Abstract
Following Hepler and Strand’s 1990 article, the concept of pharmaceutical care spread throughout US pharmacy. The profession faced a crossroads as it sought a new philosophy and practice model. Individuals and organizations dedicated resources to help community pharmacists adopt a fully professional, clinical practice grounded in pharmaceutical care. In Iowa, a long‐term, statewide initiative emerged to implement these changes. This article describes the events, influences, and outcomes in Iowa community pharmacy during the profession’s initial endorsement of pharmaceutical care (1990–1998), applying Andrew Abbott’s theory of professions. Using qualitative methods and archival analysis, the study synthesizes these efforts within a sociological framework, filling a gap in understanding the profession’s internal attempts to reimagine community pharmacy.
Evolution of a Profession
The sociological study of pharmacy can be explained in its evolution as a profession pursuing expanded jurisdictional claims. Applying sociologist Andrew Abbott’s framework,1 this article examines the period ca. 1990–1998, when pharmacy was in the process of a major philosophical shift. These changes were internally driven, as the profession sought to maintain its status while expanding its roles in clinical patient care. Focusing on Iowa, this analysis considers people, organizations, and events, highlighting three factors: (1) the involvement of academic institutions providing intellectual, tactical, and financial resources into community pharmacies, (2) a grassroots emphasis on practical pharmaceutical care integrated into existing practice environments, and (3) enduring elements that persisted beyond the initiative’s formal conclusion. This study assesses whether pharmacy successfully expanded its jurisdictional power and situates these changes within broader systemic and external influences.
Would pharmacy’s new jurisdictional mandate expand “to meet society’s great unmet need for safe and effective drug therapy?”2 As discussions of implementation unfolded, differences emerged in how the abstraction could be realized in day‐to‐day practice. According to Abbott, the critical component of jurisdictional evolution lies in the work itself, which manifests jurisdictional claims. In the 1990s, the philosophy of pharmaceutical care evolved from being an abstract concept into a newly conceptualized practice model. The following explores the reimagining of pharmacy, focusing on events, influences, and outcomes in Iowa community pharmacy during the years of the profession’s initial endorsement of pharmaceutical care. Firsthand accounts and an understanding of the social‐historical environment illustrate the outcomes of this initial push, highlighting features that made Iowa’s efforts unique and enabling us to consider why the new knowledge abstraction may have been insufficient to compete within its broader jurisdictional and historical context.
According to Abbott, a profession evolves through interactions within the broader system of professions. Jurisdictional claims, grounded in a profession’s abstract knowledge, shape its tasks—the actual work—comprising both subjective and objective elements.3 A profession’s power is tied to its abstract “knowledge system,” which it leverages by redefining old problems in new ways. This capacity to reframe knowledge underpins a profession’s survival, expansion, contraction, or dissolution.4 Subjective elements, or a profession’s “cultural machinery,” are most vulnerable to competing professions, particularly those with similar knowledge abstractions. Objective elements encompass technical, legal, and public‐facing tasks and are most influenced by external forces, including workplace conditions, policy, consumer demand, and transactional rules. Evolution occurs through the interplay of jurisdictional claims, interprofessional relationships, and contextual pressures.5
Hepler and Strand (1990) redefined pharmacy’s role by advancing a patient‐centered philosophy of pharmaceutical care, moving beyond dispensing and traditional apothecary functions.6 They argued that this “professional maturation” required new practice standards, collaboration with other health professions, and strategies to market pharmacy’s evolving role. Pharmaceutical care emphasized the patient‐pharmacist relationship to optimize drug therapy and improve patient outcomes. Strand and colleagues detailed the philosophy’s evolution in the first edition of Pharmaceutical Care Practice.7 They attributed the concept to Mikeal et al.8 in 1975 and further explicated by Brodie in 1980.9,10 In brief, pharmaceutical care is defined as, “the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life.”11 This patient‐centered focus extended beyond earlier clinical pharmacy models, which centered on drug therapy and products, and additionally, by emphasizing a cyclical care process—encompassing both pre‐ and post‐dispensing aspects of medication use. Importantly, Hepler and Strand emphasized that pharmaceutical care was an essential element of healthcare and upheld within all practice settings.12 Pharmaceutical care was presented as a response to unmet societal needs: preventing and resolving drug‐related problems, improving outcomes, and reducing costs. While they emphasized integration across settings to unify the profession, they also anticipated barriers, including workplace redesign, policy adjustments, and the need to frame pharmaceutical care as a cost‐saving service. Their work formalized an expanded jurisdiction by articulating subjective elements’ (i.e., cognitive decision‐making) connection to objective tasks, offering the original roadmap for translating a new philosophy of pharmacy into a new kind of pharmacy practice.
The New Era of Pharmaceutical Care in the US
From about 1980 into the mid‐1990s, community pharmacies, especially independents, grew in size and sales. During the 1990s the landscape began to shift, as grocers and mass merchandisers opened pharmacies, coinciding with a gradual decline in independent pharmacies due to ownership changes.13 At this same time, the US healthcare system was changing to include managed care to control costs and increased competition in the prescription drug market. As medication use became more widespread, benefits such as reduced disease burden emerged, but concerns over adverse drug events and other drug‐related problems increasingly drew the attention of health policy experts and patient advocates. These external pressures supported the expansion of pharmacists’ roles beyond dispensing. While some pharmacists embraced patient‐care roles, leaders warned that shrinking prescription dispensing margins, driven by third‐party payer price controls, threatened community pharmacy viability.14 Beyond financial pressures, other factors prompted exploration of new pharmacy roles, including scientific specialization, the complexity of the US healthcare system, the pharmaceutical industry’s success, and policies requiring medication counseling by pharmacists. Mass drug production reduced the need for compounding skills, while pharmacy leaders advocated their expanding roles grounded in the growing scientific knowledge surrounding medications.15
It was largely during the second half of the 1980s when pharmaceutical care entered professional discourse across journals, pharmacy schools, and associations.16 These discussions were an outgrowth of the profession’s interest in embracing a fully clinical basis for its practice as well as the extension of clinical pharmacy. Key discussions regarding pharmacy’s future were had among leaders and stakeholders at the 1985 Hilton Head, South Carolina conference17 and later at a conference in Williamsburg, Virginia in 1989.18 The concept and philosophy of pharmaceutical care gained traction largely through Hepler and Strand, who had professional connections to Iowa and Minnesota, respectively.19 Their collaboration began around 1988 at the University of Florida, culminating in major contributions to the 1989 Williamsburg conference.20,21 It was there that they first publicly outlined their vision of pharmaceutical care to industry leaders, including representatives from 17 national pharmacy organizations and the Food and Drug Administration (FDA). These ideas were detailed in an American Society of Health‐System Pharmacists (ASHP) publication the following year, where Hepler and Strand described responsibilities and opportunities for a fully patient‐centered practice model.22
In addition to supportive socio‐economic externalities like increased medication use and a push for financial diversification within the pharmacy profession, the vision for pharmaceutical care was also reinforced by wider US national policy initiatives. The 1990 Omnibus Budget Reconciliation Act (OBRA 90) mandated patient counseling for all federally funded program participants, and a 1990 report by the Health and Human Services (HHS) inspector general further supported this shift.23 The report, The Clinical Role of the Community Pharmacist, recommended exploring pharmaceutical care to reduce harms and costs from “mismedication,” especially among the elderly. It also highlighted implementation challenges in community practice, including inconsistent patient counseling, product‐based reimbursement, physician resistance, limited pharmacist access to information, insufficient clinical training, and weak consumer demand.24 The inspector general was not alone in predicting challenges to achieving a more clinical, patient‐centered pharmacy. Richard Penna, who at the time was serving as the associate executive director for the American Association of Colleges of Pharmacy (AACP), wrote about pharmacy’s evolution while likewise anticipating internal and external obstacles to this expansion, including resistance from other health professions, reimbursement barriers, logistical issues, and opposition from pharmacists themselves.25
Pharmaceutical Care Enters Iowa: A Climate of Possibility
Events in Iowa mirrored national developments. In the late 1980s, key actors agreed to dedicate resources to transforming community pharmacy, and the Iowa Pharmacy Association (IPA) officially endorsed pharmaceutical care in 1987.26 That same year, a revised Iowa Pharmacy Practice Act expanded pharmacy practice to a “dynamic patient‐oriented health service profession” and granted the state’s Board of Pharmacy greater rule‐making authority.27 Throughout the 1990s, pharmaceutical care dominated IPA meetings, fueling interest in continuing education and demonstration projects.
