Journal stresses pharmacist role in adherence

NEW YORK —Not long ago, one could become a pharmacist with a bachelor’s degree. Today, going into the profession requires two years of undergraduate and four years of post-graduate study, as well as state certification and continuing education. But with pharmacy held to a standard similar to that of medicine and other state-regulated professions, the role of pharmacists in the healthcare system has increased as well.

Of all the cells in the great organism known as health care, pharmacy is well-positioned to act as an integral part of a patient’s care through medication therapy management, according to an article written by University of Connecticut Department of Pharmacy Practice head Marie Smith, with David Bates, Thomas Bodenheimer and Paul Cleary, in the May 2010 issue of the journal Health Affairs, titled “Why Pharmacists Belong in the Medical Home.”

As healthcare professionals, pharmacists can do this through collaboration with other providers and thus play a significant role in patient care, but are nevertheless often underused, the authors wrote.

“Most office visits involve medications for chronic conditions and require assessment of medication effectiveness, the cost of therapies and patients’ adherence with medication regimens,” the authors wrote in the article’s abstract. “Pharmacists are often underused in conducting these activities. They perform comprehensive therapy reviews of prescribed and self-care medications, resolve medication-related problems, optimize complex regimens, design adherence programs and recommend cost-effective therapies. Pharmacists should play key roles as team members in medical homes, and their potential to serve effectively in this role should be evaluated as part of medical home demonstration projects.”

According to studies cited in the article, 71% of physician office visits resulted in at least one prescription, while 32% of harmful side effects requiring admission to hospitals were related to medications, but one-third to half of patients with chronic conditions adhered to prescribed therapies. According to a recent study by CVS Caremark and Horizon Blue Cross Blue Shield based on e-prescribing data from 507 doctors in the latter’s New Jersey network from between January and October 2006, and published in the American Journal of Pharmacy Benefits, more than 20% of patients prescribed asthma controllers and more than 34% of those prescribed cholesterol medications didn’t fill their initial prescriptions. Another study, published in April in The New England Journal of Medicine, found that nonadherence results in more than $100 billion worth of avoidable hospitalizations every year. Estimates of the cost of nonadherence to the healthcare system as a whole tend to hover around $300 billion.

“As a clinical expert working in an interdisciplinary primary care team, a pharmacist can assess whether medication use by patients at home (in between primary care office visits) is contributing to medication-related problems or failure to achieve desirable outcomes,” the authors of the Health Affairs article wrote. “Although pharmacists are seldom mentioned in medical home discussions, the complementary knowledge and skills of pharmacists and prescribers can lead to improved patient care and medication use—especially for chronic conditions.”

The National Association of Chain Drug Stores heralded the article, promising that pharmacy would own the issue of medication adherence. “We could be witnessing a game-changing moment for pharmacy,” NACDS president and CEO Steve Anderson said.

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