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UC's goal to create better pharmacists

Wonder drugs

by Deborah Rieselman

The country's aging population longs for a wonder drug, some simple remedy for every ache and pain. The result is a pill-popping society that spent $132 billion on 3 billion prescriptions in 2000 -- a 55 percent increase over seven years earlier, according to the U.S. Department of Commerce.

Yet a well-stocked medicine cabinet almost needs its own manager these days, especially considering the Consumer Health Information Corp. found that 50 percent of prescription drugs are taken incorrectly and that complications from drug errors equal or exceed the amount of money that society invested in purchasing them to begin with. We easily forget that even miracle cures can be deadly if taken improperly.

No one knows that better than your pharmacist. This is the individual with an ever-expanding job description, from "juggler," who checks drug interactions among a dozen medicines that four different doctors could be prescribing for the same patient, to "insurance adjuster," who spends up to 20 percent of the work day handling canceled coverage, outdated prescription-card numbers and policies that reimburse for one medication but not another.

Of course, this same individual continues to maintain responsibility for clearly deciphering physicians' notorious handwriting and typing dosage directions for an average of 23,000 prescriptions a year. While that is a 32 percent increase in scripts per pharmacist since 1992 (according to the U.S. Department of Health and Human Services), today's pharmacists also have to make time to counsel patients in possible side effects of each drug.

Considering how much control that person holds over your health and financial well-being, wouldn't you feel better if he or she were a full-fledged doctor? We thought so.

Welcome to the University of Cincinnati's new PharmD program. Beginning in the fall of 2000, the College of Pharmacy implemented a six-year Doctor of Pharmacy program to replace the former five-year master's degree program, which had replaced a four-year bachelor's degree program in the 1960s. Although a master's component is still available for researchers and academicians who want to add pharmacy to their current list of degrees, traditional pharmacists coming out of UC will earn doctorates.

It's a giant step from the mortar-and-pestle days of making drugs from willow bark and poppies when the UC College of Pharmacy was founded as the Cincinnati College of Pharmacy in 1850. It's even a sizable leap from the '60s, when alumna Dorothy Smith, PharmD '72, began her career as a pharmacist with strict instructions to never counsel a patient.

"Prescriptions were written in Latin so patients couldn't understand them," says the woman now internationally renowned for patient education. "And we were instructed to never answer a question. If a patient asked about a prescription, we were supposed to refer them to their doctor."

"Pharmacy has moved from a ‘count and pour, lick and stick' profession that has been very product oriented to a profession that puts patients and their quality of life at the center," says Robert E. Lee, associate dean at the college. Dean Daniel Acosta concurs, "Today, pharmacists are dispensing information, as well as medication."

Adding the extra year has created a greater focus on clinical experience. Students spend an entire academic year doing nine one-month rotations, instead of the previous four, at a variety of settings, including hospitals, nursing homes, retail pharmacies, industrial sites, community-service clinics and even mail-order pharmacies.

Daniel Acosta

No matter how advanced medicine gets, prescriptions only work when properly taken. The role of pharmacists grows increasingly important, says college dean Daniel Acosta. Photo/Photo Dan, Medical Center Public Relations

Opportunities abound because the field has changed so much. Today's graduates may work in a retail site with a robot dispensing medicine 24 hours a day or in the nuclear pharmaceutical field working with radioactive drugs. And those who choose a more traditional career path in a community pharmacy are trained as counselors.

"Patient counseling is written into state laws today," Dean Acosta says. "For all new prescriptions, the pharmacist is supposed to ask the patient if they want to discuss its use and effects. We've been involved in the design of patient counseling centers in a few community pharmacies -- at Kroger's, for example."

Patient education is vital to health care, says alumna Smith, who founded the Consumer Health Information Corp., an internationally recognized patient-education organization near Washington, D.C. "The patient may be the most important member of the health team, because it is the patient who decides if, how and when to take the medication," she says. "If a patient decides a medicine is not worth taking, then the millions of dollars spent to research that treatment has been wasted."

Although patient counseling seems relatively new, UC was a forerunner in the concept in 1970. In fact, a leading proponent was head of the university's clinical studies, and that is what attracted alumna Dorothy Smith to the college.

"I wanted to work with patients," says the alumna whom Women's Studies honored as "distinguished" last spring. "I became concerned that many patients were being discharged from the hospital without enough information to manage their therapy.

"We need to calm patients' fears so they can manage side effects without stopping their medication. There is simply not enough room on a prescription label to provide all of the information they need."

The College of Pharmacy was not only a forerunner in patient counseling, it was one of the first schools to require post-baccalaureate work. Ironically, it has lagged behind much of the nation in embracing the PharmD requirement, because the Ohio Board of Regents held back. "They were reluctant to hand out a doctorate after only six years instead of seven," the dean explains.

Students are not particularly thrilled at facing an extra year of education for potentially the same pay, but "you have to weigh the benefits of it," says Diane Schaller, who finished up her second year of pre-pharmacy at Raymond Walters College in June and entered the College of Pharmacy this fall. "The program has already been a huge challenge, but it's been an exciting road. One of the things I'm most looking forward to is the chance to work with patients and explain all the options."

For current pharmacists wanting to upgrade master's degrees into doctorates, the college offers a distance-learning option. The first class of five began using that option in the fall of 2001.

Distance learning also answers a corporate need on a national level for employees in pharmaceutical research and product development who want to add a master's to their chemistry or chemical engineering degrees. The prime example is a partnership the college formed four years ago with Procter & Gamble to benefit employees at a facility in upstate New York.

Employees pay tuition and attend live lectures with UC faculty through videoconferencing. "The students actually have direct interaction with the faculty via use of television," Dean Acosta explains. "It's a partnership to provide the best education for employees who have to take a number of courses and do a thesis project under the guidance of a professor here and a P&G thesis committee."

Oddly enough, the program has created UC alumni who have never set foot on campus except to defend their theses. To date, nearly 250 employees have completed 32 classes.

Steve Cammaron, P&G's associate director of process development in the New York facility, is pleased. "Technology is in a constant state of change in pharmaceuticals," he says. "If you stop learning, you'll fall behind. The university and the company have both benefitted. Internships, grant money and closer collaborations have come out of this."

"The industry has changed in so many ways," says associate dean Lee. "Pharmacists are finding themselves in some diverse situations. They have to know much more today than simply what they are dispensing."