As demonstration projects began, leaders collaborated across states to share ideas. Iowa’s first project was linked to Minnesota’s, where Strand and colleagues had launched the Minnesota Pharmaceutical Care Project in November 1992. The project’s origins and outcomes were documented.28 The Minnesota project implemented pharmaceutical care using a systematic approach to pharmacists’ roles and tasks.29 Simultaneously, Iowa’s first demonstration project, funded by the Iowa Pharmacy Foundation and led by Jay Currie at the University of Iowa, ran at Claxton Pharmacy from May 1992 to January 1994. Further details and findings of this project have been reported.30 Both the Minnesota and Iowa projects aimed at helping community pharmacists adopt a fully professional, clinical practice guided by the pharmaceutical care framework. For Iowa, favorable external factors and promising pilot projects encouraged advancement toward this new practice model.
In April 1994, a long‐term, statewide initiative was launched to transform community pharmacy practice, led by individuals who formed the Iowa Center for Pharmaceutical Care (ICPC). The ICPC emerged from years of planning by the IPA, Iowa Pharmacy Foundation, and the state’s two colleges of pharmacy (Drake University and University of Iowa). With an initial $300,000 budget, the ICPC focused on converting community pharmacy practices to the pharmaceutical care model, adopting the mission: “A resource center dedicated to the adoption, evaluation, and promotion of the tenets of pharmaceutical care as the basis and central focus of the practice of pharmacy in the state.”31 Initially, pilot pharmacies in Iowa (Table 1) participated in a joint training program led by ICPC faculty and staff from the University of Minnesota’s Peters Institute for Pharmaceutical Care.32 Drawing on experiences and the results of the Claxton project,33 the ICPC developed a training program that could be applied to other community practices.
Iowa Center Pharmaceutical Care (ICPC) Pilot Pharmacies in 1994
Firsthand accounts of the individuals who staffed the ICPC were interviewed for this study. The names of those interviewed were the pharmacy faculty members John Rovers and Harry Hagel (Drake University), Jay Currie and Randy McDonough (University of Iowa),34 and Janelle Sobotka (IPA staff member).35 These individuals recounted their professional efforts with the ICPC in a 120‐minute oral history interview and follow up, as needed. Selected quotes are presented below with contextual details for each topic discussed.
The Story: Pharmaceutical Care in Iowa’s Community Pharmacies
Informal Origins and a Porch
The literal beginnings of the pharmaceutical care initiative in Iowa began with a meeting on an influential community pharmacist’s porch. A porch is a physical threshold between spaces, but symbolically it can also serve as a place of dialogue and relational grounding among community members. Therefore, it is fitting that the origins of pharmaceutical care in Iowa can be traced to such a grassroots‐oriented location. Nonetheless, precursors to successful grassroots movements rely on a confluence of elements that make action possible. In the Iowa story, the factors that came together included the interest and enthusiasm of community practitioners, the promise of pilot testing, access to academic resources, and buy‐in from additional stakeholder organizations (e.g., state association, insurance/payers). What happened on an Iowa porch one evening would not have been possible had it not been for the informal conversations between Robert “Bob” Cipolle (Minnesota) and Jay Currie (Iowa), who had conducted groundwork at Claxton Pharmacy.
In the years following the conferences held between 1985–1989, Currie began communicating with Cipolle, a member of the Minnesota pharmaceutical care demonstration project, and subsequently started looking for ways to implement the pharmaceutical care concept in Iowa. Currie recalls, “Bob Cipolle [and I] struck up a friendship . . . and I just said we need to figure out how do we try to make this [pharmaceutical care] happen in the real world as opposed to a theoretical construct.” Currie, energized by the possibilities, began strategizing where to trial a new philosophy and approach in the “real world.” He noted that he thought it best to try a pharmacy that was seen as open‐minded: “We decided to put together a trial, and we had a pharmacy in Cedar Rapids [Iowa] that was like, well, if this can happen in community pharmacy, this is the pharmacy where it can happen, because it was a pretty progressive community pharmacy at the time, and the medical providers in Cedar Rapids saw it as a different kind of pharmacy.” After the Claxton Pharmacy trial, Currie saw sufficient evidence that pharmacists could implement pharmaceutical care to improve patient outcomes. However, one pharmacy alone could not drive widespread change; a network of community pharmacies was needed. The goal was to demonstrate wider success, with support from local insurers seeking both cost savings and value‐added services for beneficiaries and plan sponsors. Currie stated, “in my recollection, that need from the private sector to try to create a network quickly to offer these services out and try to develop a business model was what really spurred on the need to do something with the results I had found in my trial.” Once pilot testing showed promise, the next step was to engage those who could influence its wider adoption.
It was at a porch meeting one evening, where the ICPC was born. The meeting was hosted by influential Iowan pharmacist Robert “Bob” Osterhaus.36 It was here, where key Iowa stakeholders convened to commit to the formation of an initiative to be known as the ICPC. In addition, Currie noted another local pharmacist, T. J. Johnsrud,37 had helped arrange the porch meeting. Currie stated that Johnsrud had the foresight to emphasize the need for private‐sector involvement, inclusive of both insurers and community pharmacies. Currie recalled:
T. J. Johnsrud was able to infiltrate Blue Cross/Blue Shield enough that he convinced them they should pay for [pharmaceutical care], and he immediately had a need for a network, and that was really the thing. Him [Johnsrud] needing to create a network and people who were wanting to be in that network were basically the thing that initiated the meeting on Bob O’s porch and getting everybody to agree and the colleges to agree and all that stuff . . . But in my recollection, that need from the private sector to try to create a network quickly to offer these services out and try to develop a business model was what really spurred on the need to do something with the results I had found in my trial.
