Canadian report and previous experience show pharmacists can wear more than one lab coat

Many patients have already benefited from expanding pharmacists' role in health care

A new report released by Shoppers Drug Mart and Pharmaprix shows that the Canadian healthcare system could save C$1.4 billion to C$1.9 billion by expanding the role of pharmacists.

While there are some important differences between the healthcare systems in the United States and Canada, both face common problems, in particular, a rising burden of chronic disease and rising costs. But they also have in common a way to alleviate some of the burden on physicians and some of the costs: increasing the kinds of services that pharmacists can provide.

California is already in the early stages of doing this. Last month, Gov. Jerry Brown signed into law a bill that allows pharmacists to perform physical assessments, order and interpret laboratory tests, refer patients to other providers, work with providers to evaluate and manage patients' health issues and start, adjust and terminate medications under physician protocol.

As the Canadian study noted, chronic diseases affect 37% of Canadians and are a factor in 70% of deaths, with associated medical costs estimated at $42 billion and expected to rise to $53 billion by 2015. In the United States, the Milken Institute estimates that chronic disease costs the healthcare system $1 trillion per year, and the Centers for Disease Control and Prevention estimates that 75% of healthcare dollars goes to treatment of chronic diseases.

It's already known that pharmacists provide services like vaccinations for lower prices than physicians do, and in a more convenient setting, typically with no appointment needed. Outside the retail setting, pharmacists also have proven to be effective providers of other healthcare services.

For example, according to a 2011 report by the U.S. Public Health Service, pharmacists working for the Indian Health Service with pharmacist-physician collaborative practice agreements under the National Clinical Pharmacy Specialist program deliver direct patient care through disease management for cardiovascular disease, diabetes, respiratory disease, end-stage renal disease, pain management and tobacco cessation. Following an initial diagnosis, the scope of services the IHS pharmacists provide includes physical assessments, prescriptions, ordering lab tests, clinical assessments, therapeutic plans, patient education, care coordination and followup care. "Thus, pharmacists in these clinics perform direct patient care services and document the findings similar to any other healthcare provider, but with recognition and revenue generation capacity only in a limited number of areas." In the 13 years before the report's release, 278 IHS pharmacists had been certified under the NCPS program.

In the United States, an estimated 30 million people are expected to become eligible for healthcare coverage thanks to the Patient Protection and Affordable Care Act, whereas Canadians already are eligible, thanks to universal health care. But both countries have similar issues: According to a report by the National Academy of Sciences, the United States has fewer physicians per capita than most other developed countries, particularly in primary care; meanwhile, according to a report last year by the Canadian Institute for Health Information, Canada's healthcare system is behind other countries in terms of how long patients must wait for service.

Thus, in both cases, pharmacists can step in to relieve some of the burden placed on doctors. Every vaccination a pharmacist performs in a drug store is one a physician doesn't have to perform during a routine appointment, and every lab test ordered by a pharmacist is one a physician doesn't have to order. For the sake of patient access to health care, it's time for pharmacists to wear more than one lab coat.

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