A Place for All of Us in Teaching the Pharmacists’ Patient Care Process

By: Aleda M. H. Chen, PharmD, PhD; Jeannine M, Conway, PharmD; Margarita DiVall, PharmD, MEd; Michael Gonyeau, PharmD, MEd; Mary Kiersma, PharmD, PhD; Teresa O’Sullivan, PharmD; Robin Zavod, PhD, FAPhA

Comedian Jerry Seinfeld once made a joke about the job of pharmacists:“I’m taking pills from this big bottle and then I’m gonna put them in a little bottle! That’s my whole job. I can’t be down on the floor with you people. Then I’m gonna type out, on a little piece of paper. And it’s really hard.” We in the profession know that this is not what pharmacists do, yet this description summarizes the perception of many members of the public. How, then, would you describe what a pharmacist does? What activities form the core of our professional identity?

Development of a Professional Identity

In the 1990s, many pharmacy educators adopted the Hepler and Strand Pharmaceutical Care Model as the basis for teaching what pharmacists do.¹ Yet not all pharmacy educators consistently used this model, nor was there a single vision for how pharmacist-provided care both differed from and complemented other healthcare professionals. Out of this recognition, a workgroup of the Joint Commission of Pharmacy Practitioners (JCCP) created the Pharmacists’ Patient Care Process (PPCP), published in 2014. The PPCP provides a visual image explaining our professional identity and helps us tell the story of how we uniquely provide care to patients. It is a critical component of our efforts to expand the presence of pharmacists within the healthcare team.

A Consistent Care Process

The PPCP provides a common language and a consistent message to patients and the healthcare team about what pharmacists do and is not a “rebranding.” Our role is still not apparent to the public or even to many of our healthcare colleagues. A care process that is applied consistently across pharmacist practitioners enables us to demonstrate our value in healthcare and facilitates evaluation of clinical outcomes across care settings.^2,3 It defines our distinct role in the team: “Pharmacists use a patient-centered approach in collaboration with other providers on the health care team to optimize patient health and medication outcomes.”⁴

A Place for Us All

Efforts to integrate the PPCP should engage all faculty, including preceptors, and span the entire PharmD curriculum and post-graduate training, providing a “map” to patient care for our students. Pharmacy practice faculty can model the PPCP in its entirety and can help students learn and practice application of the process. Other faculty (e.g. pharmaceutical sciences, social & administrative sciences, drug information) also play a key role in addressing the PPCP by providing foundational knowledge to understand the impact of clinical decisions and challenging students to examine ALL factors that impact care plans and adherence (see Table 1). To do this well, we may need to further integrate how and what we teach across the discipline-specific siloes. Further, preceptors, who may need training in how to coach and role model the PPCP for students, are our profession’s ambassadors for using the PPCP and demonstrating what we uniquely provide as a member of the healthcare team. Given that the PPCP is “in collaboration with other providers on the healthcare team,” other health professions are clearly also part of this process. It takes us all to successfully integrate the PPCP.

Table 1. Examples of Ways to Support and Integrate the PPCP

Group	Direct Impact	Examples
Pharmacy Practice Faculty and Preceptors	Clinical aspects as well as application and integration in real patients and healthcare teams (All steps)	Organize case work-up, presentation, and written communication templates (All steps) After a real or simulated patient encounter, debrief the student on their strengths and areas for improvement (All steps)
Pharmaceutical Sciences Faculty	Foundational sciences provide rationale (Assess & Follow-Up)	Include the foundational science rationale for drug activity, side effects in a SOAP note Tie science foundation to critical patient education elements and auxiliary labels
Social & Administrative Sciences Faculty	Social, economic, and behavioral aspects (All steps)	Utilize the social determinants of health in a simulated patient encounter Discuss how cultural humility enables pharmacists to improve patient-centered care (All steps)
Drug Information Specialists	Role of evidence (Assess & Follow-Up)	When responding to a drug information inquiry, obtain and assess the quality and strength of evidence (Assess) Use primary resources to identify incidence of adverse drug effects (Follow-Up)

A Call to Action

Let’s commit to involving all faculty and preceptors in teaching the PPCP and modeling what incorporation looks like in each discipline. It will help us prepare practice-ready, team-ready pharmacists who will be seen as health care providers rather than product purveyors. There’s a place for all those involved in the education of our future graduates, from pharmacists and other healthcare professionals to our patients and communities. Maybe the next joke from a famous comedian will expand the role of the pharmacist to include the PPCP?

References:

1. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47:533–543.
2. Harris IM, Phillips B, Boyce E, et al. Clinical pharmacy should adopt a consistent process of direct patient care. Pharmacotherapy 2014;34(8):e133–e148.
3. Bennett M, Goode JVR. Recognition of community-based pharmacist practitioners: Essential health care providers. J Am Pharm Assoc 2016;56(5):580-583.
4. Joint Commission of Pharmacy Practitioners. Pharmacists’ Patient Care Process. Published May 29, 2014. Accessed August 21, 2019.

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Aleda M. H. Chen is the Assistant Dean and an Associate Professor at Cedarville University School of Pharmacy. Educational scholarship interests include: empathy development and integration of health disparities and cultural competence education. In her free time, she enjoys eating spicy food and traveling.

Jeannine M. Conway is an Associate Professor and Associate Dean of Professional Education at the University of Minnesota College of Pharmacy. Educational scholarship interests include clinical reasoning and skills development. In her free time, she enjoys reading and beer.

Margarita V. DiVall is the Associate Dean for Faculty Affairs at Bouvé College of Health Sciences at Northeastern University. Educational scholarship interests include: curricular and programmatic assessment, faculty development and mentorship. In her free time, she enjoys traveling, spending time with friends and family, and reading.

Michael J. Gonyeau is a Clinical Professor and Assistant Dean for Curriculum and Assessment in the Northeastern University School of Pharmacy. Educational scholarship interests include teaching with technology, gamification of learning, and instructional design. In his free time, he enjoys competitive volleyball and singing karaoke.

Mary E. Kiersma is the Assistant Director of Professional Degree Program Accreditation at the Accreditation Council for Pharmacy Education. Educational scholarship interests include: self-efficacy, empathy development and assessment of personal and professional competencies. In her free time, Mary enjoys traveling and shopping.

Teresa A. O’Sullivan is an Assistant Professor and Director of Experiential Education, Advanced Practice, at the University of Washington School of Pharmacy. Educational scholarship interests include quality assurance in experiential education and student performance measures. In her free time she enjoys cooking/baking, rowing, and history/genealogy.

Robin M. Zavod is a professor of pharmaceutical sciences at Midwestern University Chicago College of Pharmacy. Her educational scholarship interests include student self-efficacy, strategies to improve retention, and application of foundational science principles. In her free time Robin enjoys letterboxing and escape rooms.

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Pulses is a scholarly blog supported by a team of pharmacy education scholars.