National Association of Chain Drug Stores

The Patient Protection and Affordable Care Act has greatly accelerated the formation of team-based models of care delivery, primarily accountable care organizations (ACOs) and patient-centered medical homes (PCMHs).Many have written about the need to incorporate medication management services into these systems in order to improve care and reduce total health care costs.Two primary ways of doing so have emerged: (1) an embedded model, whereby pharmacists are employed directly by a physician practice, or (2) a "virtual care team" model, whereby a PCMH or ACO develops an arrangement with external pharmacists in community settings to provide coordinated services.

Objective: To determine any differences in career paths and career attributes of pharmacists who have completed a PGY1 community pharmacy residency program (CPRP) as compared to those that have not completed a PGY1 CPRP.
 Methods: A web-based survey evaluating various aspects of community pharmacists' careers was distributed to 274 CPRP graduates in addition to a random sample of 7,376 community pharmacists. The survey contained 32 questions evaluating various career attributes. Questions that assessed level of agreement were on a 6-point Likert-type Scale (1=strongly disagree; 6=strongly agree).
 Results: A total of 353 participants completed the survey, with 224 indicating that they had not completed a CPRP. Pharmacists who completed a CPRP responded that they spend significantly more time on patient care services, teaching, and research, and spend less time dispensing medications compared to those that have not completed a CPRP. Compared to those that did not complete a CPRP, CPRP graduates were less likely to agree that current level of workload negatively impacts job performance, motivation to work, job satisfaction, mental/emotional health, and physical health.
 Conclusion: Pharmacists completing a CPRP noted significant differences in their current employment and job responsibilities. Additional expansion and education regarding the importance of CPRPs should be considered.
 
 Type: Original Research

Objective: Concerns have been raised that antidepressants may be overused. This study aimed to provide an estimate of antidepressant overuse in a more recent, nationally representative sample of adults and with a more contemporary set of antidepressants than has been covered in prior studies. Methods: The data set included adult (weighted N=23,026,608) respondents who self-reported antidepressant treatment in the household and prescription drug components of the 2005 Medical Expenditure Panel Survey. Overuse was defined as off-label antidepressant prescribing with limited or no scientific support for use as a treatment for the diagnosis, according to the Physicians' Desk Reference, the United States Pharmacopeia-National Formulary, and the Micromedex DrugDx data system. Stratification and multivariate logistic regression was used to examine clinical and socioeconomic predictors of overuse. Results: Overuse was estimated at 20%, with the majority concentrated in newer-generation antidepressants (74% of overuse). Another 30%–40% of overuse was associated with documented diagnoses that may represent a reasonable clinical rationale for antidepressant use or suggest underdiagnosis of possible depressive and anxiety syndromes. Older age (odds ratio [OR]=.95, p=.03) and self-report of poor mental health (OR=.80, p=.02) were negatively associated with overuse. Conclusions: Antidepressant overuse among adults is less common than previously reported. Our results suggest that the actual extent of overuse may be lower than 20%. To improve treatment quality and the efficiency of the U.S. health care system, nationally representative data collection efforts on prescription drug use should aim to include enhanced measures of need in order to further refine future estimates of antidepressant overuse. (Psychiatric Services 62:720–726, 2011)

To review recent literature regarding mandatory residencies in the perspective of the historical entry-level degree debate. Articles were identified through searches of MEDLINE/PubMed, national pharmacy association Web sites, and a review of the references of related literature. Several studies, commentaries, and reviews are examined to discuss viewpoints from both the entry-level degree and mandatory residency debates. Similarities were observed between the 2 debates in regard to objectives and rationale for change, educational issues, pharmaceutical care issues, and economic issues. Fewer than 10 years ago, after many years of debate, colleges of pharmacy made the transition to offering the PharmD degree as the sole entry-level degree for licensure as a pharmacist. Similar debates have taken place over the past several years and continue to take place regarding the necessity for residency training. One key 2006 document by the American College of Clinical Pharmacy calls for mandatory residency training for entry into pharmacy practice by 2020. In parallel with the entry-level degree debate, consensus has yet to be reached among pharmacists and pharmacy organizations, but several have shown support for mandatory residency training for all pharmacists involved in direct patient care. Many questions have yet to be answered regarding the timeline, economics, and feasibility of such a mandate.

What changes do pharmacist employers believe will have to occur to make lifelong learning a part of the underlying structure and framework of an individual pharmacist's professional practice? Individual pharmacists should seek to develop a passion for their work and learn what to do with the autonomy granted to members of a profession. The pharmacy profession should develop a concept of pharmacy practice that focuses on what the public expects from a pharmacist rather than one that seeks to change the public's perception of a pharmacist. Mandating certain behaviors on the part of pharmacists will not promote lifelong learning since regulations only prescribe minimums, while lifelong learning stresses maximizing one's potential. Pharmacy educators should try to find ways to capitalize on the experience individual pharmacists have accumulated and move those pharmacists ahead to the next level of practice. This process begins with the perspective that educators should focus on enhancing a pharmacist's proficiency rather than trying to prevent obsolescence. The issue may not be whether pharmacists will participate in the learning process; rather, it is likely to be what they will learn that is directly applicable to their pharmacy practice. Pharmacist employers should create a work environment where pharmacists can fully use what they have learned. Through the proper use of individualized incentives, employers can promote self-directed and lifelong learning among their pharmacists.