Abstract
In partnership with the Hawai‘i Journal of Medicine & Public Health, the Daniel K. Inouye College of Pharmacy (DKICP) is pleased to provide Scripts on a regular basis. In the inaugural “Script,” a brief history of the profession in Hawai‘i was presented up to the founding of the DKICP, Hawai‘i's only academic pharmacy program. In this second part of the inaugural article, we describe some key accomplishments to date. The mission of the College is to educate pharmacy practitioners and leaders to serve as a catalyst for innovations and discoveries in pharmaceutical sciences and practice for promoting health and well-being, and to provide community service, including quality patient care. Examples are given to support the stated goals of the mission. With 341 graduates to date, and a 96% pass rate on the national licensing board exams, the college has played a significant role in improving healthcare in Hawai‘i and throughout the Pacific Region. Additionally, a PhD program with substantial research programs in both pharmacy practice and the pharmaceutical science has been launched. Considerable extramural funding has been garnered from organizations such as the National Institutes of Health and Centers for Medicare and Medicaid Services. The economic impact of the College is estimated to be over $50 million each year. With over 200 signed clinical affiliation agreements within the state as well as nationally and internationally, the DKICP has helped to ameliorate the shortage of pharmacists in the state, and has enhanced the profile and practice standard of the pharmacist's role on interprofessional health care teams.
Introduction
In the second part of this two-part article, we review the current status of the Daniel K. Inouye College of Pharmacy (DKICP), University of Hawai‘i at Hilo. As noted in Part 1,1 the Hawai‘i Journal of Medicine & Public Health and the DKICP have established a partnership that will enable faculty and affiliates of the College to submit articles dealing with contemporary issues of pharmacy education and practice. In upcoming issues, with one of the current authors serving as column editor (CSJM), DKICP Scripts will highlight aspects of the profession (pharmacy residency) and our College, recent drug related therapy developments (hepatitis C) and topics of controversy (drug pricing). The column editor welcomes ideas and suggestions for future publications as well as commentary.
In that the DKICP is the first and only accredited pharmacy program in the State of Hawai‘i, and the Pacific Region as a whole, a brief overview of historical aspects of the profession of pharmacy were presented in Part 1.1 The later part of the temporal sequence presented in Part 1 led us to 2006 and the launch of the DKICP. We now describe the progress and infrastructure of the DKICP.
Mission and Vision
The mission of the DKICP is: To educate pharmacy practitioners and leaders, to serve as a catalyst for innovations and discoveries in pharmaceutical sciences and practice for promoting health and well-being, and to provide community service, including quality patient care.
DKICP was founded in a manner designed to meet all of the standards for full professional accreditation. In terms of vision, the College strives for pre-eminence in two domains: (a) to be recognized among the top 25 Pharmacy programs in the world, and (b) to provide evidence of scholarship via funded research programs and innovative pharmaceutical care programs to serve individuals, families and communities. This is consistent with the Institute of Medicine (IOM) vision for academic health sciences in promoting health of people through translational research, educational reforms and practice innovations in patient care.2
Creation and Structure of the Daniel K. Inouye College of Pharmacy, University of Hawai‘i Hilo
After many years of discussion and planning, it was decided, with the support of the late Senator Daniel K. Inouye, that a college of pharmacy would be based at UH Hilo. The Senator shared a vision of establishing centers of excellence on each of the Hawaiian Islands. As became abundantly clear after the demise of a private endeavor,1 it is absolutely essential to obtain pre-candidate status from the Accreditation Council of Pharmacy Education (ACPE) prior to admitting any students to a pharmacy program.3 One of the first requisite steps in submitting an application for pre-candidate status is the recruitment of a dean to serve the program, and the qualifications of the dean must meet or exceed the applicable standards established by the ACPE.3
In 2005, UH Hilo conducted a search, and one of the authors of this manuscript (JMP) accepted the position of founding dean in the summer of 2006, with, the objective being to accept the first class of student pharmacists and initiate the course of instruction by August of 2007.
Starting a program within a year was no small task but through a coordinated effort involving intense focus and cooperation, and the leap of faith demonstrated by the inaugural class of students who did not know their status until June of 2007, the program was off to a start in August 2007. Pre-candidate status was granted during the executive board meeting of the ACPE in June 2007.
The first five years of the program have been previously described in some detail and will not be reproduced here.4 However, a few notable milestones follow.