Both Iowa colleges of pharmacy had recently appointed new deans,38 and ICPC member Randy McDonough recalled the porch meeting and the deans’ eagerness to engage in the emerging professional changes: “I was on the porch, when it was on the porch. At that point, we had two newer deans at both colleges of pharmacy . . . and we had these 12 sites that had said, ‘We really need help to be able to get this thing going.’ . . . and I think that’s how all of us got recruited into the roles we had.” The involvement of the colleges was collaborative and strategic, helping maintain relevance, enhance national reputation, and provide students with a cutting‐edge training. With new deans at Iowa’s two pharmacy schools, the academic institutions became jointly invested in the ICPC, yielding numerous benefits from the partnership.39
ICPC’s origins were grounded in Hepler and Strand’s framework and the professional relationship between Cipolle and Currie, whose friendship fostered ongoing idea generation between their respective state’s demonstration projects. Currie’s Claxton Pharmacy pilot provided materials later used by the ICPC. Influential practitioners, including Bob Osterhaus and T. J. Johnsrud, ensured their practices and networks were receptive to innovation, while the two Iowa colleges of pharmacy contributed two faculty members each and the Iowa Pharmacy Association provided staff support, supplying essential manpower for the initiative.
Distinctions: Characterizing the Iowa Ethos
Building on these early collaborations, the Iowa team began planning what became the ICPC. Strong support from the state’s colleges of pharmacy, combined with Currie’s experience from the Claxton Pharmacy pilot and his ongoing dialogue with Cipolle in Minnesota, shaped the initiative’s foundation. Unlike research‐focused projects elsewhere, Iowa pursued a pragmatic, grassroots model aimed at helping pharmacists implement pharmaceutical care in their day‐to‐day work. This approach emphasized practicality over theory, partnership over detachment, and open sharing over proprietary control, setting the stage for the ICPC’s distinctive ethos.
Currie stated, “I was trying infiltrate Iowa with those ideas that came out of Minnesota . . . I had talked to him [Cipolle] a lot.” Currie recalled working to bring Minnesota’s ideas to Iowa, adapting them into practical tools such as interview forms, medication lists, templates for clinical documentation (i.e., Subjective, Objective, Assessment and Plan [SOAP] notes), and patient communication strategies. Much of this foundation, developed in the Claxton study and in discussion with Cipolle, was incorporated into ICPC training materials. ICPC interviewees noted that the Iowa team emphasized the actual work of pharmacists, prioritizing practical over theoretical exactness. While the ICPC considered running the initiative as a research study, they ultimately adopted a flexible, pragmatic approach focusing on workflow and documentation rather than measuring outcomes. John Rovers confirmed this, stating, “The Minnesota approach was entirely theoretical. . . . using what Jay [Currie] had come up with, which was the practice side of things . . . and then Harry [Hagel] . . . worked out a workflow process everybody was interested in, which I think is one of the things that separated what we did.”
The decision to focus less on fidelity to theory and more on uptake and implementation was a conscious one. Currie stated:
We said to ourselves we can either do this like it’s a study, or we can just do it to get it done. And we decided we were going to do it to get it done and try to leave enough breadcrumbs that we could talk about it, write about it, or whatever, but not do it as a study. And as an example, Minnesota did it as a study. So . . . we didn’t write down everything, and we didn’t have this logic in testing hypotheses all the way through it, but I think a big part of it was let’s just get it done. Let’s do the things, and if that goes off protocol, we don’t care.
A distinctive feature was treating community pharmacists as “partners.” Unlike an approach of typical academic detachment, the ICPC’s faculty worked side‐by‐side with pharmacists. Currie emphasized that if extra visits were needed to support implementation, the team made them, stating, “‘Oh, you have to go out three more times to this person to get them to do something’; then we were going to go out three times . . . it wasn’t very faculty‐like in the traditional sense of doing research, but I think it was a big part of having the sites see us as partners.”
It was an investment not only in educating pharmacists but also walking alongside them in their efforts to transform. McDonough reiterated this distinctive relationship in the Iowa initiative, “from my perspective, we were the first program. It wasn’t a business . . . we were volunteering our time: we’re committing to you, now you commit to us . . . we were the first ones to really hold people accountable.” Community pharmacies across Iowa, particularly independent and local franchises, were recruited due to their administrative flexibility. Between 1994 and 1995, 85 pharmacies and 215 pharmacists participated in the program.40 The ICPC initiative focused specifically on training and implementing pharmaceutical care in community pharmacies. Pharmacists were supported in identifying, recommending, monitoring, and documenting drug‐related problems. The ICPC also assisted in building partnerships with hospitals and physicians, discussing reimbursement issues, and providing onsite guidance about workflow and physical layouts for clinically focused patient services.41
Additional elements that made the ICPC unique were its focus on coaching and its non‐proprietary and collaborative method. Harry Hagel and Currie both commented on how this contrasted with other approaches. Hagel recalled, “I remember going up to Minnesota; they knew the theory, and then observed the groups to see how they implemented it. We took a very different approach; we helped them implement.” Currie echoed this account, “Our legitimacy was that we were seen like real pharmacists, trying to help them out of the box that was being created around them.” Currie contrasted the distinctiveness of Iowa’s approach in its de‐emphasis of intellectual property, stating, “Minnesota became very proprietary in developing software and said, ‘We’re not interested in education.’ . . . Others around the country were the same, but we never were, we would share with anybody.” Additionally, both Hagel and McDonough felt that their own practice backgrounds helped the ICPC initiative gain legitimacy with community pharmacists. Hagel stated, “while we all were faculty, we all could also point to our clinical credentials.” McDonough concurred, “What made us different besides the proprietariness [sic] of everybody else was we were really focused on, ‘What is the work that pharmacists do? . . . [to] identify and resolve medication‐related problems.’”
During the ICPC years, the national pharmaceutical care movement began to diverge. Some other regional initiatives focused on disease‐specific care (e.g., diabetes, asthma, hypertension) to target patients with the highest medication risks. The ICPC, however, rejected this approach, maintaining a holistic, patient‐centered model for all patients. Currie noted that his family medicine background reinforced his commitment to this philosophy, stating, “In Richmond, Virginia . . . they focused on diabetes and hyperlipidemia and asthma. . . . An early battle was [should this] be disease state‐oriented versus [should this] be human being‐oriented, and we made a conscious decision to say this was a process to do for each person . . . it’s not, ‘let me fix their diabetes.’”
Drawing on the success of the Claxton Pharmacy trial, the ICPC team adopted a pragmatic implementation approach in Iowa’s community pharmacies, prioritizing flexibility over strict protocols and statistical rigor. They maintained a holistic, patient‐centered focus rather than targeting specific disease states and distinguished themselves by openly sharing their tools and methods with anyone interested.
Translating Philosophy into Practice alongside Operational Challenges
Implementing pharmaceutical care in Iowa required more than educating others about a new philosophy; it demanded overcoming the many challenges presented by translating abstract concepts into busy practice settings. The ICPC engaged community pharmacies over several months, guiding staff through workflow redesign, patient interactions, and collaborative problem‐solving. Trainers emphasized practical applications, providing hands‐on support, communication tools, and iterative feedback, while ICPC faculty worked to bridge the gap between practice and pharmacy education.
A central challenge was helping pharmacists convert the foundational philosophy into workflow and patient care practices. John Rovers observed, “They’re clearly having difficulty getting their head around it . . . trying to get them to envision something they had simply never seen and, in many cases, never even considered.” Bridging theory to practice was a key focus of ICPC training. ICPC members also observed that participating pharmacists often lacked clinical knowledge, critical thinking skills, and confidence in therapeutic applications. They also struggled with the communication skills needed to interact with healthcare teams. Currie explained, “they didn’t have the words” to make clinical recommendations and developed scripts to guide communication with prescribers and other professionals. McDonough added, “Being an interventionist is not an easy thing to do,” highlighting that communication challenges affected both patients and other providers.
