Abstract
Objective. To explore the availability of veterinary pharmacy didactic and experiential learning opportunities in US pharmacy programs.
Methods. A 23-item questionnaire was sent to subscribers of the American Association of Colleges of Pharmacy Curriculum and Pharmacy Practice listservs, which reach 2,098 participants and 141 pharmacy programs. The Fisher exact test was used to evaluate the association of offering a didactic course and accepting credit from an outside program for veterinary pharmacy course and between pharmacy programs offering a veterinary didactic course and being affiliated with a Doctor of Veterinary Medicine program. All analyses were conducted using SPSS, version 26.
Results. Questionnaire response rate was 61% (86/141). Twenty seven percent (23/86) of pharmacy programs reported offering a didactic veterinary pharmacy course and 60% (52/86) reported having experiential rotation opportunities. Pharmacy programs that do not offer a veterinary pharmacy course, were not more or less likely to accept outside credit to gain didactic knowledge. Pharmacy programs geographically associated with a veterinary school were more likely to offer didactic as well as experiential opportunities.
Conclusion. Pharmacy programs were twice as likely to have experiential opportunities in veterinary pharmacy compared to didactic opportunities, leaving room for curricular development. With most graduating pharmacists choosing to work in the community pharmacy setting and the growth of veterinary pharmacy at several national corporate pharmacy chains, it would be advisable for pharmacy programs to expose students to veterinary pharmacy whether as a didactic course and/or an experiential rotation.
INTRODUCTION
After graduating from a Doctor of Pharmacy program accredited by the Accreditation Council for Pharmacy Education (ACPE), more than half of practicing pharmacists in the US work in a community pharmacy setting where they are expected to fill prescriptions for human and non-human patients, despite learning predominately only human pharmacology and pharmacotherapy.1 Studies have found that pharmacists feel less than confident in their ability to verify veterinary prescriptions, and this is likely because of the limited amount of veterinary pharmacy education they received in pharmacy school.2,3 In 2014, the National Association of Boards of Pharmacy (NABP) recognized the need for veterinary pharmacy education with resolution 110-5-14 that “encourage(s) the development and availability of veterinary pharmacology education in collaboration with schools of veterinary medicine” and that “pharmacists dispensing medications for veterinary patients possess competence and have access to resources necessary to appropriately dispense and provide care.”4 The American Veterinary Medical Association (AVMA) issued a similar resolution, Resolution No. 8, in 2012 stating AVMA’s commitment to engage proactively with pharmacy stakeholders to ensure the health and welfare of animals receiving prescription drugs dispensed by licensed pharmacists. In that resolution, the AVMA emphasized a need to “promote best practices in dispensing to animal patients, such as licensed pharmacist training in veterinary pharmacology.”5 Finally, the American Pharmacists Association has also begun the process of redefining the term patient to include human and non-human species since pharmacists are the only health care professional licensed to provide care to human and veterinary patients.6
Veterinary pharmacy is a growing sector of pharmacy, with national corporate pharmacy chains advertising their ability to fill veterinary prescriptions without subsequently expanding pharmacist training so that pharmacists can effectively verify these prescriptions.7 Because veterinary prescriptions are not bound by traditional insurance limitations and reimbursements, including Direct and Indirect Remuneration (DIR) fees, they represent a “cash” business for pharmacies. Therefore, some corporate pharmacy chains and other organizations have backed the Fairness to Pet Owners (FTPO) Act (H.R. 1607), which would require veterinarians to give pet owners a paper copy of all prescriptions so they have a choice of where they fill their pet’s prescription(s).8 If the FTPO Act passes, community pharmacies are likely to see an influx of veterinary prescriptions mainly because of the availability of low-cost generic lists and the better buying power of community pharmacies compared to small veterinary clinics. Furthermore, veterinarians have routinely expressed concerns about sending prescriptions to community pharmacies because of the lack of appropriate veterinary pharmacy training that their pharmacists have.9 This concern is not unfounded. A questionnaire conducted by the Oregon Veterinary Medical Association found that 35% of responding veterinarians had experienced a pharmacist changing a dose or medication for a patient without consulting them.10
Although interprofessional collaboration has long been encouraged in pharmacist training, establishing relationships with veterinarians seems to have lagged behind building relationships with physicians and other human health care professionals. A 2013 study surveying over 700 veterinarians across the United States found that they interacted the most with pharmacists and that respondents felt they could positively affect pharmacists by explaining specific challenges in treating veterinary patients.11 Pharmacists dispensing veterinary prescriptions are bound by corresponding liability, which the Drug Enforcement Agency (DEA) via 21 CFR.1306.04 defines as a responsibility upon the prescriber for proper prescribing and dispensing but “a corresponding responsibility rests with the pharmacist who fills the prescription.” Notably, the DEA’s Controlled Substances Act applies to all controlled substance prescriptions, regardless of the patient’s species. Ethically, it is important that pharmacists have enough knowledge of veterinary pharmacology to correctly verify veterinary prescriptions.12 However, the availability of veterinary pharmacy didactic and experiential offerings at US pharmacy programs has not been described. Understanding the training pharmacy students receive in this area and their ability to correctly verify veterinary prescriptions as a result of the training would be helpful. Thus, the objective of this study was to evaluate the availability of current didactic and experiential opportunities in veterinary pharmacy for students at pharmacy programs with an Accreditation Council for Pharmacy Education (ACPE) designation (accredited, candidate, pre-candidate, probation).
