{"id":1202,"date":"2012-02-02T00:22:12","date_gmt":"2012-02-02T08:22:12","guid":{"rendered":"https:\/\/blogs.ubc.ca\/phar330\/?p=1202"},"modified":"2012-02-02T00:23:13","modified_gmt":"2012-02-02T08:23:13","slug":"the-blueprint-for-pharmacy-and-personalized-medicine","status":"publish","type":"post","link":"https:\/\/blogs.ubc.ca\/phar330\/2012\/02\/02\/the-blueprint-for-pharmacy-and-personalized-medicine\/","title":{"rendered":"The BluePrint for Pharmacy and Personalized Medicine"},"content":{"rendered":"

All the talk nowadays in local pharmacy classrooms is about the budding shift in pharmacy practice: moving the pharmacist out of the dispensary to newly furnished counselling booths, movement from product-centred care to outcome-focused patient care, optimal drug therapy outcomes for Canadians through patient-centred practice \u2013 that is to say, we\u2019re talking about shifts towards Personalized Medicine<\/strong>. \u00a0And rightly so; the demands of health care are changing, and as our culture grows so should the practice of pharmacy grow, learn, and evolve towards the principles of practice that will allow us to provide for patients optimal, thorough, and well-evaluated care. \u00a0Pharmacogenomics is a valuable field in which a lot of potential for Personalized Medicine is available to be maximized, allowing for the impact of gene variation on drug response to be studied and the results to be used to help us tailor medical care to the individual patient. \u00a0Practice of Personalized Medicine has plenty of room to grow with advances in pharmacogenomics, as a student points out:<\/p>\n

\u201cI think personalized medicine is a very interesting and unique forefront to take on as a new service we can provide to our patients. \u00a0Not only will this set us apart from other health care professionals, it is also a tool to help us build a strong individualized therapeutic relationship. \u00a0Personalized medicine utilizes and integrates all aspects of what we learn in Pharmacy school and make us better equip to provide our patients with the best care possible. \u00a0Although pharmacogenomics is a new, and the use of genome sequencing is not easily accessible nor affordable – over time with increasing popularity and as more efficient, high-throughput technology is developed, these concerns are minor in comparison to the benefits of what personalized medicine can provide. \u00a0With extensive pre-existing databases of sequenced genomes and identification of genes responsible for breast cancer, Parkinson\u2019s, and cystic fibrosis (just to name a few), development and the growth of personalized medicine is just the tip of the ice-berg.\u201d<\/em>
\n-a student<\/p>\n

If Personalized Medicine is the forefront concept and priority with which we are advancing this march, our call-to-arms is going to be the BluePrint for Pharmacy: an extensive document released in 2009 that outlines some of the principles and policies behind developing this professional shift in practice. \u00a0The BluePrint identifies key areas of action -including increases in education and continual development, changes to legislation, regulation, and liability- all of which are in discussion and different phases of action today.<\/p>\n

However, mixed in with excitement, we must also be critical and practical:<\/p>\n

\u201cAlthough I think that the Pharmacy Blue Prints are important for shaping the future of Pharmacy. I think that these plans are too idealistic and do not conform to the realities of society (taking into account how the government and employers want to cut back wages).<\/em>
\nIn the blueprints, it comments on how as Pharmacists we should do more, have we forgotten the business model where doing more means more compensation? Sure, we get compensation for our services, but the means of compensation are so tedious, time consuming and the value of compensation are not signficant that there would appear to be a lack of incentive to expand the role of Pharmacists<\/em>
\nI think rather than spending a ridiculously long time trying to fufill each of the points made in the blue prints (like a checklist), we need to appoint a vocal, strong headed and perhaps \u201carrogant\u201d leader to boost the image of Pharmacists in the healthcare hierachy. Too often are the Pharmacists thrown under the bus because we are too \u201cpolite\u201d or too \u201cinactive\u201d to step up and fight for our recognition in the health care -team.\u201d<\/em>
\n-a student<\/p>\n

Though there is discourse on what changes are appropriate and practical, a very common ground for many students and pharmacists on our changing practice is our lack of strong professional advocacy. \u00a0We do, however, seem united in our understanding of the strength in our ability to provide valuable, cognitive services, the potential for pharmacogenomics to positively impact the landscape of our practice, and the need for the appropriate changes to wage compensation to be addressed.<\/p>\n

