Recently, I was at a multidisciplinary meeting to discuss how pharmacists and prescribers can work more effectively together to identify patients with certain risk factors and ensuring that they receive appropriate drug therapy. As I discussed our continuous medication monitoring process (CMM), the prescribers in the room indicated that they were not familiar with pharmacists in their communities doing anything like what I was describing. Sadly to say, their own experiences going to a pharmacy as a patient did not help my argument. The other providers described the situation, that is all to common, that they seldom talked to a pharmacist and if they did, they had to wait 25 minutes. Now I realize that this may not be the actual case, but we have to remember that their perceptions are their realities. After some heated discussion about the roles of pharmacists and turf issues, I finally said to one of the physicians who was sitting next to me questioning how pharmacists can do what I was describing that he should change pharmacies and go to one that does provide clinical services.
Unfortunately as we have written in previous blogs, too many community pharmacies (chains and independents) have settled for a “strip-down” model of practice where there is little to no overlap between pharmacists and just enough technician help to ensure prescriptions can be filled efficiently–but little thought to clinical services. This “strip-down” model evolved out of profit motives and not what was best for patients and as reimbursements dwindled over the past decade, the “strip-down” model became even more prevalent and accepted. Because of this, patients, providers, and payers get mixed messages. They hear what I and others are talking about, but they experience something totally different when the go to a pharmacy. It is time to change the paradigm of community pharmacy practice.
The paradigm change that I am talking about will change the perceptions of all who come to a community pharmacy. First, we have to stop using the word “retail” when talking about community pharmacy as it gives a much different description then if you say community pharmacy. Secondly, pharmacists need to become interventionists identifying and resolving drug therapy problems, counseling an educating patients, consulting with other providers, and documenting their activities. Thirdly, pharmacists have to stop being passive in the dispensing functions. We need to make sure that we engage patients to collect information that will help us better manage their medications. Lastly, we need to make sure we have sufficient staff so that pharmacists are freed up to provide clinical services including CMM during the dispensing process.
For the past twenty something years we have been pushing community pharmacists to move from distribution functions to patient care. One would think, after all these years, that we would have a critical mass of community pharmacists providing ongoing clinical services. But given the response I received from the other providers at this meeting obviously they have not been exposed to it yet (and these providers were from around the country). We have to stop apologizing and making excuses for why we are not providing patient care services and just be doing it!