Pharmacist education and new roles

[Drug addict]

Hi everyone, I'm interested in finding out what people know about pharmacists' education, both undergraduate and postgraduate, and also what you think about pharmacists taking on new roles such as prescribing and medication reviews, and the increase in products being made available from pharmacies without prescription (such as simvastatin)

 

I'd also be interested in your views on pharmacies selling products which have no evidence base, such as homeopathic products and copper bracelets.

 

I can only add comments from a UK (possibly European) point of view.

 

Cheers

[coquina]

In the US, most pharmacies are more like a department store. As a matter of fact, you can have scripts filled at big box stores like Walmart.

 

I think that if they are going to sell homeopathic remedies, they need to be put in a separate section of the store.

 

I also think there should be a database of scripts linked to a person's social security number, so that if you are on vacation and have an unexpected illness or accident, the pharmacist can see what other medications you are taking, in order to prohibit adverse drug interactions.

 

However - this could still be tough, because OTC medications wouldn't be in the data base.

[Guest alias420]

Maybe I'm missing something here or things are different from here in Canada buy why would a pharmacist ever be prescribing drugs? That is what Doctors are for, here in Canada only doctors can prescribe drugs the pharmacist shouldn't have to worry too much about you mixing drugs because they just dispense them. Your doctor should have already checked what you are taking when prescribing the drug. In Canada how ever the pharmacist does check with you what you are already on and give you information sheets every time you fill your prescription for Canadian drugs to make sure there isn't something the doctor missed.

[Mokele]

Well, from what I know, for undergrad you do Chemistry or Biology with a concentration in pre-Pharm, but some schools may offer Pre-Pharm as it's own major. From there, AFAIK, you apply to Pharmacy School, which has *really* stringent requirements, like Med School.

 

Sorry for the lack of details, I'm not actually in such a program myself, but I have friends who are.

 

Mokele

[blike]

As a premedical student, I share most of my classes with prepharm students. They take the same undergraduate classes we do, and most of them have a biology or related science major. However, one thing that separates prepharm from premeds is that some pharmacy schools don't require a degree. You can get your prerequisites and then apply, whereas medical schools require a degree before matriculation.

 

I know that competition is very high, and that it is a very intensive four year program. I don't know much beyond that.

[john5746]

Maybe I'm missing something here or things are different from here in Canada buy why would a pharmacist ever be prescribing drugs? That is what Doctors are for, here in Canada only doctors can prescribe drugs the pharmacist shouldn't have to worry too much about you mixing drugs because they just dispense them. Your doctor should have already checked what you are taking when prescribing the drug. In Canada how ever the pharmacist does check with you what you are already on and give you information sheets every time you fill your prescription for to make sure there isn't something the doctor missed.

 

Physician\Pharmacist Roles

 

Even patients should play a role in therapy if possible. Relying on doctors only is disaster - they have too little time.

[Drug addict]

To apply to do pharmacy in the UK, you need to have A-level chemistry, and two other subjects. Normally these two others are taken from biology, physics and maths.

 

It used to be that the grades needed to do pharmacy were lower than for medicine (I managed to get in with BCC), but the requirements are tougher now, particularly in the top schools of pharmacy. The pharmacy course in the UK is four years, and leads to a MPharm degree. After graduating you have to undertake at least one years training in a pharmacy (community or hospital), and pass an exam (the pass mark is 70% and you only have three attempts), before you are a pharmacist and have the magic initals 'MRPharmS' after your name.

 

The degree course is intensive, though not as intensive as medicine, and it was quite normal for me to have 25-30 hours of lectures and practicals a week - the fourth year is different as that is when the research project is done.

 

Maybe I'm missing something here or things are different from here in Canada buy why would a pharmacist ever be prescribing drugs? That is what Doctors are for, here in Canada only doctors can prescribe drugs the pharmacist shouldn't have to worry too much about you mixing drugs because they just dispense them. Your doctor should have already checked what you are taking when prescribing the drug. In Canada how ever the pharmacist does check with you what you are already on and give you information sheets every time you fill your prescription for Canadian drugs to make sure there isn't something the doctor missed.

 

Pharmacists should prescribe drugs, because, quite frankly, they are the experts on medicines. There is absolutely no way a doctor can know as much about medicines as a pharmacist does, because doctors have to have a broader knowledge.

 

To say that pharmacists should just dispense is insulting and a waste of a five year specialised education. Doctors frequently make mistakes, but they are not always what people think of as 'mistakes'. Not giving someone the optimum standard of care is a mistake as well, for example not giving a patient a statin for secondary prevention of MI. These types of errors can be picked up in hospitals where pharmacists have access to patient notes. However in the community this is not always possible. The standard of care could be better if doctors diagnosed diseases and pharmacists prescribed.

