Providing Patient Care in a Community Pharmacy Career

The COVID-19 pandemic has changed the way the public seeks health care. For example, it has highlighted the value of community pharmacies as a location where health care professionals can provide vaccinations, testing, and medication-related care, in addition to triage or other health care services.

Community pharmacy practice is experiencing a critical transformation that will modify the way pharmacy professionals and the public think of the community pharmacist’s role. Many factors are coinciding to set up community pharmacy for an exciting evolution that will continue to grow in the coming years.

The business model of health care is rapidly changing as communities need their local pharmacies to meet gaps in care. Meanwhile, pharmacy technology has expanded to allow community pharmacists to better document patient care and outcomes.

The COVID-19 pandemic has created new opportunities for pharmacists in community pharmacies to provide care and express value to other members of the health care system in the United States. Community pharmacists, pharmacy faculty, and student pharmacists are all taking part in practice transformation, making it an exciting time to explore community pharmacy as a career.

Declining margins on medication dispensing are a well-known topic in community pharmacy. Although gross margins of pharmacies have decreased over the past several years, provision of additional patient care services have grown significantly.¹ This provides additional revenue to community pharmacies while allowing the pharmacy team to put their focus toward providing patient care over time.²

There is also a growing shortage of primary care physicians in the United States, which is expected to more than double between 2017 and 2032.² This shortage heightens the need for pharmacists in the community to step into primary care and chronic disease management roles.³

Pharmacists are trained as clinicians, and their incorporation into chronic disease management efforts has a positive impact on clinical outcomes and return on investment.³ There are critical gaps in health care that pharmacists in the community can meet with their accessibility and skill sets.⁴

Provision of enhanced patient care services has grown significantly over the past 2 decades, including milestones of Medicare Part D Medication Therapy Management Programs (MTMPs) in 2006, allowance in all 50 states for pharmacists to immunize by 2015, and the growing recognition of pharmacists as health providers within 18 states, with additional states having pending legislation.^4,5

Importantly, pharmacists in communities are being increasingly compensated for the patient care they provide. This is happening with opportunities like MTMPs and negotiated payer programs through clinically integrated networks of pharmacies, such as Community Pharmacy Enhanced Services Network (CPESN) USA and their state affiliates.^6,7

Many of these new and expanding payer programs utilize the Pharmacist eCare Plan technology standard for documentation of care.^7,8 The eCare plan is a community pharmacy electronic health record that allows for more robust documentation of care provided over time beyond prescription dispensing and supports adjudication of payment for services.⁸

The COVID-19 pandemic has accelerated community pharmacy practice transformation and has expanded patient care service provision even further. An example of this is the ability of student pharmacists across the nation to immunize the public with the COVID-19 vaccine, when, in many states, restrictions prevented this less than a year ago.⁹

Additionally, community pharmacies have been able to offer COVID-19 testing, other point-of-care tests, and essential services while many other destinations for health care had to close their doors during lockdowns. All these changes have resulted in both patients and other providers viewing the role of community pharmacists differently. Patients have always put great trust in their pharmacists, but their view of what pharmacists can provide is growing.¹⁰

It is an exciting time in the world of community pharmacy practice. Community pharmacists are getting paid for patient care now more than ever, and new doors are opening daily for pharmacists to make a positive impact on the health of their patients.^6,11 CPESN USA now includes over 3000 pharmacies nationwide, all of which are united by providing enhanced patient care services.

Growing patient care programs and transforming workflow come with challenges, and the Flip the Pharmacy program has made great strides toward supporting pharmacies in their change efforts.¹² As pharmacies have united to work toward transformation, colleges and schools of pharmacy have also come together to mobilize community pharmacy practice transformation efforts.

In 2019, the Academia-CPESN Transformation (ACT) Pharmacy Collaborative formed as a learning and acting collaborative between colleges, schools of pharmacy, and clinically integrated networks of community pharmacies.¹³ The goal of the collaborative is to support the transformation of community-based pharmacy practice from a product-based care model to a community-based pharmacy care delivery model.

To date, the ACT Pharmacy Collaborative has 93 colleges and schools of pharmacy in its membership, each with an ACT Champion designee who serves as a liaison for efforts at the college/school surrounding community pharmacy practice transformation.¹³

ACT Champions and their teams strive to advance community practice and promote it as a promising career for student pharmacists through education, research, and connection to community pharmacy practices. The network of faculty, staff, and students that has formed through the ACT Pharmacy Collaborative has fostered meaningful connections and opportunities to get involved in community pharmacy practice transformation.

Students are powerful change agents; a student adds a lot of value to community pharmacies as they transform their practices. Don’t be afraid to do your part to support community pharmacy practice transformation and to take your first steps in the exciting career path of community pharmacy practice.

Sophia Herbert, PharmD, is a community pharmacy practice development fellow at the University of Pittsburgh School of Pharmacy.

REFERENCES

1. Michos L, Holmes E, Lewis R, et al. NCPA 2017 Digest. Opportunities
   for community pharmacy in a changing market. National Community Pharmacists Association. Accessed August 30, 2021. https://www.ncpa.co/ pdf/digest/2017/2017-digest-lr.pdf
2. Dall T, Reynolds R, Chakrabarti R, et al. The complexities of physician supply and demand: projections from 2019 to 2034. Washington, DC: HIS Markit Ltd. Accessed August 30, 2021. https://www.aamc.org/media/54681/ download
3. Smith M, Bates DW, Bodenheimer TS. Pharmacists belong in accountable care organization sand integrated care teams. Health Aff (Millwood). 2013;32(11):1963-1970. doi:10.1377/hlthaff.2013.0542
4. Somma McGiveney MA, Pope DD, Trygstad T. Unrealized potential and unrecognized value: community-based pharmacy practice is reinventing itself—join the movement. JACCP. 2019;2(4):330-334. doi:10.1002/jac5.1147
5. 2021 state provider status mid-year legislative update. National Alliance of State Pharmacy Associations. June 24, 2021. Accessed August 30, 2021. https://naspa.us/resource/2021-state-provider-status-mid-year-legislative-update/
6. Community Pharmacy Enhanced Services Network. Accessed August 30, 2021. https://www.cpesn.com
7. NCPA Innovation Center releases assessing trends in enhanced services and medication support with value-based payment models in Medicaid. Community Pharmacy Enhanced Services Network. Accessed August 30, 2021. https://www.cpesn.com/report
8. Pharmacist eCare Plan Initiative. Accessed August 30, 2021. https://www. ecareplaninitiative.com
9. Fifth Amendment to declaration under the Public Readiness and Emergency Preparedness Act for medical countermeasures against COVID-19. Public Health Emergency. Accessed August 30, 2021. https://www.phe.gov/ Preparedness/legal/prepact/Pages/COVID-Amendment5.aspx
10. Murphy J. Public views pharmacists as trusted professionals with high levels of virtue. Pharmacy Times®. April 18, 2020. Accessed August 30, 2021.
11. Pennsylvania pharmacist care network information. Pennsylvania Pharmacists Association. Accessed August 30, 2021. https://www.papharmacists.com/page/PPCN_Information
12. Kondic AMS, Trygstad T, McDonough R, Osterhaus M. Scaling community pharmacy transformation with the ‘Flip the Pharmacy’ implementation model: program origins. Innov Pharm. 2020;11(3):10.24926/iip.v11i3.3399. doi:10.24926/iip.v11i3.3399
13. Academia-CPESN Transformation Pharmacy Collaborative. Accessed August 31, 2021. https://www.actforpharmacy.com/