Clinical pharmacy: looking 20 years back... looking 20 years forward.

Angaran: We have two main goals in this panel discussion. First, to describe the current status of the health care delivery environment, the medication use system, and the pharmacy profession. And second, to discuss the specific challenges and opportunities for pharmacy over the next 5–10 years. Our hope is that you identify at least one specific action that you can apply that will catalyze change in your professional practice, regardless of your country of origin. Our discussion will be in three sections. The first part will concentrate on the broad topics of health care and the health care environment, admittedly from only the European and United States’ perspectives. The second part will deal with pharmacy specifically, and how pharmacy should respond to these environmental changes. And finally, we will close with specific recommendations from each panelist. Bert, you have written about future scenarios regarding medication use in health care. Probably every country in the world is faced with a demand for health care that exceeds the resources available to support that health care. In the U.S., spending on prescription pharmaceuticals constitutes 7–11% of total health care expenditures—and that percentage is rising. Further, the cost of pharmaceuticals is rising at a faster rate than any other segment of health care. Recognizing that differences exist among countries, can you provide a perspective on the current status of health care systems in Europe and comment on important trends that you envision over the next 5 years?