2006 - J.M. Pezzuto leaves the position of Dean of Pharmacy, Nursing and Health Sciences at Purdue University and accepts the position of Founding Dean of DKICP
2006–2007 - Following ACPE designation of pre-candidate status, and a successful change of status application reviewed by the Western Association of Schools and Colleges (WASC), the first class of student pharmacists enroll and begin classes; design and construction of temporary facilities for the College begins
2007–2008 - College is awarded candidate status by the ACPE, accreditation is affirmed by WASC, and faculty and staff grow to about 40
2009–2010 - Expansion of college faculty to O‘ahu and Maui hospital sites for experiential rotations, ACPE affirms candidate status, $5.5 million is approved by the State Legislature and released by Governor Linda Lingle for planning and design of a permanent building, and modular facilities are occupied
2010 - Expansion of the modular facilities to enable full conduct of the didactic portion of the curriculum at one site (facilitated by a $1 million gift from the J.M. Long Foundation), ACPE approves continuation of candidate status, launch of Center for Rural Health, and first DKICP residency program begins in Maui
2011 - Inaugural class graduates with PharmD, full accreditation is granted by ACPE, alumni association is created, programs are launched to offer the PhD in Pharmaceutical Sciences and the MS in Clinical Psychopharmacology, and accredited continuing education programs continue
2012–2013 - The UH Board of Regents approves naming the College the Daniel K. Inouye College of Pharmacy
2013–2014 - ACPE finds the College out of compliance for the standard dealing with physical facilities; in the final days of the Legislative session, funding is approved to construct a permanent building for the College; funds for construction are released by Governor Neil Abercrombie; a groundbreaking and blessing ceremony for the permanent DKICP building is held at the construction site on December 12, 2014
2015 - ACPE finds the DKICP in compliance with all 30 accreditation standards and continues Full Accreditation status
The Dilemma and Resolution of Physical Facility Issues
On October 31, 2009, the University received $5.5 million for design and planning of a building. The design was completed by WCIT Architecture of Honolulu by December 2011, but funding was not made available during that legislative session (2012). During the following legislative session, plans were revised and extensive interaction occurred, but again, no funding was provided.
In anticipation of future challenges with funding, the architectural plan was scaled-down. With the revised design, the DKICP would continue to use the modular facilities, but all activities would be consolidated and conducted in close proximity. At the end of the legislative session (May 2014), the State Legislature allocated $33 million for the construction of the revised facility at a site adjacent to the pre-existing modular facilities. The cost of the building was estimated to be $29–30 million, allowing for a 10% contingency fee. The funding was approved as $28 million in General Obligation bonds (to be paid by the State) and $5 million in revenue bonds (to be paid by the DKICP). A financial plan is still under development to determine exactly how the DKICP will cover the revenue bond.
Since that time, the University of Hawai‘i Office of Capital Improvements has assembled a committee to oversee the project. The time-line for completion is not clear but ranges from 24 to 48 months. In addition, the plan considered by the DKICP as minimal for the advancement of our mission was unilaterally modified by the Office of Capital Improvements to a design that would reduce construction costs to $25 million. Their opinion was that the remaining $8 million should be used for contingency, equipment and furnishings, and building management. Once it became apparent this approach was unacceptable, the architectural firm returned to the second version of the plan for construction of a building comprised approximately 40,000 square feet, which is considered adequate, assuming the existing modular facilities remain in service following some remodeling. Design and construction documents are being prepared.
Clinical Affiliation Agreements: Preceptors - the Unsung Heroes
The four-year pharmacy program culminates with awarding of the profession's terminal Doctor of Pharmacy (PharmD) degree. The curriculum involves approximately two-thirds didactic and one-third experiential coursework. During the first three years of the curriculum, Introductory Pharmacy Practice Experiences (IPPE) extends over 330 hours with exposure to the various types of pharmacy practices and the role of pharmacists in hospital, retail community, long term care and ambulatory care settings. Advanced Pharmacy Practice Experiences (APPE), held entirely in the fourth year, requires clinical training in areas of hospital, community retail, acute care medicine, and ambulatory care. Pharmacy Practice faculty and volunteer preceptors (affiliate faculty) are key to the success of the experiential program. As unsung heroes, volunteer preceptors, comprised of pharmacists, physicians, nurses, psychologists, and even respiratory therapists, commit additional time over and above their usual practice and work hours in order to mentor students on rotations. These types of interprofessional affiliations help us and other professions to comply with accreditation standards outlined in other health care professional program's accreditation standards.3,5–7 The DKICP currently has over 200 clinical affiliation agreements on a state, national and international level.
