Integrating Pharmacists Into Care Teams Is Crucial

Pharmacists receive traning in general health, medication use, patient and provider education, pharmacotherapy, preventive care, and wellness. However, it was not until the early 1960s that the health care model adapted to allow pharmacists a more clinical role.^1,2

Historically, a pharmacist’s core role was dispensing medications and ensuring their safe use. In the 1960s, government health care programs began enlisting pharmacists to aid in disease management and primary care.¹ By the 1970s, a core responsibility of pharmacists became drug regimen reviews, particularly in long-term care facilities—this practice has extended into all other settings in which pharmacists are employed.^1,2 By the early 2000s, collaborative drug agreements were on the rise in government health care facilities, further expanding the scope of practice for pharmacists within direct patient care.¹ The role of pharmacists and their impact on patient care is still evolving and adapting to gaps in the health care system.

Within integrated care teams, a pharmacist’s primary responsibility is to optimize patient medication therapies through continuous coordinated medication management and review.³ Pharmacists accomplish this on their own and through multidisciplinary teams by doing the following^3,4:

• Communicating issues with physicians
• Ensuring therapies are not lost to transitions of care
• Evaluating patients and patient profiles for medication appropriateness
• Identifying and discontinuing duplicate or unnecessary therapies
• Identifying drug-related problems, such as allergies, dosing, drug interactions, and the potential for adverse events
• Identifying potential barriers to patient adherence
• Initiating or modifying medication therapy plans as patient needs change
• Monitoring outcomes of medication therapy, including effectiveness and safety
• Providing patient education

Although pharmacists are qualified to take on these responsibilities, allowing them a larger role on these teams has not been easy. Studies have shown that the rate of acceptance of pharmacist recommendations by physicians and their teams can vary from 11.4% to 94.2%.⁵ A successful team is built through respect and trust, which depend on the professional relationships among members. Consequently, varying team dynamics and relationships cause a wide range in the acceptance rate. Teams with experience in integrating other health care professionals or that had prior relationships with pharmacists allowed for easier collaboration. Additionally, orientation and role definition are common barriers to integration.

Understanding the clinical roles and skills of pharmacists within the team fosters better relationships among health care professionals and less uncertainty about the benefits of integration. Finally, visibility and lack of resources are a major challenge to integrating pharmacists. Often, there is not dedicated space for clinical pharmacists on the floors, causing teams to sometimes forget about this resource and not consult them. This causes barriers in fostering the pharmacist-physician relationship because of lack of interaction.^6,7

However, the role of pharmacists is expanding continuously, causing a positive shift in the health care system. Although there are barriers to integrating pharmacists into primary care teams, more health care professionals and patients are recognizing the need for such integration. In a cross-sectional survey conducted in California, 90% of 69 physicians noted that integration of pharmacists in their team improved medication management, and 93% considered pharmacists’ recommendations clinically meaningful.⁸

Furthermore, patients benefit from pharmacist-provided education, having a better understanding of the medications they are taking and being more adherent. Patients are also at reduced risk of medication-related problems because pharmacists prevent many errors prior to dispensing the medications. The results of a study involving 969 patients in Ontario, Canada, showed that when a pharmacist was integrated into a primary care team, at least 1 drug-related problem was identified and prevented in 93% of patients.⁸ The results of another study involving 237 patients showed that 16 pharmacists divided into different care teams found an average of 2.1 medication discrepancies and 3.6 drug-related problems per patient.⁸

Pharmacist integration also benefits the health system. Regardless of practice setting, pharmacist-driven services have shown economic benefit: For $1 invested in pharmacist integration, more than a $4 benefit was seen.9 Evidence-based practice by pharmacists can further reduce downstream health care costs by doing the following⁹:

• Providing medication reconciliation to detect and reduce drug discrepancies
• Providing behavioral and educational counseling to improve medication adherence
• Providing preventive care services such as immunizations
• Working in collaborative practice agreements to facilitate access to care and decrease the demand of physician-provided care

Pharmacists have been advancing their practices to deliver the most qualified care in specialized areas of medicine and to provide medication information to other health care professionals. The pharmacist’s role has expanded beyond medication dispensing and management to multiple therapeutic areas and settings. These include the following:

• In ambulatory settings, pharmacists play a behind-the-scenes role by reaching out to providers about alternate therapy because of cost issues, drug interactions, inappropriate prescriptions, and patient education prior to dispensing medications.¹⁰
• In infectious disease, pharmacists are respected members of integrated teams, with involvement in developing algorithms and antibiograms, evaluating and promoting optimal antimicrobial use, and leading antimicrobial stewardship efforts.
• Oncology pharmacists work closely with nursing departments to administer anticancer medications effectively and follow up with chemotherapy management throughout a patient’s life, monitoring medication adherence and safety.¹¹ Furthermore, oncology pharmacists in investigational drug studies are responsible for working with institutional and legal representatives to ensure that certain qualified patients have access to investigational drugs.¹¹
• In critical care, physicians often rely on pharmacist recommendations regarding antibiotics. Pharmacists are heavily involved in daily rounds, evaluating and monitoring efficacy of pharmacological treatments and providing relevant information to the team.¹²

It is worth noting that during the COVID-19 pandemic, critical care and infectious disease pharmacists have played a vital role in developing and implementing protocols.

Conclusion

In general practice, care team members gain drug knowledge from pharmacists, increasing safety. Although there are challenges to integrating pharmacists into primary care teams, it is ultimately beneficial, clinically and economically.

Rana Said and Eojin Lee are PharmD candidates at the Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey in Piscataway.

Deepali Dixit, PharmD, BCPS, BCCCP, FCCM, is a clinical associate professor at the Ernest Mario School of Pharmacy at Rutgers, The State University
of New Jersey, and a clinical pharmacy specialist, critical care at Robert Wood Johnson University Hospital in New Brunswick, New Jersey.

References

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2. Avalere Health LLC. Exploring pharmacists’ role in a changing healthcare environment. National Association of Chain Drug Stores. May 2014. Accessed February 8, 2022. https://www.nacds.org/pdfs/comm/2014/pharmacist-role.pdf

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8. Khaira M, Mathers A, Gerard NB, Dolovich L. The evolving role and impact of integrating pharmacists into primary care teams: experience from Ontario, Canada. Pharmacy (Basel). 2020;8(4):234. doi:10.3390/pharmacy8040234

9. Manolakis PG, Skelton JB. Pharmacists’ contributions to primary care in the United States collaborating to address unmet patient care needs: the emerging role for pharmacists to address the shortage of primary care providers. Am J Pharm Educ. 2010;74(10):S7. doi:10.5688/aj7410s7

10. Chiara A. The expanding role of pharmacists: a positive shift for health care. Commonwealth Medicine. March 26, 2019. Accessed February 9, 2022. https://commed.umassmed.edu/blog/2019/03/26/ expanding-role-pharmacists-positive-shift-health-care

11. Holle LM, Segal EM, Jeffers KD. The expanding role of the oncology pharmacist. Pharmacy (Basel). 2020;8(3):130. doi:10.3390/pharmacy8030130

12. Mohiuddin AK. Pharmacists in critical care. Innov Pharm. 2019;10(1):10.24926/iip.v10i1.1640. doi:10.24926/iip.v10i1.1640