April 3, 2017

Pharmacist Providers: An Untapped Resource

Access to high-quality, cost-effective care can be achieved by leveraging our existing pharmacist workforce.

Access to care is one of the greatest barriers patients face in today’s broken healthcare system. As the population grows and the Boomer population ages, healthcare demand is skyrocketing.

A recent study from the Association of American Medical Colleges (AAMC) estimates America will be short 105,000 physicians by 2030 based on the growing demand (1,2).

Physician shortages plague patients across the entire nation, but the greatest demand is in less-populated regions.

The current wait time to see a physician is estimated at 32 days across small metro areas (2,3).

Pharmacists are uniquely trained to manage chronic disease and are an untapped resource for improving patient access to high-quality, cost-effective care.

Pharmacists provide care.

We (pharmacists) have been working with physicians and other members of the care team to optimize mediation therapy and improve patient outcomes for almost 100 years. Since 1928, pharmacists at the University of Iowa Hospitals and Clinics (my alma mater) have been directly involved on patient care teams, participating in inpatient medical rounds. Since then, the breadth and scope of pharmacist patient care has been continuously elevated (4).

Pharmacists are medication experts and core members of the healthcare team almost every patient care environment.

In parallel, pharmacy technician practice is advancing. Technicians are fulfilling technical, administrative, and, the largest opportunity, distributive roles to support the advancement of pharmacists providing direct patient care. From the neonatal ICU to the hospice setting, pharmacists and pharmacy technicians ensure patients receive the right treatment, at the right dose, at the right time.

Pharmacists are medication experts.

“I thought pharmacists just counted pills, are they even qualified to manage my medications?”

YES!

Let’s look at education and training. Pharmacy education pretty much mirrors medical training. Pharmacists take undergraduate courses, complete 4 years of pharmacy school, graduate with a Doctorate of Pharmacy (Pharm.D.), get licensed, go on to complete residency and fellowship training, and obtain board certification. Although a majority of the workforce is in dispensing-focused roles, clinical practice has been around since the early 20th century and continues to grow rapidly. The following are examples of contemporary pharmacist roles (ranked in relative order of prevalence):

  • Community Pharmacists — see patients in their local pharmacy, review medications and work with primary care physicians to optimize medications
  • Hospital Pharmacists — see patients admitted to the hospital, core members of the medical team, participate in daily clinical rounds with physicians
  • Ambulatory Care Pharmacists — see patients in clinic, often times independently manage chronic disease states (e.g. hypertension, diabetes, heart failure, anticoagulation) in collaboration with physicians
  • Consultant Pharmacists* *— see patients in nursing homes and long-term care facilities, required by law to review patient charts monthly and work with physicians to optimize medications
  • Specialty Pharmacists — manage patients on high-cost specialty medications, promoting adherence and appropriate medication use

Pharmacists optimize medications.

Pharmacists are really good at evaluating the big picture. There are so many factors to consider when crafting medication regimens personalized to each patient — drug interactions, side effects, dose frequency, co-morbidities, cost, and most importantly, what goals does the patient want to achieve?

Here are just a few examples of what we do every day:

  • Disease Management — create the best medication regimen personalized to each patient (based on diseases states, concurrent therapy, cost, ability to tolerate side effects, etc.)
  • Medication Reconciliation — ensure each patient’s medication list is accurate and prescriptions are up to date, preventing medication errors
  • Medication Dosing — dose medications that have narrow therapeutic indexes (e.g. vancomycin, warfarin, phenytoin) ensuring the right medications achieve optimal efficacy and minimizing risk of potential adverse drug events

Pharmacists improve outcomes.

Great patient care leads to better outcomes.