The pharmacies participating in the ICPC program were not the only beneficiaries of the practice change. ICPC trainers held faculty appointments in Iowa colleges, further bridging practice with education. Hagel reflected, “that [pharmaceutical care] evolution from 1990 to 1993, that was a short period of time before it got implemented into the curriculums . . . I think that evolution of education changed a lot of the fundamentals of what was happening in pharmacy in Iowa.” Interviewees noted that insights from practice were quickly integrated into educational approaches, including problem‐based learning to foster critical thinking. A new professional socialization emphasized accountability in clinical care, prioritizing patient responsibility over profitability. Currie reflected, “we have to take responsibility for what we do. That was something pharmacy really didn’t do before. We just filled the scripts . . . So if you say, ‘Well, the doctor wrote the script, I just filled it, no change will ever happen, because there’s no risk to that. . . . helping pharmacists understand they had a responsibility to their patients was a big part.”
The ICPC emphasized the physical layout, workflow, and logistics of practice sites, alongside collaborative accountability during site visits. Trainers spent considerable time observing, questioning, and providing feedback, allowing practitioners to adapt their practice through an individualized approach. Currie reflected, “The biggest part of the training, as far as I was concerned, was site visits . . . you need to make change, as opposed to a CE [continuing education] program. . . . ‘And Tuesday, there’s a test. I’m coming to your site. Let’s see what you did.’ . . . it was a different level of engagement work, implementation work, that we did beyond providing the training materials for a CE program.” Hagel recalled challenging observations in pharmacies, “I remember walking into a pharmacy and the pharmacist is getting bombarded, he’s got a phone in each ear . . . or I had a pharmacist who said, ‘I just really have no space to do a semi‐private,’ and I’m walking around, and I said, ‘You’ve got a school supply section here that’s got dust on it. How much are you really selling?’” McDonough noted that lessons from the ICPC are still applied today, including better use of pharmacy technicians, “I left my academic position because I wanted to prove the concept . . . how do we work on workflow? How do we improve efficiencies? . . . we’ve got to utilize our technicians differently . . . but at the end of it, what was supposed to happen then is the pharmacist is freed up.” Currie concurred regarding technicians, “Very quickly we figured out that a technician is a key to this working, because it’s the only way to get you away from that computer, having a good technician.” Interviewees also noted external challenges, such as physicians’ familiarity with pharmacists. Rovers stated, “I think one of the things that helped that was external to us is that probably every physician out there today has been trained alongside a pharmacist at some point in their life, and that wouldn’t have been the case for a lot of the physicians when we first got started. Those would have been the old‐school MDs: ‘I went to medical school. You didn’t. What the hell do you know?’” As interprofessional education expanded following the ICPC efforts, physicians increasingly encountered pharmacists during their training.
A persistent challenge identified by the ICPC team was pharmacists’ ability to value, request, and obtain reimbursement for their services. Hagel observed that pharmacists often focused “too much time working in your business and not on your business,” and noted gaps in pharmacy education: “And then there wasn’t even strong business training in the pharmacy curriculum. There still isn’t . . . practice management, that’s still a major gap.” Additionally, insurers often emphasized adherence metrics rather than the standards of clinical value pharmacists sought to provide. Currie recalled, “I think it was the whole region 7, a Medicare meeting . . . all the faculty people were talking about making these big, decisive impacts on care and quality of life . . . and the feedback from the regulator people and the people who control payment was, can you just help us understand whether people are taking their medicine or not?”
The ICPC program guided Iowa community pharmacies to adopt pharmaceutical care through regular site visits and hands‐on support. Pharmacists sought to change workflow, and develop clinical judgment, therapeutic reasoning, and interprofessional communication, while trainers provided scripts, feedback, and practical guidance. ICPC faculty bridged practice and education, fostering problem‐based learning and patient‐centered accountability among their students. From a logistics standpoint, pharmacies had to adjust workflow, layouts, and technician utilization to free up pharmacists to focus on clinical care. It was noted that external factors, such as physician familiarity and renumeration limitations, shaped uptake. The ICPC created a flexible, collaborative model that enabled sustainable implementation, laying the groundwork for broader institutionalization and the next phase of community pharmacy transformation.
Threshold of Transition: Institutionalizing Informal Beginnings
Word of the success of the Iowa initiative spread regionally and nationally in the form of collaborative networks, educational reforms, published literature, and eventually through American Pharmacists Association (APhA) continuing education (CE) offerings. In February 1995, Iowa pharmacists convened at the Implementing Pharmaceutical Care: A Consensus Conference to unify their vision for re‐engineering community pharmacy practice.42 Later that year, a smaller group of ICPC‐trained independent pharmacies in eastern Iowa formed the Certified Pharmaceutical Care Network (CPCN). This network extended practice transformation by developing quality assurance measures and standards to evaluate pharmaceutical care services. The pharmaceutical industry soon took interest, particularly in outcomes for high‐risk patients and quality‐of‐life impacts, partnering with CPCN to study pharmacists’ effect on patient care.43
The ICPC’s efforts turned towards expanding clinically oriented community practice sites, which soon became experiential learning placements for students in the new Doctor of Pharmacy (PharmD) curriculum. The Iowa colleges readily used these practice sites, with ICPC staff preparing pharmacists to serve as competent preceptors. This preparation benefitted practitioners as students contributed to the clinical manpower required for expanded services. The ICPC thus served as a bridge between community pharmacists and the growing experiential needs of PharmD education. Currie recalled, “part of the arrangement with sites was, at least the ones we trained through ICPC: ‘we’ll give you this training . . . once you get up and running and you’re good enough, we’re going to send students to your site.’” He noted that these rotations created “care‐oriented community rotations, as opposed to distribution‐related rotations,” while also maintaining quality that satisfied the state’s Board of Pharmacy. Currie emphasized, “we really used our curriculum and our students to help the sites continue to advance.”
ICPC members also reflected on how their work aligned with broader changes in pharmacy education. Currie noted the shift toward active‐learning approaches, recalling, “about the same time I was trying to work at the college with developing problem‐based learning instead of didactic teaching: what information do you have, what information do you need to move forward, how do you get that information, then how do you apply it and how does that change?” Hagel added that the ICPC also help shape experiential learning, stating, “ICPC evolved into the colleges in terms of that education, and part of it was to train the students, but also through the sites that we needed as we converted from bachelor’s to PharmD program.” After training and site visits concluded, ICPC efforts turned toward broader dissemination.
In October 1995, the APhA announced its plans to purchase the ICPC’s education and training program for its newly created American Center for Pharmaceutical Care.44 The following month, the ICPC’s experiences were presented at a national conference, Implementation of Pharmaceutical Care and Payment Systems, attended by state associations and colleges of pharmacy.45 In 1996, the ICPC relinquished the rights to the training program to the APhA. With its new national center established, the APhA paired its new training program with the resource manual Positioning Your Practice for Pharmaceutical Care: An Individualized Blueprint for Change, extending Iowa’s local efforts to the national stage.46
In 1997 and 1998, the ICPC continued to disseminate its work through conferences, peer‐reviewed publications, and specialized projects advancing pharmaceutical care. Initiatives included a hospital implementation project, curriculum case development, and support for community practice residencies with an emphasis on pharmaceutical care.47 Two peer‐reviewed articles emerged from these ICPC efforts. In the paper by Hagel et al., the team outlined the training program’s structure, emphasizing its heavy educational component for community practitioners. The article described pharmacists’ challenges in transitioning to expanded roles, noting the extensive time commitment required of practitioner‐faculty educators to lead change in experiential settings. It also underscored the benefits of strengthening relationships between colleges and workplace practice sites where students would eventually enter.48 However, the paper remained focused primarily on internal professional implementation challenges specific to community pharmacists, devoting less attention to the external health system barriers that shaped the broader adoption of pharmaceutical care.
