| by David K. Buerger |
On the morning of November 12, 1997, a long-held vision will become
a reality as pharmacists from across the United States and from
all types of practice settings gather in Philadelphia to sit for
the first Geriatric Pharmacy Practice Certification Examination.
The exam will be rigorous and comprehensive, consisting of 150 questions designed to assess competency in care planning, therapeutic monitoring, disease management, quality improvement, and many other skill areas. Those who achieve a passing score will receive a "diploma" from the newly created Commission for Certification in Geriatric Pharmacy and earn the right to use the designation "Certified Geriatric Pharmacist (CGP)."
The certification program-conceived by ASCP but born of a process marked by profession-wide input and interdisciplinary guidance-will give pharmacists a way to affirm their geriatrics-specific competency and expertise. This new credentialing option may prove to be a vital bridge on the road to expanded clinical responsibility, professional growth, job security, and, ultimately, improved care for millions of elderly patients.
Pharmacists who serve the uniquely demanding population of elderly patients have long desired a formal program for demonstrating their special skills and hard-won expertise, but attainment of that vision has been long deferred.
"Some sort of program to help pharmacists differentiate their geriatrics-focused skills has been under consideration for many, many years, and discussed in earnest for at least five years," says ASCP Director of Professional Affairs Tom Clark, who coordinated the initial planning of the program and is overseeing development of its various components. "Despite steadily growing interest, however, there hasn't been a concerted movement to establish a distinct geriatrics subspecialty, and until recently there wasn't a solid consensus-even within the consultant pharmacy profession-regarding the most appropriate focus of such a program: Should it be consulting activities, nursing facility services, or something else entirely?"
In October 1995, a task force of ASCP members was convened to explore that question and related issues. Following a national needs assessment survey of roughly 500 current and prospective ASCP members, hospital pharmacists, and retail pharmacists, the task force concluded that ASCP members and the pharmacy professional would be best served by a geriatrics-focused program, and that pharmacists in all major practice settings would eagerly embrace such a program if it were developed (see page 643). Indeed, roughly 85% of respondents who identified long-term care as their primary practice setting, as well as 80% of hospital-based practitioners and 70% of community pharmacists, said geriatrics-specific certification would be "very" or "moderately" beneficial.
The needs assessment survey also indicated that ASCP was widely perceived as the organization best suited to take the lead in developing a geriatrics-focused certification program.
Several other factors and considerations entered into the task force's final recommendation in late 1996 that ASCP proceed immediately with program development activities.
"First of all," Clark explains, "geriatric patients are really the common denominator across the entire long-term care spectrum-from skilled nursing facilities, to subacute care units, to assisted living and board-and-care facilities-and the rapid expansion of the elderly population over the past 20 years has increased the need for a formal program to help pharmacists become more knowledgeable about these patients and more skillful in meeting their complex medication needs.
"Second, pharmacy schools traditionally have not taught geriatrics-specific skills as a distinct area of practice; consequently, many pharmacists lack formal training in provision of high-level pharmacotherapy services to the elderly. The task force felt that a certification program could help fill this gap by giving pharmacists a way to get formal recognition for high-level geriatrics skills acquired in practice," says Clark.
"Third, we've seen a distinct trend in recent years toward increased public and media scrutiny of health care quality and provider competency," Clark notes. "More and more, consumers are concerned about the quality of care they're receiving from HMOs and other providers. Issues of quality and competency are being widely discussed and debated right now in newspapers, on TV, in public forums, and also among legislators and policy-makers. The task force felt that a certification program would be one positive response to growing societal concerns about quality and competency."
With the issue of program focus resolved, the next task was to identify the specific skills and competencies to be assessed and certified. To accomplish this ambitious task, ASCP retained Applied Measurement Professionals, an independent research and testing company based in Lenexa, Kansas. Through a national practice analysis study, AMP set out to define the broad scope of geriatric pharmacy practice, as well as the core requisite skills and competencies involved in providing high-level pharmaceutical services to seniors in various patient care settings. A detailed survey was sent out early this year to 600 consultant pharmacists, hospital-based pharmacists, and chain and community pharmacists across the United States.
"Upon tabulating the survey results, it became clear that in order for the program to have broad, profession-wide applicability, it must have a primarily clinical rather than site-specific focus," Clark says.
The practice analysis data suggested that the certification exam should be geared to assess competency in two broad content areas: provision of pharmaceutical care services to geriatric patients, and pharmacotherapy of specific disease states common in the elderly. Within those two broad areas, survey respondents were asked to weight the importance of a wide range of specific skills and competencies in serving geriatric patients. The resultant data analysis yielded a detailed certification program content guide (see pp. 648-49).
"The content guide provides a comprehensive picture of what it takes to provide high-level geriatric pharmacy practice-and exactly what to expect on the first certification exam this November," Clark says.
An ASCP-appointed Examination Development Committee met last month to begin drafting test questions; the final exam document will be completed this month. After the first group of applicants takes the test in November, AMP may revise or fine-tune the content prior to the second exam administration, scheduled for May 1998 at as many as 20 sites across the country.