We have been tirelessly working to show how pharmacist care improves outcomes, increases efficiency, enhances satisfaction, and saves the healthcare system money (LOTS of money). There are countless studies (5) that demonstrate this, here are a few:

  • Improving Blood Pressure — Twice as many patients achieved blood pressure control when managed by pharmacists (6).
  • Improving Blood Glucose — Pharmacists improved hemoglobin A1c control, yielding an est. $9K in cost-avoidance over 3 years, a $7:1 return on investment (7).
  • Reducing Hospital Readmissions — Readmissions dropped by 30% when pharmacists complete medication reconciliation and discharge counseling, saving est. $15,000 per incidence (8).

Pharmacists improve access to primary care.

Pharmacists are uniquely suited to design and manage medication regimens, allowing physicians to focus on diagnosis and patients requiring intensive medical care.

Think about it — how much clinical information do primary care physicians need to keep up with? They need to identify and diagnose pretty much every common and not-so-common ailment in the book. They also have to stay up to date on evidence-based medication regimens, dosing, side effects, and drug interactions. We work better together as a team.

Pharmacists are an untapped resource and can improve access to care. There are over 175,000 full-time practicing pharmacists in the United States (well beyond the est. deficit of 105,000 physicians mentioned earlier). Patients see their pharmacist over 2 times per month! Each encounter is a touch point where medication regimens can be reviewed and tweaked to improve outcomes.

Pharmacists can and should be more involved in patient care. We’re working to achieve this in a variety of ways, and I should highlight advocating for provider status.

If added to the list of providers under the federal Social Security Act, pharmacists could bill Medicare directly for clinical services (just like physicians, nurse practitioners, and physician assistants).

H.R. 592 / S. 109, the Pharmacy and Medically Underserved Areas Enhancement Act has been introduced in congress with overwhelming bipartisan support. As most Medicare policy changes go, commercial payers follow suit. Provider status is a stamp of approval on pharmacist patient care, providing a mechanism to legitimize the business model and activating expansion of services.

We can improve access to care with existing healthcare resources. Let’s do something that makes sense and is right for the folks we care about most — our patients. It’s time to call the pharmacist.

Samm Anderegg, Pharm.D., MS, BCPS is CEO at DocStation, a patient care platform for pharmacists. Learn more at docstation.co.

P.S. If you want to advocate for pharmacist patient care, educate your friends and family about the great things pharmacists do every day and support the Pharmacy and Medically Underserved Areas Enhancement Act by sending a note to your congressional representative.

  1. Gudbrandson E, Glickman A, Emanual E. Reassessing the Data on Whether a Physician Shortage Exists. JAMA. 20 Mar 2017. Online. 3 Apr 2017.
  2. Tully S. Obamacare or Trumpcare, Here’s the Real Problem for Healthcare Reform. Fortune. 27 Mar 2017. Online. 3 Apr 2017.
  3. 2017 Physician Appointments and Wait Times and Medicare and Medicaid Acceptance Rates. Merritt Hawkins. 2017. Online. 3 Apr 2017.
  4. Gubbins PO, Micek ST, Badowski M, et al. Innovation in Clinical Pharmacy Practice and Opportunities for Academic-Practice Partnership. Pharmacotherapy 2014;34(5):e45–e54) doi: 10.1002/phar.1427
  5. Chisholm-Burns MA, Kim Lee J, Spivey CA, et al. US Pharmacists’ Effect as Team Members on Patient Care: Systematic Review and Meta-Analysis. Med Care. 2010 Oct;48(10):923–33. doi: 10.1097/MLR.0b013e3181e57962
  6. Carter BL, Ardery G, Dawson J, et al. Physician and Pharmacist Collaboration to Improve Blood Pressure Control. Arch Intern Med. 2009;169(21):1996–2002. doi:10.1001/archinternmed.2009.358
  7. Morello CM. Abstract 12-OR. Presented at: American Diabetes Association’s 74th Scientific Sessions; June 13–17, 2014; San Francisco.
  8. Anderegg SV, Wilkinson SJ, Couldry RJ, et al. Effects of a Hospital-Wide Practice Model Change on Readmission and Return to Emergency Department Rates. Am J Health Syst Pharm. 2014 Sep 1;71(17):1469–79. doi: 10.2146/ajhp130686