Pharmacy Practice-M Homaida Presentation-NK-2015...Edward Said (1953-2003)- Palestin ian American...

5/6/2015

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QU- CPH- NKheir1

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6 May 2015

QU- CPH- NKheir

Pharmacy Education and Practice :Reflections and Common Grounds

Dr. Nadir Kheir, PhD MPS FNZCPAssociate Professor of Pharmacy Practice

Coordinator of Continuing Professional Pharmacy Development

Disclaimer: PRESENTING AUTHORS HAVE NO RELATIONSHIPS TO DISCLOSE

Learning & Education

[To learn is to change. Education is a process that changes the

learner]

College of Pharmacy-NKheir2-Oct-08

Edward Said (1953-2003)- Palestinian American literary theorist,

cultural critic, and political activist.

Aim

To reflect on the current status of pharmacy, the role of pharmacy education, and how pharmacy academia could contribute in advancing pharmacy practice


A short story

• Selling an ‘OTC’!

• The Basic requirements in ALL transactions at a pharmacy:

• Check:

Drug‐drug interaction

Drug‐disease interaction

Pregnancy or/and breast feeding effects

AllergiesCollege of Pharmacy-NKheir2-Oct-08

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Which means, in all transactions we need:

1. A knowledge of pharmacological effects

2. A knowledge of pharmacotherapy

3. The skill of searching the literature

4. The skill of evaluating the literature

5. Professional practice

6. Communication skills


Why doesn’t that happen?

• Lack of knowledge?

• Lack of time?

• Lack of interest?

• Lack of confidence?

• Lack of motivation?

• All of the above?

• May be another reason?



Educational

Caregiver

Manager

Teacher

Qualities of graduates and educated citizens

Knowledge, Decision making

Communication abilities

LeadershipLifelong learning

The 7‐Star PharmacistThe REAL Problems

• Problem with inadequate training

• Problem with inadequate pharmacy curriculum

• Problem with following professional practice


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College of Pharmacy-NKheir2-Oct-086 May 2015 NKheir



Clinical Pharmacy: Issues of role and identity Retail pharmacy: Issues of professional purpose Pharmacy education: Issues of lack of focus and

leadership

Societal perception of pharmacists: ‐ Helpful, accessible, friendly, chemist, druggist, provider of their

prescribed medication,

Pharmacy Realities Health-related Factors Affecting Pharmacy Education

• The growth in pharmaceutical product development

• Increased drug‐related mortality and morbidity

• The growth in the use of OTC drugs, herbal products and complementary therapies

• A need for multidisciplinary approach in patient care


Pharmacy Realities

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How does the Society Express the Need for Better Pharmacy Education?

• The society paying heavy price for the advancement of drug therapy, and the wide availability of drugs

• Evidence to treatment failure, preventable drug‐related hospital admissions, and DRPs

• High prevalence of medication‐related errorsthat accounts for a sizeable increase in health care costs.


Winterstein AG et al,. Preventable drug-related hospital admissions Ann Pharmacother 2002;36:1238-48

Pharmacy Realities


• To help patients make the best use of medicines

• This mission is facilitated only by providing Pharmaceutical care

The New Mission of Pharmacy


• Responsibility

• Caring

• Accountability

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Elements of Pharmaceutical Care

For outcomes

Technical care, or worry, concern

For the patient, for oneself

College of Pharmacy College of Pharmacy-NKheir2-Oct-08

Nursing Care

Mental Health Care

Pharmaceutical Care

Strand, Morley, Cipolle, 2004

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xx

Pharmaceutical Care

Nursing Care

Dental Care

Mental Health Care

Geriatric Care

Eye Care

Surgical Care

Maternal Care

Nutritional Care

Pediatric Care

Physiotherapy Care

Medical Care

The Patient

Kheir’s Version, 2007

The Dart-Board Model of Pharmaceutical Care

“like a bridge over troubled water, I will lay me down”Education and the Society

• Education is empowerment to society

• Education is key for development and societal transformation

• Education shifts society from dependency to share‐holding

• Education’s quality must be relevant and culturally appropriate


Status of Pharmacy Education in the Middle East

• 78 private and public pharmacy schools in 12 ME countries generating 14,000 graduates

• Pharmacy schools started as early as 1824 (Cairo)

• The majority of programs were introduced after 1970

• More than 20 new programs started since 2000, and the majority are privately funded.


Kheir N, Zaidan M, Younes H, El Hajj M, Wilbur K, Jewesson P. Pharmacy Education and Practice in 12 Middle Eastern Countries. Am J Pharm Ed 2008 (accepted June 17, 2008).

