Pharmacy Needs New Practice Models Now

Small changes will make a big difference in all settings of pharmacy practice.

Change may be hard for most people, but I think the personality type that dominates our profession finds change really difficult. So when I propose change, I can understand why many pharmacists disagree. In fact, not all changes are good, so it is healthy to be skeptical at first—but not resistant if the facts seem to suggest change makes sense.

For me, many signs have come together in the last few years to suggest that our profession needs to look at new practice models for all pharmacy practice settings. Society has a need for someone to do a better job of helping the patient manage drug therapy. Frankly, the existing practice models for all health professionals do a poor job of this. Drug therapy costs too much. Studies show that preventable adverse reactions occur too frequently, unnecessary hospitalizations occur, and even preventable deaths results from poorly managed drug therapy.

If pharmacists are the “drug experts,” then maybe it’s time for our profession to step up and claim this role as our responsibility. Of course, pharmacists have a choice. If they don’t want to change, they can let someone else take on this role. There are nurses and physician assistants ready to claim it.

Why aren’t pharmacists doing this job well now? Some may feel that our education didn’t prepare us for this role, but that is not true of our current graduates. Some may think that it is not our job but, of course, I would disagree. I think the biggest reason is that we do what we get paid to do—and pharmacists are not currently paid to do this job. Another major reason is that our current practice models do not support this role, so even if you wanted to it would be hard to make it happen.

The profession has been talking about creating a new practice model for pharmacy. The Joint Commission of Pharmacy Practitioners Organization (JCPP) started the idea of a new practice model with its Vision 2015, which said pharmacists would be responsible for drug therapy outcomes. Following this, the American Society of Health-System Pharmacists held its Practice Model Summit and has been working at the state and national level to change the acute care pharmacy practice model. Community pharmacy has been talking about practice model changes as well.

Then, last October, the Centers for Medicare & Medicaid Services (CMS) proposed that nursing home consultant pharmacists needed to be independent from the pharmacy that provides the drugs to the facility. Last month, CMS released its response to the profession’s reaction.

Although the CMS said that it was not planning to implement the proposed separation rule, it did suggest that a number of problems with the current nursing home pharmacy practice model exist. It hoped that the nursing home pharmacy industry would work to improve the existing practice model so the issue would not have to be revisited.

Have I convinced you that a new practice model is needed where you are currently working, no matter what the setting? Probably not, because when I make this suggestion to most pharmacy audiences they usually think I am not talking about their workplace but somewhere else. It’s human nature to think we are doing a good job and not needing to make changes. After all, we are making a good salary, we received a good evaluation last time, and some patients even tell us “thanks.”

What I’ve learned in life is that we often realize the need to change when it is almost too late. We need to be thinking about change when things are still going well—not beginning to decline. It seems to me that we are on the verge of a decline in our existing practice model in all practice settings because drug products are being viewed more as a commodity. Getting paid to assure that the right drug is in the container doesn’t seem to be as important to payers any more. Thus, our dispensing fees are declining and our existing practice model may not be able to sustain us into the future. Changing what we do and how we do it seems to be the answer.

Does that famous quote “insanity is continuing to do the same thing and expecting different results” apply to pharmacists who don’t want to change how they practice? I think it does. Our patients are not going to get the results from pharmacist services they deserve unless we change our practice model. In most settings we will not be able to change everything all at once. So the key is to begin making small changes to get ready for the future. Have you done anything different in your approach to practice in the last year? If not, could you be part of the problem?

Mr. Eckel is a professor at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He is past executive director of the North Carolina Association of Pharmacists.