The front line of healthcare is crammed between the linguica and callus removers. Yet we breeze past pharmacists as though they were dried prunes.
It’s time to break that habit. Pharmacists and a handful of others – including nurse practitioners and midwives -- are part of a growing, important corps of service providers called “physician extenders.” Although that makes them sound like a variety of Hamburger Helper, they are bridging the very real gap between the doctor supply and the unmet demands of newly insured patients.
They’re becoming advocates, educators, psychologists, lifestyle translators, life-saving human data bases, and red, green or yellow flags to our habits. They’ve come a long way from the tart British description of pharmacist as “chemist.” Fact is, you can almost always find a pharmacist. How quickly can you see your doctor? And, behind-the-scenes, pharmacists are playing increasingly important roles at patient bedsides.
Legislation has placed both retail and clinical pharmacists at the nexus of ethically complex encounters that can include providing medications for patient-assisted suicide (or not), over-the-counter contraceptives (once the prescription-only province of physicians) and involvement with medical marijuana.
While still answering “do I feed a cold and starve a fever” queries, they also now translate the arcane world of formularies. That includes sometimes determining whether a pricey brand name drug prescribed by a physician –unaffordable for some patients and therefore unused – can through science and diplomacy be changed to a cheaper generic acceptable to everyone including insurers.
“The needs of people go beyond their medication needs,” said Will Ofstad, Pharm.D., BCPS, CDE, assistant dean for education at California Health Sciences University (CHSU), which opened in Clovis in 2012. “A big part is education. Another big part is motivation.”
Ten years ago, pharmacists handled medication dosing and didn’t spend time outside the four walls of their offices, said Bruce A. Lepley, RPh, director of pharmacy at Fresno’s Community Regional Medical Center.
They’re now part of a daily caravan of stethoscopes and smocks, visiting hospitalized patients, working with other professionals on treatment plans and medication selections.
“We try to get to know you better than your family physician does,” said Lepley, who has been part of the profession’s metamorphosis for nearly 40 years. In the next 10 years, pharmacists will likely become more involved – and get more cooperation from physicians some of whom initially rebuffed interactions with harsh words and an occasional tossed scalpel.
“Including a pharmacist in a care team leads to significant savings -- $10 for each dollar invested – and reduces medical errors,” said Ofstad. “It improves access to high-quality, patient-centered care, particularly in underserved communities.”
Ofstad, a certified diabetes educator, said benefits can be keenly felt in that disease which hits hard in the Central Valley and costs California $24 billion annually. Diabetes hospitalization accounts for half that spending.
As the region’s safety net, Community Regional and its pharmacists try to alter that trajectory. “Can we convince patients to get well in the time we have them? Then we can make a difference,” said Lepley.
Discharge planning – where to guide patients for continuing care when they’re healthy enough to leave the hospital -- can reduce costly hospital readmissions. “The more we can do before discharge the more effective we are,” he said. Once out the door, do they keep taking their medications? That follow-up’s tricky when patients have no permanent address or phone number.
Building a new sustainable dietary way of life for a diabetic is far preferable to helping them adjust to a prosthetic leg from an avoidable amputation. Yet some insurers won’t pay for diabetes education.
Pharmacy education goals are changing. At CHSU in Clovis, the published targets include civic engagement and “a high degree of innovation, divergent thinking and risk taking.” The future mandates such adjustments, says the American Association of Colleges of Pharmacy:
* We’re living longer and, consequently, getting more chronic diseases;
* We’re presented with medications and devices in increasing numbers and complexity;
* More physicians are retiring and fewer are specializing in primary care (let alone gerontology);
* We’re trying to control costs and ensure quality, and
* We’re relying more on preventive, home and long-term care.
The number of pharmacy schools and colleges in the United States has exploded – from about 80 in 2000 to about 135 now.
There were more than 297,000 pharmacists in 2014, earning about $121,500 annually, according to the U.S. Bureau of Labor Statistics. Most than 50% work in pharmacy, grocery or department stores, and about 20% in hospitals.
However, there are kinks in the hose.
Researchers warn of a pharmacist glut. The labor bureau estimates job growth at 3%, slower than the average of other occupations. And the market is shifting.
Hiring is slowing in retail – where pharmacists were once lured from hospitals by better pay, bonuses and shorter hours. Corporate mergers and online and mail-order pharmacies are eroding that face-to-face market.
Demand is tilting toward direct patient care. But there are problems.
Hospitals need a reimbursement formula that pays fairly for pharmacists as the delivery system shifts from volume to value based. Medications can be ordered from many specialists, but pharmacists are expected to assess them and prevent screw-ups. Who has a rewards category for errors avoided? Another hang-up: Less than half of pharmacy colleges and schools offer patient physical assessment courses. Those courses are required by California’s SB 493 which created the hands-on category of Advanced Practice Pharmacists in 2014.
So, sit and wait as your prescription is filled at a Walgreens or CVS. You may overhear personal talk of great complexity with little filtering.
Will this drug make my wife’s constipation worse? I know it makes you sick so I’m trying to get your doctor’s permission to switch to another medication, and his staff is slow about returning calls. I know it’s a hassle, but the law requires written prescriptions each time you get pain medication to limit abuse. Yes, we can provide bottle labels in Spanish.
Throw in a flu shot. Guidance on using the free blood-pressure tester. And help in purchasing a cane. These investments of time and skill aren’t usually built into a physician’s workday.
Give the future a whirl. Spend less time selecting salsa and a few minutes asking for a pharmacist consultation.
(Also published as an op-ed in the June 23, 2016 edition of The Fresno Bee)