An attitudinal studya need to develop better interprofessional relations
"If both the pharmacist and the veterinarian fully appreciate the abilities bf each, and make use of the combined knowledge and talents that each possesses; and each exercise good faith in the business relationship, our traditional battles will be overcome." 1 Twenty years after that statement was made, one finds that the traditional battles have not been overcome. While much progress has been made, there is still a lack of understanding and cooperation between the two professions. Unfortunately, it is no surprise to read the following-"It's obvious to everyone that the only special qualification of a pharmacist is to fill prescriptions . Any over-the-counter drugs he sells can be sold by a farm store dealer, grocer or anyone else who chooses to stock his shelves with the products." 2 Two major problems cited for impeding pharmacy-veterinary medicine relations were "(1) the pharmacist who presumes to practice veterinary medicine by 'counterdiagnosis ' and 'counter-prescribing' and (2) the veterinarian who is as much interested in merchandising drugs as in offering professional services." 3 The same philosophy was expressed as " . .. the veterinarian who appears to be a part-time pharmacist, and the pharmacist who appears to be a 'moon-lighting' veterinarian ." 4 From these statements, it seems obvious that there isn't as strong a triad of pharmacist-veterinarian-animal as exists between pharmacist-physician-patient. Because of community or public health involvement, this relationship becomes more than personal and interprofessional. 5 At the present time, there are more than 100 diseases that animals can transmit to man and new ones are being periodically recognized. 6 On the other hand, man may transmit some diseases to animals either directly or indirectly. Both pharmacists and veterinarians must participate in educating the public in regard to care and treatment of animals. 4 The pharmacist should not only refer definitely sick animals to the veterinarian but he must inform patients at the appropriate time about transmissible diseases. In order that pharmacists can be effective as members of the health care team, they must have some understanding about animal and transmissible diseases, drug dosages and treatment. Pharmacy schools recently surveyed showed that 41 percent were teaching a course similar to veterinary pharmaceuticals while 25 percent were planning to implement one. 5 In one school, when asked " In what ways do you feel that
relations between the pharmacy and veterinary medical professions can be improved?", undergraduate pharmacy students responded that the agricultural pharmacy course helped them in understanding some of the veterinarians' problems .7 Where pharmacy and veterinary schools are located on the same campus, a joint course could be offered which would be beneficial to both future practitioners . The American Pharmaceutical Association has been involved for more than four decades in promoting greater interprofessional relationships between pharmacists and members of the public health professions .s The " Pharmacist-Veterinarian Code of Interprofessional Relations" resulted from the establishment of the Commission on Pharmacy and Veterinary Medicine. 9 The first sentence of this code states that its purpose is " ... to improve relations between doctors of veterinary medicine and pharmacists. " Educators, students and practitioners of both professions should read and become familiar with this code . The Commission has met at the following places-Chicago in 1970, Denver in 1971 and Austin, Texas in 1972. Veterinary and pharmacy officials from surrounding state associations and schools of pharmacy and veterinary medicine were invited to participate. According to Richard Penna, APhA's assistant executive director for professional affairs,10 the purpose of
the meetings was to stimulate relationships between pharmacy and veterinary medicine on a state and local level. As a result of other Commission Action, a "Comparative Guide of Veterinary and Human Pharmaceuticals" was published. 11 While published articles point out the need for better inter professional relations between the two professions, there has been little or no attempt in probing the actual practices and attitudes. The purpose of this study is to collect some descriptive data as well as look at attitudes existing between pharmacists and veterinarians . Method The entire state of Georgia was selected as the study area . In July 1973, separate questionnaires were mailed to approximately 3,000 pharmacists and 625 veterinarians; many of these were not actively practicing for various reasons. In order to make comparisons, similar attitudinal questions were asked of both practitioners. The data was computerized and compared by employing various non-parametric techniques. Research Findings Although a considerable amount of data were collected from the responses of the questionnaire, only selected segments are reported in this paper. The results are based on 317 pharmacy and 137 veterinaTable Iia
Joint Meeting Ouestion b
- --- --------------------------- ----_.-
Pro fessio n
315 (69.8 %) 136 (30.2%)
315 (69.8 %) 136 (30.2 %)
73 (1 6.2%)
378 (83 .8%)
a x 2 = 5.59 ( si gnif ican t), df = 1 b " Are yo u awa r e th at th e AP h A a n d th e AVMA estab li shed a Comm i ss i o n o n Phar macy a nd Ve t e rin ar y Medic in e in 1 9 6 5 ?"
a x 2 = 33 .59 ( sign i f ican t), d f = 1 b " Have you eve r at t e n ded a professi o na l m eeting w h e r e th ere we r e p h a r mac ists an d ve t e r inar ia n s in att en d an ce? "
Formal Course b
Agree with Reservations
Disagree wi th Reservati ons
50 (1 1.3%)
41 (9.3 %)
DVMED Total a x2
187 (4 2.2%)
165 (37 .2%)
78. 8 0 (si gnificant), df 3 b "Each sc h oo l of p ha r ma c y sh o ul d in c l ude a co urse o n an ima l produc t s a n d di seases in it s curriculu m ."