[blike]

Pharmacists should prescribe drugs, because, quite frankly, they are the experts on medicines. There is absolutely no way a doctor can know as much about medicines as a pharmacist does, because doctors have to have a broader knowledge.

I disagree, but not completely. I think the role of prescribing medicine should still belong to the physicians, because that's what they're trained to do. Although the pharmacists are experts on medicine, they are not experts on the human body. Prescribing medicine isn't always "diagnosis -> prescription". Treating a patient is much more than having an extensive knowledge of medicines. "Diagnosing is only 25% of the problem", as one physician put it.

 

These types of errors can be picked up in hospitals where pharmacists have access to patient notes.

I agree that they could pick up mistakes, but what happens when the pharmacist can't understand why the physician prescribed (or didn't prescribe) certain medication. Is it at the pharmacists discretion to change the doctor's orders? Does he or she have to page the doctor? Maybe the doctor, having seen the clinical presentation, the lab results, the images, and having a strong background in clinical medicine didn't feel a certain medication was necessary in this case. Doctors are in the best position to dispense medicine because they have direct contact with the patient and understand the patient's physiological state far better than a pharmacist reading the patient's chart would.

 

I don't think you're giving physician's enough credit in the pharmacology arena. A physician's knowledge of pharmacology is extremely extensive and is kept up all the time. Pick up an issue of JAMA or Hopkins' Advanced Studies in Medicine. Most mistakes made by doctors can not be attributed to a lack of understanding of pharmacology. They occur as a result of time constraints or other pressures that can contribute to stupid mistakes, such as an adult dose prescribed for a child. Pharmacists routinely catch these sorts of things.

[badchad]

I agree with Blike. Physician's should be doing all the prescribing, they're trained to better understand the boddy as a whole, and not just its interactions with drugs.

 

Here at the University of Buffalo we have a pharmacy program which is designed to be done in one shot (no pun intended). Basically, as an undergraduate you apply to the "Pharm D" program and in total it's 6 years. Not bad for a large starting salary. It's my impression you can specialize even further and gain more responsibility although I'm not positive of this (e.g. making highly specific drug "cocktails" for HIV patients).

 

All in all I think pharmacists are valuable, however I feel their overpaid. Seems to me the large majority take orders from an M.D. and thus, lay responsibility on someone else.

[mak10]

am doing my a-levels currently in bio/chem/phy and cant make up my mind whether to opt for pharmacy (concentrating on pharmacology) or getting an MD. as fas as i know, pharmacy with a concentration on pharmacology studies the effects of various types of drugs on the human body... in which case, i cant think of any difference between this and what a physician studies. someone told me that a major in pharmacology, as a premed, and then doing medicine is possible in states. is this a better option than doing MBBS directly and then MD?? thanks!

 

-mak10

[Guest alias420]

Canada pharmacy

[blike]

someone told me that a major in pharmacology, as a premed, and then doing medicine is possible in states.

You could theoretically major in pharmacology, if you could find a university that offered that degree. Nonetheless, an undergraduate degree will do you no good in the professional world (aside from previous exposure to pharmacology). Your B.S. becomes largely irrelevant once you have a professional or doctorate degree.

[Drug addict]

Blike and badchad, I did mean to reply sooner, but my stupid internet connection wasn't working.

 

I just want to make a couple of quick points. Firstly, knowledge of medicines is not just pharmacology, the pharmacokinetics are also important, as is the formulation of the product. Pharmacists are the only people who have this knowledge.

 

In the UK, pharmacists routinely go on ward rounds with the medics and intervene to prevent inappropriate prescribing. Very few hospital pharmacists in the UK spend all their time in the dispensary. I have met one pharmacist who has lost his access to his hospitals pharmacy system, because he doesn't use it, but cannot cope if he doesn't have access to the pathology system. He also used to be in the position of having to write prescriptions out for TPN, and then getting a doctor to sign it - does that make sense to anyone?

 

Blike, prescribing an adult dose for a child is not a 'stupid mistake', it is a fundamental error which could hve fatal consequences and should not occur.

 

Badchad, one of the difficulties in the UK has been the medical profession holding tightly onto its responsibilties and not wanting to let anyone else take new roles on. Medics always oppose new developments. One example of this was the decision to make emergency hormonal contraception available direct from pharmacies without a prescription. in 1992, 27% approved, by 2004 this was up to 60%.(http://www.pharmj.com/ContentsPages/Contents20041204.html'>http://www.pharmj.com/ContentsPages/Contents20041204.html p819.)

Pharmacists want to take on more responsibility, but are having to fight every step of the way with the medical profession.

 

I do look at JAMA, NEJM, the Lancet and the BMJ when I have time, but I wonder how many medics, or medical students look at pharmacy journals, such as http://www.pharmj.com