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9/20/2004

Intl. Pharmacists Group Supports POC Testing in Pharmacies

Cheryl A. Thompson

Delegates to the policymaking group of the International Pharmaceutical Federation (FIP) recently agreed to support point-of-care disease screening and monitoring, but not full-fledged laboratory testing, in pharmacies.

What started as a statement on the testing of body fluids in pharmacies evolved after much discussion into support of point-of-care testing, said Henri R. Manasse Jr., ASHP executive vice president and one of the Society's two delegates to the FIP Council.

The FIP Council, consisting of delegates from 90 countries, met Sept. 4, 5, and 9 in New Orleans to discuss and vote on policies that the various member organizations could support at home.

ASHP, the American Pharmacists Association, and the American Association of Pharmaceutical Scientists served as hosts for the meeting, held in conjunction with the World Congress of Pharmacy and Pharmaceutical Sciences.

"There are some countries where some laboratory work is common [in pharmacies] and a regular part of practice," Manasse said, naming France and Italy, as well as countries in Central and South America, as examples.

In those countries, pharmacists perform urine and blood analyses and "even sanitation analysis" of water from swimming pools and spas, he explained.

Manasse said his unease, and that of other delegates, with the original policy statement rested with uncertainty about pharmacists' ability to engage in good laboratory practices, such as quality assurance and equipment maintenance.

"If we're going to essentially become a laboratory in pharmacy practice," he said, "what implications does that have" for pharmacists' qualifications and training and "how does that relate to our role as practitioners as we're advancing pharmaceutical care?"

In the end, Manasse and other delegates agreed that they could support pharmacists' involvement in tests that use a blood sample obtained from a fingertip, "but it probably isn't appropriate for us to contemplate having pharmacies become certified laboratories," he said.

Less contentious to the delegates from the U.S. pharmacy organizations was the policy statement on "confidentiality of information gained in the course of pharmacy practice," which calls for the groups to issue guidelines to practitioners on their country's relevant legislation.

Manasse said pharmacists in the United States, because of the privacy regulations related to the Health Insurance Portability and Accountability Act of 1996, already understand the importance of safeguarding patients' personal health information.

The FIP statement of professional standards on "the supply of medicines affecting driving performance" was promoted by drug information pharmacists who had studied the work of the International Council on Alcohol, Drugs & Traffic Safety, Manasse said.

"I think this [statement] was stimulated by the fact that both nonprescription and prescription drugs ... can affect driving performance," he said. "And when you look at the incidence of automobile accidents, apparently there's a fair amount ... that are related to medication use."

The professional standards recommend that member organizations produce guidelines to help health care professionals inform patients about the possible effects of medications on the ability to drive or operate machinery.

For the most part, the FIP statement avoids mentioning alcohol—the word is used only twice in the 3.5-page document, and both times in reference to alcohol's ability to worsen drivers' drug-induced impairment.

These sparse references to alcohol, Manasse said, "ended up being a pretty contentious point because there were some people who were arguing that alcohol is in fact a drug."

But the FIP Council stuck with the initial emphasis on medications as they are widely understood, he said.

Newly approved updates to the FIP code of ethics call for individual countries' codes to require pharmacists to recognize and respect the cultural beliefs and values of patients and to encourage patients' participation in decisions about medication therapies.

FIP also recommends that countries' code of ethics require pharmacists to ensure that people continue to have access to professional services in the event of a labor dispute or a conflict with personal moral beliefs.

The ongoing issue of who can be an "FIP member organization" and who can be an "observer," meaning the organization has an interest in FIP Council issues but does not represent pharmacy practitioners, took a new twist this year as a national organization of pharmacy technicians asked to be an observer. Manasse said this was the first year for implementation of the membership policy that he helped to develop.

He said that, although the FIP officers had recommended acceptance of the technician group as an observer organization, the delegates rejected the request by "a very close vote."

"There is a lot of paranoia among organizations that represent pharmacists," Manasse said, noting that some pharmacist organizations worry about an eventual takeover of pharmacy practice by technicians.

He said the group that asked to be an observer organization is from Denmark, which has a rigorous training program for pharmacy technicians.

"The main concern [by pharmacist organizations] appears to be the potential independent practice by technicians in pharmacies," he said.

"It's hard for us to imagine it in the U.S.," he said, "because we have no training standards and we have no legal authority for technicians."

Manasse said he expects that the issue of observer status for technician organizations will be raised again.

The FIP Council will next vote on new policies and membership applications at the September 2005 meeting in Cairo, Egypt.