The Changing Face of Pharmacy

The practice of pharmacy is constantly evolving to meet the needs of patients struggling within an increasingly complicated healthcare system.

Consider the following: more than 3.5 billion prescriptions are written each year, medications are involved in 80{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of all treatments, and Medicare beneficiaries with multiple chronic diseases see an average of 13 physicians annually and take 50 different prescriptions per year. Complicating this is that patients spend increasingly less time within the structured and supervised elements of the healthcare system and far more time in an unstructured environment where they are far more independent and autonomous.

The move to an ambulatory patient — a patient who lives within his or her own residence independently or with minor assistance — has always been the goal, but the lack of structure creates its own series of problems: drug-therapy problems and the accompanying morbidity and mortality that can cost as much as $200 billion annually, in addition to negatively impacting clinical and humanistic outcomes. Initiatives such as the patient-centered medical home are underway to resolve these challenges, and into these initiatives the new role of the pharmacist fits well.

The evolving role of the pharmacist has taken many forms and has several definitions.  According to the 2008 “Future Vision of Pharmacy Practice” by the Joint Commission of Pharmacy Practitioners, “pharmacists will be the healthcare professionals responsible for providing patient care that ensures optimal medication-therapy management.” ‘Optimal medication therapy’ can be further defined as the use of medications to achieve the best possible clinical, humanistic, and economic outcomes. With respect to optimal medication therapy, there is a lot of work that can be done to improve a system in which far too many patients do not achieve the desired health outcomes.

The practice of pharmacy today reflects a profession that delivers a range of patient-care services through a variety of settings, and is extremely accessible to patients within the community.  Pharmacists work with patients seeking over-the-counter medications to resolve various health issues, and are integrated into primary-care activities and participate in inter-professional activities as well. Given the challenges and fractionation of the healthcare system, the community pharmacist is sometimes a point of commonality for the ambulatory patient with multiple chronic health conditions who is seeing several different physicians.

Two specific examples of how pharmacy services are evolving are though collaborative pharmacy practice and pharmacist provider status, both of which represent inter-professional collaboration with the goal of optimized patient care.

Pharmacists within many states can engage in collaborative pharmacy practice (CPP) agreements, which are voluntary agreements between the pharmacist, physician, and patient that facilitate the pharmacist taking a more active role with that specific patient. Examples include monitoring and making adjustments to the patient’s medications and ordering labs based upon patient-specific protocols. In Massachusetts, CPP is early in its evolution, as the legislation was passed only within the past four years. The results in states with a history of CPP arrangements have been extremely positive for improving patient outcomes in a variety of diseases, including diabetes, asthma, and hypertension.

While the vast majority of states have CPP, few have enacted legislation for the pharmacist to achieve provider status. Legislation was recently introduced in Massachusetts to initiate pharmacist provider status (PPS) to build upon the quality activities in which pharmacists are already engaged, further enhancing their contributions to patient care and outcomes. The topic has also been discussed at the national level. Currently, pharmacists are not recognized within the Social Security Act or the Centers for Medicare and Medicaid Services as either healthcare providers or non-physician practitioners. Recognition of pharmacists as healthcare providers would clear obstacles that could expand the number of pharmacists who are providing direct patient care in collaboration with physicians.

Collaborative pharmacy practice and pharmacist provider status are but two examples of the ways in which pharmacists are seeking to practice at the top of their license and to facilitate patient success, something we all seek. Whether it is pharmacists as immunizers, pharmacists as educators, or pharmacists who through patient-centered care assist the patient with a question by virtue of accessibility, the role of pharmacist is continuing to evolve.

One local example is the Western New England University and Big Y Consultation and Wellness Center located at the Cooley Street Big Y in Springfield. Within the center, patients meet with a clinical pharmacist faculty member during scheduled appointments via physician referral to discuss various health issues. The power of the ‘pharmacist as educator’ has been demonstrated at the center through improved patient care outcomes.

As the healthcare system in this country is changing, so is the practice of pharmacy. Pharmacists in every practice setting are engaging in activities to work with their healthcare partners for the betterment of each and every patient. No one can dispute that it is challenging at times, but we can all agree how rewarding it is. v

Evan Robinson, R.Ph., Ph.D., is the founding dean of the Western New England University School of Pharmacy. He helped establish two new schools of pharmacy, at Shenandoah University and the University of Charleston, before coming to WNEU. He has published more than 40 peer-reviewed and non-peer-reviewed manuscripts and book chapters, and engaged in more than 50 presentations on a variety of topics, many in the area of the impact of technology on teaching, learning, and assessment; erobinson@wneu.edu