Editorial
LiJ
Measuring Up To The Challenge
Knoben reports in this Journal (page 614), "the PSRO program has established without equivocation that the non-physician health care practitioner is to be involved in both a PSRO advisory and review capaci-
Peer review is a much-used term which has been defined in many ways. To some it reflects judgments by "like-trained" professionals such as physicians reviewing physicians, pharmacists reviewing pharmacists and dentists reviewing dentists. Others feel that peer review entails members within certain specialties of practice reviewing other "like-trained" specialists. The development of the peer review concept has given rise to many definitions. As early as 1928 Dr. Thomas R. Ponton introduced the "medical audit," and when Congress enacted Public Law 89-97 in 1965 establishing Medicare and Medicaid, the legislation provided that services for beneficiaries in hospitals and extended care facilities be subjected to a utilization review. Concluding its work in 1969, the HEW Task Force on Prescription Drugs recommended more research in the development of drug utilization programs, and on June 16, 1970, APhA Executive Director William S. Apple stated before the U.S. Senate Committee on Finance that "the most important aspect of drug utilization review, and one for which the pharmacist can make the greatest contribution, is the assurance of rational drug prescribing and dispensing practices." On October 30, 1972, Congress passed what T. Donald Rucker called, "the most significant piece of health care legislation since the passage of Medicare and Medicaid ." In fact, Public Law 92-603 was enacted in response to the need for a more effective medical care review system than had been previously required under the Medicare and Medicaid as well as the maternal and child health programs. The legislation is based on the concepts that health professionals are the most appropriate individuals to evaluate the quality of medical services and that effective peer review at local levels is the soundest method for assuring the appropriate use of health care resources and facilities. The mechanism for achieving these goals is the establishment of Professional Standards Review Organizations (PSROs). As currently structured under the 1972 Amendments to the Social Security Act, only doctors of medicine or osteopathy can be members of a PSRO. But, as James E.
Vol. NS 15, No. 11, November 1975
ty." On July 25, 1973, John D. Twiname, in discussing PSROs, told the APhA Annual Meeting in Boston that he was hopeful that pharmacists would become "a full partner in utilization review"; and two months later in an address to the Iowa Pharmaceutical Association, APhA's Richard P. Penna advised that "the pharmacy profession must give serious consideration to deciding which of its services appropriately should be reviewed by PSROs and which of those should be reviewed by pharmacists under the control of pharmacists." On the recommendation of the APhA Policy Committee on Professional Affairs, the APhA House of Delegates adopted the following pOlicies on April 24, 1975, at the APhA Annual Meeting in San Francisco"1. The Association advocates active involvement of pharmacists in the development of professional standards review procedures and the review process itself, since the success of such review in maintaining the quality and appropriateness of health care is dependent upon informed participation. "2. Pharmacists should work through their state and/or local pharmaceutical associations to participate in the activities of PSROs. "3. The Association should develop programs to assist state and local pharmaceutical associations in their participation with PSROs." At the same Annual Meeting, the APhA House of Delegates adopted the recommendation of the Policy Committee on Public Affairs that "APhA supports amendment of the Social Security Act to make pharmacists eligible for membership in PSROs." This August, a statement entitled "PSROs and Pharmacy" prepared by APhA and the American Society of Hospital Pharmacists (ASHP) was sent to all state pharmaceutical associations and all state societies of hospital pharmacists.
The statement notesPharmacists may participate in PSRO activities on two levels: (a) The PSRO levelas members of advisory groups to PSRO councils or to PSROs themselves, and (b) at the practice level-participating in the review process in hospitals which have been delegated review by PSROs or in providing data on pharmaceutical service for review by PSROs. APhA and ASHP promise to provide in the near future a complete glossary of terminology used in PSROs to assist pharmacists in familiarizing themselves with the unique language of professional service review; updated listings of PSROs; a recommended basic structure for a review mechanism; models which can be utilized by pharmacists in PSROs for establishing standards, norms, and criteria for pharmaceutical service (see definitions on pages 614-615); and current national developments as they affect PSROs loca.lly. Pharmacy's participation in the PSRO movement is a new experience for all concerned. Therefore development of materials for use by pharmacists relies heavily on the "feedback" received. Potential changes in the PSRO program make your personal experience with PSROs invaluable. APhA and ASHP specifically ask for the names of individuals who serve on PSRO advisory groups or who are otherwise involved in PSRO activities; documents which have been developed in connection with pharmacists' participation in PSROs; a review of problems encountered along with steps which have been or are being taken to meet these problems; and descriptions of achievements (e.g., number of pharmacists on advisory groups, acceptance of pharmacist's recommendations for review, etc.) made at the local level. The long-range nature of the PSRO movement and the impact that it will have on every facet of pharmacy practice demands that programs developed by pharmacists to be utilized by PSROs be devised with great care. Furthermore, such programs will require continual revision based on actual experience and "feedback." How well the pharmacist measures up to this new challenge depends on you.