Pharmacy Practice faculty hired full time by the DKICP are placed in-residence at area hospitals (The Queens Medical Center, Pali Momi Medical Center, Wilcox Memorial Hospital, Maui Memorial, and Hilo Medical Center) and at various ambulatory care clinics (Hawai‘i Island Family Medicine Clinic, Bay Clinics- Hawai‘i, and John A. Burns School of Medicine (JABSOM) Clinics, including the Department of Native Hawaiian Health's Lau ‘Ola Clinic, and Department of Family Medicine's Physician's Center at Mililani). Faculty duties range from coordinating student teaching activities at these various sites, maintaining progressive academic clinical practices, both didactic and experiential teaching, and scholarship.
Research, Scholarship and Graduate Education
In the seven years since the opening of the DKICP, a plethora of new schools have opened for the sole purpose of filling the pharmacist gap. Scholarly innovation and discovery defines the uniqueness of DKICP. Our department of Pharmaceutical Sciences boasts an international panel of faculty that has successfully launched research programs with a respectable amount of extramural funding.
Going hand-in-hand with research and scholarship is graduate education. Since 2011, the college has admitted about 12 graduate students working toward a PhD in Pharmaceutical Sciences. This is the first science-based PhD program ever to be launched at UH Hilo, and the only such program within the entire UH System. In addition, the College established the Masters of Science (MS) in Clinical Psychopharmacology, a program to provide additional training for PhD-trained clinical psychologists. In partnership with Tripler Army Medical Center (also a training site for PharmD students and residents), our first students have graduated and now have gained prescription authority. This is the only such program offered by a college of pharmacy in the United States.
Although pharmacists are usually not formally trained in clinical research, innovative studies are currently underway. With much of the foundation built for the PharmD curriculum, the faculty in the Department of Pharmacy Practice (DPP) can dedicate more time to scholarly activities related to patient care, medication compliance and partnerships with other health professions, and entities such as the Department of Health (DOH). DOH projects include collaboration with the Asthma Initiative to provide asthma control and Antibiotic Stewardship Program (ASP) state-wide in hospitals. ASPs are programs that are designed to ensure optimal use of antimicrobial agents so that we are using the right medications to combat infections while avoiding the excessive use that leads to the development of resistance. There is a particular focus on community and critical access hospitals.
One question that invariably arises is why the DKICP was placed in a rural setting as opposed to urban Honolulu. Most recent data that describes the desperate shortage of health care professionals in rural Hawai‘i justifies the placement of our program.8,9 One of our most innovative projects is the program Pharm2Pharm, supported by a $14.3 million grant from the Center for Medicare and Medicaid Services (CMS) (Dr. Karen Pellegrin, PI). The study is being held on all islands and focuses on pharmacist liaisons to fill the gap from hospital discharge to the patient home in terms of patient medication education and adherence. Another initiative from the DPP is work in quantifying and describing the types of medications returned to the Narcotics Enforcement Department. Continued work in this area will hopefully decrease the inventory of unused medications in the home, that may lead to decreasing the incidence of home robberies and drug misadventures.10 Ongoing studies in the ambulatory care setting include investigating the usefulness of technology such as Fitbits and monitoring of blood sugar. Projects that help patients with color-coding medication boxes may help to improve drug adherence in non-English speaking patients.
Other examples of ongoing projects and research (Table 1) at the DKICP include:
The Pezzuto lab continues with ongoing projects related to resveratrol, having produced more than 100 derivatives, some of which have demonstrated better activities and more positive controls than the original compound.11 The emphasis of the research is on the discovery and characterization of natural product cancer chemopreventive agents. Tests are conducted with natural products procured throughout the world including Brazil, China, India, Italy, Pakistan, and Thailand.
Rat lungworm disease (RLWD), caused by the nematode Angiostrongylus cantonensis, is considered a global, emerging, infectious disease. RLWD can be considered as one of the most serious threats to human health of diseases carried by wildlife in Hawai‘i, and in many other tropical and subtropical countries around the world.12
Design and synthesis of new antibacterial agents targeting problematic bacterial infections such as Mycobacterium tuberculosis and Clostridium difficile. In collaboration with Dr. Richard Lee at St. Jude Children's Research Hospital in Memphis, TN and Dr. Julian Hurdle at Texas A&M in College Station, TX, as well as some other colleagues, we are designing and synthesizing novel small molecule and natural product-inspired chemotherapeutic agents for subsequent antibacterial evaluation.
