[Editor’s note. This column is based on the remarks delivered by Dr. Kehoe during his Incoming President’s Address, October 17, 2010, in Austin, Texas, during the 2010 ACCP Annual Meeting.]
Being the president of ACCP is a really unexpected experience for me. When finishing my residency in 19… well, a long time ago, Betty Dong told me about a new organization formed to meet the needs of clinical pharmacists. She thought the goals of this new organization called the American College of Clinical Pharmacy fit with my personal goals and views on the profession. As I looked into it, I found she was right. I was excited to see a group like ACCP getting started just as I was finishing my training and still enthusiastic about the direction pharmacy was taking. So I thought I’d give this group a try.
In 1984, I decided to attend an Annual Meeting, which was being held in San Diego. I was a little starstruck since many if not most of the people I had looked up to as a student were there. I attended the platform presentations for research, where I got a pretty good picture of the intensity that was possible at one of these meetings. A fellow was presenting his research. At the end during questions, he was taken to task by someone in the audience. Seriously taken to task. In a few moments, his mentor was standing up and engaging his detractor. It was intense, more intense than I would have wanted to endure. Finally, the moderator said the time was up and basically told these guys they could take it outside. I told my wife later, “This was a great meeting, but I’ll never take any of my work to this shark tank.” So maybe I lived to eat my words.
Our History Informs Our Future
Lately, I’ve been reading the books by Bob Elenbaas and Dennis Worthen and Harvey Whitney about the history of clinical pharmacy, which of course include the formation of ACCP. Some of the comments you see from early pioneers of the movement are informative. A reflection written by Drs. Jere Goyan and Bob Day said the following: “But most of all, the new breed of pharmacist was proud, alert, feisty, and confident in a way that the profession has never known before (1984).” In his reflections on being a member of the well-known “9th Floor Project,” Dr. Richard DeLeon said,
Early on, anxiety dominated my emotions; fear of failure, fear of making a mistake and affecting a patient, fear of jeopardizing the Ninth Floor Pharmacy Project. However, I also recognized that I was happy being able to create and do something that others had not done; I was part of a team—the pharmacy team, the health care team. I knew I wasn’t wasting my time or education.
So what can we take home from a look back at some of the early clinical pharmacists as ACCP develops a renewed focus on its strategic plan? It’s clear that there was a sense of venturing into the unknown. The drive to do this was to improve the care patients got in terms of medication therapy. There was also the sense that clinical pharmacists had much to offer, even if not recognized by patients or other health care providers. And even though, as Dr. DeLeon pointed out, there was often a sense of angst in actually stepping out and committing to providing a new kind of service, it was more than offset by the “feisty” and “confident” manner in which they did it. These latter qualities probably moved the profession off the dime, so to speak. What we face today is not entirely different, and maybe these qualities could serve us well.
There Is Angst in Not Knowing What the Future Holds
We live in uncertain times as we think about health care reform. Given what’s going on in Washington, DC, we can’t be certain that true reform is happening. We also don’t know what roles pharmacy will play in our system just a few years from now. What we do have are vision statements from organizations like ACCP, JCPP (Future Vision of Pharmacy Practice), ASHP (Vision 2015), and others that indicate the roles we might play, and the preparation to provide clinical pharmacy services, will change. Here’s the challenge for ACCP. We can’t fix all the problems pharmacy has, nor can we meet every challenge in the future. So what is our contribution going to be? In what area of pharmacy practice, as we think it will be, can we have the most impact? We have to focus on what we do best. That is what I’d like to talk about for a few moments.
ACCP Needs its Membership to Get the Job Done
Before I mention specifics, I’d like to say something to every member of the College. In my view, it’s “showtime.” We’re still on the ground floor of health care reform, and it’s going to take a concerted effort from our members to make sure we’re on the elevator. My being the incoming president is testimony to the fact that every member has the opportunity to serve the College. I spent my share of time in the background remaining unknown. But with the encouragement of friends who were involved (actually pushing), I began to serve in various capacities. And now you know the rest of the story. And I even presented some of my work here! I want to encourage you to get involved. But I’ll come back to this point.
We Have a Renewed Focus
For a little more than a year now ACCP has looked at its strategic plan to sharpen its focus on top priorities. As I’ve already said, the central question was, Where in pharmacy practice can we have the most impact? The membership was engaged, and it gave us good feedback. From this process came three principal priorities: develop clinical pharmacists, advance clinical pharmacists, and position clinical pharmacists. ACCP is positioned to make significant contributions in each of these areas. So how do we approach them?
