Expanding Pharmacy-Based Screening Initiatives for Public Health Impact

Introduction

Chronic disease remains a leading driver of morbidity, mortality, and health care expenditure in the US, with many conditions progressing silently for years before diagnosis.¹ Traditional health care models often rely on episodic, symptom-driven encounters, leaving a significant gap between early dysfunction and clinical recognition.

In real-world pharmacy encounters, patients rarely walk in saying, “I think I have metabolic dysfunction or diabetes.” They say, “Something just feels off.”

Within that space between feeling off and receiving a diagnosis lies one of the greatest opportunities in modern health care, and community pharmacies are uniquely positioned to meet patients there.

With approximately 90% of Americans living within 5 miles of a pharmacy,² these settings offer an accessible, trusted entry point into the health care system. As provider shortages grow and access delays persist, expanding pharmacy-based screening initiatives offers a scalable, cost-effective strategy to improve early detection and long-term outcomes.

To fully realize this potential, however, screening must evolve. It is no longer enough to identify disease at diagnostic thresholds. The next step is learning to recognize dysfunction earlier and respond accordingly.

The Accessibility Advantage of Community Pharmacies

Community pharmacies sit at the intersection of accessibility and consistency. Patients may see their pharmacist far more frequently than their primary care provider, often without appointments and in settings that feel familiar and low-pressure. This repeated access creates something powerful: visibility into patterns over time.

Pharmacists are already advancing preventive care through immunizations, blood pressure monitoring, and point-of-care testing.³ These services have been shown to improve patient engagement and clinical outcomes, particularly in underserved populations.⁴

Expanding screening initiatives allows pharmacies to build on this foundation, moving from isolated services to more intentional, structured approaches to population health.

Limitations of Traditional Screening Models

Conventional screening models are designed to detect disease once specific thresholds are met—hypertension, diabetes, and hyperlipidemia. These markers are essential, but they often represent the later stages of a much longer process. Before diagnosis, there are patterns.

Patients frequently present with symptoms that are diffuse and easily overlooked, such as fatigue, poor sleep, digestive changes, and mood fluctuations. They may not meet clinical criteria for disease, yet underlying dysregulation is already present. This in-between population is where screening can have the greatest impact.

A root-cause-informed model recognizes that chronic disease develops along a continuum. Identifying early imbalances allows for earlier, more meaningful intervention, before progression to more complex pathology.

Expanding Screening Through a Root-Cause Lens

A root-cause approach to screening does not replace traditional metrics. It builds on them.

Foundational screenings, such as the following, remain critical:

• Blood pressure
• Fasting plasma glucose and hemoglobin A_1C (HbA_1C) levels
• Lipid profiles

However, expanded screening can offer additional insight into early dysfunction, including:

• Thyroid function (eg, thyroid-stimulating hormone)
• Nutrient status (eg, vitamin D, vitamin B12)
• Inflammatory markers (eg, high-sensitivity C-reactive protein)

These markers, when interpreted together, begin to tell a story that reflects metabolic, endocrine, and inflammatory patterns, rather than isolated laboratory values.⁵ In practice, this shift changes the conversation.

Instead of asking, “Is something diagnosable?” or “What code can we use for this intervention?,” we begin asking, “What patterns are emerging?” That question alone opens the door to earlier insight and more personalized care.

The Pharmacist as a Clinical Connector

Pharmacists are among the most accessible health care professionals, with training that spans pharmacotherapy, physiology, and patient communication. Yet their role in screening is often underutilized. Screening is not just about collecting data: It is about making sense of it.

Patients frequently share concerns with pharmacists that they have not yet brought to a physician. This creates an opportunity to connect symptoms, lab trends, medication effects, and lifestyle factors into a more complete clinical picture.

Within this model, the pharmacist becomes a clinical connector, someone who can do the following:

• Recognize patterns that warrant further evaluation
• Provide education on modifiable risk factors
• Facilitate appropriate referrals
• Identify drug-induced nutrient deficiencies
• Support deprescribing
• Support medication optimization and adherence

Increasingly, a new wave of pharmacists is stepping into this space with a more integrative lens, looking beyond isolated symptoms to understand the broader drivers of health. This includes recognizing the roles of nutrition, stress, sleep, and environment in shaping patient outcomes.

