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11/5/2003

International Pharmacists Group Convenes

Cheryl Thompson

Delegates at the annual convention of the International Pharmaceutical Federation (FIP) adopted four policy statements that the organization said “strengthen the key role pharmacists play in modern health care.”

With the main theme of “Developing a New Contract between Pharmacy and Society,” the September event in Sydney, Australia, attracted more than 2000 pharmacists from 84 countries who came for FIP Council sessions or the associated World Congress of Pharmacy and Pharmaceutical Sciences.

New policy statements. Counterfeit medications. The new Statement of Policy on Counterfeit Medicines, which replaces a four-year-old document, reflects the organization’s belief that counterfeiting is a serious international issue, said ASHP President Daniel M. Ashby, who represented the Society during deliberations and voting sessions by the FIP Council.

Developers of the statement, he said, assigned blame for the problem on the large profits that could be obtained by counterfeiting relatively small quantities of medications.

“The statement is consistent with the concerns that exist for U.S. pharmacists,” Ashby said, “and therefore, by supporting the concerns that we have, I think it helps to convey the importance of this issue to other countries.”

Billy W. Woodward, who attended the World Congress in his role as treasurer of the FIP Hospital Pharmacy Section, said representatives of the Asian and African countries seemed the most vocal about drug counterfeiting.

“Apparently in a lot of the underdeveloped countries, they’ve got a huge problem [with counterfeiting], the Asian countries particularly,” he said. Counterfeiters in those countries, he explained, target antibiotics and other commonly used medications, not the high-cost products typically counterfeited in the United States, mainly because the underdeveloped countries lack access to expensive medications.

Much of the problem in other countries seems related to their lack of governmental controls, Woodward said.

Adherence to long-term therapies. By adopting the Statement of Professional Standards on the Role of the Pharmacist in Encouraging Adherence to Long Term Treatments, FIP gives its member organizations more power to pursue the issue at home, Ashby said. 

The statement defines the term adherence and offers general recommendations on improving patients’ taking of treatments for HIV infection, tuberculosis, mental illnesses, and heart disease.

While FIP promoted adherence as a better term than compliance, the U.K. pharmacists launched a discussion of “medication concordance,” which encompasses the need to include patients’ agreement with the treatment plan, Ashby said.

“It can’t simply be us saying ‘here’s your regimen, you need to adhere to it,” he said in explaining concordance. The pharmacist and patient must develop a treatment regimen that incorporates the patient’s lifestyle, values, and medications.

Although a good concept, Ashby said he was not sure the phrase “medication concordance” will become popular in the United States.

But pharmacists in Great Britain, according to a recent report from the U.K. Task Force on Medicines Partnership, “have a relatively well developed interest in and awareness of concordance,” unlike physicians in that country. The task force planned the October 11 BMJ theme issue on concordance.

Tobacco-free future. The Statement of Policy on the Role of the Pharmacist in Promoting a Tobacco Free Future addresses pharmacy organizations and individuals. Among the recommendations is one for pharmacy organizations, through FIP and its regional forums, to participate in the World Health Organization’s Tobacco-Free Initiative.

Also, pharmacy organizations should participate in various initiatives, including urging regulatory bodies not to license pharmacies in businesses where tobacco products are sold. And pharmacists, themselves, should not use tobacco. Earlier in the year, FIP launched the Global Network of Pharmacists Against Tobacco.

Medications on ships. The Statement of Policy on Provisioning Ships with Medicines for Their Effective Use recommends actions to ensure these vessels carry medications appropriate for meeting the urgent needs of the crew.

Unfinished business. The task force working on the definition of “FIP member organization” suggested relaxing the entry requirement to simply an organization representing pharmacists, Ashby said.

Membership applications from organizations not clearly representing the interests of pharmacists or pharmaceutical scientists, he added, would be deferred to the 15 elected FIP officers for a final decision.

“The biggest area of confusion,” he said, “was whether or not [a member] organization could be based as a governmental organization,” as is the situation in Sweden, where a state-owned organization operates all the hospital and community pharmacies and represents pharmacists as an employer.

ASHP Executive Vice President Henri R. Manasse Jr. served on the task force.