JOURN AL OF THE AMERICA N PHARMACEUTICA L A SSOCI ATION
by Edward D. Sumner, Jeffrey A. Kotzan and Durward N. Entrekin
ry responses respectively. There were missing observations in some questions. It was found that the pharmacists surveyed had been in practice for an average of 20.7 years as compared to 13.6 years for the veterinarians. To the question, "How many miles is the nearest pharmacy from your office?" veterinarians gave an average answer of 0.9 miles. Pharmacists were asked, "How many miles is the nearest veterinary practice from your pharmacy?" to which they responded 4 miles. The responses to this question are significantly different and is probably the result of a professional-social artifact. There appears to be a greater professional gap as viewed by the pharmacist than on the part of the veterinarian. Table I (page 454) shows a cross tabulation on the question, "Are you aware that the American Pharmaceutical Association and the American Veterinary Medical Association established a Commission on Pharmacy and Veterinary Medicine in 1965?" The results indicate a significant difference at the 0.05 level, which means that after 10 years, pharmacists are less aware of organized efforts to improve relationships. Perhaps, the responsibility falls more on the educators and professional organizations rather than the practitioners. More emphasis should be placed in the local and state organizations. One of the reasons pharmacists and veterinarians are not aware of organized efforts is demonstrated in the responses for the question, "Have you ever attended
Counter-Diagnosis and Counter-Prescribing b
Disagree with Strongly Agree with Reservations Reservations Disagree
303 (69.5 %)
133 (30.5 %)
57 (13.1 %)
207 (47.5 %)
= 4.25 (insignificant), df = 3 b "Pharmacists have a tendency to practice veterinary medicine by counter-diagnosis and counterprescribing."
a professional meeting where there were pharmacists and veterinarians in attendance?" Again, there is a significant difference in professions attending and not attending such a meeting. Table II (page 454) shows that only 10 percent of both groups have attended a joint meeting. Out of the 10 percent stating that they had attended jOint meetings, 69 percent were veterinarians. The results of this question points out the need for combined local and state joint meetings. Both professionals were asked to respond to the following, ''There should be occasional joint meetings for pharmacists and veterinarians." These results were as follows: 48.6 percent strongly agreed, 43.9 percent agreed with reservations, 5.8 percent disagreed with reservations, 1.8 percent strongly disagreed. There was no significant difference in the way pharmacists and veterinarians responded at the 0.05 level of significance. This confirms that while the professions are attending few
joint meetings, the majority thinks that there should be occasional ones. As mentioned previously, individuals from both professions have been advocates of including a formal course on animal products and diseases in schools of pharmacy. Table III (page 454) shows a significant difference in the responses of pharmacists and veterinarians to the question, "Each school of pharmacy should include a course on animal products and diseases in its curriculum." Approximately 90 percent and 56 percent of the pharmacists and veterinarians agreed respectively. The questionnaire was not designed to determine whether these responses were economically or professionally oriented. Even though the results are not statistically different, it may be of interest to look at the responses given for the question, "Pharmacists have a tendency to practice veterinary medicine by 'counter-diagnosis' and 'counter-prescribing.'" In Table IV (above) it can be observed that the major i-
Pharmacy-Veterinary Interchange Pharmacy students watch local veterinarians perform surgery as part of an unusual class at the University of the Pacific. Small Animal Surgery is the title of a one unit school of pharmacy course offered each semester under the direction of Howelll. Runion, associate professor of physiologypharmacology. The course requires students to attend ten surgical operations performed by local veterinarians and file a report on each one. The students also have the option of a term paper report on a disease that can be transmitted from animals to people. The class is so popular that the original enrollment of 25 has been increased to 40. "We feel there are several reasons for this course to be offered," explained Runion, who originated the idea some four years ago. "For example, this gives the student a chance to observe the
NS15,No. 8,AuGUST 1975
immediate action of drug use. The student can converse with the veterinarian as to why a particular drug was chosen over some other. This direct observation and dialogue is extremely valuable to the student of pharmacy by providing real application of pharmacological principles. Runion feels this type of program also goes a long way toward developing an increasing respect between veterinarians and pharmacists as members of the health care field. He stressed that the veterinarians are very much a part of the community health care team because numerous infections are transmitted from animals to people. "Our students become aware of the services and expertise of the veterinarian, and they should because these people do prescribe medicine which may be filled by the pharmacist, " he concluded.
ty of pharmacists and veterinarians agree with this statement. A question was designed to determine if increased prescribing would bring about better relations between pharmacists and veterinarians. There was a significant difference in the way both professions answered this question. As can be seen, in Table V (at right), the vast majority of the pharmacists strongly agreed with this statement while the veterinarians did not support it as strongly. Surprisingly, only 6.5 percent of both professions disagreed with the statement. Again, it was not determined why either pharmacists or veterinarians thought that relations would improve if there were an increase in prescribing habits. Summary An attitudinal study of pharmacy-veterinary medicine was conducted in Georgia by using questionnaires. In order to make comparisons, similar questions were asked of both practitioners. The data was computerized and compared employing various non-parametric techniques. The results indicated the following1. Probably as a result of a professionalsocial artifact, there appears to be a greater professional gap as viewed by the pharmacist than on the part of the veterinarian. 2. Even though a Commission on PharmaEdward D. Sumner
Veterinary Prescribing b
- - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ------ - -
302 (69.3 %)
134 (30. 7%)
DVM ED Total
Agree with Disagree wi th Reservations Reservations
122 (28 %)
= 55 . 14 (significant), df = 3 b "Increased veterinary prescribing will help bring about bette r relat i ons between the pharm acist an d veter inarians."