Early this year, its confidence bolstered by the needs assessment data, the ASCP Board of Directors finalized plans to develop the new certification program. The Board appropriated a start-up loan for creation of a new Commission for Certification in Geriatric Pharmacy (CCGP). This free-standing entity-distinct from ASCP and with its own offices, articles of incorporation, and bylaws-will be solely responsible for all aspects of program operations, exam administration, and issuance of credentials.
With the certification commission now up and running, the role of ASCP has shifted from direct involvement to program support.
"Although consultant pharmacists' long and close involvement in geriatrics-focused pharmacy practice made ASCP the clear choice to assume a leading role in the initial planning and program development stages, the Society recognizes and is committed to fulfilling its obligation to maintain a proper distance from certification commission operations, exam administration, and credentialing decisions. Maintaining this distance is essential to protecting the credibility and objectivity of the program.
"The CCGP is not part of ASCP, nor controlled by ASCP," Clark emphasizes. "The CCGP is an autonomous credentialing entity."
The first appointments to the certification commission-including three long-term care pharmacists-were announced in May. Over the next few months, the CCGP will be expanded to include medical, health care purchaser, and consumer representatives. "Broad inclusivity will bring an interdisciplinary perspective to the program, and help the CCGP be responsive to the diverse certification goals and desires of practitioners in a wide variety of settings," Clark says. "This approach will also help ensure that the program fulfills its prime objective: promoting and enabling improved health care-not just improved medication services-for geriatric patients."
Last summer's needs assessment yielded some interesting insights on what pharmacists hope to gain by investing their time and effort to achieve certificiation.
Topping the list of perceived benefits were "improved care for elderly patients"-both institutionalized and noninstitutionalized patients-and advancement of efforts to arrive at "valid, universal standards" of care for the elderly. Other frequently cited perceived benefits included enhanced professional credibility, personal satisfaction, and demonstration of competence. Perhaps surprisingly, economic and financial considerations-things like enhanced earning power and higher reimbursement-ranked far down on the list of perceived benefits.
While clearly not foremost in the minds of prospective certification candidates, financial rewards and enhanced leverage with payers will almost surely accrue to certified pharmacists-and the companies that employ them, says Clark.
"For pharmacy owners or employers, one major benefit will be the ability to demonstrate to current and prospective customers-nursing facilities, managed care organizations, or whatever the case might be-that the pharmacists it employs have demonstrated their skill in providing high-quality pharmaceutical services to an especially demanding patient population," he says. "If, for example, 50%-80% of a company's pharmacists are certified, it might say to clients, 'This company is a cut above the competition.'"
In addition, Clark points out, an investment in certification will also help companies meet the Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) human resources standards, which call for an accredited provider to continually assess, maintain, and demonstrate the competency of its employees. "For JCAHO-accredited pharmacies, as well as pharmacies seeking JCAHO accreditation, the certification program will provide an important new tool for meeting those standards."
For self-employed or employee pharmacists, the certificiation program will provide a powerful vehicle for attainment of professional growth, greater clinical responsibility-and enhanced job security.
"Clearly, the future of pharmacy lies in the application of clinical knowledge and clinical skills to influence patient care decisions and overall treatment outcomes-not in the dispensing function, which is increasingly being taken over by automation, bar-coding, and the like, says Clark. Pharmacists whose livelihoods still revolve around dispensing realize they need to go beyond that and show they have the knowledge and ability to do more. This program will give these pharmacists a way to demonstrate those skills and abilities in a concrete, credible fashion. Pharmacists who've been in practice for a while may find certification helpful in competing for job positions with younger PharmD graduates"-a group that currently comprises only about 10% of the profession but will soon swell as even more pharmacy schools transition to the PharmD-only curriculum.
"Regardless of your career path, degree status, or practice setting, certification in geriatric pharmacy practice will be a major feather in your cap," Clark says. "Especially in the current climate of downsizing and market consolidation, certification will be a powerful way for you to show that you have the ability to interact with patients in a clinically meaningful way-that you're able to do much more than sit behind the counter supervising technicians and counting pills.
"This will be an increasingly important distinction as pharmacists seek to market their services effectively to an expanding array of cost-, value-, and quality-conscious payers in an extremely competitive, dynamic marketplace," Clark notes.
To help pharmacists get ready for the certification exam, ASCP is working to assemble a variety of study resources and preparatory materials. ASCP Program Officer Caren McHenry Martin, who is coordinating these efforts, points out that the study materials will serve two equally important functions.
"The certification program is not intended to serve only as a mechanism for demonstration of already-acquired skills and expertise. Just as important, the program is intended to provide a pathway-a well-defined roadmap, if you will-to acquisition, development, and continuous updating of skills for those who are deficient in some areas. The idea is not, 'Here's the exam; sink or swim.' It's more like, 'If you're ready to sit for the exam, great. If you're not, here's how to obtain and hone the requisite skills and competencies.'"
In July, the certification commission will issue a "Candidate Handbook" containing application materials, a detailed description of program content and eligibility requirements, and CCGP policies and procedures.
