By Michelle Andrews
Provided by Kaiser Health News
More from this Series: Insuring Your Health
The average adult fills about a dozen prescriptions and refills every year; after age 65, they fill more than 30 prescriptions annually. For many people, their local pharmacist may be as familiar as their doctor — and often a lot easier to get time with. Some pharmacists are building on that position, expanding their role from drug dispenser to drug educator and chronic disease coach. By doing so, they may fill a void created by the shortage of primary-care physicians while boosting their business.
Janis McGannon has heart disease, Type 2 diabetes, high blood pressure and high cholesterol. A few months ago she accepted an offer from a nurse at the Bay Street Pharmacy near her home in Sebastian, Fla., to join a new “healthy heart” program at the pharmacy.
At a meeting of the program’s participants, Theresa Tolle, a pharmacist and the owner of Bay Street, gave a talk to about a dozen customers about cholesterol: what it is, how it works and how it can be managed. After everyone was weighed and measured, they received a goody bag that included a pedometer to encourage them to walk 10,000 steps a day.
The next month, the topic was blood pressure. In addition to having their pressures checked and discussing the medications they were taking, participants learned about using light weights and stretchy bands for exercise.
In between monthly meetings, McGannon, 74, logs onto a website to record what she’s eating and how much she’s walking. Tolle and the nurse e-mail her regularly to check on her diet or offer tips to keep her on track. Medicare doesn’t cover the $20 monthly fee for the program, but McGannon thinks it’s worth it.
“Most of us need to be reminded to do these things, and I’m reminded every day,” she says. “It’s right there on the computer.”
Pharmacists are perfectly positioned to help address the drug “adherence” problem: Research shows that only about half of people take their medications as prescribed. They may fill a prescription but not take the drugs as instructed, for example, or they may discontinue a course of treatment before it’s completed; often, people such as McGannon — who take multiple pills for multiple chronic conditions — simply forget. Lack of drug “adherence,” costs $290 billion in medical costs annually, according to a study by NEHI, a health research organization.
Bay Street is one of 50 independent pharmacies offering the heart program nationwide. It and a diabetes management program launched two years ago — available at more than 400 independent pharmacies — were developed by Augusta, Ga., pharmacist David Pope, who is working in partnership with drug wholesaler Cardinal Health. “We’re providing a communication tool to allow pharmacists to step into a coaching role,” says Pope.
In recent years, both independent and chain pharmacies have come under pressure from mail-order pharmacy services, in part because some insurers require that their members get their drugs through the mail. (In 2009, mail-order prescriptions made up 6.6 percent of all retail prescriptions, according to the national association of chain drug stores.) Drug chains and mass-market retailers such as Walmart have fought back with some success, offering $4 generic prescriptions, for example, and 90-day supplies. As for independent pharmacists, “it makes so much sense … to offer services beyond just filling prescriptions,” says Steve Lawrence, a senior vice president with Cardinal.
In the past year, Walgreens has rolled out a diabetes education program that provides customers in 10 cities with one-on-one sessions about the drugs they’re taking, how to use a blood glucose meter and other issues. The program is provided through insurers or employers; more than 1,000 people have participated so far, says Colin Watts, chief innovation officer for Walgreens.
In January, CVS Caremark kicked off a program that identifies insured diabetes patients who aren’t getting the drugs they need. The company contacts these patients and invites them to talk with a pharmacist by phone or in person at the store. The company plans similar programs for heart disease, high blood pressure and high cholesterol.
Primary-care physicians are generally supportive of such efforts as long as the pharmacists coordinate care with doctors.
“Answering questions about prescription drugs is important,” says Roland Goertz, president of the American Academy of Family Physicians. “But with the time pressures physicians are under, they can only accomplish so much.”
For many patients, pharmacists are the easiest to access and the most trusted medical professional they know. In a Gallup survey released in December, pharmacists ranked third among professions for honesty and ethics. That put them behind nurses (No. 1) but ahead of doctors (No. 5).
When pharmacists reach out to patients, patients may find themselves turning to them for advice and information more frequently.
