Pharmacist Can Become The Single Most Important Transformative Force In Improving Health Care And Reducing Health Care Costs -- But Will They?

October 06, 2011

Terry McInnis, MD, MPH

To some this may appear to be a provocative statement - I hope that it is! Let's see if there are facts that could possibly support this assertion, and if so, direct us to a course of action appropriately aligned with other key system changes. Together these changes beg us to move toward a more coordinated, quality focused, patient-centered delivery system that will improve health outcomes and reduce overall costs.

Chronic disease consumes over 75% of our cost for health care and approximately 95% of Medicare costs. 80% of the way we prevent and manage chronic disease is with medications. The United States spends over $200 billion annually in drug costs and an estimated equal amount on the problems that these medications cause (in use, omission, and non-adherence). These simple facts mean that our quality of life and our healthcare costs will not improve until we focus our efforts on making sure that patients are on the most effective and appropriate medications to prevent and control disease and that they are engaged, informed, and willing and able to follow a medication care plan. As the Institute of Medicine pointed out - "Pharmaceuticals are the most common medical intervention, and their potential for both help and harm is enormous. Ensuring that the American people get the most benefit from advances in pharmacology is a critical component of improving the national health care system."1

But isn't this the role of a physician? Yes and no. I am a physician who practiced medicine for many years. Physicians are very good at understanding the conditions that they treat and the medications used to treat those conditions. However, they are usually not experts on the medications that their other colleagues in various specialties prescribe. As the number of providers a patient sees increases, and the number of co-morbidities increase, then the need for an expert in pharmacology also increases. This expert can work directly with the patient and prescribers to systematically identify drug therapy problems and suggest drug therapy changes to resolve these problems. This unique "added value" service can greatly improve patient outcomes and reduce total costs.

So enter the pharmacist!

Please see my discussion on the transition of the profession of pharmacy from dispensing to direct patient care as automation takes over many dispensing functions. These changes free Doctors of Pharmacy to become integral team members in our delivery system.

In my keynote address at the National Leadership Roundtable hosted by the University of Maryland, School of Pharmacy, I outlined the challenges and opportunity for pharmacists to fulfill this role. (Click for the Slides and Abstract.)

In summary, what critical steps are necessary for a major transformation in the pharmacist's role on the health care team?

  1. The profession of pharmacy must adopt a standardized practice approach to clinical pharmaceutical care that directly links the identification and resolution of drug therapy problems to the optimization of the clinical goal or patient outcome the drug influences. (Click here for the Suggested Standards of Practice for Pharmacists Delivering comprehensive Medication Management (McInnis, 2011.))

    Automation and readily available IT solutions can provide information on drug- drug interactions, medication side-effects, and generic alternatives. We don't need Doctors of Pharmacy for those functions- others can fill those needs. The unique value that these professionals can bring is making recommendations to prescribers and patients to change the dosage of an existing drug, change or add a medication, and educate a patient on exactly how all of their medications modify or perhaps prevent the worsening of a particular disease. The pharmacist ensures that the patient is on the most appropriate medications to achieve the clinical goals of therapy and assure adherence.

  2. Payment systems must align to compensate clinical pharmacists as service providers. This function is a clinical service separate and distinct from a dispensing role or payment derived from a particular drug product.

  3. IT systems must be robust to deliver the service, adequately document the visit and recommendations based on clinical guidelines and evidenced based practice, provide for prescriber and patient communications, and meet electronic billing and meaningful use standards.

  4. Pharmacist Integration into the delivery system also requires payer, provider, and patient acceptance of the clinical pharmacist as a critical "team member" responsible for coordination of medication-related care.

  5. Pharmacist providers must train, maintain, and demonstrate a level of competency to deliver "comprehensive medication management". (Click here to review the Patient Centered Primary Care Collaboratives' Resource Guide) Although their settings may vary- including telephonic services, community settings, or integrated within a clinic- the pharmacist must be competent by seeing a minimum number of patients on a regular basis (as physicians and mid-levels currently do) to deliver the level of service that clinical pharmaceutical care requires.

So, in conclusion - although we have some pharmacist currently in various clinical care settings such as hospitals and long term care, we need a mass expansion from dispensing activities into general ambulatory settings to work directly with patients, physicians, care coordinators, nurses and others as the experts in coordinating and recommending drug therapy changes - BUT WILL THEY?

1 The Institute of Medicine, National Academy of Sciences. Informing the future: Critical issues in health. Fourth edition, page 13.
2 BLS statistics 2010-11

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