A new contract with patients. The FIP Board of Pharmaceutical Practices said it derived its theme for the 2003 congress from the Institute of Medicine (IOM) report Crossing the Quality Chasm: A New Health System for the 21st Century, which called for changing the relationship between health care professionals and patients.

FIP Hospital Pharmacy Section Secretary Philip J. Schneider, an ASHP past president, said the goal of the symposium at which he reviewed the IOM report before an international audience was to examine how the rest of the world views pharmacy. Typically, he said, the profession engages in introspection.

“The audience was challenged with the task of seeing how what we do on a daily basis is viewed by people who we serve,” Schneider said.

Judging from the reactions from attendees, Schneider said it seems that some countries have already solved some of the problems facing pharmacy in the United States.

“In other countries, for example, where [community] pharmacies have to be owned by pharmacists,” he said, “it’s very likely that pharmacists have a more patient-oriented relationship with their customers than they do in our country.”

Schneider also spoke at the symposium on public accountability of the pharmacy profession. Among the issues raised was the public’s rating of pharmacists’ job performance in light of the current effort to be frank about medication errors and gaps in the quality of the health care provided. Also discussed was how governmental regulation of pharmacists’ ability to practice pharmacy meshes with the profession’s interest in being candid about errors and gaps.

From one of the U.K. speakers Schneider said he learned that regulatory agencies can coexist with quality-improvement efforts, which is often not the case in the United States. The speaker explained that regulatory agencies balance the public’s needs with a profession’s needs and that regulatory oversight helps keep some professionals in line.

A novel idea that aired during the symposium, Schneider said, was recognition that not every patient implicitly trusts pharmacists to do what they should do.

Schneider served on the committee that planned the five symposia for the Board of Pharmaceutical Practices and agreed to serve as the next chair, starting with the program for the 2005 meeting in Cairo, Egypt.

It’s a wide, wide world. Woodward, who said the recent FIP meeting was his sixth in the past eight or so years, presented posters on two projects conducted at Scott and White Health System in Temple, Texas, where he is executive director of the pharmacy department.

“It’s pretty amazing to see the differences between countries,” he said.

Despite the differences, Woodward found a strong, common theme in the 78 posters from the Hospital Pharmacy Section and some of the educational sessions: There is a problem “transitioning patients in and out of the hospital.” Patients arrive at the hospital with medication issues in need of resolution, other issues arise during the hospital stay, and then patients return home needing a medication regimen compatible with their normal life.

“It’s more and more evident that everybody’s sort of asking the same questions, and we need to do better” at tackling continuity-of-care issues, he said.

“I always come back from that meeting not feeling haughty . . . but feeling grateful that, even with all of the issues we have—health care costs and all the budget battles and everything else we struggle with—that [on] our worst day, we’ve typically got a lot more to work with than a lot of people around the world do,” Woodward said.

Whereas U.S. pharmacists are “struggling with how to pay for $10,000 therapies for chronic rheumatoid arthritis,” he said, pharmacists in India are struggling to provide remedies for malaria.

FIP’s four-year-old Pharmabridge aims to connect persons in developing countries to individuals or groups with resources in developed countries, said Toby Clark, North American vice president of the Hospital Pharmacy Section. For example, a pharmacist in India can indicate his or her training needs and, through Pharmabridge, be matched with a U.S. pharmacy school that can fulfill those needs.

“ASHP has contributed over 500 volumes of materials to Pharmabridge,” Clark said, making the Society the largest contributor among organizations.

He noted that Pharmabridge Coordinator Agathe Wehrli has been urging the donation of relatively new drug information resources, not out-of-date books and hand-me-down throwaways. A book used in 1995, he said, might not include recent treatment recommendations.

Young Pharmacists’ Group. At its business meeting, the FIP Young Pharmacists’ Group appointed its first newsletter editor: Ryan Forrey, a student in the master of science program in health-system pharmacy administration at Ohio State University in Columbus.

New Orleans in 2004. Next year’s meeting will occur September 4–9 in New Orleans, Louisiana, and have the main theme “The Patient and Pharmacist—A Key Partnership in Health Care.”

Schneider said the five symposia presented by the Board of Pharmaceutical Practices will cover such issues as the patient–pharmacist relationship in different health care settings and patients and pharmacists working with new technologies.

ASHP is one of three U.S.-based hosts for the meeting.