cy and Veterinary Medicine was formed in 1965, the pharmacists are less aware of organized efforts to improve relationships than veterinarians. 3. Only 10 percent of the sampled Georgia pharmacists and veterinarians stated that they had attended joint meetings. However, the majority of both groups thought that there should be occasional ones. This pOints out a need for more involvement on a local and state level. 4. While the questionnaire was not designed to test economical or professional responses, pharmacists were more favorable toward the inclusion of a course on animal products and diseases in the pharmacy curriculum than were veterinarians. 5. The majority of both professions agreed that pharmacists have a tendency to Edward D. Sumner, PhD, is professor of pharmacy at the Medical University of South Carolina college of pharmacy . He earned his BS in pharmacy from the Medical University of South Carolina , and an MS and PhD from the University of North Carolina . Sumner has practiced both community and institutional pharmacy . His research interests include clinical pharmacy programs, interprofessional relationships and medication profiles of senior citizens. He is a member of APhA, ASHP, AACP, Sigma Xi and Rho Chi. Jeffrey A. Kotzan, PhD , is associate professor of pharmacy care administration at the University of Georgia school of pharmacy . He received his BS in pharmacy from Purdue University and is a registered pharmacist in Georgia and Indiana. He obtained his MS and PhD from Purdue University where he specialized in consumer psychology and pharmaceutical care . Among his memberships are APhA, American Public Health Association, AACP, Rho Chi, Phi Kappa Phi and Sigma Xi. He has contributed numerous articles in pharmaceutical, educational and marketing research journals.
Durward N. Entrekin
Durward N. Entrekin, PhD, is professor of pharmacy and associate dean of the University of Georgia school of pharmacy. He earned his BS at the University of Georgia and his MS and PhD at the University of Florida . He holds a Georgia license to practice the profession. Entrekin was employed as a research associate for E. R. Squibb & Sons prior to joining the faculty at University of Georgia . His memberships include APhA, AACP, Georgia Pharmaceutical Association, Rho Chi and Kappa Psi.
12 (2.8 %)
Jeffrey A. Kotzan
16 (3. 7%)
practice veterinary medicine by 'counter-diagnosis ' and 'counter-prescribing' . 6. Only 6.5 percent of both groups disagreed with the statement that increased prescribing would bring about better relations . In conclusion , the pharmacist does have an important role in the triad of pharmacist-veterinarian-animal. However, the results of this study indicate that there must be a vast improvement in communicating and understanding the problems of each. Specific roles of professional responsibility need to be developed on a local and state level-the Pharmacist-Veterinarian Code of Interprofessional Relations can be a useful tool in this direction . • Acknowledgment The authors wish to acknowledge the valuable assistance lent by Lester M. Crawford, DVM, PhD, associate dean for continuing education, college of veterinary medicine, University of Georgia, in formulating the final questionnaire, and the school of pharmacy of the University of Georgia for its financial support.
References 1. Knapp , W.A., " The Prescription, The Pharmacist , The Veterinarian, " The Southeastern Veterinarian, VIII, 11 (Fall 1955) 2. Editorial Comment , " What's Going On? " Hog Farm. Mgmt., 7 (Aug . 1968) 3. Jones, M.L., " Pharmacy and Veterinary Medicine," JAPhA , NS6, 144 (1966) 4. Schroeder, R.J., " Veterinarians and Rx Men Can Help Each Other! " Am. Prof. Pharm. , 31 (May 1968) 5. Zopf, L.C ., " Pharmacy-Veterinary Medicine Relations ," JA PhA , NS11, 168 (1971) 6. Huebner, R.A ., " Veterinary Services, " in Remington 's Pharmaceutical Sciences, 14th Edition , Mack Publishing Co ., Easton , Pa ., 1859 (1970) 7. McCulloch, W.F., " Socioeconomic Aspects of Pharmacy-Veterinary Medical Relations, " JAVMA, 149, 12, 1518 (1966) 8 . Griffenhagen, G.B., " Mobilizing Our Enormous Potential," JAPhA , NS11, 153 ( 1971) 9 . Anon ., " Pharmacy-Veterinary Link ," JAPhA, NS6, 671 (1966) 10. Personal Communication , Richard P. Penna , executive secretary, Academy of General Practice of Pharmacy, APhA (June 10, 1971) 11 . Hansell, D.N. and Scheu, J.D., " Comparative Guide of Veterinary and Human Pharmaceuticals ," APhA Academy of General Practice of Pharmacy (1973)
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