Based on a survey by the association, we can say more than half of the schools believe additional scholarship funds should be available. We have determined that pharmacy students need $5.1 million and we request the subcommittee to appropriate sufficient funds to allow pharmacy schools to receive $5.1 million. Grants for training, traineeships, and fellowships for health professions teaching personnel.—Additional clinical faculty members are needed. Pharmacy schools will have to retrain some present faculty as well as appoint new members who must also be trained for clinical applications of their knowledge and teaching skills. To do the job we believe is necessary, will require about $3 million. The prospects for establishing the needed training programs are good, but we believe that $1.5 million will be sufficient for pharmacy in fiscal year 1973. Grants for computer technology.-Several pharmacy schools are doing computer research in drug-related fields. Drug information retrieval and evaluation is an absolute necessity to back up the developing health care team. Having accurate and up-to-date information assures that drug judgments will be more right than wrong. University-based drug information centers are conservatively estimated to cost $250,000 to set up and operate for 1 year. For maximum efficiency and utilization, the Nation will need one center in every State or at least in every area designated for a federally supported health education center. At this time we believe that three to six pharmacy schools are ready to establish these centers. Therefore, we request the subcommittee recommend $0.75 million as a minimum for this specific purpose. Other NIH programs.-Pharmacy schools have a real interest in the various research and health care programs at NIH and HSMHA. The National Institutes of Health in fiscal year 1971 gave pharmacy schools a total of $4.9 million for 110 research grants. These grants support research in pharmaceutical chemistry, pharmacology, and other areas as well as fellowships for young scientists. The NIH source of funds and number of schools receiving grants were: National Institute of Allergy and Infectious Diseases (11). National Institution of Dental Research (5) 793, 066 National Library of Medicine (17)__. National Institute of General Medical Sciences (58). National Institute of Environmental Health Sciences (5) 203, 595 248, 218 1,678, 166 360, 141 Division of Allied Health Manpower, BHME (4). National Institute of Neurological Diseases and Stroke (21). 82, 047 386, 477 667, 696 94, 471 4, 931, 834 Total You will notice our interest in cancer research, environmental research, and in other vital areas of national concern. We believe our schools can do much more scientific research in synthesizing cancer drugs, testing them in animals, and assisting the health team conduct research on drug effectiveness in patients. In the same way, we believe pharmacy schools can do more to develop drugs to treat addiction and to increase the effectiveness of drugs currently used for those purposes. This subcommittee can encourage pharmacy school researchers to become engaged in additional research by providing increased appropriations. One of the programs which serves to strengthen health research is the general research support grant program. It is one of the most powerful instruments the Federal Government has for aiding the development of manpower education and research. Appropriations have been kept level by Congress for the past 3 or 4 years. The President's budget even recommends a reduction for fiscal year 1973 of $588,000. Therefore it is up to this subcommittee to determine if the research is to be supported or not. Apparently the administration does not desire to continue the backup support so necessary to successful research efforts. We recognize the President's budget does increase other research institute budgets, some very slightly. However, overall the President's recommendation for the research institutes amounts to 80.5 percent of the authorizations. While this is good, it could be a bit closer to the level Congress determined was necessary in enacting the various laws which establish the research programs. We recommend that the subcommittee add $381 million to the President's research program including another $100 million for cancer research, $83 million for heart and lung research as recommended by the coalition for health funding. HSMHA PROGRAMS The various programs conducted by the Health Services and Mental Health Administration are vital to improved and successful health care. Pharmacy schools, through faculty and students, are involved in several projects with the National Center for Health Services Research and Development. This particular agency funded a study by our association last year to allow us to document the state of the art of clinical pharmacy education. Because of this, pharmacy schools can now move ahead more assuredly than without the study. Pharmacy educators are actively involved in comprehensive health planning (CHP), regional medical programs (RMP), and other programs. Several pharmacy educators serve as chairmen or members of State and local health planning councils. They know the needs and are attempting to marshal the resources to provide the required health services. Good planning assures that our resources are not wasted. It will take several years to assure the best utilization of health manpower and health facilities resources. Drug-abuse education has been supported by the National Institute of Mental Health. There is much pharmacy schools can do to prevent drug abuse, if additional funds are available. So far, pharmacy schools have not received many grants from this source, but we do expect them to do better in the future. The President's budget recommends a total of $1,964 million for HSMHA programs in fiscal year 1973. This is $4 million less than for fiscal year 1972. Frankly, this backward slide does not make sense. The administration has stated