ 2000: ♦ 2004: ♦ 2015: ♦ 2020: ♦ 2021:  50% of pharmacists (source: www.bls.gov) 217,000 230,000 297,000 322,200 323,500 Median annual income (source: www.bls.gov) ♦ 2005: ♦ 2010: ♦ 2015: ♦ 2020: ♦ 2021: $84,900 $111,570 $121,500 $128,710 $128,570 Pharmacy Salaries  Top paying states in 2021 (annual mean salary) ♦ ♦ ♦ ♦ ♦ California - $146,140 Alaska - $145,910 Oregon - $136,520 Washington - $134,290 Vermont- $130,460 ♦ ♦ Iowa - $122,090 Nebraska - $118,940  Top ♦ ♦ ♦ ♦ ♦ source: paying metro areas in 2021 (annual mean salary) San Jose/Sunnyvale/Santa Clara, CA - $168,640 San Francisco/Oakland/Hayward CA - $163,840 Santa Rosa, CA - $158,420 Vallejo/Fairfield, CA - $156,850 Santa Cruz/Watsonville, CA - $152,770 www.bls.gov Common Health Care Providers          MD/DO –Physicians --Doctor of Medicine/Osteopathy DDS/DMD—Dentist-- (the degrees are equal) DPM—Podiatrist DVM—Veterinarian OD—Optometrist RN—Registered nurse APRN—Advanced Practice Registered Nurse PA—Physician Assistant CRNA—Certified Registered Nurse Anesthetists Health Care Professionals Prescribing privileges Professional Prescribing Privileges Physician Dentist Podiatrist Optometrist Veterinarian Registered Nurse Advanced Nurses APRN/CRNA YES YES YES YES YES NO YES Physician Asst. Under a supervising MD Restrictions on Prescribing NONE Dental-related Foot-related Eye-related Animal-related WITHIN THE PRACTICE SPECIALTY YES Please note, these are meant to be very general. You will learn the particulars in your Pharmacy Law course. This is to be an introduction only and is not intended to serve as practice guidelines Physicians  154 U.S. med schools in 2021 (up from 125 in 2000)  Medical education is a post-baccalaureate program ♦ First two years of in-class education in basic sciences ♦ Followed by 2 years of clinical training  Upon graduation, enter a minimum 3 years of post-graduate training in area of specialization - residency Physicians by the Numbers  Over 762,000 physicians in U.S. ♦ Approx. 17,500 graduates per year ♦ About half (~49%) of all graduates are female  Compensation depends on area of specialization, but in general, physicians are among the highest paid occupations (source: www.bls.gov). Median annual income 2021: ♦ Pediatricians ~ $198,420 ♦ Psychiatrists ~ $249,760 ♦ Family practice ~ $235,930 ♦ Internists ~ $242,190 ♦ OB/GYN ~ $296,210 ♦ Anesthesiologists ~ $331,190 ♦ General Surgeons ~ $297,800 Nurses  Largest health care occupation (~ 3.64 million in 2021)  Median compensation in 2021 ♦ APRN ~ $120,680 ♦ RNs ~ $77,600 ♦ LPNs ~ $48,070  Professional development of nurses was key in transformation of hospitals ♦ Nurses contributed to efficacy of treatments, cleanliness, nutrition, and formal treatment routines Nurses: Education and Training  LPN – usually a 2-year associates degree  RN – usually a 4-year B.S. in nursing  Post graduate programs for nurses ♦ Clinical nurse specialists certified in area of care (e.g., pediatrics, critical care) ♦ M.S or PhD required for advanced registered nurse (APRN) with limited prescribing privileges ♦ Certified registered nurse anesthetists (CRNA) have advanced training in critical care and anesthesiology Physicians Assistant (PA)  Physician extenders with limited prescribing privileges that perform many physician functions under supervision by a physician.  Most complete a masters program and pass a national certification exam, continuing education, and recertify every 6 years  139,110 PAs in 2021  Mean income in 2021: $121,530 Other Health Professions  Dentists  Physical (Median income 2021~ $163K) therapist (Median income 2021~ $96K)  Occupational therapist (Median income 2021 ~ $86K)  Respiratory therapist (Median income 2021 ~ $62K)  Recreational therapist (Median income 2021 ~ $48K)  Social Worker (Median income 2021 ~ $50K)  Dietician (Median income 2021 ~ $62K) Improve Pharmacist-Physician Relations in Community Practice  The following suggestions may improve community pharmacist-physician relations ♦ Get business cards and use them liberally Especially the physician’s office ♦ Print up some referral forms for the doc to use Find out if you can supply some service for the office: such as patient education in the use of asthma inhalers or blood glucose monitors, research of potential adverse drug reactions, etc. If so, give the doc a pad of referral forms for those services The list of services will grow over the years! Barriers to Pharmacist-Physician Relationships  Attitude ♦ Pharmacists too many times feel that physician is unapproachable Pharmacist many times do not approach encounters with confidence  Time and money constraints ♦ A weak excuse Barriers to Pharmacist-Physician Relationships  Physician concerns ♦ Afraid pharmacist will give conflicting advice from their own ♦ Confidentiality issues make physician reluctant to give pharmacist diagnosis information  The education of the physician by the pharmacist would mitigate their concerns Once the physician knows you are a reasonable and dedicated professional they will not have second thoughts about your judgment. This is one of the benefits of building good professional relations. Pharmacy Technicians  Role has expanded over the last 40 years ♦ Assist pharmacist in serving patients ♦ Maintain medication and inventory control systems ♦ Participate in the administration and management of a pharmacy practice  Certification for some  Mean compensation in 2021 ~ $37,000. Professionalism Group/Class Discussion  Campus Students: Form Groups of 5 – 6 where you are sitting  Faculty will assign each group one of 5 sections of AJPE article or the ACCP article  20 minutes to read and formulate response  Class discussion  Identification of Professional Behaviors Exercise The End