Pharmacists provide key services in lean times

The front line of health care is crammed between the linguica and callus removers. Yet we breeze past pharmacists as though they were dried prunes.

It’s time to break that habit. Pharmacists and a handful of others – including nurse practitioners – are part of a growing, important corps of providers called “physician extenders.” Although that makes them sound like a variety of Hamburger Helper, they are bridging the gap between the doctor supply and the demands of newly insured patients.

They’re becoming advocates, educators, psychologists, lifestyle translators, life-saving human data bases, and red, green or yellow flags to our habits. You can almost always find a pharmacist. How quickly can you see your doctor? And pharmacists are playing increasingly important roles at patient bedsides.

Legislation has placed pharmacists at the nexus of ethically complex encounters that can include providing medications for patient-assisted suicide (or not), over-the-counter contraceptives (once the prescription-only province of physicians) and involvement with medical marijuana.

While still answering “Do I feed a cold and starve a fever?” queries, they also translate the arcane world of formularies. That includes sometimes determining whether a pricey brand-name drug prescribed by a physician can through science and diplomacy be changed to a cheaper generic that is acceptable to everyone.

“The needs of people go beyond their medication needs,” said Will Ofstad, assistant dean for education at California Health Sciences University in Clovis. “A big part is education. Another big part is motivation.”

Ten years ago, pharmacists handled medication dosing and didn’t spend time outside their drugstores and offices, said Bruce A. Lepley, director of pharmacy at Fresno’s Community Regional Medical Center.

They’re now part of a daily caravan of stethoscopes and smocks visiting hospitalized patients.

“We try to get to know you better than your family physician does,” said Lepley, who has been part of the metamorphosis for nearly 40 years.

“Including a pharmacist in a care team leads to significant savings – $10 for each dollar invested – and reduces medical errors,” Ofstad said. “It improves access to high-quality, patient-centered care, particularly in underserved communities.”

Ofstad, a certified diabetes educator, said benefits can be keenly felt in that disease, which hits hard in the Valley and costs California $24 billion annually. Diabetes hospitalization accounts for half that spending.

As the region’s safety net, Community Regional and its pharmacists try to alter that trajectory.

“Can we convince patients to get well in the time we have them? Then we can make a difference,” Lepley said.

Discharge planning – where to guide patients for continuing care when they’re healthy enough to leave the hospital – can reduce costly readmissions. Once out the door, patient follow-up can be tricky when they have no permanent address or phone.

Building a sustainable dietary way of life for a diabetic is preferable to helping them adjust to a prosthetic leg from an avoidable amputation. Yet some insurers won’t pay for diabetes education.

Pharmacy education goals are changing. At CHSU in Clovis, the published targets include civic engagement and “a high degree of innovation, divergent thinking and risk taking.”

The future compels adjustments, says the American Association of Colleges of Pharmacy:

▪ We’re living longer and getting more diseases.

▪ We’re encountering more complex medications.

▪ More physicians are retiring.

▪ We’re trying to control costs and ensure quality.

▪ We’re relying more on education-based preventive and home care.

The number of U.S. pharmacy schools has exploded – from 80 in 2000 to 135 now. Federal statistics say there were more than 297,000 pharmacists in 2014, most working in stores. Researchers warn of a glut. Hiring is slowing in retail – where pharmacists were once lured from hospitals by better pay and shorter hours.

Corporate mergers and mail-order pharmacies are eroding that market.

Demand is tilting toward direct patient care. But hospitals need a reimbursement formula that pays fairly for pharmacists as the delivery system shifts from volume-based to value-based. Medications can be ordered from many specialists, but pharmacists are expected to assess them and prevent screw-ups. Who has a rewards category for errors avoided?

There is much incidental wisdom available as Walgreens or CVS fills your prescription.

▪  “Will this drug worsen my wife’s constipation?”

▪  “I know this nauseates you, so I’m phoning your doctor to get the OK to switch to another medication.”

▪  “Yes, we can provide bottle labels in Spanish.”

Throw in a flu shot. The how-to’s on using the blood-pressure tester. And help in purchasing a cane. These investments of time and skill aren’t usually built into a physician’s workday.

Give the future a whirl. Spend less time selecting salsa and a few minutes asking for a pharmacist consultation.

This story was originally published June 22, 2016 at 2:32 PM with the headline "Pharmacists provide key services in lean times."