Rise of the Community Pharmacist

Since the introduction of the Affordable Care Act in 2010, the landscape of health care has changed dramatically, resulting in greater emphasis on key issues such as expanding access to care, lowering costs, and improving overall health—particularly through better management of chronic disease.

The New England Healthcare Institute estimates that $290 billion per year in health care costs result from failure to properly take medications for conditions such as diabetes, asthma, and heart disease. According to a study from the US Department of Health and Human Services, chronic disease management accounts for more than 75 cents of every health care dollar spent.

Costs have spiraled out of control, and as providers struggle to adjust to changes in the way that care is delivered and reimbursed, a need has emerged for pharmacists to take on a greater role.

“There’s such a focus right now within the health care system as well as the government in trying to curb these costs and trying to figure out solutions for being able to afford care,” said Edith Rosato, RPh, IOM, senior vice president of pharmacy affairs at the National Association of Chain Drug Stores (NACDS) and president of the NACDS Foundation. “This is a fantastic opportunity for pharmacists, who are so welltrained in the appropriate use of medications, to be able to step up to the plate and really develop a specialized niche to help contribute to lowering overall health care costs in the US, and also enhancing the quality of care.”

Pharmacists can help shift the landscape of health care to a more patient-centric model by providing medication therapy management (MTM), increasing medication adherence, and promoting and increasing the use of generic medications—services that are all a high priority for national retail pharmacy chains such as Walgreens, CVS, and Rite Aid.

Partnering with Patients

Some of the programs aimed at improving both medication adherence and overall health include the following:

• Walgreens is collaborating with Johns Hopkins Medicine (JHM) on a population-based research initiative to develop protocols to improve outcomes for patients with chronic diseases. By partnering, Walgreens and JHM hope to develop new ideas for research in disease management, screening, and prevention; develop and review clinical protocols; provide training for pharmacists and other care providers through onsite and distance training; and work to develop lifestyle, chronic care, and disease-specific programs.

• Walgreens is also partnering with Northwestern Memorial Physicians Group of Chicago on a coordinated care program through which it will share the results of pharmacist clinical interventions with primary care physicians to improve the care of individual patients.

• CVS Caremark Special Pharmacy’s Hep C CareTeam—a group composed of pharmacists, nurses, and pharmacy service representatives— aims to improve the treatment of patients with hepatitis C by providing training and education related to the disease and its available therapies. The Hep C Care- Team works to ensure that patients safely and effectively take prescribed medications and proactively communicate with their physician to address any treatment-related issues or complications that may arise. • Through its Care 1on1 program, CVS/pharmacy offers patients one-on-one time with a pharmacist during which they can discuss cost issues, safety, and side effects when a prescription is transferred or filled for the first time.

• Rite Aid Pharmacy has partnered with the American Diabetes Association to educate patients and their loved ones about how to effectively manage the condition and take on a more active role in their health. Through Rite Aid’s Web site, patients can download a list to track their current medication regimen, calculate their estimated average glucose, watch educational videos, and use the My Food advisor to plan healthy meals and track calories and carbohydrates.

In addition, all 3 national retail chains offer interactive weight loss programs and immunization programs to help protect against conditions such as influenza, human papillomavirus, shingles, and pertussis.

Through these initiatives, community pharmacists can establish strong relationships with patients and help them to better manage chronic conditions, according to Jay Nadas, PharmD, director of retail clinical pharmacy programs at Walgreens.

“All of these services provide the ability to offer the assistance patients need in a way that lets us form lasting relationships with our patient base,” he said. “These relationships are absolutely crucial as we move into a performance-based paradigm within health care.”

By interacting with patients on a daily basis, pharmacists are able to build and maintain a level of trust that is more difficult for physicians— who see patients less frequently—to establish, according to Rosato.

“That’s the beauty of community pharmacy,” she noted. “Pharmacists are moving from a dispensing role to one where they are face-toface with patients, providing important services. Pharmacists are positioning themselves as the new patient advocate for care and act as a patient’s coach.”

In addition to offering testing services for blood pressure, blood glucose, A1C, and total cholesterol, Walgreens features centers of excellence focused on compounding, HIV, and other disease states at selected stores.

“In any long-term behavioral change, ongoing encouragement from a reputable source is crucial,” said Dr. Nadas. “We, as pharmacists, who see the patient more than any other clinician, are in the best position to provide regular and constructive feedback.”

One of the key components of pharmacist training at Walgreens focuses on the patientcentered consultation, which involves using open-ended questions to help patients identify their needs. “It is much easier to align services to a patient’s needs when we’ve worked together to determine what those needs may be,” he added.

The Future of Community Pharmacy

For both pharmacists and pharmacy students, there are a number of options that can lead to a fulfilling and successful career. Working as a community pharmacist in retail affords individuals the opportunity to interact with patients in an intimate setting while benefiting from the resources and reach of a larger company.

It also offers a career setting that is extremely versatile, according to Dr. Nadas. “For those looking to specialize and target complex disease states, there are community-based centers of excellence. For those looking at more in-depth relationships with patients, there are worksite pharmacies that focus on particular employer groups and allow deep-rooted relationships over time.”

Additionally, there is a great deal of variance within freestanding pharmacies based on their geographic location. For example, those that are within close proximity of a children’s hospital may offer more of a pediatric focus, whereas pharmacies that are located near senior communities may focus more on geriatric care.

“There is so much for our industry to offer patients,” he said, emphasizing pharmacists’ increasing role in “improving engagement and overall health outcomes. Community-based pharmacy is on the front lines of this powerful movement.”

One of the keys to further advancing the profession, according to Rosato, is in changing the perception that many patients have of pharmacists, and helping them to understand the role pharmacists can play in improving a patient’s overall health.

“Patients should view the pharmacy as a health care destination,” she noted. “Pharmacists can be a sounding board and help triage patient conditions and determine the next step, whether that is recommending over-the-counter medications, or advising a patient to go see a physician to get a prescription medication, or go to the emergency room or an urgent care facility.”

As MTM and other services continue to expand, particularly in community pharmacies, Rosato believes that more patients will take advantage of the high level of care offered by pharmacists.

“In the next 10 years, there’s going to be a sea change in the way health care is delivered,” she said. “We’re going to see more focus on looking at patients in a holistic way. This is an exciting time for pharmacy as a career.” %u25CF