Drug discovery research is conducted for malaria and leishmaniasis, both of which are caused by parasitic organisms with extraordinarily complex life cycles and host defense mechanisms. Researchers have also been screening natural product-derived samples for antibacterial and antifungal activity on a continuous basis.
Pharm2Pharm is a pharmacist-care system designed to save more than $27.1 million in health care costs in Hawai‘i that has received a $14.3 million award from the federal government. The project strives to reduce medication-related hospitalizations and emergency room visits by establishing teamwork between hospital and community pharmacists.
A career development award from the National Cancer Institute (NCI) has been awarded to a professor of Native Hawaiian descent (Dr. Dana-Lynn Koomoa-Lange). This is a first within the entire UH system. Her work concentrates on finding an effective treatment strategy for advanced stage neuroblastoma (NB), an extra-cranial pediatric cancer.
Development of novel natural product-inspired antitubercular agents for treating pulmonary tuberculosis. By employing approaches guided by high-throughput screening methods and inspired by natural products, researchers aim to develop small molecule piperidinol- and natural product engelhardione-based analogues as novel antituberculosis drugs.13
Collaboration with Rutgers University on structured organic particulate systems as part of the National Science Foundation's Engineering Research Center (NSF-ERC). Researchers use materials science and engineering principles that cover a broad spectrum of uses, from basic elementary education and applications in pharmaceutical manufacturing facilities to actually producing the end product.
Investigating the links between inflammation and cancer and the regulation of osteoprotegerin (OPG) expression and its role in primary tumor growth and spread (metastasis) of breast cancer. Since many patients do not respond or become resistant to current targeted therapies, identification of new therapeutic targets such as OPG will increase treatment options and improve prognosis for breast cancer patients.14
Finding newer effective and safer therapeutics options for treatment of asthma and lung cancer using novel drug delivery approaches.15 Researchers are evaluating the innovative encapsulation and delivery mechanisms using gelatin nanocarriers.
Work from a health economist that combines investigative research, education, training and networking to study various health care issues such as the effectiveness of self-management education and financial incentives for patients and physicians compared to usual care in patients with diabetes. Other projects promote networking among researchers from minority institutions.
Work to find natural product treatments for cancers with fewer side effects and lower toxicity than current therapies. One lab is focused on Stat3 as a cancer chemotherapeutic molecular target.
A variety of biomedical research projects with the IDeA Networks for Biomedical Research Excellence (INBRE) program, a collaborative research program with UH Manoa and other universities in Hawai‘i.
Collaboration with the State of Hawai‘i to help develop standards to control the quality of medical marijuana.
Table 1.
Research Projects and Extramural Funding, Daniel K. Inouye College of Pharmacy, 2008 – 2014
| PI Name | Title | Award Sponsor | Award Amount | Award Start Date | Award End Date |
| Andre Bachmann | Development of neuroblastoma therapeutics by optimization of polyamine inhibitor Strategy | University of Hawai‘i Foundation | $40,488 | 09/01/10 | 05/31/12 |
| Andre Bachmann | In vivo efficacy of novel proteasome inhibitors in neuroblastoma | Hawai‘i Community Foundation (HCF) | $47,372 | 09/01/10 | 11/05/12 |
| Andre Bachmann | CA-111419-04 Polyamines | NIH | $91,243 | 09/01/10 | 06/30/12 |
| Andre Bachmann | Optimization of pediatric neuoblastoma treatment through bimodal anti-tumor therapy | Hawai‘i Community Foundation (HCF) | $40,000 | 05/15/14 | 11/14/15 |
| Robert Borris | EPSCOR | NSF | $979,510 | 09/01/09 | 08/31/14 |