METHODS
A 23-item questionnaire was created in Google Forms and sent to members of the American Association of Colleges of Pharmacy (AACP) via their Curriculum and Pharmacy Practice listservs. The link to the Google Form was sent out on September 10, 2020, and the survey was closed to responses on December 1, 2020. Binary (yes/no), multiple choice, select all that apply, and free response type questions were used in the questionnaire. Respondents were told it would take approximately 10 minutes to complete the survey. Questions included the presence or absences of didactic courses in veterinary pharmacy, the respective credit hours, credentials of instructors, class resources, presence of experiential opportunities, location of these opportunities, and opportunities for outside credit in veterinary pharmacy course(s), among other questions. Following completion, any duplicate submissions (ie, multiple faculty members at the same program submitted a response) for a pharmacy program were reconciled. Any incomplete responses were investigated by contacting the program directly, and if the program did not respond, the data was excluded from analysis. Investigators followed up with any pharmacy programs that had not responded via email to encourage questionnaire completion. In total, the questionnaire was sent to 2,098 participants. Only responses from pharmacy programs with an ACPE designation (ie, accredited, candidate, pre-candidate, or probation) were included for analysis. In some cases, inconsistent reporting occurred (eg, two faculty members from the same program reported different information). The investigators reconciled the data by accessing information on the pharmacy program’s website as well as by contacting a representative from the respective pharmacy program prior to data analysis. If information could not be verified or obtained, the data in question was excluded from analysis.
Demographics of the responding programs were evaluated using descriptive statistics. The Fisher exact test was used to evaluate the association between offering a didactic course and accepting credit from an outside program for a veterinary pharmacy course and between pharmacy programs offering a veterinary didactic course and being geographically associated with a veterinary program. All analyses were conducted using SPSS, version 26, and an a priori alpha of 0.05. This study was approved by the University of Missouri-Kansas City Institutional Review Board.
RESULTS
This study received 126 responses from 86 pharmacy programs in the United States. Duplicate responses were reconciled prior to data analysis for a final total of 86 responses from ACPE-designated pharmacy programs. At the time the questionnaire was deployed (September 2020), there were 141 ACPE-designated pharmacy programs.13 Of these programs, 96% (n = 135) were accredited, 2.8% (n = 4) were candidate schools, 0.7% (n = 1) was pre-candidate, and 0.7% (n = 1) was on probation. As of March 2021, an additional school was seeking pre-candidate status but was not included in our analysis. Therefore, our response rate was 61% (86/141) with 27% (23/86) of responding programs offering a didactic veterinary pharmacy course and 60% (52/86) offering an advanced pharmacy practice experience (APPE) in veterinary pharmacy.
Twenty-three programs confirmed they had a dedicated didactic course for veterinary pharmacy. Additionally, 23 programs (not the exact same schools) said they allowed their students to take a veterinary pharmacy course outside of the school for credit. Notably, pharmacy programs that did not offer a didactic veterinary pharmacy course were not more or less likely to accept outside credit for a veterinary pharmacy course (p = .66). An additional 12 respondents indicated that they had offered a veterinary pharmacy didactic course in the past, but it was currently not offered.
Course coordinator credentials for didactic veterinary pharmacy courses varied widely, with pharmacists (defined as having a Doctor of Pharmacy degree or Bachelor of Pharmacy [BSPharm] degree, but no other degrees, with or without board certification in veterinary pharmacy) being the most common (60%, n = 12/20) Notably, of all course coordinators with pharmacist credentials (including dual-credentialed), only 40% (n = 6/15) were board-certified in veterinary pharmacy and signified as a Diplomate of the International College of Veterinary Pharmacy (DICVP). Of respondents, four (15%) had a DVM degree and four (20%) had a PhD.