It’s About the Patients We Serve
The first step is to realize that it’s not about us, but rather the patients we serve. It’s not about the advancement or survival of a profession per se. Instead, it’s about looking at the opportunities clinical pharmacists have to improve medication use and avoiding the many well-recognized problems patients experience. In other words, will the services clinical pharmacists are able to provide be valued in the health care system of the future? I’m preaching to the choir here, but I’m betting that everyone in ACCP believes clinical pharmacists are up to the task. ACCP is committed to patient care. So how do we do this?
I was recently looking at a picture of a clinical pharmacist at the bedside of a young woman. It struck me that if I thought about that young lady in the bed as my daughter, I had very high expectations of that clinical pharmacist. Who would I want helping to take care of her? What training and credentials would I expect? Maybe that’s how we should frame discussions of the training of future clinical pharmacists.
Opportunities Exist
The new ACCP strategic plan states, “ACCP will position clinical pharmacists.” Recognition of and demand for clinical pharmacy services remain critical factors for the advancement of the discipline if it is to flourish in the future. Without demand for our services, not much else matters. This has been one of the most difficult hurdles for us since the beginning. It’s easy to become discouraged by the slow pace of recognition and payment for clinical pharmacy services as essential components of our health care system. Yet if one scans the health care environment, there are many opportunities we should grasp. For example, the concept of “medical homes” is gaining ground. Groups like the Patient-Centered Primary Care Collaborative include pharmacists and advocate for them as essential members of the team. We are actively engaged with this group. The concept of “team” is catching on among purchasers of health care. Indeed, one of the common themes we hear during conversations about health care reform is the team approach. The ACCP priority of “positioning clinical pharmacists” is about bringing recognition to the value of our services. We all know that failure to optimize drug therapy and medication misadventures are national problems. But where problems exist, opportunities to show our stuff also exist. As Dr. Ed Webb put it in an e-mail to me, “what are we waiting for – a formal invitation to be change agents?” ACCP is firmly committed to positioning clinical pharmacy and clinical pharmacists to meet these challenges and demonstrate its value in our health care system.
So how are we going to address this priority? First, we have a very effective staff in our Washington, DC, office that keeps us not only informed but also involved with various other stakeholder groups to advance clinical pharmacy. We have also charged several committees with work that will focus on this priority. For instance, the discipline is going to need process indicators as defined by external agencies, accrediting bodies, or others involved in ensuring quality performance so that constituents know what to expect of us. The Public and Professional Relations Committee has been charged with developing a set of process indicators that mean something to external constituents for clinical pharmacy services during transitions of care. One of the problems we have faced is a lack of recognition of what clinical pharmacists actually do for patients. The Residency Advisory Committee has been charged to develop a set of talking points directed at external constituents describing what we do and to look at the feasibility of developing a “care report” that patients can be given after an encounter with a clinical pharmacist. Our Presidential Task Force has been asked to develop a report providing recommendations on how ACCP can facilitate the appointment of qualified members to national treatment guideline panels and committees.
Wisdom from the Past Applies Today
Another part of this priority speaks to our need to work collaboratively with groups inside and outside of the profession to advance clinical pharmacy. I am reminded of something Harvey Whitney said in an editorial written in 1979 as ACCP came into being. He said,
It will be important for the ACCP to work in harmony with the organizations that represent the various facets of pharmacy and medicine. In this way, the ACCP can foster the clinical pharmacy movement, and promote the clinical pharmacist as a professional with an important position in the decision-making process of drug therapy.
This wisdom is still valid today. An old proverb says, “in an abundance of counselors there is victory.” ACCP will work with other organizations to bring the strengths of each to bear on the challenges we face. Because ACCP is a member-driven organization, its leadership assertively advocates for the priorities you, the membership, tell us to. These will be central to our activities. At the same time, we will strive to work collaboratively with other stakeholders to advance the discipline. Successful advocacy requires a balance between “feisty” assertiveness and humility. We will try to strike that balance.
Who Will Be in a Position to Provide Solutions?
Another strategic direction included in the 2010 ACCP strategic plan is, “ACCP will advance clinical pharmacists.” This priority is about getting clinical pharmacists in places of opportunity. How do we gain recognition of clinical pharmacists as the most qualified health care professionals to solve our system’s medication-related problems? As I’ve already said, ACCP believes that credentialing and privileging of clinical pharmacists will be important as future roles develop. Consumers, other members of the health care team, and payers expect some way of documenting qualifications. It is standard in other health care disciplines. As it stands today in pharmacy, credentialing may be through a pharmacy degree and licensure, postgraduate training, and certification. Some may be recognized experts because of several years of practice. But how will clinical pharmacy specialists be recognized in the future? There remain widely divergent views within the profession about the process and roles certification should play. But it is reasonable to assume that in the future, consumers and payers will expect a system that documents expertise in a recognizable way. ACCP and the Board of Pharmacy Specialties both value certification as a means to bring this about. What we need to do now is find ways to work collaboratively to increase certification opportunities, increase recognition of what certification brings to the care of patients, and continue to document the value of services provided by appropriately credentialed clinical pharmacists.
