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National Pharmacy Technician Association

PARK RIDGE, Ill. -- Responding to concerns about patient safety and potentially harmful mistakes in drug therapy, The National Association of Boards of Pharmacy is looking again at the issue of mandatory competence exams for practicing pharmacists.

The call to revisit the contentious issue of competency came from NABP executive director Carmen Catizone in the organization's recently issued 2000 Annual Report. Catizone noted that a new report from the Institute of Medicine called on state governments to establish a mandatory reporting system to collect standardized information about adverse health care events that "result in death or serious harm." That report, Catizone told board of pharmacy members, also urged health professional licensing bodies--including boards of pharmacy--to "implement periodic re-examination and re-licensing of...providers, based on competence and knowledge of safety practices, and work with certifying and credentialing organizations to develop more effective methods to identify unsafe providers and take action."

In light of those safety concerns, said Catizone, "Perhaps the time is right for NABP to reintroduce the development and implementation of a continuing competence assessment program. Perhaps the time is right for the profession to work with the state boards of pharmacy and NABP to demonstrate a commitment to patients and quality care."

If the organization follows through on its executive director's recommendation, it won't be the first time the national organization representing the state boards attempts to mandate continuing competency exams. When first proposed four years ago, the issue drew immediate and determined opposition from many community pharmacy leaders, including chain drug people.

Among the objections to the proposal were fears that the exams would add unnecessary costs and burdens to already-qualified professionals and their retail employers, and could exacerbate an ongoing shortage of pharmacists. Those objections were enough to quell, at least temporarily, the move to mandatory testing.

In his report, Catizone referred openly to the dispute. "In 1996, when NABP announced its intention to develop a continuing competence examination, the pharmacy world imploded, and NABP was vilified and criticized," he observed. "The days and months that followed that announcement were difficult for NABP and its leadership.

"However, it now seems that the Institute of Medicine's findings and recommendations indicate that NABP was right," Catizone continued. "Our earlier calls for mandatory reporting of significant adverse reactions and assessment of continued competence, although rejected by the pharmacy community just a short time ago, are on target for dealing with a serious, identified, and life-threatening health concern."

Despite the re-emergence of the competency issue, the NABP report also points out many areas relating to pharmacy's future in which pharmacy regulators and chain pharmacy leaders appear to be in sync. In particular, NABP leaders expressed support for the host of efforts under way in community pharmacy to broaden pharmacy practice into new areas of patient care and disease management.

"The boards of pharmacy must redefine the practice of pharmacy in terms of pharmaceutical care and outcomes," noted Catizone, "so that patients can expect the same consistent level of care as they now expect and receive in regard to the quality and stability of their medications."

Added NABP president-elect Jerry Moore, "As pharmacy's scope of practice continues to evolve, we are the architects building a regulatory infrastructure that will support the continued growth of the practice."

Through a number of standing committees like the Task Force on Pharmacy Manpower Shortage and the Task Force on Centralized Prescription Filling, the organization is also tackling some of chain pharmacy's biggest concerns, according to the annual report. Among the recommendations now under consideration to alleviate the pharmacist shortage: the complete elimination of pharmacist-to-technician ratios; more frequent opportunities for new pharmacists to take licensing examinations; and the further delegation of dispensing functions to techs.

VIPPS program cited

The task force on pharmacy manpower also asked the NABP's Committee on Law Enforcement/Legislation "to develop model language enabling the operation of central-fill pharmacies."

In his own segment of the report, current NABP president Dyke Anderson also praised the organization's regulation and oversight of online pharmacies through its VIPPS program. VIPPS, which stands for Verified Internet Pharmacy Practice Sites, has garnered enormous exposure in the media and in Congress, according to Anderson, as "concerns about the safety of online prescribing sites and Internet-based pharmacy practice exploded."

The VIPPS seal of approval, Anderson noted, has become "a key characteristic" in the selection process for a reputable Internet-based prescription provider. NABP, he added, has appeared before two congressional committees investigating online dispensing practices, and the Food and Drug Administration and other groups have voiced support for the program. In addition, he noted, interest in VIPPS is coming from other countries, as well.

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