The second peer‐reviewed paper, published by McDonough et al. in the Journal of the American Pharmacists Association (JAPhA), targeted a practitioner‐scientist audience and focused on the “obstacles” faced by the ICPC team.49 The authors organized these obstacles into six categories: pharmacists’ attitudes, practice skills, resource constraints, system‐related constraints, interprofessional issues, and educational factors. Like Hagel et al., this account largely emphasized challenges internal to the profession. The only externally oriented category was “system‐related constraints,” which included lack of billing mechanisms, patient demand, and physician or nurse acceptance. The authors noted that pharmacists may need further education in billing but acknowledged that reimbursement was also dependent on patient‐driven demand. Regarding other health professionals, they emphasized long‐term strategies of relationship building and referral networks as necessary for success. Finally, they underscored the absence of evidence or outcomes data—an issue often tied to the broader narrative that pharmacy must demonstrate value to external stakeholders in order to secure recognition and support. In 1998, APhA published A Practical Guide to Pharmaceutical Care, authored by the ICPC team as a process‐focused manual to help practitioners integrate pharmaceutical care into their community practices.50 The book incorporated elements from ICPC’s training program as well as insights from the implementation efforts. A second edition expanded to incorporate new educational experiences from teaching students, updated evidence on outcomes, and reflections on the evolving health information ecosystem, particularly the rise of the internet.51 This second edition also devoted more attention to practical community practice site concerns such as workflow, staffing, marketing, billing, and quality assurance. It also appeared to be a self‐authored response to challenges outlined in McDonough et al.’s 1998 paper, with new chapters on interprofessional buy‐in, marketing, and reimbursement.52 Around the same period, Hagel and Rovers of the ICPC team edited an APhA management‐focused volume on patient‐centered pharmacy that incorporated broad healthcare system and business perspectives.53 A third and final edition of the guide by Rovers and Currie, published in 2007, returned to a stronger focus on patient‐centered care.54
After ICPC training and site visits concluded in 1995, the team shifted toward dissemination, creating new collaborations and publishing their methods and experiences for educators, practitioners, and PharmD students. Their work continued through teaching, research collaboration, consulting, and supporting the implementation of the PharmD credential for new pharmacy graduates.
Extended Endings: Adaptations and Ongoing Legacies
The conclusion of the Iowa initiative paradoxically marked the beginning of new efforts to shape the pharmacy profession. These efforts extended Iowa’s work in three areas: continuing education for licensed pharmacists, measurement of outcomes and evidence on pharmaceutical care effectiveness, and evolving the name and representation of pharmaceutical care.
The APhA rebranded the ICPC’s process‐oriented approach into CE, aiming for national dissemination. Hagel reflected on the limits of CE alone: “I was hoping that APhA would not just offer CE to change practice but actually provide a level of support . . . just teaching them was not going to do it. A didactic course, even if you’re doing some skill training in that, if you don’t follow up, you’re not going to see the change.” When considering the trade‐offs of their program, Harry Hagel acknowledged the inevitability of market adoption, stating, “The marketplace took it over . . . There’s no way we could still be doing ICPC. The cost would be prohibitive, and nobody would spend the time. The marketplace had to take it up.” Ultimately, the Iowa initiative was transitioned to professional organizations, insurers, and payment‐adjacent innovators, who advanced the process through documentation and measurement. These elements would be key precursors to make a case for reimbursement. Today, one ICPC member remains active in community pharmacy practice, with Randy McDonough attributing his ongoing commitment to the philosophy he learned during the ICPC.55
A theme highlighted by former ICPC members was the evolution of pharmaceutical care terminology and new variations of philosophy. For example, John Rovers mentioned disease‐state management, medication‐therapy management, and the current contemporary approach referred to as the Pharmacists’ Patient Care Process.56 Rovers observed, “I find it remarkable that if you take the very first edition of ‘A Practical Guide to Pharmaceutical Care’ and look at page 16, you’ll find something that looks surprisingly like the Pharmacists’ Patient Care Process . . . They created ‘disease management,’ and then that did its thing, and then a few years later we had ‘medication therapy management.’” Curried agreed with this sentiment, adding:
And I think what’s happened with it, and this happens in academia all the time, if you come up with a new thing, you’ve got to get an acronym to go with it, and now that’s the new thing, and that’s what happened with pharmaceutical care. Those early definitions of pharmaceutical care apply to all this that’s trickled down . . . a new group of people looked at that thing and said, ‘Let’s call this something new so we can own it.’ . . . we pretty much stayed out of those fights.
These reflections from the ICPC team align with other documentation from the late 1990s and early 2000s, which noted that complete practice transformation remained more aspirational than realized. Iowa was not alone in implementing practice changes in community pharmacy. Minnesota’s pharmaceutical care implementation project, described in Cipolle et al.57 and further detailed by Tomechko et al.,58 ran from May 1992 to October 1995. The article by Tomechko et al., presented in question‐and‐answer format, reviewed the application of comprehensive pharmaceutical care, obstacles in the workplace, patient perceptions, and reimbursement challenges. It acknowledged that not all pharmacists would adopt the new model but emphasized that sufficient participation was necessary to meet third‐party service obligations and patient demand, highlighting the broader systemic considerations in achieving sustainable practice change.59
In the early 2000s the use of “pharmaceutical care” began a shift into a variety of different phrases to more specifically represent the billable service provided by pharmacists. One phrase was “drug therapy management”60 and another, which became widely used, was “medication therapy management” or MTM.61 Although the emergence of the specific terminology in the early 2000s and the billable aspects of MTM are beyond the scope of this study, it is important to note that the term “pharmaceutical care” appeared to evolve out of the profession’s lexicon beginning in the early 2000s. One ICPC member, representing the IPA explained in her remarks that the term, “pharmaceutical care” did not resonate with legislators in US Congress, limiting its viability in policy and Medicare reimbursement discussions.62 This key observation is confirmed by the discussions in the late 1990s as the profession increasingly focused on making a compelling case for billable pharmacy services. One account of the emergence of MTM in the US is documented in an oral history interview with Robert Cipolle, one of the original implementers of pharmaceutical care in the Minnesota project. When asked if pharmaceutical care had been transplanted outside of Minnesota, his response was, “Oh, yes. That’s the practice. It is now a billable service in healthcare everywhere in the country. It’s called medication therapy management [MTM]. That’s what the government tagged, this service that developed from this practice. It’s like my brother the surgeon . . . He practices surgery; that’s his practice. He bills for appendectomies. So MTM is the appendectomy.”63
As initial pharmaceutical care demonstration projects were concluding in the late 1990s, the profession continued to outline next steps and wrestle with challenges presented by pharmaceutical care. Knowlton and Penna’s 1996 text Pharmaceutical Care provided a comprehensive overview, with 16 chapters covering pharmacy history, the nature of pharmaceutical care, and its implementation.64 Chapter 12, “The Pharmacist and Pharmaceutical Care,” specifically addressed changes in pharmacists’ work, highlighting milestones such as a shift toward patient care, strengthened interprofessional relationships, workflow and technological improvements, and expanded roles beyond dispensing to include assessment, counseling, and surveillance. They emphasized that sustaining these advances required measurable evidence of effectiveness, arguing that effective outcomes such as reductions in patient medication costs, improved adherence, self‐efficacy, patient satisfaction, and decreased adverse‐drug events would validate the new practice model. Evidence would serve to solidify the transition from traditional dispensing‐focused functions to a fully patient‐centered pharmaceutical care paradigm.65
Posey’s 1997 paper, “Pharmaceutical Care: Will Pharmacy Incorporate Its Philosophy of Practice?,” assessed whether pharmaceutical care could move from concept to broader practice, integrating interviews with Hepler and Strand.66 Hepler reflected on the challenge of reconciling the philosophy with day‐to‐day pharmacy work, while Strand emphasized linking concepts to real‐world practice. Posey highlighted ongoing implementation challenges, including debates over disease‐specific versus general models, citing Iowa’s ICPC initiative and software projects as rare examples of full adoption. Strand later advocated for a unified, general model focused on professional obligations and the service of humanity, dismissing “branded” versions.67 Hepler emphasized external market barriers, noting that few practices changed because pharmacists were not reimbursed for their services, and he promoted the creation of self‐sustaining micro‐markets between pharmacists and third‐party payers.68
The conclusion of the Iowa ICPC initiative contributed to ongoing efforts to modernize pharmacy education and outcomes measurement, and refine pharmaceutical care terminology. National approaches varied, and use of the “pharmaceutical care” term gradually gave way to disease‐state management and MTM to better align with the rhetoric of billable services. The profession increasingly focused on advancing adoption through documentation, measurement, and reimbursement. While implementation projects showed uneven uptake, books, interviews, and articles from the period consistently pointed to the remaining work to be done to fully integrate the pharmaceutical care philosophy into a patient‐centered, interprofessional practice alongside existing external market and policy forces.