That’s what’s happened in Janis McGannon’s case. Now that she knows Thesesa Tolle and the nurse at Bay State, she calls them or stops by when she has a question about her medication.
“Theresa’s very willing to sit down with you and talk about how to take [a drug] and how it will affect you,” says McGannon.
That’s not always the case with doctors, she says: “Sometimes they just gloss over things. They just say, ‘You’ll be fine. Call my office if you have problems.’”
This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.
Not sure about anyone else, but I am sure getting sick of other healthcare professionals attempting to profit from the physician shortage by expanding their role. NPs (now DNPs), Naturopaths can now write for prescription drugs in some places, optometrists trying to do surgery, CRNAs, etc etc etc. Now, we have pharmacists taking on part of the role of the family practitioner. Yet, people still wonder why family medicine is dying?
i don’t find it profiting as much as helping out the patient and the healthcare community in general. most patients don’t want to spend another copay visiting their physician just to answer a simple question about their health; i know many patients find it much easier to call their pharmacist or a triage nurse to get the answers they were looking for. i bet you anything that if physicians made themselves more available to them, patients would be more than willing to call them first, but that’s just not the case. also, pharmacists, as well as other health professions, go through very rigorous coursework and are very knowledgeable in what they practice; its a shame to think that pharmacists don’t have the ability to aid patients in their medical concerns. i think it’s actually beneficial to the healthcare community to have all professions working as a team and communicating in order to help their patients. i, for one, am really happy to see the role of pharmacists expanding and creating more programs for medication therapy management and overall treatment plans for patients; alot of times, patients visit more than one physician for different types of care and don’t vocalize this. by keeping track of a patient’s care, pharmacists can play an integral role in their health by watching for drug interactions and communicating to them the best way to make sure their prescrive treatment (by their physicians, mind you) is on track and working. i don’t think in any way that pharmacists (or other healthcare professionals for that matter)are trying to “profit” from the physician shortage; they’re just stepping up to meet the evolving needs of their patients and doing their job.
Right, all these professions attempting to expand their scope are doing it solely for the benefit of the patient right? Would a patient benefit more from someone more knowledgeable answering their questions, or someone more available? Who is reponsible for any adverse consequences due to the pharmacists increased role? Likely the patient’s family practitioner. Everyone says they have the knowledge of a physician these days and use the “team” approach to get their hands on a piece of the pie.
Well, considering that most physicians take what, ONE pharmacology course during their entire didactic curriculum? – I would say it’s the PharmD who is generally more knowledgeable. It seems to me that certain physician groups are basically saying: “we’re most qualified because we say we’re most qualified,” without any recent research to back that up. Research has repeatedly shown that pharmacist intervention helps, especially in patients with disease states like hypertension and diabetes. Instead of encouraging physicians to rise to the needs of patients and up their game, it seems that groups like the AMA are basically sitting back and pointing fingers while other professions are taking steps to better educate and train their practitioners.
inez: well said!
+1 here. And just to put things into context… to explain simple topics like cholesterol to a person, you don’t need a rocket scientist! That’s what pharmaceutical companies have already figured out so they are increasing their patient communication role by all channels possible and in this context extending the role of the Pharmacist is of major value to them. In this new scenario medical associations should be working closely with the pharmaceutical companies in order to seek and redefine the strategies that will maximize the goals and roles of the different members of the medical community, specially when it comes to patient communications.
This article is encouraging. I recently was able to sit-in on a type II diabetes meeting at a local clinic here in Salt Lake City, UT. There were 5 elderly female diabetic patients, two pharmacists, a 3rd year medical student, and the patient’s PHP. It was a round-table discussion including education about what diabetes, glucose, and insulin are, what guidelines to use when selecting foods and portions, an overview of each patient’s cholesterol, triglycerides, and comparisons of their current levels to older tests.
Three of the five ladies were managing their diabetes with diet and exercise alone, while the other two were showing marked improvements; accrediting this largely to the education they were receiving in these group sessions. Both pharmacists present were very helpful in answering drug-interaction questions, and each patient seemed thankful to be on such a personal basis with their health care team.
