Changing Healthcare Environment Prompts New Roles for Pharmacists

July 13, 2019

Changes fueled by the 2003 Medicare Prescription Drug Improvement and Modernization Act.

https://www.drugtopics.com/shingles-vaccine/side-effects-shingles-vaccinesPharmacists have come a long way since the days when their only responsibility was dispensing drugs. 

Starting in the 1980s, pharmacists were urged to take on a vital role by providing medication expertise to ensure patients properly and safely use their medications. The 2003 Medicare Prescription Drug Improvement and Modernization Act fueled the change.

“The changing healthcare environment has required pharmacists to assume advanced roles. They now must focus not only on how to improve healthcare quality, but also on driving down healthcare costs, of which medications comprise a significant proportion, for organizations and patients,” says Bernice Man, PharmD, practice coordinator at Northwestern Specialty Pharmacy in Chicago.

“The increase in the number of specialty therapies has  . . . promoted integration of pharmacists into clinics to ensure appropriate initial and continued education, as well as timely follow-up and medication management,” she adds.

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As a practice coordinator and clinical pharmacist, Man supervises clinical pharmacists within specialty pharmacy, assumes administrative/management-oriented decision-making responsibilities, serves as the point person for electronic medical record issues, handles human resources-related activities and time cards, precepts pharmacy residents and students, and helps patients navigate their insurance benefits.

Pharmacists at Northwestern Specialty Pharmacy also recommend adjunct medications as necessary, perform interventions such as dose adjustments, clinically monitor patients after starting therapy, and counsel patients. 

Synergies in Multiple Roles 

Laura Happe, PharmD, MPH, wears a lot of hats as a pharmacist. She is not only editor-in-chief of the Journal of Managed Care and Specialty Pharmacy, but is also an associate professor in population health at Wingate University, Charlotte, NC; an adjunct associate professor at the University of Florida at Gainesville; and an author.

Happe warns, however, that multiple gigs like hers should be complementary and not in conflict. “In a gig economy, it is necessary to establish synergy between what I do, making logistics easier, and creating a better product,” she says.

As the journal’s editor-in-chief for the past six years, she sets the publication’s strategic agenda, makes final decisions about which articles to print, and oversees the peer review process.

In her role at Wingate, Happe teaches population and public health across interdisciplinary departments, providing an interprofessional educational experience for pharmacy students.

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At the University of Florida, she is director of the managed care pharmacy track in a master of science pharmacy outcomes program designed for working professionals and post-PharmDs.

Happe’s book, If You Give an Ox an Oxy (Morgan James Publishing), is due out in November and is geared toward teenagers  to use in conversation with their parents and teachers about opioids. She wrote it after she saw some disappointing statistics about the low rate of discussions between parents and their children on the subject of prescription drug abuse.

“I’ve never served in a retail setting because I have always been interested in nontraditional pharmacist roles,” Happe says. She notes an oversupply of pharmacists and insufficient roles in traditional retail and hospital settings, leading to shorter hours and less pay. “But there are a plethora of opportunities-research, consulting, analytics, technology, and writing-for specialized pharmacists with a secondary degree or additional experience,” she adds. 

Continue reading on page 2...“I don’t let walls or silos become a constraint,” she says. Physicians recognize that pharmacists can help with diagnoses and medication therapy, and with quality measures tied to medication in value-based programs, and contribute to the financial success of a team.

“I also have an opportunity to practice at the top of my license, pursue things about which I am passionate, and make a difference,” she says.

On the other hand, Happe faces a few challenges as a pharmacist with many roles: 

  •  Difficulty being reimbursed for service.

  •  Not being identified as a provider.

  •  Lack of collaborative practice agreements in many states.

  •  The logistics of management, accounts, and calendars.

The Multifunctional Pharmacy

Randy McDonough, PharmD, co-owner of Towncrest Pharmacy in Iowa City, IA, says his pharmacy has been evolving since its inception and is integrated into healthcare teams with which it works.

Towncrest encompasses five areas, McDonough says:

  • Traditional dispensing. McDonough says Towncrest has become more efficient in dispensing drugs by using automation-the pharmacy has three robots and an automatic pill counter-and by optimizing the use of technicians who conduct medication verification. 

  • Clinical responsibilities. Medication therapy management, transitions of care, and medication optimization and synchronization-enabling consumers to fill all of their prescriptions on the same day and receive compliance packaging to spur adherence-are key clinical roles. McDonough says that the pharmacy makes recommendations to physicians, 50% of whom accept them.

  • Durable medical equipment. Pharmacists fit customers for CPAP masks  diabetic shoes, and compression stockings, and assist with ostomy bags and wound care. 

  • Compounding. Pharmacists work with prescribers to establish proper dosage  and products for patients with special needs.

  • Long-term care. Pharmacists provide medication management, make home visits, evaluate and optimize medications, and share information with prescribers. Between 500 and 600 of Towncrest’s patients are in a nursing facility.

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McDonough says the changing roles of pharmacists align with the dynamic healthcare industry and could also be attributed to pharmacists gaining additional education and training. 

“You can no longer make money just from dispensing, but have to be diversified, so we work closely with accountable care organizations (ACOs), payers and physicians to develop new reimbursement models,” he says.

Towncrest has conducted a variety of pilot programs, including one that indicated a $300 per member per month savings due to medication management.  

Added Education

Nidhi Saraiya, PharmD, clinical pharmacy manager, infectious diseases, at Montefiore Health System in New York City, agrees with Happe that more education and training have opened up opportunities for pharmacists to move from the retail setting and into clinical roles in the inpatient setting.

“The pharmacist’s role [has] become a bridge in a clinical setting, aiding physicians with the ever-changing and expanding realm of pharmaceuticals,” says Dale Shaw, PharmD, based in Tucson, AZ. Shaw has served in a hospital setting, as an entrepreneur, and a consultant for a digital pharmacy company. During a stint at the Naval Medical Center San Diego, he went on rounds with the intensive care unit, pathology, and medical teams, and became the link between nursing and physicians. Nursing relies on pharmacists for information, such as on which medications can safely be delivered in the same IV or administered simultaneously, he noted.

At Montefiore, Saraiya meets daily with an infectious disease team to assist with dosing, choosing the most effective drugs for specific diseases, and minimizing adverse effects. She also serves as a precept for students and residents, lectures on infectious disease, attends antimicrobial meetings, and is responsible for the hospital’s antimicrobial stewardship program, which has been in place for 10 years. 

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Some of Saraiya’s colleagues are specializing in statistics, population health, public health, ambulatory care for patients with chronic diseases, managing readmissions programs; and serving on transplant teams as required by CMS. 

Saraiya says that pharmacists with enhanced training are no longer uncommon. “However, that’s not the public perception. We need to change that; the public is not aware of our training and background,” she says.

But physicians are clamoring for assistance with medication and appreciate pharmacists’ new roles. Shaw agrees that physicians have offered little resistance. “Although economics has played an important role over the last few decades to reshape healthcare, the exponential advancement in medicine has created a necessity to work as a team to provide seamless care,” he says.

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