Exploring the Role of the Pharmacist in Healthcare: What We Can Do to Improve Patient Outcomes
As health care costs continue to rise and every stakeholder in the chain, from patient to physician to insurance, is looking to cut costs, many are reviving interest in the campaign to make the role of the pharmacist a more active part of patient healthcare. The push comes from those who believe pharmacists are both well trained and well suited to provide more than education and medicines. In fact, expanding the role of the pharmacist to become healthcare providers (HCPs) can make a world of difference in today’s resource-tapped health system.
Dr. Elyse Tung, a clinical assistant professor of pharmacy who works at the Kelley-Ross Pharmacy in Seattle, agrees.1 She recites the tale of a high-risk HIV+ patient who was diagnosed in her clinic, but did not have the ability or interest in making an appointment with a doctor to start treatment. The result was that, unlike his partner who did begin treatment three months earlier, this patient had much a much higher viral load and thus a worse prognosis. Tung’s pharmacy later became the first in Washington state to provide an HIV prophylaxis in such high-risk patients. She, and other pharmacists like her, believe they have the right experience, training, and access to help more patients have better outcomes.
So what’s stopping them? Pharmacists can dole out medicines but they aren’t enabled to act as actual “healthcare providers,” meaning they can’t even do a lot of the routine questioning, diagnosing, and prescribing that makes common sense. In a society where health and money balance each other, sometimes well and sometimes frighteningly poorly, we have a duty to consider each potential role of the pharmacist.
The Current Landscape Regarding the Role of the Pharmacist
Thirty-seven states currently recognize pharmacists as HCPs, which sounds great but in actuality is impractical because pharmacists can only provide that service for free. That, in turn, means longer lines, less access, and less staff to perform their primary function of filling prescriptions. On May 11, 2015, however, Washington became the first state to require that pharmacists be included as health insurance providers.2 Practically, this law opens up options for physicians and other members of a patient’s healthcare team to work with pharmacists for patient benefit, based on licensures and practice settings. Proposed changes would allow pharmacists to:
- Dispense birth control directly;
- Administer travel shots;
- Provide pain management;
- Treat chronic diseases such as diabetes and heart diseases; and
- Conduct Pap smears.
And they will be reimbursed for it, meaning they can dedicate the resources they need to fill prescriptions and do a lot more. This is just the beginning. The idea is to expand the role of a pharmacist so that he or she can perform routine tasks that are necessary but which are burdensome on an already overburdened medical system.
Initial results are already encouraging. In a study called the Asheville Project3, pharmacists met with 620 patients in one community who had diabetes and other vascular system problems. Researchers measured many health factors over three years, such as blood pressure, cholesterol, and triglyceride level; they also educated patients, and performed follow-up exams. The results are hopeful.
- Sixty-seven percent of the patients reached their target lowered blood pressure and heart health goals, and the number of patients at risk for a cardiovascular episode was significantly reduced; and
- The average cost per hospitalization dropped significantly; cost of medication rose, but the overall healthcare costs on both the patient and the city decreased by 45%.
Overall patients also seemed much more comfortable talking about their medical health with their pharmacist, who they can see without making an appointment and who often have more time than their physicians. Seniors make up a large contingent of these patients, but the current role of the pharmacist does not allow for covering the cost of these services under Medicare Part B.
What’s the Other Side?
Many of the arguments against the idea of incorporating pharmacists into a healthcare team stem around cost-benefit analysis. The obvious costs include:
- Training pharmacists in new technologies and examination areas;
- Switching physician fees to the pharmacist [a contentious switch from the physician POV];
- Redesigning reimbursement structure; and
- Ensuring patient safety outside of dispensing.
Then, too, there is the cost of changing hospital and clinic access models to provide pharmacists with electronic and other comprehensive patient medical records.
In terms of patient outcome, the benefits are still promising but need more study. And questions regarding who would manage the role of the pharmacist and how far action and responsibilities would reach remain unclear.
These are difficult questions, but we shouldn’t shirk away from them because we don’t have all the answers yet. Overhauling the current state of healthcare does not have to mean starting over. Pharmacists undergo training from pharmacology to patient safety, with clinical rotations as well. The tide is starting to turn and here’s what we can do to help:
- Highlight the use of quality compounding ingredients and compliance with new laws that show how we work with our partners to maintain drug integrity;
- Educate patients on the extra steps pharmacists already take to ensure medications are safe for them in terms of drug quality, but also drug interactions and possible allergies of pill coating and dyes that are routinely avoided; and
- Join the campaign to speak with legislators and make our voices heard.4.
Pharmacists are an untapped resource, and we owe it to our patients to consider every resource we have to optimize their health. In the end, patients will get the care they need, pharmacists will expand their knowledge base and skills, and physicians will have more time to see other patients. It’s a win all around.
Pharmaceutica North America is committed to researching the latest in legislation and policy so that you can make the best decisions for your patients. We not only have a proven record of providing safe and high-quality compounding materials but are passionate about providing current, comprehensive pharmacy news. Please contact us today to learn more about how we can help you deliver effective personalized medicines that optimize patient health.
- “Pharmacist sees opportunities, trailblazes for clients’ health,” June 29, 2015 http://hsnewsbeat.uw.edu/story/pharmacist-sees-opportunities-trailblazes-clients%E2%80%99-health ↩
- “Big Win for Pharmacist Provider Status in Washington State,” May 11, 2015, http://www.pharmacytimes.com/news/big-win-for-pharmacist-provider-status-in-washington-state ↩
- “Pharm.D. or M.D.?: The Growing Role of Pharmacists in Today’s Healthcare,” 2012, http://pitjournal.unc.edu/article/pharmd-or-md-growing-role-pharmacists-today%E2%80%99s-healthcare ↩
- ”Pharmacists Provide Care,” http://www.pharmacist.com/providerstatusrecognition ↩