Support grows in medical community for larger health role by pharmacists

WHAT IT MEANS AND WHY IT’S IMPORTANT Community pharmacists are lining up powerful professional allies as they fight for a full seat at the health provider table and fair payment for the critically needed patient-care services they can provide.

(THE NEWS: JAMA article points to pharmacy's role in MTM, improved patient care system.For the full story, click here)

In just the past few days, two prestigious medical journals and the highly regarded New England Healthcare Institute have issued reports calling attention to the prominent role that retail pharmacists can play in a more effective, cost-efficient and patient-centered healthcare system. And the contributions they can make in disease and medication therapy management and in patient adherence, the reports noted, are best realized when pharmacists are working in collaboration with a team of patient-care professionals.

That means working in close partnership with family-care physicians, specialists, nurses, nurse practitioners and health-plan sponsors, the reports agreed.

Measured against the old pharmacist-doctor turf battles of recent decades, the change in tone is striking. Much of the last century of American medical practice has been dominated by a climate of professional stake-holding, with many doctors fiercely guarding what they considered a unique and inviolable relationship with the patient. Pharmacists, many physicians asserted, simply were not qualified to dispense anything much beyond medications and basic counseling on their use, and had no business inserting themselves in that finely calibrated regimen of care developed between doctor and patient.

How times have changed. There still may be lingering suspicion of pharmacy’s aims and abilities among a diminishing number of family practice doctors — along with a few lingering questions of professional turf and responsibility. But most primary care physicians are in dire straits, swamped by rising case overloads, third-party billing headaches and the enormous demands of a fast-changing health system in the throes of an information technology revolution. They’re only too happy to have community pharmacists, nurse practitioners and other patient-intervention professionals as allies.

That’s particularly true in light of the growing body of evidence demonstrating just how much community pharmacists and nurse practitioners can bring to help doctors manage their caseloads, especially if working in a collaborative, team approach with shared patient data. As the Journal of the American Medical Association made clear in an article published Oct. 13, pharmacists and nurses can help close the loop for a fully integrated link with patients and create a more “cohesive” network of care.

Indeed, wrote Jerry Avorn in JAMA, “pharmacists and nurses could work with physicians to develop, implement and monitor drug regimens.”

The Archives of Internal Medicine went even further. Pharmacists, Archives author B. Joseph Guglielmo noted, can play a “valuable role ... in chronic disease management in outpatient clinic settings.” But they’ll never be able to fully deliver on that promise without fundamental structural changes to the health delivery system — and a fair system of reimbursement for their clinical and medication therapy management services.