As we near the end of the year it is a natural time to refect on the past and I have been doing just that lately. I’ve been at ASHP for nearly 25 years now and a member long before that. My first role here at ASHP was as the Director of the Clinical Affairs Department. As we pursue provider status in earnest I have been reflecting on how far we have evolved as a profession and how we got there and I thought I would share some of my reflections with you.
Building a Vision for Pharmacy as a Clinical Profession
Most pharmacists are probably at least familiar with ASHP’s seminal consensus conferences such as the Hilton Head Conference in the 1985, the San Antonio Conference in the 1993, or the more recent PPMI and Ambulatory Care Conferences that have all supported and indeed helped to drive the evolution of pharmacy practice from a product-centered focus to today’s more clinical focus of the profession. The Hilton Head Conference established the vision that pharmacy must evolve to a clinical profession and the San Antonio Conference built on that idea but also advanced the concept of pharmaceutical care and the pharmacist’s role in leading all aspects of safe and effective medication use (not just the therapeutics). The more recent PPMI and Amb Care conferences have set the stage for reimagining how to best enable pharmacists to practice to the full extent of their knowledge and skills. I wonder how many of you also remember that ASHP also played a key leadership role in convening the Directions for Specialization in Pharmac Practice Summit in 1990 that laid the ground work for the evolution of specialties for the next 20 years. (AJHP 1991;48:469-50 & AJHP 1991; 48:691-719). This rich history of advocating for pharmacists to evolve and embrace their role as providers has been a part of ASHP’s DNA for as long as I have been a member.
Residency Training
Residency training has been an integral tool in helping to achieve the vision of pharmacy as a clinical profession. ASHP was an advocate for residency training long before others joined in supporting the concept and recently celebrated 50 years of accrediting residency training programs. Standards evolved over the years from standards for hospital pharmacy, clinical, and specialty standards to pharmacy practice and specialty standards in the 1990s, and now the current PGY1 and PGY2 standards. The continued effort to support effective postgraduate training models that prepare pharmacists to practice to their full potential has been instrumental in this evolution of pharmacy practice.
Board Certification
Despite how some individuals occasionally tried to portray things, ASHP has long been a champion of board certification. ASHP (sometimes in partnership with others) led the development of six of the eight petitions to BPS resulting in official recognition of new specialties. Nuclear pharmacy and pharmacotherapy are the only petitions that ASHP was not involved in developing. Some may not recall that certain pharmacy organizations staunchly opposed the approval of petitions for psychiatric pharmacy and for oncology pharmacy practice arguing that all other specialties were really subspecialties of pharmacotherapy. The oncology petition remains the only petition that resulted in an appeal of a BPS decision. ASHP continues to support the recognition of new specialties and importantly the development of adequate numbers of PGY2 residency training programs to prepare specialists and provides innovative review courses and recertification programs to maintain their credentials.
Provider Status for Pharmacists
ASHP is currently engaged in a broad coalition to obtain provider status for pharmacists. But some may not recall that it was the submission of a New Business Item by the ASHP Section of Clinical Specialists and Scientists in the 1999 session of the ASHP House of Delegates that served as the initial spark that started us on the road to pursuit of provider status. Efforts have been underway since but this year has seen a broad coalition of organizations banded together to support this important effort. Provider status is important in part because it demonstrates that the profession has evolved and recognizes pharmacists’ role as providers of patient care.
Credentialing and Privileging for Pharmacists
ASHP has been a staunch supporter for the development of credible credentialing and privileging models for pharmacists. During his tenure as CEO of ASHP Henri Manasse was instrumental in the formation of the Council on Credentialing in Pharmacy (CCP ) . Over the last decade this organization has promulgated a number of resources that promote the implementation of effective credentialing and privileging models that will be crucial once provider status in obtained. When pharmacists are recognized as providers there will be an even greater need for effective models to credential and privilege pharmacists. It is hard to imagine that pharmacists will face less scrutiny than physicians and other providers who already are required to participate in credentialing and privileging based upon the scope of care they provide to patients. The documents at the CCP web site are valuable resources.
Therapeutic Guidelines
ASHP has been publishing high quality therapeutic guidelines since early in the 1990s. These guidelines have evolved from quality review articles to systematic literature reviews that meet criteria for quality for clinical practice guidelines established by AHRQ. These publications are among the most downloaded papers from AJHP. Therapeutic Monitoring of Vancomycin in Adult Patients is the most frequently downloaded paper in AJHP with over 205,000 downloads and Guidelines on Antimicrobial Prophylaxis in Surgery is the second most downloaded paper with over 130,000 downloads. These guidelines are featured on the National Guideline Clearinghouse. Not only have these been valuable tools for pharmacists but they are also highly regarded by other professionals and have helped to establish the role of pharmacists as experts in the use of medication.
OK, this is probably too long already, but after all these years it is sometimes good to look in the mirror and reflect on how we got here. New years is about sharing memories and I hope I have rekindled a few memories for some of you that I have worked with over the years. Thanks to everyone for their support in this journey and I look forward to working with all of you in the journey yet to come.
Happy New Year and best wishes for a safe and healthy New Year!