Discussion: Contextualizing the Evolution of Pharmacy
Using Iowa’s experience implementing pharmaceutical care in community pharmacies, in combination with Abbott’s theory of professions, we gain a novel lens to understand the evolution of community pharmacy. Pharmaceutical care, as conceived by Hepler and Strand, represented a new conceptual framework for pharmacists to establish jurisdictional claims over medication management services. Abbott’s theory emphasizes how jurisdictional relations shape professional control. The Iowa ICPC initiative uniquely operationalized pharmaceutical care through collaboration between academic and private sectors, with an emphasis on coaching, follow‐up, and non‐proprietary relationship‐building. Unlike other initiatives, the ICPC prioritized sharing the vision and focusing on the work of pharmacists. Thus, the pharmaceutical care philosophy represented the abstract, or subjective framework of professional pharmacy practice, while the ICPC initiative operationalized these ideas into concrete, objective processes and actions in community pharmacy settings. This aligns with Abbott’s premise that the strength of a profession’s jurisdiction depends on both subjective and objective aspects of the work.
Despite clear subjective claims made under the pharmaceutical care philosophy, it appears that pharmacy’s jurisdiction over medication management services remained vulnerable. Pharmacists faced skepticism from physicians, who retained control over prescribing, and nurses, who managed medication information during care transitions. Over time, integration in medical training has helped, as most physicians today have worked alongside pharmacists. In addition, pharmacists struggled to fully adapt to the professional culture shift required of pharmaceutical care—which emphasized communication, accountability, and patient‐centered care. Thus, pharmaceutical care philosophy may have lacked internal support or was inconsistently applied among community pharmacies, leaving expanded subjective claims of pharmacy’s jurisdiction fragile; evidence from ICPC publications and firsthand accounts confirms these vulnerabilities.
Objective elements of pharmacy’s jurisdiction were even more exposed. Despite clearly delineated processes for decision‐making, documentation, and follow‐up with patients, community pharmacies faced systemic, structural pressures such as shrinking dispensing margins, automation, and mass distribution changes. In addition, a lack of standardization of pharmaceutical care became a critique.69 Although these pressures existed to prompt need for professional reinvention, external forces in the system of healthcare may have been too powerful to permit widespread implementation of new elements of “work.” While clinical pharmacy had expanded in hospitals to a greater degree, community pharmacies strained to redefine themselves amidst the struggle for survival. Third‐party payment and reimbursement presented barriers. Even with state‐level jurisdictional victories through updated pharmacy practice acts and Medicaid reimbursement programs, pharmacists often did not bill for new services provided. Despite isolated markets created to directly bill health insurers, managed care organizations and more specifically, Pharmacy Benefit Managers (PBMs), emerged to control costs and medication use. The connection between managed care and pharmaceutical care was predicted in 1998 as a “natural marriage.”70 PBMs grew following the federal Medicare Modernization Act in 2003 to both administer and reimburse for medication management services for Part D beneficiaries (i.e., pharmaceutical care, MTM).71 These developments have arguably further diluted community pharmacy’s direct jurisdiction over medication management services. Finally, public buy‐in and visibility can influence successful expansion of a profession’s jurisdiction. The degree of exposure of pharmaceutical care to the public is an area that could be further explored. It is possible that pharmaceutical care was not clear outside academic circles, or alternatively, that there was low public demand for the service. As healthcare became increasingly consumer‐oriented in the 1990s, it is possible that overt public demand for pharmaceutical care remained limited.
Attempts to expand community pharmacies jurisdiction in the provision of pharmaceutical care may have been less successful than desired. Pharmaceutical care’s abstraction in the 1990s was vulnerable across both subjective and objective domains, and neither internal nor external forces fully supported its expansion. What distinguished the ICPC’s approach was its ability to translate theoretical knowledge into practical work, integrating both subjective and objective dimensions, with a humanistic and relational implementation model. Evidence of enduring success exists in the creation of the patient care process (PCP) model,72 which continues today to operationalize pharmaceutical care and ICPC processes, demonstrating that jurisdictional expansion is possible under the right conditions. Notably, Abbott emphasizes that a singular or unified group of organizations (i.e., national/professional organizations) serves as a prerequisite to a profession’s jurisdictional claims.73 Thus, the active contribution of state (e.g., IPA) and national pharmacy organizations (e.g., Joint Commission of Pharmacy Practitioners [JCPP]) have and will continue to be, a valuable requisite for jurisdictional expansion of the profession of pharmacy.74
The ICPC’s work also illustrates broader lessons about national professional evolution. The ICPC initiative, alongside other regional efforts, helped catalyze change in education, outcome measurement, and adaptive terminology to align with external stakeholders. By the late 1990s and early 2000s, publications contextualized the profession’s evolution and the limits of complete practice transformation. For example, Knowlton and Penna’s 1996 volume highlighted milestones of the profession’s evolution, such as shifts in pharmacists’ attitudes toward responsible patient care, stronger interprofessional relationships, workflow/technological improvements, and expanded roles beyond dispensing.75 However, it was emphasized that sustaining these advances required measurable evidence of effectiveness.76 In addition, testimony from articles assessing the progress of pharmaceutical care expansion often commented on fractured implementation, with debates over disease‐specific versus general models of pharmaceutical care. Although complete transformation was not achieved nationally from 1990–1998, the ICPC initiative demonstrated the potential for effective implementation strategies. The ICPC’s legacy, reflected in ongoing practices and persistent philosophical influence, shows that jurisdictional expansion in community pharmacies is possible but requires alignment of subjective commitment, objective demonstration, and systemic support from external entities.