\u201cAs the role of the pharmacist continues to move away from dispensing and towards cognitive services, pharmacists need to prove their worth to both the government and society in general, as well as embrace the expansion of our scope of practice. We need to stress the importance of pharmacists\u2019 interactions with patients. Pharmacists are in the perfect position to prevent ADRs, educate and ensure patient compliance, all of which are extremely important for improving patient health. In addition, as the field of genetics continues to grow, the opportunity for pharmacogenetics to be introduced into both hospital and community pharmacy practice is increasing. Using pharmacogenetics to personalize medications based on an individual\u2019s DNA is quite possibly the future of pharmacy. Pharmacogenetics can be used by pharmacists to determine the most effective and safe drug therapy for an individual. In order for pharmacogenetics to become mainstream pharmacy practice, the cost of DNA sequencing needs to be affordable and completed before therapeutic decisions need to be made, pharmacists need to be educated in the field of pharmacogenetics and an E-health medical record that is easily updated and accessible to all healthcare professionals needs to be introduced. However, this switch from dispensing to cognitive services needs to be met with a changed model for compensation, where like doctors, pharmacists are paid for their services and time spent with patients, not for the amount of product sold. A major barrier to this is the fact that pharmacist compensation comes from both private and government sources with private companies profiting from Rx sales. This begs the questions: Should private companies continue to be involved in pharmacy practice? Where do we draw the line in public health care funding? What services should Pharmacists be paid for?\u201d<\/em>
\n-a student<\/p>\n

Pharmacogenomics does face a lot of complications in these earlier stages of integration and development. \u00a0A new frontier of sorts, we can speculate that a number of issues can arise in practical application:<\/p>\n

\u201cMultiple obstacles currently lie on the path to the integration of pharmacogenomics into pharmacy practice. Many of these obstacles are likely due to that pharmacists simply do not feel ready.<\/em>
\nFirstly, most pharmacists have not had much formal training in pharmacogenomics while pursuing their entry-to-practice programs. Newton et al. 2007 and a US survey have pointed out that pharmacists, particularly ones working in the community setting, are not well informed regarding advances in genomics technology and the pharmacogenomics of various disease states.<\/em>
\nSecondly, pharmacists currently have limited direct access to complete medical records of their patients. Appropriate pharmacogenomics services cannot possibly be provided without full access to the genotype test results and comprehensive medical records. It will be interesting to see whether the introduction of electronic health records (eg e-Health) will be able to address this concern by broadening pharmacists\u2019 access and encouraging collaboration among healthcare professionals.<\/em>
\nLastly, do pharmacists feel comfortable regarding utilizing pharmacogenomics in their practice and the impact that pharmacogenomics may have on the healthcare professional-patient relationship? Some pharmacists may have concerns regarding the psychological distress that genotype test results may bring to their patients, especially when the patients discover that they are pre-disposed to certain diseases.\u201d<\/em>
\n– a student<\/p>\n

The BluePrint also outlines a detailed implementation plan that describes specific actions to execute its desired changes. \u00a0This plan relies heavily on success in sequence; coordination is required for this transition, and it is hard to say how effective we are currently being in creating these changes appropriately. \u00a0Furthermore, we still can\u2019t be entirely sure where we can truly fit pharmacogenomics into this plan.<\/p>\n