613
LiJ
Measuring Up To The Challenge
Knoben reports in this Journal (page 614), "the PSRO program has established without equivocation that the non-physician health care practitioner is to be involved in both a PSRO advisory and review capaci-
Peer review is a much-used term which has been defined in many ways. To some it reflects judgments by "like-trained" professionals such as physicians reviewing physicians, pharmacists reviewing pharmacists and dentists reviewing dentists. Others feel that peer review entails members within certain specialties of practice reviewing other "like-trained" specialists. The development of the peer review concept has given rise to many definitions. As early as 1928 Dr. Thomas R. Ponton introduced the "medical audit," and when Congress enacted Public Law 89-97 in 1965 establishing Medicare and Medicaid, the legislation provided that services for beneficiaries in hospitals and extended care facilities be subjected to a utilization review. Concluding its work in 1969, the HEW Task Force on Prescription Drugs recommended more research in the development of drug utilization programs, and on June 16, 1970, APhA Executive Director William S. Apple stated before the U.S. Senate Committee on Finance that "the most important aspect of drug utilization review, and one for which the pharmacist can make the greatest contribution, is the assurance of rational drug prescribing and dispensing practices." On October 30, 1972, Congress passed what T. Donald Rucker called, "the most significant piece of health care legislation since the passage of Medicare and Medicaid ." In fact, Public Law 92-603 was enacted in response to the need for a more effective medical care review system than had been previously required under the Medicare and Medicaid as well as the maternal and child health programs. The legislation is based on the concepts that health professionals are the most appropriate individuals to evaluate the quality of medical services and that effective peer review at local levels is the soundest method for assuring the appropriate use of health care resources and facilities. The mechanism for achieving these goals is the establishment of Professional Standards Review Organizations (PSROs). As currently structured under the 1972 Amendments to the Social Security Act, only doctors of medicine or osteopathy can be members of a PSRO. But, as James E.
Vol. NS 15, No. 11, November 1975
ty." On July 25, 1973, John D. Twiname, in discussing PSROs, told the APhA Annual Meeting in Boston that he was hopeful that pharmacists would become "a full partner in utilization review"; and two months later in an address to the Iowa Pharmaceutical Association, APhA's Richard P. Penna advised that "the pharmacy profession must give serious consideration to deciding which of its services appropriately should be reviewed by PSROs and which of those should be reviewed by pharmacists under the control of pharmacists." On the recommendation of the APhA Policy Committee on Professional Affairs, the APhA House of Delegates adopted the following pOlicies on April 24, 1975, at the APhA Annual Meeting in San Francisco"1. The Association advocates active involvement of pharmacists in the development of professional standards review procedures and the review process itself, since the success of such review in maintaining the quality and appropriateness of health care is dependent upon informed participation. "2. Pharmacists should work through their state and/or local pharmaceutical associations to participate in the activities of PSROs. "3. The Association should develop programs to assist state and local pharmaceutical associations in their participation with PSROs." At the same Annual Meeting, the APhA House of Delegates adopted the recommendation of the Policy Committee on Public Affairs that "APhA supports amendment of the Social Security Act to make pharmacists eligible for membership in PSROs." This August, a statement entitled "PSROs and Pharmacy" prepared by APhA and the American Society of Hospital Pharmacists (ASHP) was sent to all state pharmaceutical associations and all state societies of hospital pharmacists.
The statement notesPharmacists may participate in PSRO activities on two levels: (a) The PSRO levelas members of advisory groups to PSRO councils or to PSROs themselves, and (b) at the practice level-participating in the review process in hospitals which have been delegated review by PSROs or in providing data on pharmaceutical service for review by PSROs. APhA and ASHP promise to provide in the near future a complete glossary of terminology used in PSROs to assist pharmacists in familiarizing themselves with the unique language of professional service review; updated listings of PSROs; a recommended basic structure for a review mechanism; models which can be utilized by pharmacists in PSROs for establishing standards, norms, and criteria for pharmaceutical service (see definitions on pages 614-615); and current national developments as they affect PSROs loca.lly. Pharmacy's participation in the PSRO movement is a new experience for all concerned. Therefore development of materials for use by pharmacists relies heavily on the "feedback" received. Potential changes in the PSRO program make your personal experience with PSROs invaluable. APhA and ASHP specifically ask for the names of individuals who serve on PSRO advisory groups or who are otherwise involved in PSRO activities; documents which have been developed in connection with pharmacists' participation in PSROs; a review of problems encountered along with steps which have been or are being taken to meet these problems; and descriptions of achievements (e.g., number of pharmacists on advisory groups, acceptance of pharmacist's recommendations for review, etc.) made at the local level. The long-range nature of the PSRO movement and the impact that it will have on every facet of pharmacy practice demands that programs developed by pharmacists to be utilized by PSROs be devised with great care. Furthermore, such programs will require continual revision based on actual experience and "feedback." How well the pharmacist measures up to this new challenge depends on you.
613
