Improving the delivery of care through pharmacists

You can see a pharmacist for that? See how expanding roles for pharmacists can help improve access to health services.

By | 4 minute read | October 21, 2021

Male pharmacists speaking with female patient

The current challenges within the US healthcare system of access to care, cost and anticipated shortage of physicians is providing new important roles for pharmacists to embrace.

As a pharmacist, I enthusiastically say, “Bring it on — we’re ready!” Let me explain why.

Pharmacists are medication experts

Pharmacists spend a minimum of 6 years in pharmacy school learning how drugs work so that they can identify and resolve drug-related problems. Post-graduation, more than 25% of pharmacists complete at least one year of residency and provide pharmacy services directly to patients. As of January 2021, there are more than 50,000 board certified pharmacists in one of 14 specialty areas of pharmacy practice, such as cardiology, critical care and infectious diseases.1

Pharmacists improve patient satisfaction and medication adherence.  For example, pharmacists know if a medication has an unpleasant side effect or taste, and they can proactively warn patients or offer mitigation strategies. Pharmacist knowledge of drug costs and price tiering can save patients money.

See how hospital-based pharmacists can use one system for clinical decisions

Pharmacists expand access to health services and improve outcomes

Multiple studies have shown that pharmacist-provided clinical services expand access to care, improve chronic disease management and decrease cost of care. A US Surgeon General report found that pharmacist-delivered patient care services related to medication management can yield a cost efficiency return-on-investment as high as 12:1 (average 4:1). These cost savings arise from reduced hospital admissions, unnecessary or inappropriate medication use, reduced emergency departments admissions and decreased physician visits.2

When pharmacists are part of the healthcare team, studies show improvement in health outcomes related to preventing or managing chronic disease (such as blood pressure, blood glucose, cholesterol, obesity and smoking cessation) and medication adherence3, 4.

Pharmacist-led vaccination programs have helped immunize Americans

Pharmacists have long been identified as trusted healthcare professionals who are easily accessible in the community. A Gallup poll listed pharmacists among the most trusted healthcare professionals.5 In addition, pharmacists in drug stores and other retail locations are often accessible when physician offices and clinical pharmacies are closed.

In 1981, the American Public Health Association declared that pharmacists were an underutilized resource in promoting public health and disease prevention. Since then, several public health needs–such as public access to immunizations–have been addressed by community pharmacists.6

The pharmacist’s authority to administer vaccines and deliver clinical care is determined by state law and regulations.7 All states permit vaccine administration by pharmacists as part of the scope of pharmacy practice, although the details vary state by state.

Pharmacists are increasing vaccination rates against COVID-19

Since the COVID-19 pandemic began, multiple US Health and Human Services (HHS) orders have given pharmacists additional authority, such as:

  • Pharmacists can now order and administer FDA-approved COVID-19 tests in all 50 states.8 This expands public access to testing and offers pharmacists an opportunity to educate patients about vaccination against COVID-19.
  • HHS amended the Public Readiness and Emergency Preparedness Act (PREP Act) to allow all state-licensed pharmacists to immunize children over the age of 3 “to increase access to childhood vaccines and decrease the risk of vaccine-preventable disease outbreaks.”9
  • HHS launched the Federal Retail Pharmacy Program for COVID-19 Vaccination so retail pharmacies can receive COVID-19 vaccine supply directly from the federal government. As of March 2021, 21 retail pharmacy partners were participating with more than 41,000 locations administering doses.10

With this trusted relationship, community-based pharmacists can educate patients about common misconceptions regarding COVID-19 vaccination. With almost 90% of Americans living within 5 miles of a community pharmacy, we welcome these opportunities.11

Pharmacists are expanding their clinical roles in health care

Collaborative Practice Agreements (CPAs) establish a formal relationship between a pharmacist and a health care provider that allows the prescriber to delegate certain patient care functions to the pharmacist beyond the pharmacist’s typical scope of practice. This is an exciting area for pharmacists to explore in their career paths.

