Response to AHCPR on CERTs:

Gary C. Stein, American Society of Health-System Pharmacists
December 18, 1998

The American Society of Health-System Pharmacists (ASHP) is pleased to provide comments on the November 3, 1998, Federal Register notice and request for nominations for topics of study and ideas for implementation of the Agency for Health Care Policy and Research's (AHCPR) new program, the Centers for Education and Research on Therapeutics (CERTs). ASHP is the 30,000-member national professional association that represents pharmacists who practice in hospitals, health maintenance organizations, long-term care facilities, home care agencies, and other components of health care systems.

ASHP believes that the following topics should be high priorities for research by the CERTs program:

  1. A study or studies to determine the most effective combination of written information and oral information for the purpose of fostering appropriate medication-taking behavior by patients. Consideration of written information should include determining the optimum characteristics of such information. Consideration of oral information should include the various health professionals who may be in contact with patients during the medication-use process.
  2. A study or studies to determine the most effective process for monitoring the medication outcomes of ambulatory patients in "real-word" situations. This type of study should include consideration of how the roles played by the several health professionals who are typically in contact with patients during the medication-use process can be changed or enhanced to foster optimum outcomes from medication use.
  3. A study or studies to determine the most effective ways to prevent medication errors in all settings-ambulatory care, acute care, long-term care, home care, etc.
  4. A study of patients discharged from a hospital with more than five medications, and how the high number of prescribed medications may have a negative impact on compliance with drug therapy. The study would relate this to patients' predisposition to toxicity or decision to not take their medications, either of which could lead to rehospitalization.
  5. A study or studies to determine the most effective ways to ensure that physicians, pharmacists, and others base their prescribing decisions, patient counseling behavior, and outcomes monitoring on the most current clinical research and authoritative therapeutic guidelines.
  6. A study to determine the feasibility of significantly improving medication use in the ambulatory care setting through an improved team relationship between the physician and pharmacist.

In terms of suggestions for implementing the CERTs program, ASHP makes the following recommendations:

  1. It will be important for each of the CERTs to include direct involvement by a college of pharmacy. Such involvement will provide the CERTs with access to appropriate expertise in clinical pharmacy practice and research, outcomes research, sociobehavioral research (related to both patients and health professionals), as well as the classical pharmaceutical sciences such as pharmaceutics, pharmacology, and pharmacognosy.
  2. In its November 3 Federal Register notice, AHCPR asked whether it would be appropriate for the CERTs to seek funding partners. ASHP believes that funding partners would certainly increase the resources available for research, and the CERTs should seek such partners, especially nonprofit foundations. One such foundation is the ASHP Research and Education Foundation, which, among other activities, funds patient care traineeship programs and quality research in pharmacy practice.

ASHP appreciates the opportunity to respond to AHCPR's request for suggestions of topics of study for the CERTs program.

Gary C. Stein, Ph.D.
Senior Government Affairs Associate
American Society of Health-System Pharmacists
gstein@ashp.org

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