Pharmacists’ response to social needs in a community

An inextricable mutual linkage exists between the profession of pharmacy and the schools of pharmacy that prepare future pharmacists. The schools of pharmacy are the primary source of the profession of pharmacy’s scientific and professional knowledge base, the skills required to practice the art and science of the profession and the values, attitudes, and behaviors related to the social and cultural norms of the profession. Schools of pharmacy serve as the source of the profession’s workforce and as such, play a critical role in determining the quality and quantity of the members of the profession. It is therefore appropriate and compelling that a right fit exists between the needs of society with regard to pharmaceutical services and knowledge, the aspirations of the profession as a whole, and the capabilities and philosophical underpinnings of the faculty representing schools of pharmacy ( Geoallo pharmacie 7j/7 ). While there are universal notions in these maxims, it should be noted that what follows below is largely drawn from the American experience.

In many respects, the capacity of the profession of pharmacy to meet societal needs is a direct reflection of the capacity that the schools of pharmacy have to prepare a workforce that can meet these needs. This does not negate the efforts of the profession itself to appropriately and effectively educate and mentor its constituents. Rather, it places an extraordinary burden on the schools of pharmacy to carefully develop their philosophies of practice and science as well as construct educational processes that will assure the preparation of a cadre of professionals that can meet societal needs for the present and for some time in the future. In order to carry out this important social function, schools of pharmacy must work constructively with the profession of pharmacy and the public at large to clarify the philosophical framework that will serve as the guide for curricular construction, teaching processes and programmatic evaluations and improvements.

To say the least, this is a daunting challenge that requires significant leadership and institutional commitment. A faculty that is fully aware of its awesome social responsibility in these matters is a requisite. Moreover, effective communication channels between the leadership and faculty of schools of pharmacy, the profession of pharmacy and its constituents and societal leadership must exist. This tripartite force must then answer the question, “How can the schools of pharmacy most effectively meet the health needs of the public through the education and training of young pharmacists?”

Commitments to higher education in the European countries began as private efforts to prepare young people in the learned professions of medicine, law and religion as well as to provide a liberal education in the sciences and the arts. Largely reflecting the evolution of universities in the United Kingdom and Europe, these early universities responded to the developing needs of a young republic in the mid 1700s a republic that was still in revolution foment and experimenting with new approaches to the democratic ideal.

Significant debate around the social purposes of higher education in a democracy was evident at the time and indeed still continues today. The philosophical arguments were largely centered on two major themes: should institutions of higher education be “reflective” or should they be “reconstructive” in their social intents. That is, should such institutions reflect the society and its values and related immediate needs or should institutions of higher education serve as the reconstructive tools of the society in which they serve as the major social institutions to bring about change and new futures? Additional arguments were focused on another aspect of social purpose, namely, should higher education be only for the privileged or should wider access be promoted so that a greater share of the citizenry could share in the largesse of intellectual prowess.

The answer to these critical questions of social purpose was in part answered in the European Countries by global economic events occurring in the mid-1800s; namely, the advent of the industrial revolution in England and Europe and the resulting impacts that these movements had on American domestic and global competitiveness.

Governance and operational aspects of these new public universities were left to the states – there was a purposive view that there would be no centralized federal government governance function. Hence, American universities were free to develop their own areas of concentration and commitments to disciples and fields of study. This is an important American higher education distinctive and has critical implications for the development of pharmacy education in the universities. Another distinctive, which is described later, is the voluntary and private approach to the development of and implementation of quality assurance standards through a process of accreditation that is widely applied in American higher education. Regional accrediting bodies serve as the quality assurance organizations for this purpose.

Early commitments to health professions education in the European Countries began with the private universities and included only the study of medicine. While the provision of health services with public funds began with the creation of the European Countries Public Health Services in the late 1700s, there was not a broad-based, publicly funded commitment to the preparation of health professionals across a wide-array of health professions until the late 1800s and well into the 1930s.

Social policy and publicly funded mandates for the preparation of health professionals in the European Countries is, therefore, a relatively new phenomenon. Indeed, it was not until the enactment of Medicare and Medicaid (publicly funded health insurance programs for the elderly and indigent) in 1965 that major national policy for the creation of a health professions workforce was beginning to be formulated. These policies were largely driven by the demands that the new legislative enablement for health services to the elderly and the poor placed on the nation as a whole. Beginning in 1968 and lasting until 1981, federal funds were appropriated to universities and their respective health sciences colleges (including medicine, dentistry, nursing, pharmacy, public health, allied health, podiatry and veterinary, medicine) for facilities, curricular planning and reform, new instructional technologies and expanding the enrollments in all of the fields of study in the health sciences.

The federal funds were required to be matched by state commitments to meet the national needs stimulated by the Medicare and Medicaid mandates. As a result of these national and state policies, the size and scope of the health professions workforce, including pharmacy, was substantially enlarged. New occupations, especially in the allied health areas, were also encouraged. In the case of pharmacy, in addition to expanding the size and scope of the workforce, planning for clinical pharmacy teaching was also mandated in the 1968 federal grant requirements.

