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National Board Of Pharmacy

PHILADELPHIA -- Laws and regulations that require pharmacists to perform minimum standards of patient counseling don't work very well, the incoming president of the National Association of Boards of Pharmacy said at the organization's 99th Annual Meeting here last month. Instead, said NABP president-elect Donna Wall, it will take new solutions to the perennial stumbling block of time pressures on pharmacists and new regulatory approaches and professional practice models to encourage better counseling.

"As president, I will ask the executive committee to support a task force to address this issue and propose new solutions to this age-old problem," Wall told NABP members at the conference. "I believe that now is the time to design regulatory incentives for pharmacists to provide patient care for reasons other than fear of discipline.

"In my experience as a member of the Indiana Board of Pharmacy, it appears to me that mandating responsibilities works only to a certain extent in motivating pharmacists to provide the type of care that should be provided," added Wall, who serves as a clinical pharmacist with Indiana University Hospital. In particular, she said, the effort to mandate patient counseling ushered in a decade ago by the Omnibus Budget Reconciliation Act of 1990--better known as OBRA '90--has "not worked as Well as intended.

"Mandating counseling was a noble effort, but a not-so-successful action," she asserted.

Referring to a recent editorial in The New England Journal of Medicine that called on pharmacists to make a greater effort to talk to their patients and partner with physicians, Wall said she had "mixed emotions" about the attention being paid to the issue in the respected journal.

"On one hand, the profession is vindicated and acknowledged that we make a huge difference in patient care, Wall told attendees. "On the other hand we have physicians who are having to remind us-in a very public manner-that we are not doing what we can for our patients' safety."

Wall acknowledged the difficulties pharmacists face in counseling patients-including language barriers, heavy workloads and a lack of willingness or confidence among some pharmacists to interact more closely with patients. However, she said, "Rather than list the excuses and resolve ourselves that the obstacles to change are insurmountable, we should ask how ... we change this situation. How do we change patient expectations as board members and pharmacists? How do we motivate pharmacists to provide these patient care services?"

The answers, Wall added, "are not that difficult." The pharmacy profession, she argued, needs to change its message and "set a new expectation from our patients," that they "deserve to receive the correct medication and quality patient care services from the health professional best suited to deliver this care, the pharmacist.

"As boards of pharmacy supporting this new expectation and standard, we need to change our approach to regulation," Wall said. "It will require us to tackle issues and barriers, economic and otherwise, which have prevented pharmacists from interacting with their patients."

One of the toughest hurdles that pharmacists complain about when asked why they don't perform more patient care services, said the new president, is the heavy workload behind the counter. Time-strapped pharmacists, she said, are often "forced to choose or target only certain patients for counseling" in a sporadic and unstructured approach" that "does not serve the patient well."

Besides calling for a task force to pursue workload solutions, a said that as a top pharmacy regulator she also would champion specific approaches that make it easier for pharmacists to educate patients and monitor their conditions.

"I believe that if [pharmacy] boards mandate that prescriptions or drug orders include a medication indication line that must be completed by the prescriber in order for the prescription or order to be deemed legally valid, that the problem can be addressed effectively. As NABP president, I will do my best to move this item forward."

Wall also called for "the elimination of handwritten prescriptions [with their] language of codes and outdated symbols," in favor of electronic prescribing and other advances. She also said she would propose a session on best pharmacy practices to encourage the profession to share new ideas and solutions.

In a separate address, outgoing NABP president John Fiacco cited another approach that he said holds great promise "to redefine some of the basic tenets of pharmacy and support all of those patient care services." That approach, which he called the organization's newest project, is dubbed Continuing Professional Development, and it will include an Internet-based self-assessment exam, continuing education and management strategies "that will help pharmacists change their practices to effectively serve as their patient's medication advisor.

"What has me most excited about this project," said Fiacco, "is the open collaboration that is occurring between NABP and the other pharmacy groups."

RELATED ARTICLE: Brooks pharmacist named to top spot at NABP next year

PARK RIDGE, Ill. -- Reflecting chain pharmacy's increasing influence among state pharmacy regulators, the National Association of Boards of Pharmacy named Donna Horn, manager of regulatory affairs at Brooks Pharmacy, as the organization's president-elect during its 99th Annual Meeting in Philadelphia last month. Another chain pharmacy representative, Eckerd Corp.'s Oren Peacock, was elected to the organization's executive committee.

Horn, who also represents Brooks as a member of the Massachusetts Board of Registration in Pharmacy, previously served a one-year post as NABP's treasurer. 'As president-elect, she automatically assumes the role of president at NABP's 100th Annual Meeting next year," said Courtney Karzen, a spokes woman for the group. In line with NABP's three-year leadership rotation, Horn will serve as chairman following a one-year stint as president that begins May 2004.

Peacock, who is Eckerd's vice president of pharmacy relations, is one of three newly elected members of the six-person executive committee. In recent years, he has served on various task forces and committees for NABP, which represents the nation's 50 state pharmacy boards, Karzen said.

Donna Wall, a clinical pharmacist with Indiana University Hospital and Clarian Health Partners, was elected NABP president for 2003-2004. Former president John Fiacco, who is vice president of central fill pharmacy for Cardinal Health, has moved up to chairman.

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