Specialization is pharmacy's future


It may seem like pharmacy has reached a very low point. One pharmacist argues that specialization could be the best way forward.

The future of pharmacy-a healthcare profession in which the role in patient treatment and care is continually growing-is specialization. It is pharmacy specialization that will enable our healthcare system to meet the mandate of controlling cost by improving medical outcomes. This will be accomplished through the provision of more care in community settings, as well as by reducing unnecessary hospital readmissions.

We are already seeing it happen. Where, once, all pharmacy services were provided in one place, specialty pharmacies are currently operating in areas such as oncology, geriatrics, diabetes, fertility, HIV, psychiatry, nuclear medicine, nutrition support, the compounding of specialty medications, and pharmacotherapy. Various pharmacy specialty certifications are granted through organizations such as the American Pharmacists Association, the Board of Pharmacy Specialties, the American Society of Health-System Pharmacists, and the American College of Clinical Pharmacy.

I never envisioned the degree of specialization that
exists today when I converted my retail pharmacy to one of the nation’s first women’s health and fertility pharmacies in 1982. At that time, specialty pharmacy was considered to be on the periphery of pharmacy, in much the same way that some consider alternative medicine to be on the periphery of the medical field.

The current trend toward pharmacy specialization is rooted in many factors. Chief among them is that pharmacy students today receive more clinical training than ever before. The six-year PharmD program includes many more hours of clinical medication management than did the shorter programs. Residency and fellowship requirements for pharmacists have also become increasingly stringent and demanding.

Also supporting the drive toward specialization is the heightened role of the pharmacist as a collaborator on the patient care team. The nation is confronted with a shortage of primary care physicians, and this has led to the elevation of other members of the care team, including nurse practitioners, physician assistants, and pharmacists. As pharmacists become more involved in evaluating a patient’s therapeutic options, they will need to possess expertise in a broad array of different areas. This is where a specialized approach will be particularly needed.

Pharmacists will be able to drive more cost-effective approaches to treatment because they are trained in these therapies. They can monitor patients and make changes to drug therapies based on a patient’s response, eliminating ineffective treatments that are high in cost, and ensuring that the most targeted and effective therapy is being used. And with $750 billion-with a “b”-in annual, unnecessary healthcare spending, according to the Institute of Medicine, there is no time like the present.

In-home assessments

Massachusetts-based Dovetail Health uses pharmacist care managers to conduct in-home patient assessments. The observations these pharmacists make regarding a patient’s response to a medication can avert costly emergency department visits and hospital readmissions. The pharmacists are capable of doing this work because they know how medications work and how patients should be responding, but they also are trained in how to manage the other complex risk factors that are often present with elderly and sometimes frail patients.

Pharmacy specialists will also play a bigger role in the Risk Evaluation and Mitigation Strategy (REMS) process, which can keep ineffective drugs off the market.

That the pharmacy industry is moving toward specialization portends better patient care and cost savings for patients and healthcare payers.

As the escalation of healthcare costs leads to new approaches in care-approaches that patients want-the time is right for working smarter and doing things differently. Pharmacy specialization will lead to lower cost and better care. It is time for the profession to embrace it wholeheartedly.

Ernest P. Gates, Jr., RPh, FASCP, FIACP, FACA,  is the president of Gates Healthcare Associates (http://www.gatesconsult.com/).

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