George’s Corner: November/December 2013
Longtime readers will remember that I have written a lot about what pharmacists can and should be doing. For too long pharmacists have been taking care of pills instead of patients. It looks like things are starting to change. The future is finally starting to happen.
Pharmacists are highly trained healthcare professionals. We know about drugs, that’s for sure. But we also know about a lot of other things that are related to drug use. Let’s remember that most encounters with the health system result in a drug being prescribed, and (hopefully) the prescription being filled, and (hopefully) the drug being taken by the patient. The first thing that needs to happen is to get rid of the “hopefullys” in the previous sentence. That is not an easy task. It has lots of challenges. Those challenges can only be met if pharmacists and pharmacy systems focus on the patients instead of the pills.
The dispensing functions are important and offer plenty of opportunities for pharmacists’ knowledge to bring about the desired result. Patient counseling is, of course, first and foremost. Counseling is now a requirement of good dispensing practices. That requirement has brought about better understanding, and therefore better self-care, by the patients. But there is much more that can be done.
One breakthrough is that mechanisms and laws are being put into place that will compensate pharmacists for these additional, much-needed services. Pharmacists are being recognized as healthcare providers who can have roles independent of dispensing and be paid for performing these roles.
In many healthcare settings pharmacists are very active in these roles and have proven their value in them. There are numerous examples in our literature documenting the value of these services. Most of the documentation also describes the methodologies, as well as the settings, for these services. Since this is not an academic paper, I will not burden you with a long list of citations from the literature.
Most people who write about this compile a long list of things that pharmacists can do. My list is different. It is a list of things that pharmacists and pharmacy-oriented computer systems providers should examine and contemplate as they develop new practice models.
■ There are not enough primary-care providers to take care of primary medical-care needs. (Not enough M.D.s, too many patients.)
■ Drug distribution systems are too complicated.
■ Do all encounters with a primary-care provider need to end with a prescription?
■ How can more rational prescribing be embraced?
■ Solutions for the antibiotics resistance problem. (Not more antibiotics.)
■ There has to be a better way to deal with “controlled” drugs. Some people need them, others want them. There is too much hassle for those who need them.
■ Monitoring and improving the adherence to chronic-drug dosing schedules.
■ Availability of testing systems for a huge number of health-level measurements. Who has access to the test? Who administers the test? Who interprets the test? Who tells the patient what to do?
■ Health information communications. Different computer systems need to be able to talk to each other. There is a huge job that must be done to establish data element standards as well as communications protocols.
■ Who gets to see what’s in all those records? (NSA protocols are not appropriate.)
■ Where do the smartphone apps fit into the healthcare system? I have apps that keep track of my blood pressure (if I take it and enter it), my pulse (ditto), and my blood sugar levels (ditto). What happens when “If I take it and enter it” goes away because the data is automatically taken and entered?
■ Are there sickness prevention actions that need new motivators? What can those motivators be?
■ Who should be doing what to improve the statistics on heart disease, obesity, cancer, stroke, and diabetes?
■ How do providers and systems deal with the fact that many people do not want anybody to know anything about their health and others believe that the more people know, the better the outcomes will be?
■ What kind of efforts need to be made to reduce the impact of erroneous health information on the Internet?
■ What new roles and systems will be needed for all of the new therapeutic innovations that are rapidly being developed?
I hope the above list causes you to think of additional subjects that need to be addressed.
Roles Are Being Redistributed
Old roles are going away: You don’t have to go to the M.D.’s office to get your blood pressure taken.
New roles are being created: Your pharmacist can give you detailed instructions on controlling diabetes.
Who does what in the provision of healthcare is being shuffled — just like a deck of cards. That deck of cards is being re-dealt. There are some new cards (roles). The players are the various healthcare providers,* patients, insurance programs, the media,** the government, big business, and healthcare manufacturers (drugs and medical equipment). Who is going to get what roles?
*Healthcare providers include physicians, dentists, chiropractors, pharmacists, nurses, physical therapists, psychologists, etc.
** The media include newspapers, magazines, radio, TV, and Internet sites of all kinds.
Next week I will spend time with my alma mater’s class of 2015. Many of them are concerned about the future because they are hearing that there are not enough jobs for the some 13,000 pharmacists who are graduating from U.S. pharmacy schools every year. My response is that I wish I were just starting now. There are so many opportunities and so many interesting things to do. The biggest problem will be deciding which way to go. CT
George Pennebaker, Pharm.D., is a consultant and past president of the California Pharmacists Association. The author can be reached at firstname.lastname@example.org; 916/501-6541; and PO Box 25, Esparto, CA 95627.