We all have a team we rely on for health care and advice: our primary-care physician, first and foremost; our dentist and other specialists; and perhaps trusted friends, books and online resources. But now, for many people, one often overlooked professional — the pharmacist — is playing an increasingly important role.
In an era when doctors' time with patients is pressed, pharmacists are stepping up in a variety of ways to make sure people take medications for chronic illnesses properly and get the newest and best drugs for their conditions:
- CVS Caremark launched its Pharmacy Advisor program for diabetes and heart disease patients in 2011. The program encourages patients to have brief one-on-one consultations with trained pharmacists about improving their adherence to their medication regimens and identifying potential gaps in their care. In 2013, it will add programs for patients with asthma, depression, osteoporosis, breast cancer and chronic obstructive pulmonary disease as well.
- Walgreens pharmacies have their own program for training diabetics how to self-inject their medication and manage side effects. A study presented at the American Diabetes Association’s 2011 annual meeting found that patients who had two training sessions with Walgreens pharmacists were 24 percent more adherent to their medication regimen at the end of three months than those who had not received the training.
- Several other retailers, including Kroger, Safeway, Winn-Dixie and Rite Aid offer the Diabetes Control Program at certain locations with in-store pharmacies. Open to federal government employees and their families and those enrolled in employer-provided health insurance plans through UnitedHealthcare, the program provides diabetes patients with a quarterly private consultation with a pharmacist.
“I do think pharmacists will do more and more of these types of things,” says Bill Grambley, senior director of the Pharmacy Advisor program at CVS Caremark, which refills prescriptions through the mail and at more than 7,300 CVS drugstores. Pharmacists have the expertise and the access to patients to improve health care, Grambley says, pointing out that while a patient might see a doctor only two or three times a year, he or she may visit a retail pharmacy twice a month or more.
In 2011, pharmacists participating in the CVS Caremark program interacted with 300,000 of the 700,000 diabetes patients who receive their medications through it and who were targeted for consultations. The consultations take place over the phone or face-to-face in a CVS store, usually at a specially designated pharmacy counter. Typical sessions take less than five minutes.
When eligible customers bring in a prescription for a drug they haven’t previously taken, they get a "first fill" consult in which the pharmacist talks about potential side effects, including non-life-threatening reactions such as fatigue or nausea. “We want to make sure that people don’t see those side effects as barriers" to adherence, Grambley says.
In a recent study published in the journal Health Affairs, Harvard researchers found that proactive, face-to-face counseling by drugstore pharmacists in the CVS program raised diabetic patients’ medication adherence rates by about 4 percent, about twice that accomplished by phone consultations. That might not sound like much, Grambley says, but given that the complications from uncontrolled diabetes can result in amputations and kidney failure, the consultations can produce significant savings in potential health expenses, not to mention reduce patient suffering. A more active consulting role for pharmacists could reduce emergency room visits and other hospitalizations related to poor medication adherence.
From Behind the Counter to Inside the Practice
Pharmacists cannot prescribe drugs themselves, but they can identify and warn patients of potentially harmful interactions between medications prescribed by different doctors, and they can contact doctors to discuss and recommend medications that might have been overlooked.
Some physicians have brought pharmacists into their practices to consult directly with both their patients and themselves, but the practice remains uncommon because neither Medicare nor most insurance companies will reimburse for the sessions, says Allen Nichol, a Columbus, Ohio, pharmacist. “Medicare won’t allow us to do direct billing for our services,” says Nichol, who has long lobbied for changes in the system that would facilitate closer partnerships between doctors and pharmacists. “We need to have a compensation mechanism.”
Nichol started working directly with doctors in 1998 when a physician asked him to help his diabetes patients manage their medications. He has also trained with the Department of Veterans Affairs, whose VA hospital system has long recognized the value of pharmacists collaborating with physicians in outpatient clinics. “It benefits patients, it benefits the physician and it benefits payers,” Nichol says. “There are no losers in this thing."
John Hickner, chair of family medicine at the Cleveland Clinic, agrees. Internal and family medicine practitioners at the medical center are hiring pharmacists to work in their offices. "I think all of us who are in leadership positions understand that pharmacists have a lot to offer in primary care settings," he says. “They have a detailed knowledge of medications. They generally have more time with patients. We can get more bang for our bucks by having the pharmacists right there.”