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Commentary

The Time for Pharmacists to be “Essential” in Primary Care is Now: Part 3


September 28, 2020

mungerThere are multiple factors coming together that support pharmacists becoming “essential” in primary care. Perhaps the most important is the COVID-19 pandemic for which several persons have written commentaries on the importance of pharmacists in the COVID-19 crisis.  Specifically, the United States Health and Human Services granting pharmacists the ability to order and administer COVID-19 testing.1-3 Multiple data recognize the need and opportunity for pharmacists to participate in primary care throughout the United States (US).

This is a three-part series on the opportunity, changes needed in pharmacist education and practice, and how to become essential in primary care. The third part provides the pharmacist community with a plan to move into community-based primary care practice.  

Pharmacists have the ability to provide essential primary care services to the US health care system. As outlined in the second part of this three-part series, there will be a need for pharmacist educational and practice initiatives to have the ability to meet primary care practice. However, for many pharmacists they already have the knowledge and skills to meet this practice. 

Practice Measures for Pharmacists in the Primary Care Arena 

What types of practice measures could be performed by pharmacists in the primary care arena? Several measures could be supported by the family medicine profession. These include asthma control (e.g., inhaler education, medication management); ischemic heart disease medication prescription and adherence (e.g., ß-adrenergic blockers and statin use); monitoring hypertension and hyperlipidemia medications and control; cancer screening (e.g., referral to a primary care office for breast, cervical, and colorectal); diabetes screening and treatment (e.g., A1C, foot exam, referral for retinal and renal examinations); medication reconciliation; adult and pediatric vaccinations; and preventative care (e.g., BMI, tobacco and alcohol use). This list is not an exhaustive list. In some cases, pharmacists may be doing point-of-care, physical examination, and more comprehensive preventative screening and education. The above list, however, would allow the pharmacist to begin discussions with the family practitioner(s) to enter into a collaborative practice agreement. Medicine-pharmacy collaborative agreements are central to the expansion of community pharmacy. 

Comprehensive medication management (CMM) is another area that would be beneficial to patients. Comprehensive medication management delivers clinical services aimed at ensuring a patient's medications (including prescribed, over-the-counter, vitamins, supplements and alternative) are assessed to determine the appropriate reason for use, efficacy including meeting patient or clinical goals, are safe, and are able to be taken without difficulty.CMM is generally conducted in collaboration with other health care providers. On occasion, CMMs occur through a collaborative practice agreement.   

Comprehensive disease management is a system of coordinated heath care interventions and communications for conditions where self-care efforts can be implemented.5 Disease management empowers individuals, working with other health care providers to manage their disease and prevent complications. This practice requires a collaborative practice agreement and for many pharmacists may require additional knowledge and skill-based training.

Consumers want to see additional point-of-care laboratory testing conducted by community pharmacists.6 These tests may include chemistry, hematology, coagulation, cholesterol, and tests for common infections. Other tests may become available for testing in community pharmacies over time. 

It is important that all pharmacists learn and apply the pharmacist patient care process.7 The pharmacist develops an individualized patient-centered care plan. (Figure 1)  This is done in collaboration with the physician provider. 

Figure 13

fig 1

Why Pharmacists Should Become Essential in Primary Care? 

Why should pharmacists become essential through a primary care focus?  Drug misadventuring is a major health care crisis.8-11  The annual estimated annual cost of drug-related morbidity and mortality resulting from non-optimization of medication therapy is $528.4 billion (range $495.3 to $672.7 billion).8 This estimated annual cost is equivalent to 16% of total U.S. health care expenditures in 2016. The average cost to prescription drug-related morbidity and mortality individual after initial prescription experiencing a treatment failure (TF), new medical problem (NMP), or both was $2481/event (range: $2233 to $2742).8 Pharmacists working with physicians can impact this crisis in a very positive manner.  Reduction of this cost by 50% would save the U.S. health care system billions of dollars while still providing base funding for all pharmacists in the U.S. 

The time is now to reach out to our family medicine colleagues, to become involved in primary care health care, and expand practice to the patient while maintaining our medication expertise that is so valuable.

Mark A. Munger, PharmD, FCCP, FACC, is a professor of pharmacotherapy and adjunct professor of internal medicine, at the University of Utah, where he also serves as the associate dean of Academic Affairs for the College of Pharmacy.  

References:

  1. To Err is Human: Errors in Health Care – A Leading Cause of Death and Injury. https://www.ncbi.nlm.nih.gov/books/NBK225187/   Accessed 03/2020
  2. Watanabe JH, et al.  The cost of prescription drug-related morbidity and mortality Ann Pharmacother 2018;52(9);829-837.
  3. Assiri GA, et al. What is the epidemiology of medication errors, erro-related adverse events and risk factors for errors in adults managed in community care contexts? A systematic review of international literature. BMJ Open 2018;8:e019101
  4. The Patient-Centered Medical Home:  A Resource Guide for Integrating Comprehensive Medical Management to Optimize Patient Outcomes (Second Edition).  innovations.ahrq.gov. United States: AHRQ Health Care Innovations Exchange, Government of United States. Accessed 09/2020.
  5. Comprehensive Disease Management. https://www.amcp.org/about/managed-care-pharmacy-101/concepts-managed-care-pharmacy/disease-management Accessed 09/2020\
  6. Feehan M, Walsh M, Godin J, Sundwall D, Munger MA. Patient preferences for Health Care Delivery through Community Pharmacy Setting in the USA: A Discrete Choice Study. J Clin Pharm Ther 2017:00:1-    12 doi.org/10.1111/jcpt.12574 PMID: 28627110
  7. Pharmacist Patient Care Process. https://jcpp.net/patient-care-process/ Accessed 09/2020
  8. To Err is Human: Errors in Health Care – A Leading Cause of Death and Injury. https://www.ncbi.nlm.nih.gov/books/NBK225187/   Accessed 03/2020
  9. Watanabe JH, et al.  The cost of prescription drug-related morbidity and mortality Ann Pharmacother 2018;52(9);829-837.
  10. Assiri GA, et al. What is the epidemiology of medication errors, erro-related adverse events and risk factors for errors in adults managed in community care contexts? A systematic review of international literature. BMJ Open 2018;8:e019101
  11. Lin CW, et al. Potentially high-risk medication categories and unplanned hospitalizations: a case-time-control study. Scientific Reports (Nature) 2017;7.41035 DOI:10.1038.

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