Most of the pharmacy programs (96%) offered only one course in veterinary pharmacy and awarded a median of one credit hour. Twenty-one of the responding pharmacy programs indicated the size of their veterinary pharmacy elective class, with 48% (n = 10) accommodating only 11-20 students per course offering. The most reported resource used in veterinary pharmacy didactic courses was Plumb’s Veterinary Drugs (34%,), which is available as an electronic resource. Primary resources used were Pharmacotherapy for Veterinary Dispensing and Saunder’s Handbook of Veterinary Drugs. Ten (29%) of respondents listed “none” or “unknown” when asked about their course reference. Pharmacy programs located in the South and Midwest regions of the United States had the greatest concentration of veterinary didactic courses, encompassing over 60% of all available courses (Table 1). Sixteen of the 33 (49%) veterinary schools have a pharmacy program located on the same campus, and pharmacy programs associated with a veterinary school were more likely (p = .007) to offer a veterinary pharmacy course (Figure 1).
Location of Pharmacy Schools Providing Information Regarding Veterinary Pharmacy Opportunities for Students (N=23)
Geographical Comparison of Location of Veterinary Schools and Doctor of Pharmacy Programs in the United States
Note: Only the main campus of a given program is indicated on the map (Satellite campuses are not included).
Fifty-two (60%) responding pharmacy programs reported having an advanced pharmacy practice experience (APPE) in veterinary pharmacy, which was more than the number of didactic course offerings (23 [27%]). The most common sites for APPEs were veterinary teaching hospitals and compounding pharmacies (Table 2). Those that responded that compounding pharmacies were their only source of veterinary pharmacy experience did not specify the percentage of veterinary compared to human compounding that occurred at the site.
Advanced Pharmacy Practice Experiences in Veterinary Pharmacy Offered at US Schools and Colleges of Pharmacy (N=52)a
Similar to didactic offerings, pharmacy programs associated with a veterinary school were more likely to offer an experiential opportunity in veterinary pharmacy (p = .04; Fisher exact test). Geographically associated veterinary schools and pharmacy programs can be seen in Figure 1.
DISCUSSION
Pharmacists are expected to fill prescriptions for all species as part of their professional responsibilities. Although other studies have reported on the importance of veterinary pharmacy course implementation in pharmacy programs, a comprehensive evaluation of the availability of didactic and experiential opportunities for pharmacy students in US pharmacy schools is lacking.14-17 There has not been a study to evaluate the demand, current availability, or current course-design of veterinary pharmacy courses in the United States, and evaluation of this data is an important step to determining the pharmacy graduate’s ability to therapeutically evaluate veterinary prescriptions and establishing standardization for didactic courses. Despite the NABP and AVMA resolutions encouraging pharmacists to have competence in providing pharmaceutical care to veterinary patients, a mere 27% of responding ACPE-designated pharmacy programs offer a didactic course in veterinary pharmacy.4,5 The result of this deficit is practicing pharmacists who are unprepared to clinically evaluate veterinary prescriptions or provide evidence-based pharmaceutical care to non-human species. Moreover, many pharmacy programs list “veterinary pharmacy” as a career option for graduates on their webpage, recognizing that it is an important way for programs to differentiate their graduates in the face of dwindling employment opportunities and prepare them for the real-world community setting where they may be faced daily with filling veterinary prescriptions.18 With national corporate pharmacy chains expressing interest in pet prescriptions and even pet insurance, training of pharmacy students to be competent in veterinary pharmacy would be of value to potential community pharmacy employers.19
Currently, there is no national standardization of the content or delivery of veterinary practice coursework in pharmacy programs. In this study, we observed a wide variety of credit hours, required resources, and instructor credentials. Since the North American Pharmacist Licensure Examination (NAPLEX) does not include veterinary pharmacy questions despite the NABP’s resolution, pharmacy schools have little motivation to include these topics in their standardized curriculum. It would be in the best interest of the pharmacy profession for the Academy to encourage the standardization and mandatory incorporation of veterinary pharmacy into pharmacy curricula by ACPE and subsequently include veterinary pharmacy questions on the NAPLEX. Based on the significant (but not surprising) correlation between a veterinary school being located near a pharmacy school and the availability of veterinary pharmacy education (p = .01), pharmacy programs interested in developing didactic offerings in veterinary pharmacy should contact and collaborate with veterinary schools in their state or region of the country as a starting point for developing a course. Based on our research of physical addresses of pharmacy schools and veterinary schools in the United States, 16 of the 33 (49%) veterinary schools have a pharmacy program located on the same physical campus.20 Despite the relationship between veterinary school and pharmacy program co-location, many state-funded veterinary schools are often found at a different state-institution than the pharmacy program. The geographic separation of pharmacy programs from the remaining 52% of veterinary schools may have created an intellectual separation that is responsible for the lower incidence of veterinary pharmacy didactic courses at these programs. The next logical step is a standard curriculum so that all programs have valid, effective veterinary pharmacy didactic offerings, and this is a focus of professional veterinary pharmacy organizations, the Society of Veterinary Hospital Pharmacists (SVHP), and the American College of Veterinary Pharmacists.21,22 Although SVHP does offer board-certification in veterinary pharmacy through their International College of Veterinary Pharmacists, the Board of Pharmacy Specialties will eventually house this board-certification process for veterinary pharmacy. Future studies should also evaluate postgraduate training, including certifications, continuing education, and workplace training requirements.