The first batch of exam preparatory materials, slated for release
this summer, will reflect needs assessment, participants' strongly
expressed preference for printed study resources. Currently planned
materials include:
"As the program evolves," says McHenry Martin, "a variety of additional resources-perhaps including video or CD-ROM-based materials-will be developed."
Throughout the long process of certification program development, ASCP has striven to tap the input, involvement, and guidance of representatives of all major subsections of the pharmacy profession and long-term care community. "We cast a broad net to ensure that the program will be as broadly applicable as possible," says Clark.
"It would be a big mistake to view the certification program as an 'ASCP members-only' program, or even as a 'long-term care pharmacist-only' program. The program has been carefully designed to meet the needs of all pharmacists who serve geriatric patients, regardless of practice setting," he emphasizes. "Whether a pharmacist is serving geriatric patients in a hospital, ambulatory setting, or long-term care facility, the same basic patient-care principles apply."
As pharmacy providers ponder whether to pursue certification in geriatric practice, Clark urges them to keep in mind the ultimate thrust of the program. "Above all else, the program aims to enable pharmacists to be more astute, more effective clinical decision makers. By doing so, the program will bring the entire profession increased respect and credibility.
"Getting certified will certainly hold a variety of personal and professional benefits for individual pharmacists and the companies they operate or work for. But the ultimate beneficiaries-the biggest winners-will be the pharmacy profession and the patients it serves."
Michael C. Martin, a certification specialist with nearly 20 years
of experience implementing and managing quality and competency
assurance programs, was appointed the first director of the CCGP
in June.
Martin is responsible for overseeing all CCGP operations, including certification program development and implementation, exam administration, and issuance of credentials to qualified pharmacists.
Martin comes to CCGP after 18 years with the American Petroleum Institute, a Washington, D.C.-based trade organization with licensing, certification, and quality assurance programs in the United States and abroad. Martin held a variety of senior management positions with API, including coordinator of inspector certification programs. For the past three years, he served as head of API quality programs, managing all U.S. and global components of the Engine Oil Licensing and Certification System.
Martin was recently elected to a three-year term on the board of directors of the National Organization for Competency Assurance.
Respondent Practice Roles/Responsibilities
| Dispensing pharmacist | 44.6% |
| Hospital-based or academic-based pharmacist | 42.7% |
| Manager/administrator of one or more pharmacies | 32.0% |
| Full-time or part-time consultant pharmacist | 28.2% |
| Owner of one or more pharmacies | 17.0% |
| None of the above | 2.7% |
Degree of Expected Benefit from Certification, by Practice Setting
| LTC | Hospital | Retail | |
| Very beneficial | 60.9% | 43.8% | 30.9% |
| Moderately beneficial | 23.9% | 37.3% | 38.2% |
| Slightly beneficial | 6.5% | 13.8% | 21.3% |
| Not beneficial | 8.7% | 5.1% | 9.6% |
Motivating Factors
| Percent choosing as first or second choice | |
| Will lead to improved care for institutionalized elderly | 54.8% |
| Will lead to improved care of non-institutionalized elderly | 37.1% |
| Will result in valid, universal standards | 20.8% |
| Will give me greater credibility with prescribers and others | 19.3% |
| Will give me personal satisfaction | 14.3% |
| Will help me to demonstrate my professional competence | 12.9% |
| Will help me to differentiate my services | 12.5% |
| Will help me to market my services/be more competitive | 9.2% |
| Will give me greater job mobility or career advancement | 5.3% |
| Will help me to obtain higher reimbursement from clients | 3.7% |
| Will help me to get a higher salary from my employer | 1.8% |
| Will give me prestige among my co-workers and peers | 1.5% |
Level of Interest in Certification, by Years in Practice
| Years Licensed | Definitely/probably would apply to be certified |
| 0-5 | 76.0% |
| 6-10 | 68.4% |
| 11-20 | 56.6% |
| 21-30 | 53.5% |
| More than 30 | 52.5% |
Anticipated Time of Program Participation
| First six months | 23.8% |
| First year | 60.0% |
| Second year | 11.9% |
| Third year or later | 2.8% |
Preparatory Material Preferences
| Percent choosing as first or second choice | |
| Books/booklets | 67.9% |
| Videotapes | 67.7% |
| CD-ROM multimedia disk | 26.9% |
| Computer courses on diskette | 18.8% |
| Audiotapes | 7.65% |
| Other | 0.0% |
Sponsoring Organization Preference, by Practice Setting
| LTC | Hospital | Retail | |
| ASCP | 71.7% | 39.8% | 39.9% |
| APhA | 15.2% | 14.6% | 48.5% |
| ASHP | 8.7% | 39.8% | 1.8% |
| Other | 4.3% | 5.8% | 9.8% |
Note: The percent figures shown above indicate the approximate question distribution within each of the content areas shown below. The percent figures next to each content area indicate what percent of the disease specific portion of the examination will be devoted to each disease area.
Copyright © 1997, American Society of Consultant Pharmacists,
Inc. All rights reserved.