In 1998, under the leadership of Dr. Dennis B. Worthen and a grant from Procter and Gamble, Inc, 22 instructors of nonprescription medicines and devices (self-care) met in Cincinnati, Ohio, for the first Nonprescription Medicines Academy (NMA). Through his experience, Dr. Worthen had recognized that there was no forum for teachers of self-care and an absence of self-care as a special interest group within existing pharmacy organizations. There was no body of self-care teachers to view or review self-care research, share new teaching methodologies and products, sharpen self-care andragogy (the art and science of helping adults learn), exchange resources, and establish a professional network for continual growth, development, and scholarship.
Over the succeeding 8 years, with Procter and Gamble's ongoing support, over 200 faculty members, representing many of the nation's colleges and schools of pharmacy, have joined the NMA. Annually, the NMA Conference has been organized to promote excellence in teaching self-care and mentoring and networking among faculty members, discuss issues in self-care, and exhibit and exchange methodologies for teaching pharmacy students about nonprescription medicines and devices. The NMA also maintains a web site (http://www.nmafaculty.org/
) that provides ongoing support and tools for self-care faculty members to use throughout the year. Through the conference and its web site, educators in self-care have found a voice and a mechanism to discuss ways to enhance self-care instruction within colleges and schools of pharmacy. Self-care instruction is conveyed in a myriad of methods embedded in curricula through various techniques. There are unique challenges for this instruction as well as significant congruence with prescription therapeutics instruction in pharmacy curricula. The NMA recognizes that the pharmacist's role in self-care and wellness is critical and that the National Association of Boards of Pharmacy (NABP) has increased content in this area on its pharmacist licensure examination. In addition, self-care faculty members found it valuable to obtain guidance from one another with regard to curricular time commitment, credit hours allocated, inclusion in core curricula, and dedicated instructional personnel, among others. The NMA believes it is essential for self-care instructors to serve as advocates of self-care instruction in colleges and schools of pharmacy.
The shared vision within NMA was to support a broad structure of nonprescription medication education; to provide examples of a minimum standard for quality and quantity of educational experiences in nonprescription medication education; and to describe methods for successful teaching of nonprescription therapy. This consensus originates out of a need for increased education as directed by changes in the marketplace, the North American Pharmacist Licensure Examination (NAPLEX), the Center for the Advancement of Pharmaceutical Education (CAPE) outcomes, and the Accreditation Council for Pharmacy Education (ACPE) Accreditation Guidelines.
Currently, self-care medicines and devices are primary or adjunctive therapy for over 500 medical conditions. The market for these drugs and devices (including dietary supplements) was approximately $34 billion in 2000.1
Historically, Congress divided those medications believed to be safe for self-selection from those requiring a prescription and oversight by learned intermediaries in 1951 through the Durham-Humphrey Amendment to the FD&C Act of 1938. Although there were comparatively few classes of prescription drugs in the 1960s, an explosion of new scientific discoveries in ensuing years led pharmacy education to transition away from extensive compounding of products and towards helping the patient/consumer in selection of nonprescription medicines in the era of “Clinical Pharmacy” during the 1970s and 1980s. Historically, clinical pharmacy had its roots in institutional practice where new therapeutic discoveries, pharmacokinetics, clinical clerkships, and emerging roles for pharmacists had immediate application. While the clinical pharmacy era was exciting for students and pharmacists, the majority of patients did not benefit from this initial shift in knowledge because few patients spent lengthy hospital stays annually in comparison to the population as a whole. In addition, the marketplace has observed an explosion of products and devices (including dietary supplements and former prescription medications switched to nonprescription status).
Patients selecting nonprescription products potentially have no intermediary clinician guiding them through the selection and appropriate use of those products. Variables impacting appropriate self-care use involve health literacy and literature interpretation of product labeling. In 2003, the National Council on Patient Information and Education (NCPIE) conducted a survey to determine consumer's use and attitudes regarding self-care products. They determined that 8% of consumers read nothing on the label prior to purchase. Over half (54%) failed to read the label to discover the active ingredient, 80% did not read the label to discover possible side effects, and 77% failed to read the label for dosage information.2
Patients need to be encouraged to ask the pharmacist when they have questions about nonprescription medications and pharmacists need to be more accessible to these patients. These data suggests that an increased risk of harm to the patient may exist because patients do not read the product label or seek the advice of a learned intermediary.
Academic pharmacy is renewing its interest in educating students regarding self-care products. Historically, the discipline of “self-care” has not been supported with special interest groups within pharmacy organizations. In addition, the variety of faculty disciplines assigned for course instruction, limited presence in the curriculum, and the lack of job postings specifically calling for self-care faculty positions indicate that more attention should be paid to self-care in pharmacy education. All too often, the self-care curriculum has been a faculty member's collateral duty. With the number of self-care products purchased annually increasing at a steady rate, the increasing number of drug changes from prescription to nonprescription status, the degree of potential drug or disease interactions, and lack of safety and efficacy data on dietary supplements, pharmacists need increasing knowledge and skills to help guide/advise their patients.
For example, an emerging pertinent curricular deficiency lies within dietary supplements (herbals and nutritional supplements). These products have become a new category of unproven “drugs” through the passage of the Dietary Supplement Health and Education Act (DSHEA). As a result, these products bypass the physician/pharmacist/patient triad when purchased directly by the consumer. These products are not vetted by the FDA for safety and efficacy, although they are marketed with various health-related claims. This, also, is one of the most rapidly evolving therapy areas. For example, in 1999, St. John's wort ranked second on a list of most frequently purchased dietary supplements. By 2002, it had dropped to sixth due to increased knowledge of drug or disease interactions (eg, 34 drugs or classes of drugs are currently listed). Other dietary supplements have similar paths of perceived efficacy and anecdotal evidence.3
In certain circumstances, dietary supplements can represent a dangerous therapeutic “wild card” where pharmacists are the most proximal learned intermediaries.
Self-care is a direct application of pharmaceutical care or pharmacist-assisted self-care. Academic pharmacy must stay abreast of this area by educating competent pharmacists who can help patients determine the risk/benefit ratio of using these products. Integrating self-care products into therapeutics courses or using cases in a practice laboratory without a standalone self-care course is insufficient to prepare students for the demands of relevant practical knowledge that patients require. For these reasons the teachers of self-care, meeting over the past 8 years, have decided to collectively voice our recommendations that instruction on self-care should assume a paramount importance in the education of pharmacy students.
Writing for the NMA, the authors of this paper model the current state of self-care instruction in colleges and schools of pharmacy across the nation. Self-care instruction should be given status befitting its prevalence and importance in health care and the same principles and intensity of andragogy should be applied to self-care therapeutics as exist in other instructional areas in the nation's pharmacy programs. To that end, this manuscript addresses the following issues in self-care instruction: core curriculum, instructional methodologies, course mechanics, existing standards, assessment, curriculum placement, and quantity of instruction.