Beyond Clinical Pharmacy

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Beyond Clinical Pharmacy
Mary Anne Koda-Kimble, PharmD Professor and
Dean School of Pharmacy University of California,
San Francisco
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5 Goals

• Examine Clinical Pharmacy Today
• Identify Gaps
• Consider Healthcare Trends
• Propose Future Needs
• Share UCSFs Story

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Clinical Pharmacy Today
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Clinical Pharmacy Philosophy

• Pharmacists are the most highly trained experts
  on drugs and drug products
• Best professional to
• Promote rational drug prescribing
• Teach patients to use drugs appropriately
• Identify and prevent medication problems

Silverman, M and Lee, PR Pills, Profits, and
Politics UC Press 1975
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Pharmacy 1960s
Clinical Pharmacy 2007
Therapeutics Bedside Team Caregiver Informatio
n As best prescribed

• Drug product
• Pharmacy
• Solo
• Dispenser
• Knowledge
• As ordered

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How It Began 1960s
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Model Works Well in Hospitals
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Model Works Well in Hospitals

• Therapeutic advisors
• Patient education
• Drug use review and policy
• Formulary work
• Medication safety

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Why the Success in Hospitals?

• Practice model originated there
• All practitioners together
• Access to medical records
• Complex therapeutics
• Economics
• Cost avoidance
• Safety
• Captive patient population

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• Pharmacy Benefit Design and Management (PBMs)
• Pharmaceutical industry
• Poison control centers
• Academia
• Government

Other Areas Of Success
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Gaps

• Promote rational drug prescribing
• Teach patients to use drugs appropriately
• Identify and prevent medication problems

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But We Have Not Yet Achieved Our Vision

• A Mix of Medicines That Can Be Lethal
• Study Finds Medicine Misuse Occurs All Too
  Frequently
• Firefighter in Deadly Crash was Taking 4
  Medications
• Studies Show Anemia Drugs May Harm Patients
• Judge Upholds Vioxx Verdict
• Give Us This Day Our Daily Supplements
• U.S. Reviewing Safety of Childrens Cough Drugs
• In The World of Life-Saving Drugs, A Growing
  Epidemic of Deadly Fakes

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New Awareness of Preventable Medication Errors
and Adverse Drug Events

• Medication errors alone cause more than 7000
  deaths annually
• Preventable adverse drug events in hospitals cost
  2 billion
• Side effects cost 20 billion
• Pharmacists can reduce errors and minimize side
  effects

Institute of Medicine (IOM) Report 2000
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Drug Therapy Problems

• Access/Cost
• Quality
• Poor/uncoordinated prescribing
• Adherence
• Improper use
• Ongoing assessment and management
• Safety

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Most Drugs Are Used Outside of the Hospital
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Community Pharmacy Challenges

• Isolated practices
• No access to shared medical records
• Limited practice scopes
• Patient expectations
• Payment policies
• Environment
• Time

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Overarching Healthcare Concerns

• Access and cost
• Quality
• Safety
• Misaligned payment systems
• Episodic vs chronic care
• Prevention and early screening
• Political agenda vs health needs
• Workforce shortages/maldistribution

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Confusion and Complexity
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Trends
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• Healthcare is big business
• Fewer new molecular entities despite increasing
  RD spending
• Revolutionary information and diagnostic
  technologies
• Evolutionary practices toward lifetime and
  personalized care

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Science Biology and Translation Era
Whole-istic Biology Chemical Biology Quantitativ
e Biology Bioinformatics Complex Systems
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One Size Fits All
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Individualized Therapy
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• Small
• World
• Internet
• Manufacturing
• Healthcare
• Education
• Research
• Infectious diseases

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Future Needs
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What is Needed?

• Post-marketing surveillance
• Translational research
• Systems thinkers
• Safety officers
• Drug use policy

• Virtual teams
• Leadership with, not of
• Blended roles
• Preventive care
• Integrated/continuous care

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And More

• Health services researchers
• Drug benefit designers
• Global leaders
• Clinical scientists

• Drug therapy managers
• Drug information specialists
• Medical informaticists
• Pharmacogeneticists

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Next Steps

• Create virtual health care teams - EMRs
• Blend and expand roles
• Conduct postmarketing surveillance
• Apply technology
• Telepharmacy
• Electronic medical records
• Educate visionary, collaborative practitioners
• Learn from colleagues internationally
• Partner business, industry, government,
  community
• And more..

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Look at Who Needs Our Care
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UCSF School of Pharmacy Story
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Our Mission

• Mastering medicines to
• maximize health

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Our Plan

• Create a new framework for drug discovery and
  science
• Ensure that more patients get the best results
  from their drugs
• Shape the future of pharmacy science, policy,
  education and patient care by working in fresh
  and collaborative ways

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Some of our Tactics

• Make the promise of personalized medicines a
  reality for patients
• Help consumers take a central part in caring for
  their own health
• Minimize medication errors and adverse events
• Prepare more clinical scientists
• Advance interprofessional learning and practice
  among student pharmacists, physicians, nurses,
  and dentists.

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Safer and More Effective, Targeted
Therapies Pharmacogenomics
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UCSF Story
Education for a Pharm.D. Degree
K 1 2 3 4 5 6 7 8 9 10 11 12
1 2 3 4
5 6 7 8
Primary - Middle - Upper School
College or University
Pharmacy School
gt95 have degrees (? 4 years) at UCSF
60-75 UCSF graduates pursue postgraduate
training residencies, fellowships, degrees
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UCSF Pathway Curriculum
UCSF PharmD Curriculum
Core Curriculum 132 Units
PharmD 190 Units
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Guiding Goals and Principles

• A more nimble curriculum
• Opportunities to pursue personal interests
• All graduates will be
• Board eligible for licensure
• High level, competent pharmacists
• Adaptable to change
• Common to all pathways
• Research project
• APPEs acute care, ambulatory care, community

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Students Reaching Out
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Our Approach

• Interdisciplinary
• Entrepreneurial
• Partnership based
• Physically integrated
• Patient centered

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?
Why Do We Care?
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• Adverse effects
• Bleeding, fatigue, dizziness
• Wrong drug
• Calcium channel blocker
• Long-acting nitroglycerin
• Wrong dose
• Drug interactions
• NTG BP meds
• Aspirin Fosamax
• Adherence Iron

My Mother
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Clinical Pharmacy Philosophy

• Pharmacists are the most highly trained experts
  on drugs and drug products
• Best professional to
• Promote rational drug prescribing
• Teach patients to use drugs appropriately
• Identify and prevent medication problems

Silverman, M and Lee, PR Pills, Profits, and
Politics UC Press 1975
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