Our study found that experiential education opportunities in veterinary pharmacy (60%) are more common than didactic offerings in veterinary pharmacy (27%), which could be due to the flexibility afforded by experiential program development. Coordination of a course can be tedious and requires the instructor to oversee many students compared to coordination of an APPE, which requires supervision of only one or a few students. Most experiential opportunities for pharmacy students are found at veterinary teaching hospitals and in compounding pharmacies that fill prescriptions for animals. Experiential education also has the advantage of being offered at a wider range of geographic locations with access to a more diverse group of practitioners outside of academia. While some pharmacy schools have a very concrete experiential roster to choose from, some schools allow students to arrange their own experiential rotations outside of the regular sites with the approval of the school’s experiential education office. Because the experiential curriculum outlined by ACPE allows for greater flexibility in establishing educational experiences, this may provide a more straightforward means to expose pharmacy students to the field of veterinary pharmacy, which may be one reason for the higher percentage of pharmacy programs offering experiential education rotations compared to didactic courses.23 With the increase in veterinary prescriptions coming into community pharmacies, students may be exposed to veterinary prescriptions while completing an APPE in community pharmacy. However, if the community pharmacy preceptor is untrained in veterinary pharmacy, the student is unlikely to learn a clinically and legally sound approach to evaluating veterinary prescriptions. Thus, despite the exposure to veterinary prescriptions in a community setting, the pharmacy student may not learn the knowledge required for accurate verification of veterinary prescriptions. Although APPEs may provide more flexibility in terms of establishment, having didactic course(s) taught by credentialed instructors is important to ensure pharmacy graduates are well educated in caring for veterinary patients.
A major limitation of this study is that investigators relied on voluntary reporting. Inconsistent reporting did occurr, eg, two faculty members from one program reported different information, but investigators reconciled the data by comparing information provided with that on the pharmacy program’s website and contacting a representative from the respective pharmacy program prior to data analysis. If information could not be verified or obtained, the data were excluded from analysis. Because of variation in voluntary reporting and our questionnaire, we limited our study to the veterinary pharmacy stand-alone courses that schools offered and did not evaluate veterinary pharmacy content delivered by guest lecturers or incorporated in other courses, including required courses. We also could not verify that respondents were describing elective didactic courses, but since ACPE has not incorporated veterinary pharmacy into the required curricula, these courses likely were not considered required coursework. In addition, we allowed compounding practice experiences to count for some veterinary pharmacy education because most compounding pharmacies offer veterinary prescriptions. For the 12 schools that reported ending their veterinary pharmacy elective, we did not follow up to see the reasoning behind the course ending, but this would be of interest when establishing standardized veterinary pharmacy curriculum. Future studies are needed to determine: sources of veterinary pharmacy education other than stand-alone courses, the interest of pharmacy students in this type of training, reasons why some courses have started or ended, and how pharmacy schools design and implement veterinary pharmacy courses.
CONCLUSION
Results of this study indicate that a minority of US pharmacy schools offer didactic courses in veterinary pharmacy (27%), while a majority (60%) offer experiential education opportunities in veterinary pharmacy. Because of NABP and AVMA resolutions, as well as future legislative changes, such as the FTPO Act, pharmacists should be competent in providing pharmaceutical care to non-human patients. Ensuring that PharmD graduates have training in veterinary pharmacy may aid graduate in finding employment after graduation. The authors encourage the NABP and ACPE to develop competency statements related to veterinary pharmacy to lead the way in resolving the educational deficits defined by the NABP and AVMA. This would result in graduates that are better prepared to safely and legally dispense prescriptions to all species.
- Received April 8, 2021.
- Accepted July 12, 2021.
- © 2022 American Association of Colleges of Pharmacy
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