This year, we’ll be addressing this priority in several ways. The Certification Affairs Committee will be developing an editorial for the College that discusses the training and credentials of clinical pharmacists that warrant recognition by care providers and that discusses the value of credentialing to the public. Clinical Practice Affairs will be asked to describe best practices for the delivery of clinical pharmacy care to areas where these services are not routinely available or where there are no clinical pharmacists. They will be looking for example models that can be made available to target audiences. The Research Institute is concluding the first project of the Practice-Based Research Network related to medication errors and the impact of clinical pharmacists.
“ACCP will promote the development of clinical pharmacists as practitioners, educators, and researchers” is also one of the three primary directions of the new ACCP strategic plan. Many pharmacy organizations including ACCP have vision statements that describe what we think practice will be like in the future. A common thread is a patient-oriented, rather than product-oriented, approach. This transition is occurring at a frustratingly slow pace. Nevertheless, we need to consider what it will take to prepare clinical pharmacists to fill the roles many are predicting. ACCP is firmly committed to advancing practitioner, educator, and researcher development. We also strongly support and advocate for increased opportunities for specialist certification. And although postgraduate training is not our primary focus, it is obviously important to us. ACCP stands ready to work with other stakeholders to enhance the quantity and quality of these experiences. In fact, in February 2011, representatives of ACCP and other stakeholder organizations will join in a summit hosted by ASHP to consider how to increase residency capacity.
Several of our 2010–2011 committees and task forces will be working in the area of clinical pharmacist development. Our program committees continue to focus on quality educational programs to assist clinical pharmacists in developing and maintaining competencies. Our Academies continue to provide ongoing, in-depth training opportunities for members. The Member Relations Committee has been asked to recommend new products and services that assist in professional development. The Publications Committee will develop “ACCP Paper Packets” that provide summaries of important papers and publications of interest to our members with an executive summary of each area covered. And finally, the Task Force on Residencies has been charged with the development of a white paper looking at current PGY2 residency standards and providing recommendations for review and improvement. The Educational Affairs Committee will develop an ACCP Guide for Health Professionals titled “Educating Patients About Pharmacogenomics and Genetic Testing” to assist clinical pharmacists and other providers in caring for patients. The Organizational Affairs Committee has been asked to investigate and develop a report describing how ACCP might play a key role in the development and use of clinical decision support systems. The Research Institute will again offer the Focused Investigator Training Program to assist clinical pharmacists in obtaining significant federal funding. All of these are intended to assist clinical pharmacists in improving and expanding their skills.
ACCP Needs Your Involvement and Feedback
So now, we come to the roles that you, the members of ACCP, need to play in this process. The challenge ahead of us is daunting. Creating change is never easy. Inertia is a formidable foe. But ACCP members remain feisty, committed, and visionary. The College needs your input and involvement. We appoint as many members to committees and task forces as possible. We also encourage you to be involved in other capacities such as serving as an author or reviewer of ACCP publications or submissions, giving presentations at meetings, and serving in PRNs as officers or committee members. We also need your continued input through the annual survey or through other communications with the leadership. The Research Institute has developed the PBRN and will be asking members to be involved in research that is vital for the promotion and advancement of clinical pharmacy. So I encourage you to stay engaged.
We Can Change the Future by Mentoring/Motivating Students
I’d like to close with one more suggestion on how our members can effect change. All of us can probably look back and point to preceptors or faculty members who influenced us to become clinical pharmacists rather than follow other paths open to us. Most people in ACCP are involved with students in one way or another. We need to challenge and mentor them in the provision of clinical pharmacy care. But beyond that, we need to encourage them to become change agents. Consider the growth of ACCP. Thirty-one years ago, there were less than 50 members. Now, there are more than 11,000. Many of us became involved because one of our preceptors or teachers told us about the College. Student involvement in ACCP has grown significantly in the past few years. Each member can affect the future of one student at a time. At a time when there is increased pressure from more and more IPPE and APPE students, it is tempting for preceptors to pull back. I encourage you to remain committed to training future clinical pharmacists. They truly are the future of our profession.
Thank you for giving me this opportunity to serve the College. I am truly looking forward to getting to know and work with as many of you as possible.