Typical activities include initiating, modifying, or discontinuing prescription medications or over-the-counter medications. Ordering and interpreting laboratory tests may also be included if these services are not already authorized in the pharmacist’s regular practice.12 Nearly all states permit some type of pharmacist-prescriber collaborative practice authority, although laws and regulations vary by state.13 Importantly, pharmacists are starting to be reimbursed for certain clinical or primary care activities.14

Pharmacist-provided clinical services provided through CPAs have led to improved patient outcomes for diabetes, hypertension, anticoagulation, and other chronic diseases.15, 16, 17 The 2014 Community Preventive Services Task Force demonstrated strong evidence for team-based care involving pharmacists and nurses to improve hypertension control and other chronic disease risk factors.18

Rising healthcare costs, complexity of care and an ongoing shortage of physicians is powering a reimagining of roles and responsibilities for all healthcare team members as well as healthcare settings. Pharmacists, already a key partner in high-performing care teams, are poised to step up and provide clinical services in three major areas:

  1. As medication experts, pharmacists have proven they can optimize medication regimens and improve patient outcomes.
  2. As trusted and readily available healthcare professionals in the community, pharmacists should continue to help identify, prevent and solve their patients’ drug-related problems by listening to their patients and coordinating care with providers, as appropriate.
  3. As public health practitioners, pharmacists can continue making sure patients are current with their vaccines, including COVID-19 vaccines and boosters.

So fellow pharmacists, which roles are you going to embrace?

Explore the future of hospital pharmacy

References:
  1. BPS Specialties, Board of Pharmacy Specialties, www.bpsweb.org
  2. Gilbertson, S., Yoder, S., and Lee, M.P., Improving patient health system outcomes through advanced pharmacy practice: A report to the U.S. Surgeon General, Washington, D.C. Office of the Chief Pharmacist, US Public Health Service, December 2011, www.accp.com
  3. Doucette WR, McDonough RP, Klepser D, McCarthy R. Comprehensive medication therapy management: identifying and resolving drug-related issues in a community pharmacy. Clin Ther. 2005 Jul;27(7):1104-11.
  4. Fera T, Bluml BM, Ellis WM. Diabetes Ten City Challenge: final economic and clinical results. J Am Pharm Assoc. 2009;49:383-391.
  5. Nurses Continue to Rate Highest in Honesty, EthicsGallupJanuary 2021, news.gallup.com
  6. Advancing Team-Based Care Through Collaborative Practice Agreements, www.cdc.gov
  7. Pharmacist Immunization Authority, NASPA.us, April 2021, naspa.us
  8. Guidance for Licensed Pharmacists and Pharmacy Interns Regarding COVID-19 Vaccines and Immunity under the PREP Act, HHS.gov, September 2021, www.hhs.gov
  9. Pharmacists now allowed to administer childhood vaccines, but pediatricians disapprove, CNN,  August 2020, www.cnn.com
  10. Understanding the Federal Retail Pharmacy Program for COVID-19 Vaccination, CDC.gov www.cdc.gov
  11. Get to Know Your Pharmacist, www.cdc.gov
  12. Pharmacist collaborative practice agreements: Key elements for legislative and regulatory authority: A report of the collaborative practice workgroup convened by the National Alliance of State Pharmacy Associations, July 2015, www.accp.com
  13. Sachdev G, Kliethermes MA, Vernon V, Leal S, Crabtree G. Current status of prescriptive authority by pharmacists in the United States. J Am Coll Clin Pharm. 2020;3;807-817, accpjournals.onlinelibrary.wiley.com
  14. connect.ashp.org
  15. Chisholm-Burns MA, Kim Lee J, Spivey CA, Slack M, Herrier RN, Hall-Lipsy E, et al. US pharmacists’ effect as team members on patient care: systematic review and meta-analyses. Med Care 2010;48(10):923–33, connect.ashp.org
  16. Chiquette E, Amato MG, Bussey HI. Comparison of an anticoagulation clinic with usual medical care: anticoagulation control, patient outcomes, and health care costs. Arch Intern Med 1998;158(15):1641–7.
  17. Davidson MB, Karlan VJ, Hair TL. Effect of a pharmacist-managed diabetes care program in a free medical clinic. Am J Med Qual 2000;15(4):137–42.
  18. Proia KK, Thota AB, Njie GJ, Finnie RK, Hopkins DP, Mukhtar Q, Pronk NP, Zeigler D, Kottke TE, Rask KJ, Lackland DT, Brooks JF, Braun LT, Cooksey T; Community Preventive Services Task Force. Team-based care and improved blood pressure control: a community guide systematic review. Am J Prev Med. 2014 Jul;47(1):86-99.