| Leng Chee Chang | BRIDGES - potential of physalis peruviaan (poha) in the treatment of breast | UH-JABSOM Cancer Center (NIH) | $25,000 | 09/01/12 | 07/31/13 |
| Leng Chee Chang | Evaluation of vernonia cinerea (VC) in the treatment of cancer | NIH | $40,000 | 07/01/14 | 06/30/15 |
| Mahavir Chougule | Transdermal permeation of magnesium supplement cream formulations across skin | Ctr for Magnesium Educ & Research, LLC | $16,347 | 10/25/11 | 04/25/12 |
| Mahavir Chougule | Targeted nanocarriers of siRNA for the treatment of asthma | HCF - Leahi Fund | $35,000 | 08/18/11 | 02/18/13 |
| Mahavir Chougule | Receptor directed nantherapeutics | Hawai‘i Community Foundation (HCF) | $50,000 | 03/14/13 | 07/13/15 |
| Mahavir Chougule | Targeted nanocarrier based gene | Hawai‘i Community Foundation (HCF) | $50,000 | 03/29/13 | 09/25/15 |
| Mahavir Chougule | Targeted combination therapy for lung cancer | NIH | $89,291 | 05/01/14 | 04/30/15 |
| Linda Connelly | Osteoprotegerin in breast cancer cells: role in tumor growth and metastasis | NIH | $410,100 | 09/01/12 | 08/31/15 |
| Linda Connelly | Role of endogenous osterprotegerin expression in breast cancer metastasis | Hawai‘i Community Foundation (HCF) | $50,000 | 05/18/11 | 11/18/12 |
| Linda Connelly | OPG expression in breast cancer | Hawai‘i Community Foundation (HCF) | $40,000 | 05/15/14 | 11/14/15 |
| Edward Fisher | Instruction in clinical psychopharmacology at Tripler Army Medical Center | Defense, Dept - Army Tripler Medical Ctr | $752,192 | 09/30/10 | 09/29/13 |
| Edward Fisher | MSCP program | Defense, Dept - Army Tripler Medical Ctr | $316,928 | 09/01/13 | 08/31/14 |
| Lara Gomez | Rural East Hawai‘i workforce development network | Bay Clinic, Inc | $120,000 | 09/01/10 | 08/31/13 |
| Lara Gomez | Immunization clinics | State of Hawai‘i - Dept of Health | $2,500 | 07/13/14 | 12/31/13 |
| Roy Goo | Antimicrobial stewardship programs | State of Hawai‘i - Dept of Health | $10,000 | 08/28/14 | 07/31/15 |
| Daniela Guendisch | Scaffolds for novel designed multiple liglands as potential therapeutics for Alzheimer's disease | Hawai‘i Community Foundation (HCF) | $45,386 | 05/15/14 | 11/14/15 |
| Aaron Jacobs | Involvement of HSF1 in bleomcin-induced pulmonary fibrosis | Hawai‘i Community Foundation (HCF) | $25,000 | 04/30/14 | 10/29/15 |
| Susan Jarvi | A statewide targeted pathogen surveillance study: diversity of avipoxvirus and avian malaria in native Hawaiian forest birds | Interior, Dept - Fish & Wildlife Svc | $58,414 | 09/01/12 | 03/01/14 |
| Susan Jarvi | Efficacy of a vaccine against angiostrongylus costaricensis to a. cantonensis in rats (rattus rattus) | $40,000 | 07/20/12 | 01/20/14 | |
| Susan Jarvi | Evaluation of a vaccine for rat lung-worm (angiostrongylus cantonesis) | Agri Dept - Animal & Plant Health Insp Svc | $33,550 | 09/10/12 | 09/09/13 |
| Susan Jarvi | Prevalence of human rat lungworm infection in East Hawaii Island | Hawai‘i Community Foundation (HCF) | $50,000 | 05/15/14 | 11/14/15 |
| Deborah Juarez | Reducing cost-related medication nonadherence in persons with diabetes | Pacific Health Research & Educ Institute | $23,823 | 09/01/11 | 08/31/12 |
| Deborah Juarez | Cost-effectiveness of e-cigarette | Hawai‘i Community Foundation (HCF) | $30,000 | 06/09/14 | 10/29/15 |
| Eugene Konorev | Inhibition of cardiac vascular network formulation by targeted anticancer drug sorafenib | HCF Medical Research Funds | $49,993 | 05/16/12 | 11/15/13 |
| Dana-Lynn Koomoa-Lange | MYCN-induced calcium and magnesium signaling regulates neuroblastoma progression | NIH | $134,922 | 09/12/12 | 08/31/17 |
| Dana-Lynn Koomoa-Lange | MYCN-induced calcium and magnesium signaling regulates neuroblastoma progression | NIH | $143,311 | 09/01/13 | 08/31/14 |
| Dana-Lynn Koomoa-Lange | ALSF DFMO-based | Foundation | $44,404 | 06/16/10 | 12/31/12 |
| Ingo Koomoa-Lange | Therapeutic strategies targeting MY | $100,000 | 07/01/14 | 06/30/16 | |
| Carolyn Ma | Hawaii state asthma initiative | State of Hawai‘i - Dept of Health | $9,500 | 03/20/12 | 12/31/12 |
| Kenneth Morris | UHH outreach partner proposal for the NSF-ERC-SOPS | Rutgers, State University of New Jersey | $50,000 | 07/01/11 | 06/30/12 |
