Evolving role of pharmacists: Patient safety advocates, core members of health care teams

Visit Fry’s Prescription Pharmacy in San Benito, Texas, and you are not likely to find Rudy Rangel, Pharm.D., or Leo Ramirez, Pharm.D., behind the counter just filling orders. Instead, the pharmacists at Fry’s Pharmacy have expanded their role and can be found compounding personalized medications, providing medication therapy management, administering vaccines or managing medications for hospice and long-term care facilities across South Texas.

Rangel and Ramirez, who both graduated in 2010 from the Texas A&M Health Science Center Irma Lerma Rangel College of Pharmacy, are not the only pharmacists with an expanding role.

Nationwide, gone are the days of pharmacists simply dispensing pills into bottles; in today’s health care arena pharmacies are much more than a place to just drop off your prescription. As demand for health care increases, pharmacists across the U.S. are providing services that extend well beyond the traditional roles of their profession – pharmacists serve as trusted health care providers and an integral part of a patient’s health care team.

“Today, more than ever, pharmacists are likely to be found engaged in conversations with customers, providing information on over-the-counter drugs, administering immunizations, and assisting with overall disease prevention and management, while improving patient medication adherence and outcomes,” said Indra K. Reddy, Ph.D., professor and founding dean of the Texas A&M Rangel College of Pharmacy.

As of today, 35 states have passed legislation that recognizes pharmacists as providers, which allow pharmacists to provide, monitor and modify drug therapy pursuant to a collaborative, protocol-based agreement with a medical provider.

Following implementation of the nation’s Affordable Care Act, millions of Americans who were not previously insured are entering the health care system, not to mention escalating numbers of baby boomers becoming eligible for Medicare every day, and dramatic increases in patients with chronic diseases requiring multiple medications. Additionally, with advancements across the pharmaceutical industry,the growing number of medications requires a new level of sophistication and choices that require experts to evaluate to ensure that prescribed medications are consistent with individual patient needs.  The complexity of this situation is impacted even further by a continued shortage of primary care providers across the U.S.

According to a recent report sent to the U.S. Surgeon General, statistically, the majority of the nation’s health care “burden” occurs primarily after diagnosis. In fact, the report found that more than 76 percent of doctor visits were for care related to chronic medical conditions. More than 45 percent of the U.S. population has at least one chronic condition, and the primary approach for treating for chronic health conditions is often through the long-term and proper use of medications. It’s no surprise that pharmacists are needed as part of the solution to improving health care outcomes.

As medication management experts, pharmacists help patients with chronic or acute health care needs. Pharmacists facilitate the therapeutic management of patients with diseases such as diabetes, asthma, heart failure, lipid, obesity-weight management, osteoporosis, smoking cessation, and develop partnerships with patients for ongoing follow-up care leading to improved outcomes. And while most patients have multiple doctors treating their varying conditions, they often need someone that ties their health care together with special attention to drug interactions and safety.

“It can be difficult for a patient to recall every medication he or she is taking during an office visit,” Reddy said. “You need someone to have all that information in combination with the drug therapy knowledge so they can catch potential interactions; and that’s one of the pharmacist’s responsibilities.”

Additionally, research shows that patients who work with a team that includes a pharmacist and one or more physicians are more likely to achieve improved health goals. This co-management of the patient with the primary care provider offers more direct, patient-focused care and ultimately, better patient outcomes.

“Pharmacists should be an integral part of team-based health care and apply their medication management skills to improve the overall well-being of the patients they serve,” Reddy said.

An example of this can be seen in patients who receive a diagnosis of a chronic condition might begin a medication regiment. As the patient begins medication treatment, the medication might not work as the health care team assumed it would. At any point during the treatment, the patient can contact their physician or pharmacist to discuss treatment options. The pharmacist can suggest alternative medications that might help to treat the problem.

Bill Moore, owner of Moore’s Pharmacy in Sinton and Corpus Christi, Texas, has helped improve outcomes for a number of patients in his 48-year career. He has also served as the past president of the Texas Pharmacy Association.

“We are gaining momentum as integral parts of the health care team and the college is preparing future pharmacists to meet the demands of team-based care to improve patient outcomes,” said Moore, who also serves as a preceptor to Texas A&M Rangel College of Pharmacy students.

According to Rameriz, every patient deserves access to exceptional health care.

“At Fry’s Pharmacy we are currently working with physicians and nurses to provide personalized care to our patients,” Rameriz said. “Our ultimate goal is to ensure optimal outcomes for our patients. This requires an integrated health care team.”

Access to a health professional is also a major factor in the patient experience, and pharmacists are in a good position to reach the public. While physicians are able to see patients on an appointment basis, pharmacists are able to hold them accountable through regular and personal interactions. In fact, more than 270 million people visit a pharmacy each week.

“Since pharmacists are accessible, patients can simply walk through the door and talk to them; and discuss any complications if problems arise after they begin medications,” Reddy said. “A pharmacist can counsel on proper use of medications, nutritional and self-care products; aid in finding cost-effective alternatives; provide vaccinations; recommend adjusting treatments if current medications are not solving the problem; and much more.”

The evidence of pharmacists’ value to the health care system is mounting. Pharmacists are well positioned to play a larger patient care role than ever before. In fact, proposed legislation would amend the Social Security Act, allowing patient Medicare beneficiaries access to pharmacist-provided services under Medicare Part B in medically underserved communities.

“Pharmacists are vital to helping close the gaps in primary care and could offer a valuable, additional solution to help mitigate rising health care costs in the United States,” Reddy said. “By working in health care teams, we can treat patients holistically by addressing the source of the problem rather than just the symptoms.”

It might be hard to see beyond the age-old image of a pharmacist in a white coat, behind the counter dispensing pills into bottles, but pharmacists now more than ever play a vital role in improving patient outcomes. It seems one solution to the nation’s impending health care demands may lie in a team-based approach, working from clinic to counter for the benefit of the community.