Expanding the role of pharmacists to that of coaching, and providing support and periodic reminders for accurate medication adherence (prescribed by their physician) would seem to be something every PCP would be on board for. I fail to see (from this article, and the general notion of better education for the patient) why any provider would object to these developments. Toes aren’t being stepped on, and new medications are not being prescribed. This is offering time for education and compliance that should be taking place as time permits in the examination room with their physician, and expanding it to ensure there are no questions or comments the patient may have that he/she was not able to communicate with his/her physician.
Interdisciplinary collaboration among physicians, NP’s, PA’s, pharmacists, and clinic employees is one of many ways to make health care delivery more efficient, and patient satisfaction, education, and compliance rates increase.
A friend of mine is a pharmacy student and they do have pharmacology “classes” just about every semester. However, these are not full pharmacology classes. These are very abbreviated “sections” of a pharmacotherapy course that gives students are brief understanding of how the drugs work. I am a medical student and we have two full semesters of pharmacology that we have to take that covers all systems and the relevant drugs. Having met some of her classmates, I would NOT be calling them for medical advice.:) Most of them have very brief science experience (2 years of CC), therefore, they normally think that what they are learning is at a graduate or medical school level.
Mr. Bean, you are one egotistic individual. What does prereqs have anything to do with the conversation at hand??? You wouldn’t call them for advice? When you make your potentially fatal med error as as physician and a pharmacist catches it, I would like to hear your tone then. Your type of personality is what is wrong with healthcare. You obviously will be at the top of the totem pole…good for you.
Mr. Bean-
Are you serious? Haha you obviously have NO idea what pharmacy school is like. I’m starting a PharmD program in the fall and have a B.S. in pharmaceutical sciences, which many would say is a harder major than your typical biology pre-med. Medical students have about two classes of pharmacology whereas PharmDs have basically three years of pharmacology, therapeutics, kinetics, pharmaceutics, etc. and a year of rotations in different types of pharmacy environments. All this is after undergrad, and more and more schools (mine included) are requiring a bachelor’s degree before one can start in a PharmD program. Pharmacists aren’t asking to write prescriptions like every other medical professional out there, so I don’t understand why doctors feel threatened by pharmacists counseling patients in the area in which they are the experts, moreso than MDs. I’ve worked in a pharmacy for 3.5 years and there are plenty of doctors who need someone more knowedgeable about medications checking the presriptions they write. I have no problem with doctors and thought about being one myself at one point, but I am more interested in the science of medication than in diagnosis so I chose pharmacy. Have a little respect for your fellow healthcare professionals, if you make it through med school you will be working with them everyday
This is all well and good, but you have to look at the bigger picture. Nearly every healthcare profession out there is expanding their role lately. Do you really think physicians wont feel threatened? Whats to stop pharmacists from writing prescriptions in the future? After all if you now counsel patients and no more about the medication, whats next? Everywhere you look there are healthcare professionals expanding their role. Like I said above, DNPs now want to be called doctor in a clinical setting, optometrists are trying to get surgical priviledges, Naturopaths in oregon can now write prescriptions (which you would think is against their whole reason for being), etc etc etc etc. This trend is not stopping, in fact it is getting worse. Psychologists are also trying to get prescription rights. So, excuse us for being leery of pharmicists now wanting to counsel patients, because quite frankly, I don’t think it will stop there. Eventually EVERYONE will be a physician.
Jay/Jenn:
It is not about feeling “threatened.” It is about patient safety. Pharmacist’s don’t have the qualifications to recognize the vast array of pathological conditions and accompanying idiosyncrasies that may exist. Therefore, it is imperative that patients get evaluated and monitored by their physicians. Pharmacist do have a major role in ensuring patient compliance and in medication therapy management (MTM). To that end, they can provide physicians critical information about any potential drug interactions since patients don’t always tell their physicians about all of the medications (Rx & OTC) plus supplements that they are taking. Pharmacist may be in a better position than physicians in establishing a thorough Rx record. Yes, I do have respect for my fellow health care providers. However, the respect rests on their ability to be compassionate, competent and their understanding of “scope of practice.” I don’t have respect for those who want to “play” surgeon or an internist with a Pharm.D..