| Kenneth Morris | Development PXRD method/device | $101,975 | 07/01/08 | 06/30/14 | |
| Kenneth Morris | Materials and dosage form characterization | Glaxosmith Kline | $78,688 | 07/01/12 | 06/30/13 |
| Kenneth Morris | UHH outreach partner proposal for the NSF-ERC-SOPS | Rutgers, State University of New Jersey | $80,000 | 07/01/11 | 06/30/13 |
| Kenneth Morris | YR3 EEC-0540855-CSOC | NSF | $30,000 | 07/01/13 | 06/30/14 |
| Karen Pellegrin | “Pharm2Pharm” service innovation in rural Hawai‘i | Health & Human Svc - Ctr for Medicare & Medicaid | $14,346,043 | 07/01/12 | 06/30/15 |
| Karen Pellegrin | 90BC0012/01 HI CTY Beacon Commconst | NIH | $14,522,189 | 04/01/10 | 05/31/13 |
| John Pezzuto | Clniical pharmacy traning program FY 2011 | Education - Dept (Federal) | $1,500,000 | 09/01/10 | 08/31/12 |
| John Pezzuto | INBRE | NIH | $3,244,858 | 06/01/10 | 05/31/13 |
| John Pezzuto | INBRE | NIH | $964,609 | 08/01/13 | 04/30/14 |
| John Pezzuto | INBRE | NIH | $884,033 | 05/01/14 | 04/30/15 |
| John Pezzuto | INBRE | NIH | $30,400 | 05/01/14 | 04/30/15 |
| Dianqing Sun | Development of novel natural product-inspired antibacterial agents for treating pulmony tuberculosis | Hawai‘i Community Foundation (HCF) | $50,000 | 08/16/12 | 08/15/14 |
| Dianqing Sun | Development nof piperidinois and engelhardiones as novel antituberculosis agents | NIH | $406,257 | 09/01/11 | 08/31/15 |
| Anthony Wright | CA-143727-03 Areca nut chemistry | UH-JABSOM Cancer Center (NIH) | $45,795 | 09/01/11 | 08/31/12 |
| Anthony Wright | CA-143727-03 Pre-pilot project | UH-JABSOM Cancer Center (NIH) | $37,312 | 09/01/11 | 08/31/12 |
| Anthony Wright | CA-143727-04 Guam 54 pilot project III | UH-JABSOM Cancer Center (NIH) | $29,391 | 09/01/12 | 08/31/13 |
| Anthony Wright | CA-143727-04 Guam 54 pre-pilot project I | UH-JABSOM Cancer Center (NIH) | $24,606 | 09/01/12 | 08/31/13 |
| Anthony Wright | CA-143727-05 Guam 54 pilot project V | UH-JABSOM Cancer Center (NIH) | $43,744 | 09/01/13 | 08/31/15 |
| Overall - Total | $40,464,174 |
The Glut of New Pharmacy Programs in the United States
After 10 years in the making, the Daniel K. Inouye College of Pharmacy was established in 2007. DKICP graduates have helped to address the local pharmacist shortage. Aggregate Demand Index (ADI), as reported from the Pharmacy Workforce Center (PWC), showed Hawai‘i's historic high in 2004 as 4.5 (5 = demand is much more than the pharmacist supply available, 3 = demand equal supply available, 1 = demand is much less than the pharmacist supply available).16 August 2014 figures indicate that national level ADI figures since 2008 (ADI of 4), show a downward trend to the equilibrium point of “3” with the community pharmacy figures reported at 3.38 and institutional pharmacy at 2.78. Hawai‘i's ADI (August 2014), is reported at 1.5 as compared to the Western Pacific Region's ADI of 3.54.16 The average class of 86 graduates from DKICP is comprised of approximately 50% Hawai‘i residents. Self-reported alumni data on post-graduate placement generally indicates that resident students are remaining within the state for jobs and non-residents return to the continental US. The majority of graduates gain employment in community pharmacy retail settings.17
The ACPE has seen rapid increases in the numbers of US schools of pharmacy. In 2000, there were 80 accredited programs of pharmacy.18 As of 2014, a 60% increase in schools has swelled the number to 130 schools.18
Based on the track record so far from the DKICP, approximately 50% of graduates report having secured a position requiring the PharmD at the time of graduation, and approximately 90% of the graduates report having secured employment requiring the PharmD within one year of graduation.12 Based on ratings provided by US News and World Report, the DKCIP was ranked as 74 among all pharmacy schools, and among the top five of the 40 or so schools created since 2000.19
The Future of Pharmacy in the United States
