In the past three years, I have seen more changes occurring in healthcare and, in particular, pharmacy, then I have seen in my entire career which now spends almost 30 years. The changes are coming rapidly and frequently to the point where it is becoming scary, challenging, and intimidating to pharmacists in all settings. One of the more significant changes is in how healthcare is being reimbursed. The old fee-for-service is no longer the standard. We have quickly moved to a system that utilizes value-based purchasing as the new standard. In this system, payers purchase services based on value and the performance of providers. Payers are looking to reduce their overall healthcare spend while simultaneously improving healthcare quality. This includes sharing the risk of healthcare costs with providers, including pharmacists. This also means new opportunities for pharmacists, including community pharmacists. With these opportunities, though, will come new responsibilities. Community pharmacists will have the responsibility to ensure that their patients are achieving therapeutic outcomes through the use of safe and effective medications. This is not a responsibility to be taken lightly, nor is it one that will allow community pharmacists to stay passive. We must change our practice setting, and what we do day-to-day for our patients.
From a practice setting perspective it means several things. First, community pharmacies need to make sure that they are being freed up to provide patient care services, and not just dispensing a product to the patient. This may require additional staff, and training of existing staff. Community pharmacists should move to a technician-driven, pharmacist-managed dispensing process. Also, it may require investment in technology whether it be a “state of the art” pill counter, or a more sizable investment in a robot for automated dispensing. Another area to look at is what is allowed under state board of pharmacy rules in regards to a tech-check-tech system. As mentioned previously, the intent of these changes is to make sure the pharmacist is freed up to review patient medication profiles, identify and resolve drug therapy problems, and document their activities.
Community pharmacists may need to make an investment in clinically oriented and/or residency trained pharmacists, especially if the current practice does not have a clinically oriented pharmacist on staff. Being responsible for therapeutic outcomes is an extremely important role for pharmacists. It requires current therapeutic knowledge, clinical skills, problem solving, and critical thinking. Pharmacists need to become interventionist, meaning that once the drug therapy problems is identified, they also provide solutions to resolve these problems. This requires communicating clinical recommendations regarding drug therapy changes to other providers. Community pharmacists should ask themselves the following questions with each patient, and every medication the patient is taking:
- Is the patient achieving their therapeutic outcome?
- Is the patient’s medication effective?
- Is the patient’s medication safe?
If the answer to any of these questions is no, then a drug therapy change may be warranted.
Re-engineering a practice also means critically evaluating the physical layout of the practice. Community pharmacists need to think about where they will counsel patients during the dispensing process, and if the space provides some level of privacy. Also, a patient care area to perform Medication Therapy Management Services (MTMS) and other clinical services is important. This space should allow a more intimate discussion where the patient does not feel rushed or concerned about privacy. These patient care areas are where patients and pharmacist can have more in-depth discussions regarding the patients medication regimen, questions/concerns the patient may be having, or providing clinical service such as immunizations.
Lastly, the new community pharmacists needs to be documenting their patient care activities including the drug therapy problems found during the dispensing process when pharmacists are performing their prospective drug utilization review (pDUR) now referred to as continuous medication monitoring (CMM) services, or while providing MTMS or other clinical services. This documentation needs to be completed real time. Drug therapy problems identified should be documented along with an action taken, and the results of the actions taken. Patient charts, electronic or hard copy, should be kept for all patients, and these charts should includes all interventions pharmacists have made to improve their patients’ therapy.
The new community pharmacist has a lot of responsibility, but also becomes a more integrated healthcare team member. With healthcare change will come a plethora of new opportunities, but community pharmacists need to by ready to accept them. The new community pharmacist needs to make every encounter with their patients count.