Improving Medication Management for Patients With Complex Conditions

Chronic conditions have grown more prevalent across the United States in recent years, many of which are managed with complex medication regimens. State and federal restrictions, workflow challenges, and other obstacles limit pharmacists in their ability to manage these regimens, says Laura Cranston, PharmD, MBA.

In this interview with Pharmacy Learning Network, Dr Cranston walks through some of these challenges and offers solutions for improving medication management processes. She also describes how the role of pharmacists is continuing to evolve in the wake of COVID-19.

Can you discuss the challenges pharmacists face when managing medications for patients with complex conditions?

Pharmacists face a myriad of challenges when managing medications for patients with complex conditions. These include an overall lack of access to a comprehensive medication history that includes the patient’s diagnosis, lack of access to an EMR/EHR, and often, the challenge of overseeing the dispensing of products while trying to balance the delivery of clinical services. These challenges prevent pharmacists from assisting patients to the best of their ability.

I believe there are three main roles most pharmacists desire to play in the health care system: testing, treating, and triaging. Pharmacists have demonstrated in droves their ability to test; treating is often restricted by scope of practice regulations; and triaging (to other health care professionals where needed) is a natural fit.

How do these challenges impact patients and providers more generally?

Pharmacists desire to practice at the top of their license and use their education and skills, which have been developed and honed over the six to eight years they committed to acquiring a Doctor of Pharmacy degree. The challenges or restrictions the profession faces in being recognized as a provider at the state or federal level can prevent patients from accessing pharmacists for a range of clinical services.

Generally, pharmacies can be found within 5 miles of every individual in the United States. However, that does not mean the pharmacist can fulfill all opportunities to optimize medication use within the four walls of the pharmacy. This is the challenge we must overcome to be patient-centric and maximize health outcomes successfully.

How can medication management processes be improved?

Medication management processes can be improved through less restrictive scopes of practice on a state level, broader recognition of pharmacists as providers on a federal level, and reimbursement of pharmacists for cognitive services—not defined to a product.

Additionally, delivering clinical services at scale is something most pharmacists aspire to do. Overcoming the challenges of workload and allowing a pharmacist the time to be able to deliver clinical services untethered to a product would be a major win.

Where do you see the future of medication management headed as the pandemic wanes?

That is probably the most interesting question to be addressed. After decades of being health care’s underdogs, pharmacists have been America’s health care heroes for the past two and a half years. They have delivered most COVID-19 vaccines, tested millions of patients in pharmacies, and witnessed the scope of practice expand across states due to the public health emergency.

However, as the pandemic wanes, the future of medication management and, specifically, the management of chronic conditions must be addressed with intention and clinical expertise. We must build or rebuild relationships with patients, many of whom have neglected their primary care visits over these past few years. Medication management will be delivered digitally, through telehealth and telephonic solutions. This is one of the changes seen during COVID-19 that will have staying power beyond the pandemic.

Is there anything else you would like to add?

We live in a world that is increasingly hybrid—hybrid in work and health care, with remote patient monitoring and clinical interventions being delivered at scale through new tech-enabled solutions.

Pharmacists never envisioned a time where they could practice at the top of their license outside the four walls of a pharmacy. However, over these past three years—even beginning before the pandemic—organizations like Aspen RxHealth have demonstrated it can be done with excellence, a high degree of professional satisfaction and autonomy, and without the pressures of shift work, personnel management, and reimbursement pressures from third party payers.

Pharmacists, particularly those with an entrepreneurial spirit, are finding these digitally enabled opportunities rewarding. Their ability to manage their own clinical practice is a fulfilling new opportunity that many are embracing wholeheartedly. Having been a pharmacist for over 30 years, it is exciting to bear witness to these changes firsthand, and I am honored to be part of this growing movement.

About Dr Cranston

A pharmacist by education, Laura Cranston serves as a strategic growth consultant to Aspen RxHealth. Throughout her career, and most notably in her previous role as founder and CEO of the Pharmacy Quality Alliance, Laura’s career has remained squarely focused on optimizing safe and appropriate medication use by tapping into the clinical expertise of pharmacists and enabling them to practice at the top of their license.

In her role at Aspen RxHealth, Laura works alongside team members and the pharmacist community to build innovative professional development programs, design revolutionary pharmacist compensation structures, and help identify strategic partnerships to further Aspen RxHealth’s position as the pioneer in modern pharmacy.