Perceived Societal Needs

A need for pharmacists who will:

improve the drug use process play a patient advocacy role integrate health promotion practices embrace life-long culture restore dignity to the profession earn the respect of the public (want & how)


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What Sort of Pharmacy Education is Required?

1. Relevant: addresses actual need

2. Flexible: changes when necessary

3. Modern: follows pharmacy developments in the international level

• Works closely with Regulatory Bodies:

1. Develop internship programs

2. Tailor education program with professional and legal requirements

3. Involved in professional training


Basically, a Need for a Change in Pharmacists Mentality:

• From dispensing pills to caring for patients• From business orientation to outcome-

orientation • From shop-keeping, to health promotion• From an inventory-control mentality to patient-

focused care• From passive, through active, to pro-active


The Traditional Pharmacy Curriculum


4th Y

3rd Y

2nd Y

1st YAnatomy & Histology, Org Chem, AnalytChem, Microbiology, phcognosy

Org Chem, analtyt Chem, pharmceutics, Phcognosy, physiology, math,

Chem of drugs, pharmceutics, pharmcologyBiochem

Applied Phcognosy, industrial, pharm chemToxicology

Disillusionment, powerlessness, chronicity of passive practice, under-valued profession,

low societal expectation

College of Pharmacy at Qatar University


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College of Pharmacy at Qatar University

• Initiated in 2007 to help meet the country’s growing demand for qualified pharmacists

• Offers two degrees:

‐ 5‐year Bachelor of Science in Pharmacy (BSc (Pharm)),

‐ 6‐year (1 year Pre‐Pharmacy + 5 years Professional) Doctor of Pharmacy (PharmD)

• The program will only offer the PharmD degree as the first degree to professional practice within five years.


International Accreditation:CCAPP


QU‐CPH Committees


Courses


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Models for Horizontal Course Alignment

• Pharmacy and Health Care

• Professional Skills

• Pathophysiology/Pharmacology/Therapeutics/Professional Skills/Integrated Case‐Based Learning



Pharm & Health Care(PHAR230)

Pharm & Health Care(PHAR231)

Professional Skills(PHAR340)

Pharmacology (PHAR320)

Pathophysiology I (BIOM610)

Therapeutics(PHAR380)

ICBL(PHAR360)

Pharmacy 1 Pharmacy 2



Fall

Spring

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Pharmacy & Health Care (PHAR230):Course Description

• Crdt Hrs: 2 (2 hrs lecture/wk; 1 semester)• A series of two (PHAR230, 231)• Has been designed to introduce first year students to the role of the pharmacist within the health care system.

• A survey course (samples from a broad range of related topics designed to inform students of current trends and challenges in pharmacy practice and health care).

• Designed to begin develop the student’s competence in the practice of pharmacy.


Pharmacy & Health Care (PHAR230):Course Objectives

• Designed to comply with the 2006 Canadian Council for Accreditation of Pharmacy Programs (CCAPP)

• Addresses the professional competencies and educational outcomes as outlined by the National Association of Pharmacy Regulatory Authorities (NAPRA, 2007) and Association of Faculties of Pharmacy of Canada (AFPC, 1998)


PHAR230: Fall Semester

• Health care systems

• History of pharmacy

• International pharmacy practice

• The drug use process

• What is pharmacy

• The pharmacist

• Professional practice

• Pharmacy regulations and practice

• Introduction to Pharmaceutical Care

• Pharmacists as primary care providers

• Self‐directed therapy (respond to symptoms)


Professional Skills (PHAR240):Course Objectives

• Crdt Hrs: 2 (2 hrs lecture/wk; 1 semester)• The first of a series of six courses.• An introduction to the prescribing process, medication dispensing practice, drug information, patient care process used in pharmacy practice and the language and terminology of medicine. This course is also an introduction to interpersonal communication theory and provides a foundation for development of the skills needed to interact with patients, customers and other health care professionals.


