Community Pharmacists Can Reduce the Healthcare Burden and Close Access Gaps-The HSB Blog 5/3/21

Our Take:

Community pharmacists (CPs) can help alleviate the healthcare burden and close healthcare access gaps since getting care from pharmacists is more convenient and cheaper for patients. For example, the Canadian healthcare system uses community pharmacists to help treat uncomplicated urinary tract infections (UTIs) which affect more than 50% of women before the age of 32 and which requires a simple round of antibiotics prescribed on time. Formal cost-effectiveness studies indicate that CPs are a viable and effective treatment option, providing readily accessible, and quick care that reduces the burden placed on other healthcare services and professionals.

Key Takeaways:

Publicly funding community pharmacists is beneficial from a societal and patient standpoint
Community pharmacists can provide certain types of care and medication management more cost-effectively than PCP for certain chronic and routine conditions
Patients prefer receiving acute care from their pharmacists due to convenient, quick and safe access to care
In many cases, community pharmacists are often more trusted and better situated to improve a patient’s health literacy than PCPs

The Problem:

When prescriptions are required for certain basic conditions they may often be accompanied by additional layers between the prescriber and patient that may result in additional inconvenience and deter patients from filling their prescriptions. For some just the actual act of having to schedule an appointment with a primary care physician can be very difficult and time consuming. For example, according to the American Pharmacists Association, patients can wait 28-34 days before seeing a healthcare provider. In addition, given the shortages of primary care providers, particularly for those who may lack health insurance or be on Medicaid, wait times may be even longer than that. Patients may also lack the appropriate technological access or literacy to avail themselves of online scheduling or administrative tools which may delay their ability to get appointments or access the appropriate paperwork. Depending upon the nature, severity or symptoms of the condition, the wait times for the appointment itself can end up jeopardizing patients health. Additionally, where patients do not have insurance coverage, it may cause them to delay or forgo care because of cost which often means waiting until conditions become more severe and problematic. Similarly, for patients in certain socio-economic groups, getting access to transportation and having to take time off from work or other care-taking responsibilities presents a practical burden that dissuades them from getting care in a prompt or timely fashion. For a number of years, policy makers have looked to advance practice pharmacists or community pharmacists to help alleviate some of these issues. As noted by the Surgeon General in 2011, pharmacists are uniquely positioned (through their accessibility, expertise and experience) to play a much larger patient care role in the U.S. health care delivery system to meet demands and improve the health of the nation. While a number of states have instituted additional designations and require additional training, this solution is still not being applied broadly enough.

The Backdrop:

For certain more routine or chronic conditions seeking care directly from a CP allows patients to skip the inconveniences of primary care appointments and logistics of getting prescriptions filled. In recent years, the pharmacist’s role has evolved to include the ability to prescribe certain types of medications, adjust and monitor drug therapy and perform patient assessments. Pharmacists routinely provide educational consultations, help manage chronic conditions, assist in the coordination of care and help provide health and wellness services. CPs broaden access to care by providing patients with a number of more convenient and easily accessible options and since they work in local communities, they are available on a more flexible schedule often giving patients a variety of access options (nights, weekends, in-store, at local clinics, without appointments, etc.). For example, according to the Journal of the American Pharmacists Association, 95% of the U.S. population lives within 5 miles of a pharmacy. More recently, a larger number of states are allowing pharmacists to take on broader responsibilities and 4 states have created “advanced practice pharmacist designations” (California, Montana, North Carolina and New Mexico). In addition, currently all 50 states allow pharmacists to furnish naloxone for opioid overdoses while 7 states allow pharmacists to prescribe smoking cessation products, and 2 states allow pharmacists to dispense pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) for HIV prevention without a doctor’s prescription.

Implications:

Uninsured Americans remain in a healthcare dilemma. The inability to secure a healthcare plan impedes their ability to get appropriate timely care often resulting in them seeking it through the emergency department and after a condition has worsened due to lack of treatment. CPs are a cost effective, patient-focused way to overcome the barrier of access and provide care that is better situated to the patient. Given their existing relationships, frequent contact with patients, their existing place in the community and their natural role as a source of healthcare information, CPs can increase access to primary care services, help control costs, and improve outcomes for chronic and more routine conditions, such as: asthma, UTI, or arthritis. As noted above CPs were proven to be an effective mechanism for improving UTI care. From a societal standpoint, publicly funded CPs were projected to save over $37.3 million CAD (approximately $30M USD) in 5 years just for UTI treatment and care management alone. Given their proximity to patients and the frequency of interactions (pharmacists have a greater number of visits per year than either primary care or outpatient hospital visits), CPs can also be effective at reaching underserved populations. For example, statin prescriptions are often lower in underserved populations despite a high incidence of conditions such as diabetes which would indicate they are warranted. A study of statin use in diabetic patients from the National Health and Nutrition Examination Survey (NHANES) found that women and blacks diagnosed with diabetes were less likely to receive statin therapy than men and whites respectively. The study’s authors concluded that “the study demonstrated successful implementation of a targeted medication initiative by pharmacists to improve statin prescribing rates.” In addition, CPs could be quite valuable in reducing medication errors and improving care when a patient transitions between care settings. It is estimated that 60% of medication errors occur during transitions of care which likely could be reduced through the use of CPs. While there are issues of liability and reimbursement that must be addressed, clearly making greater use of pharmacist skills and community connections could improve the quality and access to care.

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