its desire to emphasize health in the 1970's. Reducing money available does the opposite. We believe a more responsive budget level would be at about 87 percent of authorizations as recommended by the coalition for health funding. This would amount to $2,792 million or $828 million more than the President recommends. These increases are primarily in the areas of mental health manpower-developments grants, staffing for community mental health centers, alcoholism, child mental health, construction, and modernization grants for hospitals and CHP programs. We recognize that our requests for increases are large. However, they only approach the need already established by the Congress and the President. This subcommittee has done a good job of setting priorities in the past. As you set these priorities, we remind you that health manpower is the basic ingredient to more and better health services. The President's health manpower budget for fiscal year 1973 is down from fiscal year 1972 by $140 million. The budget recommendations for fiscal year 1973 are only 37 percent of the authorizations. This indicates where the administration's priorities are. We hope your priorities are different. Mr. Chairman, these are our requests. We believe this subcommittee can conscientiously support our requests because the ultimate result in supporting pharmacy will be increased drug effectiveness, rational drug use, and less illness for American taxpayers. Pharmacy education is responding to changing health care needs of the American public. Educational support for these changes must come from many sources including the university systems, pharmacy practitioners, and other members of the health care team. Financial support and acceptance of these new programs, services, and roles by State and Federal Government, as well as by the private section of the American economy is essential for continued improvement of patient care. Thank you for the opportunity to present this statement. We will be pleased to answer any questions you may have and invite you to visit our schools in Philadelphia and Iowa City. SUMMARY OF APPROPRIATION REQUESTS FOR PHARMACY SCHOOLS FOR FISCAL YEAR 1973 UNDER THE COMPREHENSIVE HEALTH MANPOWER TRAINING ACT OF 1971 Construction: $10,000,000 Federal share requested in fiscal year 1972, plus $21,500,000- Special projects: During fiscal years 1970-71 pharmacy schools received only $376,000... Student loans: Based on 35.8 percent of eligible students at $1,000 average loan.. Dr. TICE. First I would like to thank the committee for the support which it gave pharmaceutical education leading to the present financial aid which we are receiving. Pharmaceutical education has undergone massive changes in recent years because studies, which have been sponsored by a number of Government agencies, have shown quite conclusively that there is a critical need in this country for pharmacists who are trained to take a very active part in medical care, in seeing to it that drugs are used properly, in giving surveillance to patients, in being concerned with drug reactions, and drug interactions. These studies show that there is a great deal of improper use of drugs, not only illegal use but even when drugs which are properly and legally prescribed. These studies have led our schools of pharmacy to become completely revised insofar as the way we are presenting our pharmaceutical education. The Comprehensive Health Manpower Act mandates our schools, and properly so, to provide clinical training. Now clinical training for pharmacy students means we must organize our educational effort along lines similar to those which we find in medicine. We can't take a class of 100 or 150 students in a patient's room, and consequently we have to break down these clinical classes into small groups. We use team teaching because here again the Health Manpower Act recommends very strongly we use interdisciplinary approaches so that our teaching team is comprised of clinically trained pharmacists. That is a special breed of teacher today and in great demand. We also utilize physicians so that the teaching of the clinical pharmacy is done by the interdisciplinary approach. This obviously is a costly procedure. I want to fully substantiate the very fine testimony given by the dean of nursing at the University of Pittsburgh. I am a member of the Blue Cross Board of Directors in Greater Philadelphia, and Commissioner Denenberg, whom I am sure you know, has forced us to tell the hospitals that they no longer may charge educational costs against patient care. This is placing all kinds of education, pharmaceutical, medical and nursing, in somewhat of a bind because someone has to pay the educational costs. We are using presently two teaching hospitals, Jefferson and the University of Pennsylvania for our students. We are also using the hospital of the Veterans' Administration in Philadelphia and Hahnemann has approached us to send our students there because even the medical schools now appreciate that unless education is presented on an interdisciplinary basis that this team can't work together efficiently when it comes to patient care. I might summarize it simply by saying that a team which is to play together must practice and train together. So that we do have higher costs. We know our programs are working. I would like to submit for the record a letter from Dr. Ralph Myerson who is chief of the medical service supplied by the Medical College of Pennsylvania, at the Veterans' Administration hospital in Philadelphia and another one from Dr. Edward J. Stemmler, the chief of the University of Pennsylvania Medical Service at the VA hospital and also a letter from Dr. Robert Wise, whom you may know, who is the Magee professor of medicine and chairman of the department of medicine at Jefferson. Each of these is a letter written to us at the college telling us how much these programs of interdisciplinary training mean not only to our pharmacy students but also in their efforts