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Executive Summary

Hospital expansion into home health care should be "consistent" with the "mission statement" of the institution, and should be analyzed in relation to legal and ethical implications, the American Society of Hospital Pharmacists' (ASHP) Council on Administrative Affairs is recommending in a "policy action" proposed for the assn.'s House of Delegates. The Administrative Affairs Council's proposal urges ASHP to encourage "individual hospital administrators and pharmacists. . . [to] analyze the appropriateness of potential expanded services (e.g., home health care and ambulatory-care centers) in relation to the hospital's mission statement and to identify services that meet the hospital's needs." The council, chaired by Presbyterian Denver Hospital's Pharmacy Director Susan TeilBoyer, suggested that the "benefits of developing a team concept for the marketing of services" would allow pharmacists to work with the legal and marketing staffs in selecting pharmaceutical services that the hospital could market. Under this policy, ASHP would provide members with background on litigation that might affect hospital marketing of pharmaceutical services. The proposal on home health care is one of 22 policy actions recommended for consideration during the assn.'s June 2-6 annual meeting in Reno, Nev. The recommendations were developed by five ASHP councils. * Among other proposed policy actions, the ASHP councils are encouraging: pharmacist-dispensing of drugs switched from Rx to OTC status and of products in "a new class of drugs" uniformity in sizes of single-unit drug packages to overcome storage problems health-insurance coverage of immunosuppressive drugs for organ-transplant outpatients, and FDA review of all drugs marketed in a new dosage form or for a new indication or route of administration. In addition, the Administrative Affairs Council recommends that the assn. develop an information packet on the legal, financial and reimbursement implications of hospital participation in various home-care arrangements. The council notes a "need to encourage hospital pharmacists and administrators to evaluate the cost-effectiveness of participation in home health care." The council explained that it took into consideration "how hospital-based home care could be used as a means to assure both the continuity and quality of patient-care." In dealing with the Rx-to-OTC-switch and new-class-of-drugs issues, the Public Affairs Council noted the "potential advantage of cost-effective self-care using the professional expertise of a pharmacist." The council recommends that the assn. "support improvement of availability, accessibility, and cost-effectiveness of health care through appropriate changes to applicable federal statutes and regulations to authorize pharmacists to dispense certain drug products directly to patients (after appropriate professional consultation) without the necessity of a prescription." Support of such non-Rx dispensing authorization, the council added, should be based on principles that "the profession is willing and able to make appropriate therapeutic decisions, the drug products involved are appropriate for pharmacists' professional judgment, based upon the medical conditions to be treated, potential adverse effects (as indicated in approved labeling), and epidemiologic factors," and "there are appropriate regulatory requirements for data collection for postmarketing surveillance and adverse drug-reaction reporting." * The Legal & Public Affairs Council is also urging delegates at Reno to oppose direct-to-consumer advertising of Rx drugs, "via print, electronic, or any other communications media," and to support standardization of the product identification and package-size identification components of the Natl. Drug Code.

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