@ bob, actually pharmacist scope of practice (with BCPS certification) in several states + the VA + the IHS gives them prescribing rights already. And the VA – much to the chagrin of some of their MDs – is *further* expanding pharmacist scope of practice in this area by decentralizing pharmacists and putting them directly in the clinics. Plus, the Joint Commission now calls it a Best Practice for pharmacists and MDs to work on patient care plans together in an interdisciplinary way.
@ mr. bean, well, that’s a surprise considering that half of my credit hours here in pharmacy school are in classes with the title “pathophysiology.” =P Times have changed, and so has training.
And frankly, I don’t really care about what happens to various professions scope of practice, or that the MDs don’t have the pie to themselves anymore. It’s about the PATIENT. And patients need more care, and more complicated care. And your representatives at the AMA have done a fine job of jerking patients around by limiting the physician pool, which drives up costs yet minimizes access. So other professions have strengthened their accreditations in order to provide the care that used to be entirely on physicians’ shoulders. My pity is nonexistent.
Im getting sick of this “its about the patient” nonsense. Do you really think that having 1234324 different kinds of providers is in the patient’s best interest? Do you think patients know the difference between the different providers? They are extremely confused as has been pointed out by several studies. So, don’t use the “in the best interest of the patient” as an excuse, but that is just blatantly incorrect.
“Do you really think that having 1234324 different kinds of providers is in the patient’s best interest?”
Seriously is that what they are teaching you in med school? Scary. And again, if the physicians organizations were doing their job, there would be no problem. They aren’t, so there is, so we are stepping in regardless of how you personally feel.
Medline these. We help.
Chisholm-Burns, M.A., Lee, J.K., Spivey, C.A., et al. US pharmacists’ effect as team members on patient care. Systematic review and meta-analysis. Medical Care. 2010;48(10):923-933.
Carter BL, Bergus GR, Dawson JD, et al. A Cluster-Randomized Effectiveness Trial of a Physician-Pharmacist Collaborative Model to Improve Blood Pressure Control. J Clin Hypertens (Greenwich). 2008 April; 10(4): 260–271.
Carter BL, Rogers M, Daly J, et al. The potency of team-based care interventions for hypertension: a meta-analysis. Arch Intern Med. 2009; 169: 1748-1755.
I don’t think they know what medline is. They are obviously ignorant and egotistic a-holes
Inez:
Regardless of how many of these abbreviated pathophysiology classes you have taken, you are still NOT going to be a physician and neither are you as qualified. Hence, they have separate schools for the two areas. If you want to be a physician then I suggest you get into medical school. Otherwise, do what pharmacist are supposed to do. In an attempt to play doctor, many pharmacist continually make errors that can be omitted if they would simply concentrate at what they are trained to do. A pregnant patient in CO was given MTX. The pharmacist should have caught this immediately and thus could have prevented the medication from dispensed. However, I’m sure s/he was too busy trying to take blood pressure behind the counter.
@ Jat, you are correct most likely sadly.
@ Mr. Bean, take it up with CMMS. Take it up with the Join Commission. Take it up with the VA. Take it up with the IHS. Take it up with the (5? 6?) states that allow BCPS pharmacists to have some prescribing rights. And take it up with nearly every state legislature, who almost uniformly have passed various types laws allowing MTM services by pharmacists.
Fact is, times are changing and insulting your fellow practitioners does not earn you respect. You are angry because you don’t like the change, this isn’t what you signed up for when you wne to med school, and there is nothing you can do about it. Understandable, but it still makes you look petty to come on here and rant.
sorry for typos, that’s what I get for typing on my phone!
I wonder how pharmacists would feel if suddenly pharmacy assistants or some other group was allowed to dispense medications like a pharmacist? It is easy to talk sh*t when your job is not the one that is being invaded from all sides.
