Report: Many Opportunities for Health System Pharmacy Growth, Potential Risks Over Next Decade

In the next decade, pharmacists should continue to focus on expanding their scope of practice while being mindful of the challenges presented by vertical integration, complex policies, and high costs, according a new trend report from the American Society of Health-System Pharmacists (ASHP).

Pharmacists are the primary drivers of their destiny, according to the report, and they will continue to drive change in the industry by demonstrating their value, securing compensation, and advocating for expanded roles. Strengths will continue to include complex decision making skills as well as relational skills such as reliability and empathy.

“I don’t know that those skills are so different from previous generations, but the pace and the complexity of the environment is definitely different,” said Anna Legried Dopp, PharmD, director of clinical guidelines and quality improvement for ASHP.

Trends

Those relational skills will be especially important as patients expect their health care providers to prioritize personalization of care and engagement. The authors noted that the US National Quality Strategy emphasizes the importance of patient-centered care, and said that this trend should be kept in mind for all pharmacists working in chaotic and busy health system environments.

Other trends in the report include a global shift from improving health care to achieving overall health, increasing focus on care for the community as a whole, and a growing emphasis on the continuous care model.

Awareness of the social determinants of health (SDH) is necessary in order to adapt to the overall health and community-care trends, said the authors, because social determinants of health frequently influence health outcomes even more than medical care.

“In light of this influence, hospitals and health systems will seek to better understand the contexts of a patient’s SDH and integrate SDH considerations into patient care decisions,” said the authors.

Furthermore, continuous care models will be of increasing importance as patients transition between hospitals, rehabilitation centers, nursing facilities, ambulatory care clinics, and community settings. Staffing by interprofessional care teams, enabled by interoperable health information systems and reimbursed by health care payers, is necessary to ensure no fragmentation of care, according to the authors.

Risks

While these trends are encouraging and offer many opportunities for pharmacists to continue demonstrating their value, health system pharmacists should be mindful of several risks during the coming years that may present challenges for pharmacists’ functioning within the health system environment. These risks include both horizontal and vertical integration, complex policy and regulatory demands, and skyrocketing health spending.

While horizontal and vertical integration is typically undertaken with the goal of lowering costs, the authors said it introduces risks such as fragmenting of care delivery, organization culture, and the medication distribution system, all of which threatens patient care and safety. While it is not impossible to handle, the authors said pharmacists should be involved in careful, strategic alignment to achieve success.

On a similar note, the increasing complexities of policy, reimbursement, accreditation, and regulatory demands have all been results of the drive to improve patient care. This trend is expected to continue, but it will also challenge innovation and efficiency, according to the authors.

The final risk included in the report is the increasing challenge of financial and cost decisions. Health care spending in the US is expected to reach 25% of the gross domestic product by 2037, according to the report, and expensive therapies will require difficult cost-of-care decisions. In addition, aging populations and lifestyle-related conditions result in more expenditures and utilization increases. Tight budgets and financial stressors will not be going away, the authors said, and financial savviness will be an increasingly important skill in the pharmacy.

Opportunities

While the challenges are significant, there are several opportunities for pharmacists to expand their role and demonstrate their value in the health care team, especially by working with advancing technologies.

Machine learning and artificial intelligence will play an important role in decision-making and patient care, according to the report. Not only will it improve work flow for all medical professionals, but improved technology will allow clinicians to focus less on retrospective data and more on prospective planning and personalized care for patients. Pharmacists should work with the improving technology in order to achieve care delivery efficiencies, risk mitigation, and cost savings, said the authors.

Technology was a key foundation of the report, Dopp said, and can present both challenges as well as opportunities.

“If we can leverage technology for solutions, then it could be a great opportunity,” Dopp said. “However, we do hear from our members that technology can also be a driver of burnout.”

Advancing technologies also contribute to improvements in diagnosis and treatment options which support the managing and curing of diseases. Pharmacists in this space have opportunities to address cost-effectiveness and ethical considerations prior to the use of novel technologies in patients.

Personalized medicine and pharmacogenomics also come along with improved technology, and offer pharmacists opportunities to improve patient outcomes with tailored medication decisions. Optimizing health system infrastructure for the best use and application of pharmacogenomics and personalized medicine also provides enormous potential for pharmacist involvement, according the authors.

Finally, the authors said, there is no such thing as a totally self-sufficient clinician. Complicated and interrelated organizations demand collaboration, and pharmacists should be at the forefront of that change. Interprofessional collaborative practice will continue to expand, the authors said, and offer pharmacists many opportunities to demonstrate their value in the multidisciplinary team.

Collaboration not only improves health outcomes, Dopp said, but also allows for equal distribution of the workload among health care professionals, which reduces burnout. When interdisciplinary teams work together, “That entire care team has the opportunity to function to their highest capacity,” Dopp said.

Working with technicians and contributory members of the pharmacy team is just as important as collaborating with multidisciplinary teams. Those with financial expertise, clerks, and other employees are just as vital in the pharmacy and health system, according to the report.

“We see those roles as evolving and needing to be supported within the profession,” Dopp said.

The report’s long-term vision for pharmacy technicians includes expanded roles and new credentials allowing technicians to interact with the public to a higher degree. Advanced clinical roles and quality improvement opportunities will allow technicians to complement the evolution of pharmacist roles, according to the report.

The health system environment is constantly evolving with new technologies, systems, and policies, and while many of these can present challenges and obstacles for pharmacists, the authors emphasized that by staying at the forefront of the trends, pharmacists can ensure their continued role as safeguards of patient care and outcomes.

REFERENCE

ASHP long-range vision for the pharmacy workforce in hospitals and health systems: Ensuring medication use is optimal, safe, and effective in acute and ambulatory care settings. AJHP Volume 77, Issue 5, 1 March 2020, Pages 386—400, https://doi.org/10.1093/ajhp/zxz312 Published [online] December 4, 2019. Accessed February 18, 2020.