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Important Changes for Community Pharmacist Practice
The majority of US adults say the health care system in the United States is failing them.1
The Associated Press–National Opinion Research Center (NORC) at the University of Chicago surveyed 1505 adults from July 28, 2022, to August 1, 2022, and nearly 80% of respondents said they were at least moderately concerned about access to health care. Concern was higher in women and highest in ethnic and racial minority populations.
The US health care system remains organized primarily around hospitals and specialty care, at the expense of primary care, which is often not available or difficult to find and lends to the lack of access.2 Primary care, which is a fundamental part of any well-planned and implemented health care system,3-4 is defined by first-contact, comprehensive, coordinated, and continuous care. To this point, greater access to and use of primary care is associated with lower mortality and lower costs.5-7 However, currently there remains a low per-capita supply of primary care physicians.5 The resulting outcome of insufficient primary care is that fewer patients have access to a regular source of care.
To provide greater access to primary care, Walgreens and Village Medical are providing primary care practices in more than 200 Walgreens pharmacy locations around the nation. These practices are currently available in Arizona, Florida, Texas, New Jersey, Indiana, Massachusetts, New Hampshire, Georgia, Nevada, and Rhode Island. These co-located Village Medical practices provide primary care access to Walgreens pharmacy patients through in-person, virtual, or at-home visits. Village Medical provides expert primary care services, including treating chronic conditions, common illnesses, and injuries. Village Medical physicians and Walgreens pharmacists work together to provide care for complex medication-related problems, which provides greater patient communication and quality measures at lower total cost.
Walgreens pharmacists work under collaborative practice agreements where they view patients’ electronic medical records (EMRs) for bridging refills and allowing formulary interchange. This reduces the time patients wait before receiving their prescriptions and is also intended to improve medication adherence. Pharmacist access to the EMR facilitates a comprehensive medication review with documentation in the patient record. The common EMR platform allows greater communication between physician and pharmacist to provide coordinated care plans.
The Walgreens-Village Medical partnership is exactly what US health care consumers want for their health care. As I mentioned in a commentary from 2017:
“A large, comprehensive US-based population study modeled the demand for community pharmacy advanced services.8 A total of 9202 respondents gave valid responses to a 30-minute survey in a Discrete Choice Experiment (DCE) model, where they indicated which pharmacy they would prefer from multiple pairs of pharmacies that varied in terms of the level of services offered. The optimal pharmacy that maximized the switch rate (the probability of adult patients changing from their current baseline pharmacy) offered an integrated health electronic record system, a comprehensive level of point-of-care diagnostic testing, and some level of physical examination procedures.”9
This model is very similar to the Walgreens-Village Medical model outlined above. Importantly, in my earlier coverage of the study I mentioned:
“Two-thirds of payers were very likely or likely to reimburse for the optimal pharmacy services. This study provided empirical support for the provision of convenient primary care services in the community pharmacy setting, that consumers are willing to pay for, that would improve outcomes and the public health.”
The conclusion of the study was that the above services would be offered through an integrated model between pharmacists and primary care physicians.
Pharmacists endorsed this optimal service delivery model. Pharmacists in an online survey were 4 times more likely to switch employment from their current pharmacy to one with these advanced pharmacy services. Pharmacist demand was highest among those who held a PharmD, had less experience, worked more than 40 hours per week, and lived in rural areas.10
In a brief time, the new pharmacy health care model envisioned by consumers has become a reality. The expansion of primary care services with physician–pharmacist collaboration can make major health and economic impacts on the US health care system.
References:
1. Seitz A. Americans give US healthcare system failing mark: AP-NORC Poll. Associated Press. September 12, 2022. Accessed July 28, 2023. https://apnews.com/article/covid-health-medication-prescription-drug-costs-drugs-63b342945f9b6ab3ce0ed3920deb935a
2. Institute of Medicine (US) Committee on the Future of Primary Care, Donaldson M, Yordy K, Vanselow N, eds. Defining Primary Care: An Interim Report. Washington (DC): National Academies Press; 1994.
3. O’Malley AS, Rich EC. Measuring comprehensiveness of primary care: challenges and opportunities. Gen Intern Med. 2015;30(suppl 3):S568-S575. doi:10.1007/s11606-015-3300-z
4. Kroenke K. The many C’s of primary care. J Gen Intern Med. 2004;19(6):708-709. doi:10.111/j.1525-1497.2004.40401.x
5. Basu S, Berkowitz SA, Phillips RL, Bitton A, Landon BE, Phillips RS. Association of primary care physician supply with population mortality in the United States, 2005-2015. JAMA Intern Med. 2019;179(4):506-514. doi:10.1001/jamainternmed.2018.7624
6. Koller CF, Brennan TA, Bailit MH. Rhode Island’s novel experiment to rebuild primary care from the insurance side. Health Aff (Milwood). 2010;29(5):941-947. doi:10.1377/hlthaff.2020.0136
7. Phillips RL Jr, Bazemore AW. Primary care and why it matters for US Health system reform. Health Aff (Milwood). 2010;29(5):806-810. doi:10.1377/hlthaff.2010.0020
8. Feehan M, Walsh M, Godin J, Sundwall D, Munger MA. Patient preferences for healthcare delivery through community pharmacy settings in the USA: A discrete choice study. J Clin Pharm Ther. 2017;42(6):738-749. doi:10.1111/jcpt.12574
9. Munger MA. Will Amazon bring about the demise of community pharmacy? Pharmacy Learning Network. December 19, 2017. Accessed July 28, 2023. https://www.hmpgloballearningnetwork.com/site/pln/blog/will-amazon-bring-about-demise-community-pharmacy
10. Munger MA, Walsh M, Godin J, Feehan M. Pharmacist's demand for optimal primary care service delivery in a community pharmacy: The OPTiPharm study. Ann Pharmacother. 2017;51(12):1069-1076. doi:10.1177/1060028017722795
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