An iconoclastic perspective on progress in pharmacy practice.

Progress in pharmacy practice is examined and areas for improvement are identified. Data from surveys of hospital and health system pharmacy practice from 1957 to 1994 show that the steady progress from 1974 to 1985 was not sustained over the past decade. Changing to a profession in which all practitioners provide pharmaceutical care will be difficult when practice in hospitals, where the most acutely ill patients are treated, does not meet the profession's recommended standards. Many pharmacists may be resigned to a reality in which their services are viewed as ancillary. The number of medication misadventures that occur indicates that there is an unmet need for effective medication management. Pharmaceutical care offers the promise of better patient outcomes as well as "reprofessionalization" of pharmacists. To elevate the level of pharmacy practice, individual practitioners need will; too much attention has been given to skill. Many new practitioners have earned Pharm. D. degrees but not received enough nurturing from colleagues to develop into innovators who will continue the profession's progress. It is crucial that the pharmacy practice and education communities cooperate to prepare pharmacists to function in the changing health care system. Also, professional organizations must set aside their fragmented interests and focus together on pharmacists' survival. The restructuring and economic pressures in health care may offer pharmacists the opportunity for progress, since improving drug use would help to decrease health problems and cost.