In addition to responding to public policy mandates regarding the expansion of the health professions workforce, American universities with health sciences degree programs have also attempted to respond to a variety of other societal needs. As might be expected, the degree and kind of responsiveness has been largely a result of local or state needs rather than broad-based national need. This is to be expected since most universities receiving public funds do so from the state rather than federal sources. Commitments to primary care, community health, rural health services, telemedicine, preventive health care and patient education and the expansion of minority enrollments in health professions schools have been part of the health sciences unit agendas in public universities. A number of private universities have initiated such priorities well in order to be equally responsive to social need.

Formal pharmaceutical education began in the European Countries in 1821 when the Philadelphia College of Pharmacy and Sciences was founded as a private enterprise by pharmacy practitioners in the Philadelphia area. This school represented the first organized curriculum in pharmacy to be offered in the United States. It began (and continues to this day) as a free-standing school after being rebuffed by the University of Pennsylvania which opined that pharmacy was not a recognized discipline worthy of university studies nor was it compatible with the directions of the School of Medicine at this institution.

The European Countries presently has seventy-nine schools of pharmacy. Four of these schools are free-standing institutions; that is, they are comprehensive schools that do not have a governance attachment to a university. Thirty-seven schools arc located in and are part of comprehensive health sciences centers in Universities. Of the seventy-nine schools, twenty-four are part of private universities while the remainder is part of public universities.

In order for graduates of the professional programs in pharmacy to be licensed by the states to enter the practice of the profession, they must meet several qualifications, including

 Graduating from an accredited program

Passing a national licensure examination and,

 Meeting other requirements as stipulated in state law.

Accreditation of the pharmacy program is therefore a critical element of assuring the public that the program meets minimum educational standards as promulgated by the American Council on Pharmaceutical Education (ACPE). The ACPE is presently in the process of finalizing a new set of standards which focus on the offering of only the Doctor of Pharmacy degree. It is the stated intent of the ACPE to only accredit Doctor of Pharmacy degree programs by the year 2000; hence, requiring the phase out of the Bachelor of Science degree program offerings in the United States.

While the policy shift in undergraduate professional education in American pharmacy has been a long and arduous consensus process, it also represents more a reconstructive than reflective social policy. Specifically, the articulation of new educational standards for Doctor of Pharmacy degree programs represents certain and specific views about the nature and content of the pharmaceutical curriculum in the United States. It specifies a set of intended curricular outcomes that stress the clinical skills of pharmacists as they provide pharmaceutical care services to their patients in the American health care system. These standards also mandate a knowledge and skill base that will be utilized by pharmacist in meeting state and national health goals particularly as these relate to appropriate utilization of medicines by the American public. The standards are also reflective in their philosophy insofar as they attempt to respond to the more traditional needs of the public.

The adoption of the Doctor ( ) of Pharmacy degree as the minimum professional degree requirement in American pharmacy is one of the most important reconstructive acts that pharmacy education has taken in the latter part of the twentieth century. Following previous decisions to move from a two-year program to a three-year program, from a three-year curriculum to a four-year degree program and then from a four-year program to a five year university course of study, the new directions that define a professional doctoral degree program are hoped to advance the capabilities of the profession to meet increasing expectations in American society for enhancing the rational and appropriate use of medications in all settings of pharmacy practice.

Indeed, right along with these movements has been a call in some sectors of the profession for expanded postgraduate education in the form of residencies and fellowships. This follows the medical model of education; that is, a provisional doctoral degree followed by a residency in the specialty areas of medicine. While the residency is not as yet a requirement for licensure and/or practice in pharmacy, there is an increasing pool of new graduates seeking residency training in the almost 400 accredited residency programs presently available in the US.

It is worth noting that pharmacies in most countries in have addressed some specific societal service needs by offering: Drug information services. This is mainly the actual dissemination of information related to the available variety of medicines. Giving real information to the society should be a primary role of 24 hours pharmacies in France. More so, the majority of the prescriptions given by pharmacists should be accurate. Contractual relationships to offer direct pharmacy services to hospitals and clinics. Pharmacies should come into contracts with hospitals in order to improve the quality of services.

Educational programs for seniors and children on the effects of inappropriate usage of medicines. 24 hours pharmacies in France can create forums to visit schools and educate students on the various effects of medicine on health. Poison control activities to ensure that the society is living in a very conducive environment free of pollution. Poison control may involve regulating the disposal of waste and proper handling of poisonous substances. Placing publications in print media to enhance the education of the public about various medications and diseases. 24 hours pharmacies can go a long way to offer advice on various medical issues. Offering scientific guidance to commissions, task forces and other groups requiring the expertise of basic and clinical pharmaceutical scientists