The Time for Pharmacists to be Essential in Primary Care is Now: Part 2

There are multiple factors coming together that support pharmacists becoming “essential” in primary care.  Perhaps the most important is the COVID-19 pandemic for which several persons have written commentaries on the importance of pharmacists in the COVID-19 crisis.  Specifically, the United States Health and Human Services granting pharmacists the ability to order and administer COVID-19 testing.^1-3 Multiple data recognize the need and opportunity for pharmacists to participate in primary care throughout the United States (US). 

This is a three-part series on the opportunity, changes needed in pharmacist education and practice, and how to become essential in primary care.  The second part provides the pharmacist community with potential changes in pharmacist education and practice that need to be undertaken to better prepare pharmacists for primary care practice. 

Building on Existent Relationships between Family Practitioners and Community Pharmacists 

One potential strategy to become pharmacist primary care providers would be to build on existent relationships between family practitioners and community pharmacists.  Delivering a broader array of primary healthcare services in a convenient community pharmacy setting, with family practitioner oversight and training/teaming could improve access to health care, as has been shown in community pharmacist-family medicine collaborative studies.^4-6 This could occur where healthcare access is lacking and improve value in terms of better health outcomes through improved access and quality. By better leveraging synergistic interactions around the education, skills, and service of physicians and pharmacists, through enhanced care in the community pharmacy setting this may also assist in ameliorating challenges presented by trends in the national shortage of family physicians.  There are currently 67,000 community pharmacies in the United States.  An overwhelming 92% of the population lives within 1.6 miles of a community pharmacy.⁷ Building models of enhanced local care by activating this pharmacy setting resource with closer collaboration with, and oversight from, family medicine could improve care -particularly in rural and disadvantaged communities where access to family medicine can be challenging and limiting.  Community pharmacy would greatly benefit from this integration through provision of preventative care, the teaching of patient self-management techniques, and providing chronic disease state management. Family medicine would benefit from extending the geographical reach of their practices into local settings outside their offices (for certain limited conditions and approaches.

Sharing Goals

Successful integration and collaboration of family physicians with community pharmacists could involve a number of shared goals.  These include aligned leadership to reduce fragmentation and foster continuity of care; define roles and responsibilities to ensure accountability; develop and support appropriate incentives, and manage change.⁴ Both disciplines share a common goal of population health management through community engagement in defining population health needs in order to improve health.  Importantly, goals must be sustainable and transferable from community to community to order to build enduring impact and value.  Lastly, shared collaborative use of data and analytics is essential for continual improvement in care, and the use of enhanced collaborative electronic medical record information exchange can mitigate the risk of patients ‘falling between the cracks’ of less connected practitioners.

Integration of Educational and Training Programs

Enhanced educational and training programs are necessary in order for pharmacists to better integrate practice with family physicians.  Team-based education focused on chronic care management, preventative medicine, and including greater interdisciplinary education opportunities, especially in ambulatory care settings will be necessary.^8-14 Pharmacists will be taught how to be a dedicated patient advocates and care navigators.  Currently, there are scant best practices available in Colleges of Pharmacy that deliver this type of curricula framework.  Departments of Family Medicine, however, have implemented community-oriented primary care curricular. ¹⁵ Integrating pharmacy students into family medicine clerkship experiences with collaborative training of student physicians and pharmacist by physicians and pharmacists working in strategic partnership, both introductory and advanced, could be undertaken.  This could better align the two disciplines, thereby sustaining the goal of closer integrative practice.  

For pharmacists to become essential primary care practitioners’ pharmacist educational and practice initiatives are necessary to educate the profession.  A model of a network of community pharmacies and family physician offices could offer greater opportunities for interdisciplinary education.

References:

1. Pharmacists respond to COVID-19: An Army of Experts Needed. https://www.pharmacypracticenews.com/Covid-19/Article/04-20/Pharmacists-Respond-to-COVID-19--An-%20Army-of-Experts-Needed/57892  Accessed 09/2020
2. HHS Allows Pharmacists to Provide COVID-19 Tests. https://www.policymed.com/2020/04/hhs-allows-pharmacists-to-order-and-administer-covid-19-tests.html  Accessed 09/2020
3. Pharmacists are on the Front Line of COVID-19, but they need help too. https://www.pharmaceutical-journal.com/news-and-analysis/opinion/editorial/pharmacists-are-on-the-front-line-of-covid-19-but-they-need-help-too/20207829.article?firstPass=false  Accessed 09/2020
4. Cranor CW, Bunting BA, Christensen DB. The Asheville Project: long-term clinical and economic outcomes of a community pharmacy diabetes care program. JAPhA 2003;43(2):173-84.
5. Watson LL, Bluml BM. Integrating pharmacists into diverse diabetes care teams: implementation tactics from Project IMPACT: DiabetesJAPhA 2014;54(5):538-41.
6. Pellegrin KL.   The Daniel K. Inouye College of Pharmacy Scripts: Pharm2Pharm: Leveraging Medication Expertise Across the Continuum of Care.Hawai’I J Med and Public Health. 2015;74(7):248-52
7. Munger MA, Durante R, Ranker L, Feehan M. Integration of community pharmacies into United States primary care delivery: A Qualitative Assessment.  IP Patient Care Pharmacy and Clinics 2016;4(4).
8. The deBaummont Foundation. Practical Playbook:  Public Health. Primary Care. Together. https://www.debeaumont.org/practical-playbook/   Accessed 07/ 31/2017
9. Satterfield JM. Mitteness LS, Tervalon M, Adler M. Integrating the social and behavioral sciences in an undergraduate medical curriculum: the UCSF Essential Core. Acad Med 2004;79(1):6-15.
10. Bell SK, Krupat E, Fazio SB, Roberts DH, Schwartzstein RM. Longitudinal Pedagogy: A successful response to fragmentation of the third year medical student clerkship experience. Acad Med 2008;83(5):467-75.
11. Hirsch DA, Ogur B, Thibault GE, Cox M. “Continuity” as an organizing principle of clinical education reform. N Engl J Med 2007;356(8):858-66.
12. Allen RE, Copeland J, Franks AS, et al. Team-based learning in U.S. Colleges and Schools of Pharmacy. AJPE 2013;77(6)::Article 115.
13. Brock T, Boone J, Anderson C. Health care education must be a team sport.  AJPE 2016;80(1):Article 1.
14.  Pogge E. A team-based learning course on nutrition and lifestyle modification. AJPE 2013;77(5): Article 103.
15. American Association of Family Physicians. Integration of Primary Care and Public Health (Position Paper) Accessed 09/2020