The role of pharmacists evolving in the team-based approach to medical care

Dr Carver

As I write this article on my birthday, I have time to reflect on yet another year in my life and career in healthcare. The complex healthcare landscape continues to change, and the future is still uncertain. As I speak with other healthcare providers, I find many are in the “wait and see mode” or “waiting to see what the other guy is going to do.” Where is this other guy who they are referring to? I feel strongly that pharmacists will be that other guy.

Physicians have less time than ever to spend with patients-and it’s shrinking by the day. This deficiency in personal attention has been largely addressed over the past several decades by increased reliance on clinicians like physician assistants and nurse practitioners, but there are still not enough of these professionals available to adequately serve the increasing number of patients requiring care. 

The ratio of healthcare clinicians to patients is expected to worsen as the Affordable Care Act enables more people to seek care, leading to even more strain on quality provider/patient face time. The effects of this deficiency are amplified for those who are suffering from chronic disease states as these patients require significant explanation and care to fully understand their conditions and multiple medication therapies. Pharmacists can play an influential role in ensuring patient access to quality health care by both encouraging and enhancing patient medication adherence and increasing patient knowledge of their disease states and medication therapies.

Outcomes for chronically ill patients suffer when prescribed therapies are not properly adhered to, and these adherence rates are at astonishingly low levels. According to a study conducted by the National Community Pharmacists Association (NCPA), individuals living in the United States with chronic medical conditions received a mean grade of C+ on medication adherence; that means they averaged between 1 and 2 nonadherent behaviors in the past year.¹ Even worse, 31% of the 1,020 patients studied received a D or F, meaning they were almost entirely noncompliant with their prescribed therapies. The New England Healthcare Institute estimates that nonadherence to prescribed medication costs the US healthcare system $290 billion each year.²

Medication therapy adherence is linked to strong relationships with healthcare providers, but how can this relationship develop when clinicians are so strapped for time? The expanding role of the pharmacist in the continuum of healthcare as a true medication manager fills this gap with readily available patient access, providing tools for adherence and effective patient medical education.

Healthcare, by the nature of continued advancements, is always increasing in complexity, so the management of drug therapies continues to need major focus by pharmacists who are the experts in pharmacotherapy. Pharmacists with specialized knowledge in pharmacotherapy, as well as pharmacy-associated care coordinators, are in the unique position to help educate and monitor patients and improve therapy adherence. This role of the pharmacist is even more valuable in patient populations suffering from chronic disease states for several primary reasons: 

• Effective management of chronic conditions like HIV and HCV relies on strict therapy adherence and can be negatively impacted by slight lapses in compliance. Nonadherence can increase the risk of virologic failure and poor outcomes.

• Poor medication adherence is known to lead to poor clinical outcomes, more hospitalizations, and increased costs.^3,4

• With 75% of healthcare spending in the United States dedicated to the treatment of chronic diseases, the economic implications of noncompliance among patients cause a severe strain to healthcare systems and payers.⁵

• In fact, many studies have demonstrated access to a licensed pharmacist who provides professional pharmacy care can lower costs and improve patient safety by ensuring proper use of medications and reducing the likelihood of medication errors.^6,7

The increased value of services provided by pharmacists is leading some businesses to expand the level of services offered to include medication management and medication therapy management (MTM) services. This is one of the principles that led HealthStat Rx to recently change its name to Curant Health. Based on the Latin term curia, the new name reflects the expanded medication management services offered by the company beyond what is traditionally expected from a pharmacy to achieve positive patient outcomes and reduce the total cost of healthcare across the continuum of healthcare. Curant Health looks to be a change agent in the healthcare arena.

As the role of the pharmacist expands, it becomes increasingly important for pharmacists to serve as a crucial link in the team-based approach to medical care. Pharmacists can help patients achieve therapy adherence, better understand their medication therapies, and ultimately improve medical outcomes. When comprehensive medication management is practiced, patients form closer relationships with pharmacists and pharmacy associates, leading to better compliance, improved outcomes, and lower overall cost of medical care.

The relationship between patients and pharmacists will be an increasingly important aspect to medication adherence and medical outcomes in the future. Utilizing our pharmaceutical care knowledge in the provision of medication management services coupled with direct, ongoing patient care relationships with the patients we serve put us on the frontlines for advising patients, serving as a vital missing link in the coordination of medical care and improving outcomes.

References

1.     Langer Research Associates. Medication Adherence in America. A National Report Card. NCPA 2013. www.ncpanet.org/pdf/reportcard/AdherenceReportCard_Full.pdf. Accessed April 15, 2014.

2.     NEHI Research Brief. Thinking outside the pillbox: a system-wide approach to improving patient medication adherence for chronic disease. August 2009. adhereforhealth.org/wp-content/uploads/pdf/ThinkingOutsidethePillbox_Report.pdf. Accessed April 15, 2014.

3.     Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: its importance in cardiovascular outcomes. Circulation. 2009;119(23):3028–3035.

4.     DiMatteo MR, Giordani PJ, Lepper HS, Croghan TW. Patient adherence and medical treatment outcomes: a meta-analysis. Med Care. 2002;40:794–811.

5.     Centers for Disease Control and Prevention. The power to prevent, the call to control: at a glance 2009. www.cdc.gov/chronicdisease/resources/publications/aag/chronic.htm. Accessed April 15, 2014.

6.     Chisholm-Burns MA, Graff Zivin JS, Lee JK, et al. Economic effects of pharmacists on health outcomes in the United States: a systematic review. Am J Health-Syst Pharm. 2010;67:1624–1634.

7.     Scott DM, Boyd ST, Stephan M, et al. Outcomes of pharmacist-managed diabetes care services in a community health center. Am J Health-Syst Pharm. 2006;63:2116–2122.

Dr Carver is the director of pharmacy for Curant Health. Dr Carver has 20 years' experience across multiple pharmacy disciplines including medication therapy management, hospital pharmacy, clinical research, pharmacy regulatory compliance, and specialty pharmacy management among others.