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News 12/03/2544


IN FOCUS - THE SHORTAGE OF PHARMACISTS IN THE UNITED STATES
An interview with Richard P. Penna, PharmD, Executive Vice President of the American Association of Colleges of Pharmacy.

FDA WARNS ABOUT WARFARIN, MICONAZOLE INTERACTION
The US Food and Drug Administration on Monday warned women taking warfarin to consult their physicians before using Johnson & Johnson's Monistat or other vaginal yeast-fighting medications that contain miconazole.

TOPICAL LIDOCAINE APPEARS PROMISING AS TREATMENT FOR MIGRAINE
Lidocaine cream applied to the forehead during a migraine headache can provide rapid pain relief for some migraine patients, according to a presentation here at the annual meeting of the American Society for Clinical Pharmacology and Therapeutics.


From
Medscape Pharmacists

In Focus
The Shortage of Pharmacists in the United States


Jane S. Ricciuti, RPh, MS


In late 2000, numerous articles were published identifying a critical shortage in pharmacy staff for all of the United States. What does this mean to the practicing pharmacist?

Released in December 2000, Health Resources and Services Administration (HRSA) National Center for Health Workforce Information and Analysis, of the U.S. Department of Health and Human Services, published a study that indicated[1]:

the emergence of a shortage of pharmacists, which has resulted in less time for pharmacists to counsel patients, greater potential for fatigue-related pharmacist errors, and fewer pharmacy school faculty; sharp increases in demand for pharmacy services; significant decline in pharmacy school applications; and an unlikelihood that the many factors causing the shortage will abate without fundamental changes in pharmacy practice and education.

Overview of HRSA Study[1]

There are currently 196,000 licensed pharmacists in the United States. Although the demand is increasing, the number of active pharmacists is expected to grow only by 28,500 over this decade -- 800 less than the 29,300 over the last decade. There also is a decline in pharmacy school applications, with the number of 1999 applicants 33% lower than in 1994, the high point of the past decade.

According to the HRSA study, indicators of a shortage include:

Increased job vacancy rates and difficulties in hiring. The number of unfilled full- and part-time drugstore pharmacist positions nationally rose sharply from about 2700 vacancies in February 1998 to nearly 7000 vacancies by February 2000. Such vacancies are expected to continue to grow.

Increases in the volume and range of activities demanded of today's pharmacist. The increased volume is manifested most convincingly by the sharply increased number of prescriptions filled each year in retail settings. The increased range is manifested by the substantially expanded roles and responsibilities of pharmacists in both retail and institutional settings.

Among the factors contributing to the shortage is the increased use of prescription medications. The number of retail prescriptions dispensed per year in the United States increased 44% between 1992 and 1999, from 1.9 billion in 1992 to 2.8 billion prescriptions in 1999. The estimated annual number of prescriptions filled per pharmacist in retail pharmacies grew from 17,400 in 1992 to 22,900 in 1999, an increase of 32%.

Other factors contributing to the shortage are:

market growth and competition among retail pharmacies, resulting in increased pharmacist positions, expanded store hours, and new store openings;

expansions in pharmacy practice and pharmacists' roles and professional opportunities;

increased access to healthcare, and an increase in the number of healthcare providers authorized to prescribe medications;

changes in the pharmacist workforce, including the greater number of women pharmacists and their shorter work patterns; and

the double impact of increased insurance coverage for prescription drugs, resulting in an increase in both prescription volume and the number of third-party payment issues that need to be resolved.

What Are the Consequences of a Shortage?

Practicing pharmacists can anticipate increases in job-related stress that result from longer working hours and inadequate working conditions. An overworked labor force has the potential for increased incidences of medication-related errors, adding more stress to the pharmacist's already busy day.
The Institute of Medicine report published in 1999, "To Err is Human: Building a Safer Health System," noted the important role that pharmacists play in reducing medication error.[2] The report noted the importance of maintaining reasonable working hours, workloads, and staffing ratios, and avoiding distractions, in order to keep errors to a minimum.

As the number of prescriptions increases, pharmacists are faced with the task of implementing pharmaceutical care into their practice and expanding their roles to improve patient outcomes. In the current shortage of pharmacists, ultimately the patient is affected. For example, a patient may not receive adequate counseling or his/her complex medication regimen may not be adequately reviewed; in this setting, there is increased potential for adverse drug events.

There are many additional consequences of the shortage of skilled pharmacists in the United States affecting pharmacists' quality of life and hampering their ability to pursue continuing education to effectively perform their duties. Other healthcare providers and patients will be affected by the decreased quality of care that results from a diminished workforce.

