The University Record, February 4, 1998

Tomorrow's pharmacists will need new skills

Scott Gindlesberger, pharmacist at Manchester Pharmacy, receives prescription orders by phone and fax, and answers customer's questions in a number of ways. Photo by Rebecca A. Doyle

By Nancy Ross-Flanigan
News and Information Services

Tomorrow's pharmacists will be as likely to make house calls or see patients in a doctor's office as to work behind the counter at the corner drugstore. And wherever they're found, pharmacists will be doing much more than doling out drugs. Counseling patients about chronic conditions such as diabetes and high blood pressure, advising physicians about which drugs to prescribe, and helping everyone sort through the confusing and sometimes conflicting jumble of drug information on the Internet are among the jobs they'll be expected to perform.

At the College of Pharmacy and at other pharmacy schools around the nation, courses and requirements are being revised to better prepare today's pharmacy students for tomorrow's roles. The emphasis is on training students to provide services to patients, not to just distribute drug products, says Frank Ascione, associate professor of pharmacy administration and associate dean for academic affairs. The trend reflects changes that have been taking place in the pharmacy profession in recent years. With the explosion of drug products on the market, physicians and patients have come to rely more and more on the expertise of pharmacists, who are trained to understand how drugs exert their effects, how they travel through the body, and how they interact with one another. At the same time, methods of dispensing drugs have become more and more streamlined, allowing some of that work to be automated or done by technicians. It has made sense, then, for highly trained pharmacists to shift into roles that take full advantage of their expertise.

Changes in the health care system have contributed to pharmacists' changing roles, too. As health maintenance organizations have become more concerned with cost containment and accountability, pharmacists have taken responsibility for making sure patients get at a reasonable cost the medications that are most likely to produce the desired results.

In the past, if a doctor prescribed an antibiotic for a patient with a cold, for example, the pharmacist's job was simply to make sure the patient got the antibiotic that was prescribed. If that drug didn't help the patient's cold, the doctor might prescribe another one, and the pharmacist would simply fill that prescription. With the new approach, called pharmaceutical care, "we're much more concerned about whether the patient is going to get better," Ascione explains. "Part of the philosophy is that it's our responsibility to act as a patient advocate and ask the physician if this is really the appropriate drug for the patient."

As these changes continue, pharmacists will work more and more closely with physicians--and with patients. After a patient sees a doctor in a clinic, for example, a pharmacist might come in to discuss the drugs the patient will be taking. A person getting intravenous chemotherapy treatments at home might have regular visits from a pharmacist to check on any problems with the drugs. And, increasingly, pharmacists will act as educators, teaching patients how to manage diabetes, high blood pressure, and other chronic conditions.

Pharmacists will need a host of skills--from interpersonal communication to Internet savvy--to meet the profession's changing demands. Curriculum changes under way at the U-M are designed to provide pharmacy students with just such skills. From their first year in the doctor of pharmacy program, students learn to communicate with patients and to understand their responsibilities to the people they serve. They're exposed to the Internet right away and taught to evaluate the information they find online.

"We tell our students that if no one else can find the answer, they'd better be able to--and to come up with the right answer," Ascione says. Students also learn how to critically read and comprehend research papers. And in courses taught by interdisciplinary faculty teams, they explore how basic science meshes with clinical applications.

In one class, for example, students were assigned to figure out whether changing the way a drug was delivered--from one type of aerosol spray to another--would change its effectiveness. To answer the question, they had to understand basic principles of drug stability and activity and consider how those might be affected by the method of delivery. Finally, students learn a lesson that is increasingly important in many professions--to expect and embrace change.

"We realize that pharmacy is a changing profession," Ascione says. "We spend a lot of time orienting our students to that notion, telling them that we're at a point in time, not at the end of a time. We want them to be change agents, to continue to redefine pharmacists' roles."