to improve and broaden the training of physicians and nurses. So I would like to put these in the record if I may. Dr. PHILIP GERBINO, VETERANS ADMINISTRATION HOSPITAL, Philadelphia College of Pharmacy and Science, Philadelphia, Pa. DEAR DR. GERBINO: This is to express my endorsement and support for your program in clinical pharmacy. I have had the opportunity of seeing this curriculum in operation and am quite enthusiastic about it. The ever-increasing complexity and sophistication in the delivery of health care has created a need for expertise in clinical pharmacy in an environment of patient care. My experience indicates that you are meeting this need with your program and that the caliber of patient care has improved as a result. Good patient care frequently emanates from good training. Your program has resulted in a situation which is mutually beneficial to our house staff as well as to your students. It has made available to our staff ready access in expertise in areas such as the relationship of drug therapy to diagnosis, laboratory findings, and patient response. New emphasis has been placed on the need for individualization of drug dosage, drug interreactions, toxicity, et cetera. This has been most beneficial to our student and house staff training programs. Conversely, it appears to me that your students have greatly benefited from working in an atmosphere of patient care. Concepts hitherto abstract have had the opportunity of becoming real and meaningful to them, and they can appreciate those problems that are significant to the clinician. Thus, this has been a program mutually beneficial to both institutions from an educational standpoint. More importantly, it has resulted in improvement in our mission to provide good care to our patient population. The program bodes well for the future and my hope is that it will continue to flourish, not only here but elsewhere as well. Sincerely yours, RALPH M. MYERSON, M.D., Chief, Medical Service, The Medical College of Pennsylvania Division. Dr. PHILIP GERBINO, VETERANS ADMINISTRATION HOSPITAL, Philadelphia College of Pharmacy and Science, DEAR PHIL: I am writing to express my thoughts regarding the participation of your students in the ward activities of our medical service. As I recall, this is the second year in which we have shared some responsibility for the training of your students and in which we have had the opportunity to observe the effect of the interface between your students and our medical students in the ward setting. I am impressed at how each group of students values the other for their particular knowledge. In these days where there is a good deal of talk about the team approach to medical care, it is interesting to watch a practical expression of team care in action. I would like to see your program continue and perhaps extend it to include other avenues of communication with students in schools of medicine. It seems to me that the pool of people who are interested in health services is filled with a large number of individuals who are capable of mobility among the various disciplines. I was impressed by watching some of your students deliver information which belonged, under present organization, in the province of the physician. I was pleased to watch some of your students working side by side with our medical students in the various ward chores and communicating freely regarding the information generated by the situation. It seems to me that the major contribution of your program is to bring to the hospital setting the highly specialized knowledge offered by the clinical pharmacist. Your knowledge is a resource which has previously been relatively unavailable in the acute hospital setting. I support your efforts and encourage you to continue this line of approach to current health care needs. Sincerely yours, EDWARD J. STEMMLER, M.D., Chief, University of Pennsylvania Medical Service. JEFFERSON MEDICAL COLLEGE, JOHN GANS, Phar. D., Clinical Coordinator, Philadelphia College of Pharmacy and Science, DEAR DOCTOR GANS: I wish to report to you the impressions that we have developed of the role of the student-pharmacist in our educational and patient care programs at the Thomas Jefferson University Hospital. As you know, the undergraduate and graduate student-pharmacists have been assigned to each of our patient care units with out teaching teams on the medical service. A student-pharmacist is assigned to a teaching team consisting of 12 to 15 attending physicians, one medical resident, one medical intern with senior and junior medical students. An attending physician is service chief and a professor makes rounds once weekly. The student-pharmacist works closely with the medical resident and is under his supervision. Private patients of the attending physicians are admitted to the team and are managed by the resident and intern under the supervision and responsibility of the attending physician. The program has been very successful. The pharmacist, in this setting, develops a new role in patient care and education. I believe that this system adds a new dimension to patient care. The comments from our medical residents indicate that the pharmacists in the graduate program played an active role in patient care. They developed detailed medication histories for the patients and histories of adverse drug reactions, as well as benefits. They knew much more intimately the possibility of drug interactions in our patients. If they did not know the information, they went to the library and obtained it. This information was reported daily at the meetings of the group. The pharmacists brought to these teaching sessions and clinical rounds a knowledge of drugs and their actions which was a learning experience for our students, interns and resident-physicians. They stimulated a greater attention to the efficacy of drugs, the type of preparations used, drug interactions, potential side effects, and economics of use that we have not had to this extent in the past. |