Inez:
You have clearly made my point for me with your illogical, and poorly constructed argument; riddled with grammatical, spelling and punctuation errors. This why we as future physicians and current physicians are concerned. Medicine and the practice of medicine is constantly diluted by people like you with very little knowledge and substandard skill set. Being a pharmacist is not a bad thing. You play a crucial role in the course of the patients treatment. However, you will NOT have the training and the skill set as physicians attain from going to medical school and spending years in training as a resident. It is incomparable.
“This why we as future physicians and current physicians are concerned.”
You accidentally a word.
Actually, Mr. Bean, there are numerous grammatical mistakes in your post. If you use grammar as an indicator of the validity of an argument like you appear to be doing, you should reconsider your own position.
In case I’m not laying it on thick enough, mocking people for errors that you proceed to commit several times makes you look foolish.
How about we lay off the ad hominem attacks and stick to the topic.
Andy,
I think you need to re-read your own posts before you start teaching me.
Yes, I am prone to errors as any but you can’t compare that to our beloved pharmacy student’s fragmented and illogical attempt to a counter argument. Inez just threw a bunch of incomplete sentences asking me to take it up with various organizations, such as the VA, CMMS, etc. That is not an argument. The bottom line is that Pharmacists are NOT equal to Physicians. You can throw a million articles at me supporting the expanded role of pharmacists but it will not change the validity of that reality.
“You can throw a million articles at me supporting the expanded role of pharmacists but it will not change the validity of that reality.”
Addressing my grammar, the first post I made was a jab at you failing to include the word “is”. Additionally, I didn’t make a claim about the importance of grammar, so I can be un-hypocritically ungrammatical as I like.
Also, your stance is illogical. If you were presented with proper evidence to refute your claim but did not change your position, then you are closing your mind to reality. There is either evidence to support a claim or not. Ignoring the evidence doesn’t change reality.
To address the argument, I personally believe that IF a pharmacist’s role is expanded to overlap a physicians role AND the pharmacist has also expanded their training to cover that expansion, then there should be no problem.
Then by that argument you should have no problem with some other entity expanding into a pharmacist’s role if they have some “expanded training” whatever the hell that means. How bout that expanded training includes something like, I don’t know MEDICAL SCHOOL? This blurring of boundaries and roles is really getting out of hand.
“Then by that argument you should have no problem with some other entity expanding into a pharmacist’s role if they have some “expanded training” whatever the hell that means.”
That is correct. I would have no problem with that.
(Sorry for the multiple postings)
I think the issue is that in some cases there are simply not enough physicians to cover all the bases that need to be covered, and in that case I say fair game. If it is encroaching on an area that is already fully covered, then maybe that isn’t so productive. I see this as more of a “fill in the gaps” type thing as of right now.
You may, but others see this as an opportunity for gain. Did you know there are DNP residencys in dermatology? That is definately NOT an area of need. Also CRNAs enroaching into pain medicine is not an area of need. Optometrists doing surgery is not an area of need. Do you see a pattern? Plus, when there is no longer a need, do you think pharmacists will go back to their previous role? I don’t think so.
@bob: As an undergraduate, I spent two years in the emergency department at a teaching hospital working with a broad range of people within the titular alphabet soup.
I would overhear, at least once a week, chat among residents and occasionally an attending, expressing fear/hate about NPs “invading” their work. Of course, in the “fast track” sub-department, it was mostly NPs working on individuals that presented to the ED with non-emergent conditions.
But, why the fear? For starters, there’s the monumental hubris that many, but not all, doctors compound over the course of their MD-hood. You’ve gone through all the classes, exams, clinical training, boards, and even more training. You deserve it, right?
Fair enough. However, that’s not a good enough reason to want to limit the number of qualified health care practitioners entering the industry.
As long as the quality of care doesn’t decline, who cares if there are PharmDs, DNP residents in derm, and CRNAs expanding into the field AND making meaningful contributions. As cliched as it may sound, we’re all standing on the shoulders of giants. No individual is going to know everything there is to know about anything. Hence, the potential usefulness for clinical PharmDs. Moreover, there’s nothing wrong with NPs and CRNAs filling spots as PCPs and anesthetists, respectively. CRNAs typically don’t have the monumental malpractice concerns as traditional pain docs (but that’s probably because nurses are trusted more than doctors–though, I digress.)
