UB to Launch New Doctoral Program In Pharmacy

BUFFALO, N.Y. -- The University at Buffalo School of Pharmacy is launching a new, entry-level doctoral program designed to produce graduates who will spend far more time on patient-care management than they will on dispensing drugs.

That may sound like a contradiction for a top-ranked pharmacy school, but the new degree is in line with a directive from the American Association of Colleges of Pharmacy approving the six-year Pharm.D., or doctorate of pharmacy, as the field's only professional degree.

The American Council on Pharmaceutical Education, the accrediting body for schools of pharmacy, says that the last B.S. pharmacy class it will accredit is the Class of 2004.

The change is driving one of the most dramatic shifts in emphasis the profession has seen, according to Wayne K. Anderson, Ph.D., dean of the school.

The new emphasis, he added, is expected to produce significant health-care savings.

• An increased clinical emphasis, including 40 weeks of full-time, clinical clerkships, up from 18 weeks in the bachelor of science in pharmacy program.

• New courses, such as ambulatory and in-patient disease-state management and clinical pathways courses, in which students learn algorithms, or decision points, about how to manage drug therapy for different diseases, and pharmacoeconomics, which involves determining the economic impact of drug therapies on patients.

• A modular, rather than a departmental, approach, in which one subject, cardiology, for example, is team-taught by faculty from several disciplines.

"What most people envision when they think of a drugstore probably won't exist in the next 10 to 20 years," said Gene Morse, Pharm.D., professor and chair of the UB Department of Pharmacy Practice.

Pharmacists are assuming a much more active role in patient care, he explained, using their pharmacological expertise to act as drug-therapy and disease-state managers, in cooperation with physicians and nurse practitioners.

In hospitals, that means making rounds, reading patient charts, monitoring interactions and making recommendations to physicians. In the community, the practice of dispensing medicines -- referred to by pharmacists as "count, pour, lick and stick" -- is being increasingly handled by technicians, freeing up licensed pharmacists to counsel patients about taking medications, evaluating changes in their symptoms, possible drug interactions and optimizing management of their disease.

In programs it has developed in partnership with Tops Markets, Inc. and Wegmans Food Markets, Inc., two local supermarket chains, UB's School of Pharmacy has begun to place its graduates in pharmacies where they already function this way.

Morse said that close to two-thirds of this year's freshman class in the UB School of Pharmacy have indicated that they plan to switch from the current, five-year baccalaureate program into the new, six-year Pharm.D. track in 1999 -- the first year UB students will be able to matriculate in the program.

"The training we give our students is far in excess of what the consumer has traditionally seen," explained Anderson.

"Medical students take two semesters of pharmacology, while nursing students take one semester," he said. "By contrast, Pharm.D. students in the new program will have four years of studying various aspects of applied pharmacology."

The tremendous growth in the number and complexity of drugs on the market in the past 20 years has made such an intensive education in medicines increasingly important, Anderson noted, particularly in chronic conditions, such as hypertension, asthma and diabetes, and in AIDS and cancer, where patients take multiple drugs.

In 1995, according to an analysis Anderson made based on published data for the U.S., preventable prescription-drug-associated problems added $7.7 billion to the cost of health care in New York State.

"Insurers would prefer to pay for a pharmacist to spend an hour with a patient, if that hour will keep the patient from being admitted to the hospital," said Morse.

And patients seem to like it. At one supermarket pharmacy in the UB School of Pharmacy's network, prescriptions jumped from 650 to 750 a week since its pharmacists began actively monitoring patient care.

"Our current system does not focus on drug therapy," said Morse. "Instead, it focuses on getting a patient to go to the doctor -- or the hospital -- for a diagnosis. The patient gets a prescription and goes home. No one follows up with the patient to make sure the medicine was taken."

But now, hospital and community pharmacists are starting to communicate about specific patients and the reasons behind the therapies that have been prescribed. Community pharmacists are teaching patients how to take better care of themselves.

At Tops, for example, Linda Schultz Rothberg, a recent UB pharmacy graduate and coordinator of the chain's new pharmacy programs, has developed an asthma-management program that does just that.

Asthma sufferers attend several brief classes in which they learn about their disease, the specific factors that seem to aggravate it and how they should respond (i.e. use an inhaler, call the doctor) based on the symptoms they're experiencing. Disease-management plans are put together in class and then sent to the doctor for his or her review.

"We try to educate patients about what kinds of triggers in the environment -- even some foods -- may cause an episode," she said. "Most patients don't realize, for example, that hot dogs, cheese and bologna have chemicals in them that could cause an asthma attack."

Rothberg, also a UB clinical assistant professor, added that regular communication with patients in the non-threatening setting of a community pharmacy provides an opportunity to educate patients about their medicines and why they should take them.

"I get the biggest thrill when I am able to help someone who is taking anti-depressants to realize that this condition is not their fault, that they are suffering from something physical, from a chemical imbalance that can be straightened out with medications and their health-care professional," she said.

Many times, she said, these consultations reveal problems that need attention by the physician. In those cases, the pharmacist often will make a recommendation.

"We are building stronger communications between pharmacists and physicians," said Rothberg. "I'm a specialist in medications who knows about disease and the physician is a specialist in disease who knows about medications. Only when the two specializations are combined do you get a complete picture."