Pharmacists need fair payment, access to improve health care, journal asserts

NEW YORK The nation’s community pharmacists are highly trained but underutilized healthcare resources, and their full potential as contributing members of a new, more effective health-and-wellness network won’t be realized until they’re properly paid for their services, given full access to patient medical records and inducted fully into the healthcare team.

So says a new report from B. Joseph Guglielmo in the Archives of Internal Medicine. In a lengthy commentary on the role pharmacists could play in improving chronic disease management, Guglielmo noted that pharmacists won’t be able to fully engage with a more cost-effective, outcomes-based healthcare system until fundamental changes are made to the nation’s healthcare reimbursement system and collaborative practice structure.

“A growing body of research demonstrates the valuable role of pharmacists in chronic disease management in outpatient clinic settings,” Guglielmo wrote. However, he added, “it has been … difficult to achieve the full vision of the pharmacist's role in the healthcare team in community pharmacies.

“Most community pharmacists are isolated; they lack access to medical records with important information and in which they can document their interventions for the rest of the team. Communication with other healthcare providers is intermittent and most often telephonic,” the author noted. “Critically, community pharmacies are reimbursed for drug products dispensed, not for medication therapy management provided by employee pharmacists.

“Because pharmacies staff accordingly, there is little time for pharmacists to provide these services voluntarily,” Guglielmo wrote.

It doesn’t have to be that way, Guglielmo added. He cited the Asheville Project as proof that community pharmacists can bring real cost savings and health benefits to health-plan payers and patients, provided those pharmacists are given membership in an integrated health provider network -- and are adequately compensated for their time, training and professional skills to engage with patients and monitor their progress.

“In the Asheville Project, diabetic employees of the city of Asheville, N.C., as well as those from the Mission-St Joseph Health System, were offered general pharmacy care by trained community pharmacists," the article noted. The result, according to its author: “Mean hemoglobin A1c and lipid levels improved, and the total mean direct medical costs decreased by $1,200 to $1,872 per patient per year compared with baseline.”

Akey factor in that success, Guglielmo added, is the fact that “pharmacists participating in the Asheville Project had access to medical records … and they were reimbursed for their clinical care.”

The new health-reform law will expand coverage to an additional 32 million Americans, he pointed out. However, Guglielmo noted, “Access to health care remains bureaucratic and limited."

“Pharmacists practicing in community pharmacies, which are widely distributed throughout the United States, could potentially expand access to care, particularly in the areas of preventive medicine and chronic disease management. However, an economic model that is solely driven by prescriptions filled per day will not unleash the full potential of these well-trained but clinically underused professionals,” he reported in Archives.

In short, Guglielmo said, “It is clear that an economic model that gives community pharmacists incentives to participate in risk reduction and chronic disease management must evolve.”

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