I’ll be finishing med school this year, and I can attest to this “fear” I’ve seen in other MDs during my two and a half years in the hospital learning only a speck of the trade. While I didn’t see it as much, it was still there.
The way I see it: We need to stop artificially limiting the number of physicians entering the profession. Many well-qualified and well-intentioned applicants are rejected every cycle, so we can’t say people don’t want to enter the field.
We should also de-monopolize the match program, or find a way to put a more reasonable cap on the hours expected from a resident. There may be a slight ding to already-unsubstantial pay, but docked hours and pay would allow for more physicians into the profession.
Basically, start graduating many more physicians and let the market weed out the bad ones. Of course, we’d have to break down the good ol’ boys club to effectively do that. Though, none of this would ever happen because it’s tantamount to trying to restructure the healthcare insurance industry from scratch.
Tl;dr: bob, these times, they are a-changin’. (Big girls don’t cry.)
Monter,
I can’t wait for CNA’s to start doing brain surgery. LOL
@Mr. Bean: No one mentioned or even alluded to the idea that CNAs (I’m assuming that’s Certified Nursing Assistant) would be involved in complex surgeries.
I don’t ever see NPs (and especially not CNAs) performing brain surgery, transplants, CABG, etc. NPs, do however, perform many simple surgeries, with or without supervision.
What a leap in making such an idiotic assumption.
If by CNA, you actually meant CRNA (which I did mention), then maybe you might be able to make a point. Oh, wait… Many of the certified registered nurse anesthetists I’ve met are just as capable at delivering gas as traditional MD anesthetists. Also, neither group performs brain surgery.
I think you should just focus on driving three wheelers off the road, Mr. Bean.
Take a look at the DNP curriculums at various institutions and then get back to me.
Monter,
Are you a nursing student playing medical student here?
I’ve also heard of medical assistant students telling people that they are in medical school.LOL You know, if you want to be a doctor, just go to medical school. It’s just that simple. Why go into another health care profession so that you can “play” doctor? It doesn’t make sense.
To all you RPhs and pharm students, sorry to burst your bubble, but Bob and Mr. Bean are more correct than you. I am in a “Top 10″ pharmacy school. More than half my classmates are complete tools who think they are doctors. Sorry, WRONG. They cannot use basic medical terminology (Latin) and lack a basic understanding of the simplest physiologic processes even though half the courses have the word therapy or physiology in them. They couldn’t tell you what pneumonia is (no, it’s not bacteria) or where the introitus is. They can’t even take someone’s BP…but that’s what electronic gadgets are for isn’t it? You can all nitpick on each others’ grammar, diction, or typing skills, but I and most of the patients I meet put more trust in a physician than an RPh. It’s not bcs you are bad, it’s bcs you don’t try hard enough.
Pharmacists are Federally empowered police to guard medicines. Now, how do you feel about the police? You pharmacists start with answering that question and see where it leads you and what YOU can do to improve your profession. The first step is to admit how narrow minded many pharmacists are. Then, comparing apples and oranges is not a logical argument…This is my opinion based on facts and observations at my university, which has one of the largest classes in the country. So, if you can state facts and observations instead of how you feel, you might also improve the profession. No one cares how you feel.
As far as the turf battle, MDs will have to face the music that few people value their intellectual abilities, train of thought, or mastery in the art of medicine once health care becomes a right or comodity available to all comers. That is just how the system has evolved here, which I believe is unfortunate to say the least.
On a personal level, I used to see a DO who went through certified medical licensure and residency, but now see his PA (who only went to 2 years of school) and feel more comfortable seeing the PA. The reason, I think, is that based on my education level and independence, I felt she was more open to my ideas about my own health care than the DO. She does not let me run her, though, and tells me her point of view, which I am glad to consider and glad she provides.
@ ScarletLetter:
As a pharmacy student myself, I must ask…..
Why did you decide to pursue a career in pharmacy???? Your post sounds condescending to say the least.