Overall, the evolution of pharmaceutical care in Iowa’s community pharmacies highlights the complex interplay of theory, practice, market forces, and professional culture. The ICPC initiative provides a historical account of the profession’s attempts to reimagine itself, showing that while pharmacy may not have achieved full jurisdictional dominance in medication management services during this period, the efforts clarified the challenges and potential pathways for professional growth. Abbott’s framework remains a useful lens to understand how abstract knowledge, applied work, and environmental context converge to shape a profession’s trajectory, illustrating both the promise and the limitations of transformative initiatives from within and among health professions.
Acknowledgements
The author extends sincere thanks to the individuals interviewed for this project for generously sharing their time and thoughtful reflections. Special appreciation is given to John Rovers for his encouragement of the concept and development of this article. Gratitude is also extended to the anonymous reviewers for their time and insightful feedback, which strengthened this article.
Footnotes
↵1. Andrew Abbott, The System of Professions: An Essay on the Division of Expert Labor (University of Chicago Press, 1988).
↵2. Charles D. Hepler and Linda M. Strand, “Opportunities and Responsibilities in Pharmaceutical Care,” American Journal of Hospital Pharmacy 47, no. 3 (1990): 533–43, https://doi.org/10.1093/ajhp/47.3.533.
↵3. Abbot, System of Professions, 35.
↵4. Abbot, System of Professions, 30.
↵5. Abbot, System of Professions, 59–85.
↵6. Hepler and Strand, “Opportunities,” 533–34.
↵7. Robert J. Cipolle, Linda M. Strand, and Peter C. Morley, eds., Pharmaceutical Care Practice: The Clinician’s Guide (McGraw‐Hill, 1998).
↵8. Robert L. Mikeal, Herman L. Lazarus, Michael C. Vinson, and Thomas R. Brown, “Quality of Pharmaceutical Care in Hospitals.” American Journal of Hospital Pharmacy 32, no. 6 (1975): 567–74, https://doi.org/10.1093/ajhp/32.6.567.
↵9. D. C. Brodie, P. A. Parish, and J. W. Poston, “Societal Needs for Drugs and Drug‐Related Services,” American Journal of Pharmaceutical Education 44, no. 3 (1980): 276–78.
↵10. Cipolle et al., Pharmaceutical Care, 10–11.
↵11. Hepler and Strand, “Opportunities,” 539.
↵12. Hepler and Strand, “Opportunities,” 539.
↵13. Lee Anderson and Kathy Penningroth, Transitions Through Innovation—The Iowa Pharmacists Association and Iowa Pharmacy: 1945 to 1997 (A & P Historical Resources, 1997), 151.
↵14. Anderson and Penningroth, Transitions, 147.
↵15. Anderson and Penningroth, Transitions, 175.
↵16. William A. Zellmer, “Role of Pharmacy Organizations in Transforming the Profession: The Case of Pharmaceutical Care,” American Journal of Health‐System Pharmacy 58, no. 21 (2001): 2041–49, https://doi.org/10.1093/AJHP/58.21.2041.
↵17. Organized by the American Society of Hospital Pharmacists and summarized in the article “Directions for Clinical Practice in Pharmacy,” American Journal of Hospital Pharmacy 42, no. 6 (1985): 1287–1287, https://doi.org/10.1093/AJHP/42.6.1287.
↵18. Organized and funded by the Joint Commission of Pharmacy Practitioners and summarized in the volume on “Conference on Pharmacy in the 21st Century, Oct 11–14, 1989,” Winter Supplement, American Journal of Pharmaceutical Education 53 (1989).
↵19. L. Michael Posey, “Pharmaceutical Care: Will Pharmacy Incorporate Its Philosophy of Practice? Can the Principles and Applications of Pharmaceutical Care Lead the Profession out of the Desert and into the Promised Land?” Journal of the American Pharmaceutical Association 37, no. 2 (1997): 145–48, https://doi.org/10.1016/s1086-5802(16)30201-7.
↵20. George H. Cocolas, “Pharmacy in the 21st Century Conference: Executive Summary,” American Journal of Pharmaceutical Education 53 (1989): 1S–5S, https://doi.org/10.1016/S0002-9459(24)06429-5.
↵21. Charles D. Hepler, “Unresolved Issues in the Future of Pharmacy,” American Journal of Hospital Pharmacy 45, no. 5 (1989): 1071–81, https://doi.org/10.1093/AJHP/45.5.1071.
↵22. Hepler and Strand, “Opportunities,” 542.
↵23. Anderson and Penningroth, Transitions, 178.
↵24. Richard P. Kusserow, “The Clinical Role of the Community Pharmacist,” Office of Inspector General, Government Oversight, US Department of Health and Human Services, 1990, https://oig.hhs.gov/reports/all/1990/the-clinical-role-of-the-community-pharmacist/.
↵25. Richard P. Penna, “Pharmaceutical Care: Pharmacy’s Mission for the 1990s,” American Journal of Hospital Pharmacy 47, no. 3 (1990): 543–49, https://doi.org/10.1093/ajhp/47.3.543.
↵26. Anderson and Penningroth, Transitions, 179.
↵27. Anderson and Penningroth, Transitions, 180.
↵28. Cipolle et al., Pharmaceutical Care, 205–235.
↵29. Linda M. Strand, Peter C. Morley, Robert J. Cipolle, Ruthanne Ramsey, and Grace D. Lamsam, “Drug‐Related Problems: Their Structure and Function,” DICP, Annals of Pharmacotherapy 24, no. 11 (1990): 1093–97, https://doi.org/10.1177/106002809002401114.
↵30. Jay D. Currie, Elizabeth A. Chrischilles, Angela K. Kuehl, and Raymond A. Buser, “Effect of a Training Program on Community Pharmacists’ Detection of and Intervention in Drug‐Related Problems,” Journal of the American Pharmaceutical Association 37, no. 2 (1997): 182–91, https://doi.org/10.1016/S1086-5802(16)30203-0.
↵31. Anderson and Penningroth, Transitions, 181.
↵32. Iowa Pharmacy Foundation, Iowa Center for Pharmaceutical Care: Celebrating a Decade of Progress in Shaping a New Generation of Pharmacy Practice (Iowa Pharmacy Association, 2004), 6.
↵33. Currie et al., “Training Program,” 187–188.
↵34. Jay Currie, Randy McDonough, Harry Hagel, and John Rovers, interview communication with author, February 12, 2025. Transcript available on request.
↵35. Jenelle Sobotka, in discussion with author, February 26, 2025.
↵36. Robert “Bob” Osterhaus, of Maquoketa, Iowa, served as the Iowa Pharmacy Association’s president 1984–1985, was a member of the American Pharmaceutical Association (APhA) Board of Trustee’s 1986–1990, and APhA president 1992–1993; See Anderson and Penningroth, Transitions, 159, 203.
↵37. Thomas J. “T. J.” Johnsrud served as the Iowa Pharmacy Association’s president 1983–1984 and worked with private prescription drug benefit programs throughout the state; See Anderson and Penningroth, Transitions, 158, 186–187.