As described in Part 1 of this article, the profession of pharmacy has dramatically evolved since colonial times in the United States. Over the last century, educational programs have progressed from the two-year PhG (Graduate in Pharmacy) (1907), to the three-year PhC (Pharmaceutical Chemist) (1925), to the four-year BS in Pharmacy (1932), to the five-year BS in Pharmacy (1960), and finally, to the six-year PharmD (Doctor of Pharmacy). 1 As mandated by current accreditation standards, the only degree leading to professional licensure is the PharmD. Being a terminal degree, this is not likely to change in the future. But will admission standards change? Currently, even though approximately 70% of student pharmacists entering the DKICP program already hold a baccalaureate degree, and after two years of didactic work in the program they generally qualify for award of the Bachelors in Arts in Pharmacy Studies (BAPS; a new degree offered by our College), will admission requirements be changed to require the bachelor's degree prior to admission? The administration of the DKICP does not endorse such a requirement, but it will be necessary to conform with national accreditation standards if such a policy were to be implemented.
Perhaps a more eminent issue deals with residency programs. As will be described in the next article to be published in May 2015, at this time, approximately 20% of students graduating from the DKICP apply for advanced training in residency programs. 20 This upcoming graduating class of 2015 has a record 30% applying for residency. Considering the state-of-the art, will internships and residencies become a requirement for pharmacy graduates? Only time will tell, but there is a high probability this will become reality.
What is clear, at least by historical precedent, pharmacy is a resilient and malleable profession that plays a crucial role in modern day health care. Pharmacists play an integral role for interdisciplinary health care in numerous types of health care settings. Traditional duties mainly described pharmacists as chemists, and although the medicinal chemistry portion of the curriculum continues to differentiate this profession from other healthcare professionals' training, today's pharmacist can be considered the medication/drug experts who can manage therapeutic outcomes for complicated medication profiles, patient education and assure patients medication adherence and side effect management for chronic diseases. The continued movement of the Affordable Care Act requires medical organizations and third party payers to rely on pharmacist expertise in pharmacoeconomics or the study of cost effectiveness in relationship to effective drug therapy. Continued shortage of certain types of medications makes the pharmacist's knowledge critical for suggesting biosimilar medications or equivalent therapies.
Concluding Remarks
With a history of less than a decade, the DKICP has entrenched itself as an integral component of the UH System and the State of Hawai‘i as a whole. Total enrollment of a remarkably diverse group of student pharmacists (Figure 1) currently stands at 337. To date, 341 Doctor of Pharmacy students have graduated with a respectable 96% pass rate for the North American Pharmacists Licensure Examination (NAPLEX), which is competitive with the national average. The infrastructure of the College has continued to grow and expand (Figure 2). An independent analysis indicated the College contributes about $50 million each year in economic activity,21 but this was clearly an underestimate since extramural funding (which has exceeded $40 million) (Table 1) was not taken into account. With construction of a permanent facility now on the horizon, it is clear the College is well poised for preeminence as we continue to serve the people of Hawai‘i as well as the entire Pacific Region.
Figure 1.
Enrollment Data 2009–2014, Race and Ethnicity, Daniel K. Inouye College of Pharmacy, UH Hilo
Figure 2.
Current Organizational Structure for the Daniel K. Inouye College of Pharmacy
Acknowledgements
This article is dedicated to APEx awardees Jerry Johnson, Rose Tseng, Pat DeLeon and Steven Hora. The APEx (Advancement of Pharmacy Excellence) award honors individuals who are not employed by the DKICP and have made significant contribution to the development and growth of the college.
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