Future of the Practice of Pharmacy

The American College of Clinical Pharmacy (ACCP) published the White Paper: A vision of pharmacy's future roles, responsibilities, and manpower needs in the United States.[3] Corresponding commentaries from leading pharmacy associations were published in the January 2001 issue of Pharmacotherapy.[4] The ACCP White Paper and the commentaries offer a starting point for discussion into what lies ahead for pharmacists. Most significant is the reliance of healthcare on pharmacotherapy to cure disease and improve patient outcomes. The increasing number of prescriptions that are being written today supports this. Also notable is the fact that without automation of the drug dispensing functions of pharmacy practice, the burden on individuals would be too great. Pharmacy will be a technology-driven profession to maintain the status quo of product fulfillment. Pharmacists will need to incorporate technology into their increasing role as patient-centered caregivers. As this model of practice continues to evolve, we will see changes in our education system for pharmacists and, most importantly, changes in reimbursement for pharmaceutical care. Without the drive of reimbursement, pharmaceutical care as a business component will not be able to survive.

References

  1. Health Resources and Services Administration. The Pharmacist Workforce: A Study of the Supply and Demand for Pharmacists. Health and Human Services Health Resources and Services Administration, December 2000. Available at: http://bhpr.hrsa.gov:80/healthworkforce/pharmacist.html.
  2. Kohn LT, Corrigan JM, Donaldson MS, eds. To Err Is Human: Building a Safer Health System. Institute of Medicine Report, November 29, 1999. Available at: http://bob.nap.edu/html/to_err_is_human/
  3. American College of Clinical Pharmacy. White Paper. A vision of pharmacy's future roles, responsibilities, and manpower needs in the United States. Pharmacotherapy. 2000;20:991-1020. http://www.medscape.com/PP/Pharmacotherapy/2000/v20.n08/pharm2008.12/pharm2008.12-01.html
  4. ACCP. Manpower White Paper - Alternative viewpoints. Pharmacotherapy. 2001;21:116-127. Available at: http://www.medscape.com/PP/Pharmacotherapy/public/archive/2001/toc-2101.html

Jane S. Ricciuti, RPh, MS, Editor and Program Director, Medscape Pharmacists


FDA Warns About Warfarin, Miconazole Interaction


WASHINGTON (Reuters Health) Mar 06 - The US Food and Drug Administration on Monday warned women taking warfarin to consult their physicians before using Johnson & Johnson's Monistat or other vaginal yeast-fighting medications that contain miconazole.

The FDA said it had asked makers of creams and suppositories containing miconazole to include a warning on the products' packaging about the possible interaction.

Regulators took action after receiving two reports of abnormal blood-clotting test results in women using both warfarin and a miconazole product. The FDA said in a statement that one of the women developed bruises, bleeding gums and a nosebleed.

"Physicians and patients should be aware that patients who need to use both products simultaneously should be appropriately monitored," the FDA said.


Topical Lidocaine Appears Promising as Treatment for Migraine


ORLANDO, FL (Reuters Health) Mar 07 - Lidocaine cream applied to the forehead during a migraine headache can provide rapid pain relief for some migraine patients, according to a presentation here at the annual meeting of the American Society for Clinical Pharmacology and Therapeutics.
Dr. Frederick Freitag and Dr. E. Lockhart of the Diamond Headache Clinic in Chicago ran a placebo-controlled trial of 40 patients with migraine without aura. Among those using lidocaine, pain rated on a 10-point scale declined from a mean of 6.93 at baseline to 5.51 at 2 hours, and to 1.70 at 8 hours, a significant reduction compared with placebo.

Seven patients who used lidocaine were pain-free at 2 hours and eight were pain-free at 8 hours. Some subjects reported a tingling or burning sensation, but there were no significant adverse effects.

According to Dr. Freitag, previous studies have shown that IV and nasally administered lidocaine relieve migraine pain, most likely by desensitizing the trigeminal nerve. "Nasal administration is cumbersome at best to use. So if we can deliver lidocaine in a topical patch, it's the same as if applied intranasally or by IV, but obviously with much greater ease of use."

Dr. Freitag reports that Epicept Corporation, in Englewood Cliffs, New Jersey, has developed a sustained-release topical lidocaine formulation, which is currently in clinical trial.

The lidocaine patch could be used on its own or as an adjunct to other medications, Dr. Freitag noted. "When patients get a migraine attack, it takes a while for the normal oral medication to work, while this provides relief very quickly." He added, "We foresee people using it primarily as a mainstay of therapy."

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