↵38. New deans included Gilbert Banker in 1992 at the University of Iowa ; see “Minnesota Man Named as New Pharmacy Dean,” Iowa City Press‐Citizen, Feb 6, 1992, www.proquest.com/newspapers/february-6-1992-page-15-67/docview/2128828886/se-2, accessed August 12, 2025) and Stephen Hoag in 1993 at Drake University (Internal Report archived by Drake University ACPE evaluation report, April 13–14, 1994).
↵39. Harry P. Hagel, John P. Rovers, Jay D. Currie, Randy P. McDonough, and Jenelle L. Sobotka, “The Iowa Center for Pharmaceutical Care: An Effective Education‐Practice Partnership,” Journal of Pharmacy Teaching 6, no. 3 (1998): 19–37, https://doi.org/10.3109/J060v06n03_04.
↵40. Anderson and Penningroth, Transitions, 181.
↵41. Iowa Center for Pharmaceutical Care, 7.
↵42. Iowa Center for Pharmaceutical Care, 6.
↵43. Iowa Center for Pharmaceutical Care, 8.
↵44. Anderson and Penningroth, Transitions, 182.
↵45. Iowa Center for Pharmaceutical Care, 9.
↵46. Iowa Center for Pharmaceutical Care, 10.
↵47. Iowa Center for Pharmaceutical Care, 11–14.
↵48. Hagel, Rovers, et al., “Iowa Center,” 19–37.
↵49. Randy P. McDonough, John P. Rovers, Jay D. Currie, Harry Hagel, John Vallandinghanl, and Jenelle Sobotka, “Obstacles to the Implementation of Pharmaceutical Care in the Community Setting,” Journal of the American Pharmaceutical Association 38, no. 1 (1998): 87–95, https://doi.org/10.1016/S1086.
↵50. John P. Rovers, Jay D. Currie, Harry P. Hagel, Randy P. McDonough, and Jenelle L. Sobotka, eds., A Practical Guide to Pharmaceutical Care (American Pharmaceutical Association, 1998).
↵51. John P. Rovers, Jay D. Currie, Harry P. Hagel, Randy P. McDonough, and Jenelle L. Sobotka, eds., A Practical Guide to Pharmaceutical Care, 2nd ed. (American Pharmaceutical Association, 2003).
↵52. Rovers, Currie, et al., Practical Guide, 2nd ed., 139–152, 203–238.
↵53. Harry P. Hagel and John P. Rovers, eds., Managing the Patient‐Centered Pharmacy (American Pharmaceutical Association, 2002).
↵54. John P. Rovers and Jay D. Currie, A Practical Guide to Pharmaceutical Care: A Clinical Skills Primer, 3rd ed. (American Pharmacists Association, 2007).
↵55. Randy McDonough is co‐owner/CEO of Towncrest Pharmacy as well as several other pharmacies and related pharmacy businesses. He is also a professor of Pharmacy Management and Innovation at Loma Linda University School of Pharmacy and served as the APhA’s 170th president, https://www.pharmacist.com/About/Leadership/Board, accessed August 25, 2025.
↵56. Joint Commission of Pharmacy Practitioners. Pharmacists’ Patient Care Process. Joint Commission of Pharmacy Practitioners. Pharmacists’ Patient Care Process. May 20, 2025. Available at: https://jcpp.net/wp-content/uploads/2018/10/Pharmacists-Patient-Care-Process-Document-2025.pdf. Updated from the 2014 version, May 29, 2014, https://jcpp.net/wp-content/uploads/2016/03/PatientCareProcess-with-supporting-organizations.pdf, accessed August 25, 2025.
↵57. Cipolle et al., Pharmaceutical Care, 205–209.
↵58. Mary Ann Tomechko, Linda M. Strand, Peter C. Morley, and Robert J. Cipolle, “Q and A from the Pharmaceutical Care Project in Minnesota,” American Pharmacy NS35, no. 4 (1995): 30–39, https://doi.org/10.1016/s0160-3450(15)30168–9.
↵59. Tomechko et al., “Q and A,” 39.
↵60. Randal P. McDonough and William R. Doucette, “Drug Therapy Management: An Empirical Report of Drug Therapy Problems, Pharmacists’ Interventions, and Results of Pharmacists’ Actions,” Journal of the American Pharmacists Association 43, no. 4 (2003): 511–18, https://doi.org/10.1331/154434503322226266.
↵61. “Medication Therapy Management,” APhA Foundation, n.d., https://www.aphafoundation.org/medication-therapy-management, accessed May 1, 2025.
↵62. Jenelle Sobotka, interview communication with author, February 26, 2025.
↵63. Cipolle, Robert, “AHC Oral History Project,” Interviewed by Dominique Tobbell, University of Minnesota Oral History Project, June 12, 2012, https://ahc-ohp.lib.umn.edu/2014/09/04/cipolle-robert/.
↵64. Calvin H. Knowlton and Richard P. Penna, Pharmaceutical Care (Chapman & Hall, 2003).
↵65. Knowlton and Penna, Pharmaceutical Care, 243–256.
↵66. Posey, “Pharmaceutical Care,” 145–48.
↵67. Linda Mae Strand, “Re‐Visioning the Profession,” in Reflections on Pharmacy by the Remington Medalists 1919–2003, ed. George Griffenhagen, Grover C. Bowles, Jr., Richard P. Penna, and Dennis B. Worthen (American Pharmacists Association, 2004), 383.
↵68. Charles Douglas Hepler, “Four Virtues for the Future,” in Reflections on Pharmacy by the Remington Medalists 1919–2003, ed. George Griffenhagen, Grover C. Bowles, Jr., Richard P. Penna, and Dennis B. Worthen (American Pharmacists Association, 2004), 380.
↵69. Richard A. Hutchinson and Glen T. Schumock, “Need to Develop a Legal and Ethical Base for Pharmaceutical Care,” The Annals of Pharmacotherapy 28 no. 7–8 (1994): 954–56, https://doi.org/10.1177/106002809402800721.
↵70. Shane Desselle, “The Evolution of Pharmaceutical Care into Managed Care Environments,” Journal of Managed Care Pharmacy 4, no. 1 (1998): 55–62, https://doi.org/10.18553/JMCP.1998.4.1.55.
↵71. Emily Eddy, Jordan Marie Ballou, Jessica B. Finke, Wesley Nuffer, Carmela Avena‐Woods, and Veronica T. Bandy et al., “Medication Therapy Management: The Evolution of Clinical Pharmacy Services in U.S. Community‐Based Pharmacy Practice—An Opinion of the Community‐Based Practice and Research Network of the American College of Clinical Pharmacy,” Journal of the American College of Clinical Pharmacy 7, no. 12 (2024): 1228–34, https://doi.org/10.1002/JAC5.2047.
↵72. Joint Commission of Pharmacy Practitioners. “Pharmacists’ Patient Care Process.”
↵73. Abbott, The System of Professions, 83.
↵74. William A. Zellmer, “Role of Pharmacy Organizations in Transforming the Profession: The Case of Pharmaceutical Care,” American Journal of Health‐System Pharmacy 58, no. 21 (2001): 2041–49, https://doi.org/10.1093/AJHP/58.21.2041.
↵75. Knowlton and Penna, Pharmaceutical Care, 247–253.
↵76. Knowlton and Penna, Pharmaceutical Care, 254.
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