It is a shift from managing medications to understanding people.

Public Health Impact and Cost Implications

Early detection and intervention are critical to improving long-term outcomes and reducing health care costs. Pharmacist-led screening and management programs have been shown to improve blood pressure, glycemic control, and overall disease management while reducing hospitalizations.^6,7

Expanding these initiatives can do the following:

• Improve early detection of chronic disease
• Reduce progression to advanced disease states
• Decrease overall health care expenditures
• Enhance patient engagement and health literacy

From a systems perspective, pharmacies have the potential to function as decentralized screening hubs, extending the reach of preventive care into communities where access may otherwise be limited.

Barriers to Implementation

Despite clear benefits, several barriers remain, as follows:

• Limited reimbursement structures for screening services
• Variability in state scope-of-practice regulations
• Workflow challenges within high-volume pharmacy settings
• Lack of standardized screening protocols

Addressing these challenges will require collaboration across health care systems, regulatory bodies, and professional organizations to support sustainable implementation.

Future Directions

Health care is moving toward models that prioritize accessibility, prevention, and collaboration. Pharmacy-based screening aligns naturally with this shift.

Future opportunities include the following:

• Integration of digital tools for tracking and follow-up
• Expansion of collaborative practice agreements
• Inclusion of pharmacists in value-based care models
• Development of standardized, evidence-based screening frameworks

At the same time, there is growing recognition of the importance of addressing the underlying causes of disease, rather than just managing symptoms. This includes supporting lifestyle change, improving metabolic health, and, when appropriate, reevaluating medication burden through thoughtful deprescribing strategies.

Conclusion

Expanding pharmacy-based screening initiatives represents a meaningful opportunity to improve public health outcomes. By leveraging accessibility, clinical expertise, and patient trust, pharmacists can play a central role in early detection and prevention.

A root-cause-informed approach strengthens this impact, shifting screening from a snapshot of disease to a deeper understanding of dysfunction.

Ultimately, the goal is not simply to add services. It is to redefine the role of the pharmacy within the health care system.

From a place patients visit when something goes wrong…to a place that helps them stay well in the first place.

REFERENCES

1. About chronic diseases. Centers for Disease Control and Prevention. April 14, 2026. Accessed May 11, 2026. https://www.cdc.gov/chronic-disease/about/

2. Qato DM, Zenk S, Wilder J, Harrington R, Gaskin D, Alexander GC. The availability of pharmacies in the United States: 2007-2015. PLoS One. 2017;12(8):e0183172. doi:10.1371/journal.pone.0183172

3. Berenbrok LA, Gabriel N, Coley KC, Hernandez I. Evaluation of frequency of encounters with primary care physicians vs visits to community pharmacies among Medicare beneficiaries. JAMA Netw Open. 2020;3(7):e209132. doi:10.1001/jamanetworkopen.2020.9132

4. Goode JV, Owen J, Page A, Gatewood S. Community-based pharmacy practice innovation and the role of the community-based pharmacist practitioner in the United States. Pharmacy (Basel). 2019;7(3):106. doi:10.3390/pharmacy7030106

5. Ladwig KH, Lederbogen F, Albus C, et al. Position paper on the importance of psychosocial factors in cardiology: update 2013. Ger Med Sci. 2014;12:Doc09. doi:10.3205/000194

6. Santschi V, Chiolero A, Burnand B, Colosimo AL, Paradis G. Impact of pharmacist care in the management of cardiovascular disease risk factors: a systematic review and meta-analysis of randomized trials. Arch Intern Med. 2011;171(16):1441-1453. doi:10.1001/archinternmed.2011.399

7. Pousinho S, Morgado M, Falcão A, Alves G. Pharmacist interventions in the management of type 2 diabetes mellitus: a systematic review of randomized controlled trials. J Manag Care Spec Pharm. 2016;22(5):493-515. doi:10.18553/jmcp.2016.22.5.493