Filling the gap in primary care
This week I was reading some recently released statistics on the geographical demographics of physicians post-residency and some of the ways in which individual states are working to retain physicians. (I’d work in Alaska in exchange for student loan forgiveness, but apparently, they don’t need writers so much.) Granted, the physician shortage is not news. While the number of new graduates to primary care has remained fairly steady over the past 10 years, those primary care providers are typically NOT settling outside the cities, leaving a huge care gap—especially in rural areas. When it comes to specialists and mental health providers, the picture is even bleaker.
“[Pharmacists] are the most overeducated and underutilized healthcare professionals in the U.S. It doesn’t take eight years of education and a professional doctorate to fill a bottle with pills.” —R. Pete Vanderveen, Former Dean of the USC School of Pharmacy
Inside the pharmacy community, that shortage is seen and understood to be an opportunity. In the mainstream outside the community, that visibility is lacking and other providers are getting the nod: nurses, PAs, pay-as-you-go retail clinics; military personnel; and technology. While the mainstream media is finally starting to get fed important “insider-to-pharmacy” information about DIR fees, pricing, and PBMs, we can’t forget that there is more to the story. Here are just a few salient talking points:
Reducing the Recurrent Need for Intervention
Many studies, including this one by USC researchers, have found that when pharmacists are part of a transitional care team, patients are better able to stay out of the critical care system. In the USC study, hospital readmissions were down 28 percent at the 30-day mark and 32 percent at 180 days.
Pharmacists are already getting far more face-time with patients than are doctors. This puts pharmacists in an ideal position to perform assessment and counseling roles, provide referrals, monitor and adjust medication protocols, and team with others in the care system to manage and report on outcomes.
Providing Clinical Care
In an older study in Colorado, the Kaiser Permanente health system inducted pharmacists in several areas, including its cardiac risk practices. In the cardiac program, the study noted a 30 percent reduction in the recurrence of complications from coronary artery disease, saving the system more than $9 million in hospitalization costs (in 2006). For communities underserved by primary care physicians, pharmacists play a key role in maintaining care plans as well as catching and quashing certain issues early, before they become critical.
Over the past couple of years, pharmacists are becoming a preferred provider for immunizations. For independents, it has become an important way to compete with the chains. In the Kaiser study noted above, pharmacists ran an international travel service that provided vaccinations for travelers as well as counselling on how to avoid stomach ailments and mosquito-borne illnesses while abroad. Programs designed to intervene early—such as smoking cessation, diet, and other lifestyle programs—are also important contributions to the health of underserved communities.
CMS has already recognized the important role of prevention in its model diabetes management program, for which the agency will spend an estimated $42 billion on fee-for-service, non-dual-eligible beneficiaries with diabetes. The program encourages the establishment of community-based intervention to prevent and manage the disease in an effort to bring those costs down. Knock, knock. Who’s there? Opportunity.
Industry organizations like the American Pharmacists Association and NCPA are working to increase awareness, but pharmacists can also easily magnify those efforts—and you’ll need to. Even in states where provider status legislation has been granted, your patients may not be aware of all the ways in which you can serve them.
A great first step will be to make a concerted effort to share stories across social media of how #PharmacistsProvideCare to our legislators, patients, and communities.
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