Patient-centered outcomes research makes pharmacists even more important members of the healthcare team
The profession of pharmacy keeps evolving, continuing to make me proud to call myself a pharmacist. All of our graduates are doctors of pharmacy now. They are seeking residency training; not just in the hospital, but also in the community. We are managing disease states, administering immunizations, earning patient confidence, and saving lives by changing outcomes. Yet we are still fighting for our place in healthcare. We should be right next to the physician, nurse, dentist, patient, and the rest of the healthcare team, providing the best team-based care.
The center of the system
Through the Affordable Care Act (ACA), Congress authorized the creation of the Patient-Centered Outcomes Research Institute (PCORI). PCORI, as it was envisioned by its creators, “helps people make informed healthcare decisions, and improves healthcare delivery and outcomes, by producing and promoting high integrity, evidence-based information.” PCORI is working on reshaping our healthcare system by promoting the patient as the center of healthcare.
One of the aims of PCORI is to help define patient-centered outcomes. By defining these outcomes and delineating what should be answered, PCORI is allowing patients a voice in their healthcare decisions. Patient-Centered Outcomes Research (PCOR) is designed to help the patient and their caregivers make informed, evidence-based healthcare decisions. But even with all the evidence, patients will still rely on their trusted healthcare providers for help.
The biggest role
And isn’t this where the pharmacist plays the biggest role in healthcare, especially in the community? The November 2012 Gallup polls listed pharmacists as the second-most trusted professionals, between nurses and medical doctors. One reason I pursued pharmacy as a profession is that I get to see my patients every month, not once a year. In this new system, we have an opportunity to be true patient advocates.
By applying the vision of PCORI to our profession, we can be a catalyst for change. When I see patients with diabetes in our ambulatory care clinic, I don’t just start them on insulin, even if the guidelines suggest that is the best course of action. I try to outline the different treatment modalities available, and I ask, “What do you want to do?” The treatment of choice is not what the guidelines recommend, but what the guidelines recommend and what the patient will adhere to. This is patient-centered care.
Pharmacists can also be advocates for patient-centered care in the community setting. One of the most important questions PCOR strives to answer is: “What are my options, and what are the potential benefits and harms of those options?” Community pharmacists have the knowledge and ability to answer these questions.
All three elements of the above question can be addressed during the filling of a single medication. For example, instead of “licking and sticking” the new prescription for ticagrelor, we should talk to our patient. We have three different pharmacotherapy options for duel-antiplatelet therapy status-post stent in myocardial infarctions. Is the patient aware of all three options available, and were they part of the choice for this particular therapy?
When assessing the benefit, pharmacists can look at the primary literature. The PLATO trial compares clopidogrel versus ticagrelor for prevention of cardiovascular events; per the trial, ticagrelor had a 9.8% event rate compared to 11.7% with clopidogrel. There is benefit from the newer agent.
Finally, pharmacists can help the patient navigate the differences in potential harm. Ticagrelor is a brand medication. It will be more costly to the patient than the generic clopidogrel. Also, both medications have different side-effect profiles. Community pharmacists can ensure that the patient is aware of the options.
Get out in front
Our healthcare system is changing. With institutes like PCORI pointing the way to patient-centered care, we, as pharmacists, can be vital to the emerging healthcare team. We are the most accessible healthcare provider; we know the pharmacotherapy and options available; we can describe the risks vs. benefits of the medications; we are the medication experts.
Let’s get in front of our counters and be part of patient-centered outcomes.
Jake Galdo, PharmD, BCPS, is the clinical pharmacy educator for Barney's Pharmacy and University of Georgia College of Pharmacy in Augusta, Ga. He has been appointed to the Improving Healthcare Systems advisory panel for PCORI. He can be reached at email@example.com.