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• Pharmacy Informatics

• Medical Terminology

• Pharmacy calculations

• The prescription

• The dispensing process

• Pharmaceutical care


PHAR240: Fall Semester

Pharmacy Informatics

Medical Terminology

Pharmacy calculations

The prescription

The dispensing process

Pharmaceutical care

Communication skills

PHAR231: Spring Semester

• Health, illness, QoL

• Medication Adherence & Patient behaviors

• Drug Information

• Pharmepid/Pharmvoigil

• Drug pricing

• Special populations (ger; ped; mental health)

• Interprofessionalcolaboration



PHAR241: Spring Semester

Social context of health

Health promotion

Behavioral change

Counseling skills

Drug Information

Pharmaceutical Care

Documentation in pharmacy

Integrated Courses: Building the Case:


Pathophysiology

Pharmacology

Therapeutics

Case-Based LearningCBL

Professional Skills

Psychiatric, ophthalmic, otic, respiratory, gastrointestinal and urologic

disorders

Emphasison Pharmaceutical Care

application

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Program Features

1. SPEP

2. CPPD

3. SMSA (Structured Multi‐Skill Assessment)

4. Research (undergraduate funded)

5. Soft skills: journal club, critical appraisal, etc

6. IPE


SPEP:


SPEP website

CPPD


CPD Archive


CPPD Mission Statement

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Needs Assessment Surveys


Past Needs and Status:

Topic Status

Responding to symptoms in the pharmacy Nov 2012 (R)

Consulting and Counseling Skills Jun 2013

Health promotion Dec 2012

Complimentary & Alternative Medicine ‐

Device techniques: inhalers, spacers, stoma care, blood glucosemonitoring devices, ophthalmic products

‐

The use of guidelines in the management of chronic disease April 2014

Tips on DI resources: Searching techniques, evidence‐based Apr 2011 (R)

Diabetes, HT, osteoporosis 23 Dec 2013

Medication reconciliation ‐

Geriatrics care Feb 2012

Cancer therapy: Adverse effects management ‐

Women health ‐

Others? (patient safety; Journal clubs; antibiotics) ‐


SMSA (Structured Multi‐Skill Assessment)

• SMSA Video• A developed a modified performance‐based assessment

technique that we called the SMSA, which shares similar basic principles and mechanics with an OSCE, but designed to provide contextual validity when used as part of an undergraduate pharmacy curriculum

• The SMSA is therefore the CPH’s modified version of the traditional OSCE, used primarily for formative evaluation of student performance.


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Research (undergraduate funded)


Pharmacy Elective I: Research




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2014‐2015 Projects

1. Parental knowledge and adherence to proper administration techniques of inhaled medications in pediatric patients with asthma, an educational opportunity

2. A pilot study to examine the validity of the Communication Skills Attitude Scale (CSAS) among undergraduate pharmacy students of Qatar University

3. Development of powdered formulations of poorly soluble drugs using novel drying technologies

4. Mechanisms of Tunicamycin‐induced Renal Cell Injury

5. Design and synthesis of new piperazine derivatives as potential antidepressant agents

6. Developing narrative assessments for pharmacy clinical internships

7. Evaluation of the effect of sodium glucose co‐transporter inhibitors on the incidence of cardiovascular events in patients with type 2 diabetes mellitus

8. Medication Errors in the NICU

9. Interdisciplinary perceptions of students on their role in cardiovascular disease risk assessment and management.

10. Demonstrating the value of the community pharmacy services in Qatar



Soft Skills

1. Communication skills

2. Presentations skills

3. Journal club skills

4. Critical evaluation of the literature skills

5. Research skills

6. Cultural competence skills

7. Resolving ethical dilemmas skills!



Pharmaceutics, kinetics, pathophysiology, pharmacology, therapeutics, professional skills, case-based learning,

interpretation of lab data, patient assessment, research, ethics & law, experiential training,

Patient-centered care

Pharmaceutics, pathophysiology, pharmacology, therapeutics, professional skills, ICBL, pharmacy research & presentation skills,, pharmacognosy,

experiential training, elective

Experiential training, pharmacy research, pharmacoepidemiology,

pharmacy management, ICBL, elective

Medicinal Chem, Pharmaceutics, Biochem, anatomy, foundation of Pharmacology & Therapeutics, Pharmacy & Health Care,

Professional Skills, statistics

4th Y

3rd Y

2nd Y

1st Y

Ph

arm

ac

eu

tic

al

Ca

re c

on

ce

pts

& P

rac

tic

e

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..and the rational of the story..

• The society NEEDS competent pharmacists

• Pharmacists NEED focused and structured pharmacy education/academia

• Pharmacy academia NEEDS stakeholders

• Pharmacy academia must LEAD


Recipe of change

• Codes of ethics

• Competency standards

• Experiential training

• LLL: relevant CPD program

• Linking licensure with competence


SWOTT Analysis:1. Strengths: willing intelligent students; pharmacy academics; programs2. Weaknesses: no comp standards; small no. of academics; political issues3. Opportunities: societal needs; collaborations; need for leadership4. Threats: external opportunities; lack of funds; others?

Thank you


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