\u201cI think the ideas brought forth in Blue Print for Pharmacy are both comprehensive and important in developing a new role for our profession. However, certain aspects are coming into effect before others and we find ourselves facing an awkward and challenging transition phase. For example, licensed technicians are beginning to graduate and practice in community pharmacy settings. This is part of the blueprint, and it means that things are going as planned \u2013 pharmacy technicians will take over the roles associated with dispensing and free up pharmacists, allowing them to focus on the more clinical aspects on community pharmacy. Unfortunately, the pharmacist\u2019s role has not yet expanded to this breadth. One large reason for this may be compensation as there is no government program in place which allows pharmacists to be readily (and rightly) compensated for utilizing our specific knowledge and skill sets to help patients with their medications. There are programs in progress, such as the BC Medication Management Project, but these have not yet been expanded to include all the pharmacies in BC. Also, the Medication Review Services that started taking effect in April was found to be financially unsustainable by July and revised (aka limited). This raises the question of whether the profession of pharmacy, as outlined in the blue print, will ever be financially viable\/sustainable in terms of government funded compensation. Meanwhile, as pharmacies continue to depend on dispensing prescriptions as a means to cover costs and as pharmacy technicians are able to take a more active role in dispensing activities at lower wages, pharmacists find their livelihood in jeopardy. Pharmacists are now pressured to find ways to expand their practice. One suggestion is for pharmacists to take a more active role in applying pharmacogenomic principles to practice. However, this is still quite a new area and genome sequencing of patients is, for many reasons, not readily available for pharmacists to interpret. For these reasons, pharmacists already in practice and students do not have adequate exposure to the field of pharmacogenomics. Perhaps in another few decades this will have changed. Whether pharmacogenomics is the answer or not, this is a transitional time for the profession of pharmacy and it will be exciting to be part of the change.\u201d<\/em>
\n-a student<\/p>\n

All in all, we understand that change is necessary, and change is coming. \u00a0Action needs to be taken from this discourse, and our practice needs not only continued action, but sustainable action. \u00a0Where we can truly instigate our goals in this plan is still up for debate.<\/p>\n

\u201cSince the economic downturn, health care in general in Canada has taken a huge hit. \u00a0Not in the least, the pharmacy field is starting to feel the pressure. \u00a0Certainly, the talk of pharmacy practice change has been going on for awhile, even decades, but it is not until now, when our livelihoods are at stake, have we unanimously agreed that something has to be done. \u00a0I think the \u201cBlue Print for Pharmacy\u201d is a good idea, but it is just that…an idea. \u00a0It IS up to us to make the change. The \u201cBlue Print\u201d has provided us with the goals, the focus, and the methods of implementation. \u00a0But what was lacking all these years is the motivation. \u00a0Pharmacists has historically \u201cdone well\u201d for themselves; there was no risk of unemployment, no risk of our jobs being taken over by someone who will work for less pay, and there was no drive to do anything differently.<\/em><\/p>\n

I am glad the \u201cBlue Print\u201d focuses on patient-centered outcomes, but it also goes on in detail about implementing new business models. \u00a0Unfortunately, that is an indispensable part of our field and practice. \u00a0Unlike our partners, the doctors and nurses, our field has always had a business side. \u00a0It is what has worked for us. \u00a0Of course we care about providing the most safe and effective pharmacotherapy, of course we want to achieve patient-centred outcomes…we care so much that we are even the forerunners on personalized medicine based on pharmacogenomics. (It doesn\u2019t get anymore patient-centered than that!) \u00a0But in order to serve our patients better, we need to be sustainable. \u00a0First and foremost, we need to be compensated for what we do, and the services we provide. \u00a0We need to allot time for these services. \u00a0We need to make room for the new certified technicians (yes, the same ones threatening to take over our jobs). \u00a0At the same time, we still need to be the most accessible health care providers in the community. \u00a0We certainly will not be able to do this the old way. \u00a0And the government does not have a bottomless pit of money to dole out to all pharmacists who claimed they have reviewed and improved their patients\u2019 medications, whether they needed it or not. \u00a0Yes, we need to pressure the government. \u00a0We also need to pressure our own regulatory body, our own association, to speak up for us. \u00a0We need them to make the government realize we are an essential service, but we are not looking for a handout. \u00a0We need them to change the legislations to allow us the flexibility to be compensated for our services by other means. \u00a0In order to provide our expanded services to patients free of charge to them, we need the reimbursements from our partners, the pharmaceutical wholesalers. \u00a0We need to limit the ratio of technicians to pharmacist in each practice, in order to provide optimal care. \u00a0Lastly, we need to stop pandering to the corporations, the \u201cbig chains\u201d. \u00a0The best way to change this field is from the ground up, starting with independently owned pharmacies, where the pharmacists have actual power to change the way work is being done.\u201d<\/em>
\n– a student<\/p>\n

Group 1<\/strong>
\nReferences:<\/p>\n