The Role of the Retail Pharmacy in the New Healthcare Environment

My first job, at age 14 years, was working in a small neighborhood retail pharmacy. My role included a number of odd jobs such as stocking and selling perfume, candy, and birthday cards. What really left an impression on me in my 2 years working there was the relationship that the pharmacist had with the healthcare consumers that came into the pharmacy. He knew just about all of them, understood their healthcare needs, and truly acted as their healthcare advocate. Fast forward to today.

We are currently faced with a number of challenges that we are trying to tackle within healthcare. Don Berwick, in an attempt to focus these challenges, introduced the US healthcare system and the public to the Triple Aim.¹ The triple aim includes 1) access, 2) quality, and 3) cost as the basis for improving healthcare in the United States. Over the next few issues, I would like to focus my thoughts on the emerging role (and potential role) of pharmacists in the new healthcare world. I would like to consider each portion of the triple aim and the retail pharmacy’s potential relationship with each.

First, let’s focus on the issue of access. Access is more than just about covering the approximately 60 million Americans without healthcare insurance today; it is also about addressing the impending primary care shortage and making care available to those with insurance in an appropriate setting when they need it. For basic needs and advice, most Americans have a healthcare professional, the pharmacist, within a few blocks of where they live, work, and play. We are now beginning to see pharmacists take on greater roles within the healthcare continuum outside of dispensing medications. Here are just 3 examples of how the retail pharmacy and pharmacists can address some of the access issues we have today.

First, a large number of adults and children remain unimmunized, placing themselves and others in harm’s way. A large number of pharmacies offer these immunizations at times that are very convenient. Second, programs such as those in Asheville, North Carolina, and Pope County, Florida, have shown that a pharmacist-directed diabetes program can be very successful in helping those with chronic disease better control their conditions. The third example is focused on medication therapy management. As a physician, the most comprehensive training I received in medication therapy was my fi rst year in medical school. Needless to say, much if not most of what I learned I have long forgotten. The medications that I know the most about are the 10 to 15 medications that I prescribe the most often. Just like doctors that specialize and know a great deal about that disease state or part of the body, pharmacists know medications. Why not make those with the greatest knowledge about medications accessible to the patients that are taking medications? This seems to me to be a “no brainer.”

Up to this point, I have focused my comments on retail pharmacies as we have always known them. The world continues to evolve and so have retail pharmacies. Whether it be CVS, Walgreens, Target, or Walmart, many pharmacies have begun to expand their services into retail clinics, utilizing nurse practitioners or physician assistants to offer care to the healthcare consumer. The services that these clinics within pharmacies offer vary, but all can help someone in need of self-contained minor acute care medical attention at a reasonable cost without appointment, and often with expanded clinic hours. Some of these clinics are also beginning to support the healthcare consumer in addressing their common chronic conditions, such as diabetes, asthma, and heart disease with support that augments the care they are already getting from their physicians. Other clinics are offering support, education, and training on selfinjected medications.

As more individuals get access to health insurance, we will have to stop ignoring the fact that we will not have enough providers to care for those that need it. By making the most of these underutilized healthcare experts, we can begin to address the growing healthcare deserts. We hear about food deserts as geographic areas without access to fresh food. We do not often speak about healthcare deserts as places that are lacking in primary healthcare resources. There are a number of challenges to making the pharmacist and retail pharmacy part of the triple aim solution. I do not believe that any of them are beyond solution, but I will speak about this over the next 3 issues.

I would love to hear from you regarding the use of pharmacists and retail pharmacies taking on a greater role as part of the healthcare team.