Managing U.S. population health — pharmacy steps into frontline role
For decades, the pharmacy profession labored under a widespread, but inaccurate, public perception of pharmacists as little more than dispensers of prescription medicines and givers of basic counseling on their use. No more. Pharmacists today are highly trained, clinically engaged patient-care specialists making a huge and rapidly growing impact on population health management in communities all over America.
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“The vast majority of pharmacists today are already doing much more than simply filling prescriptions,” noted Dr. Harry Leider, chief medical officer for Walgreens. “They’re helping patients manage chronic disease, providing medication management services, conducting health tests to diagnose conditions like diabetes or high cholesterol, and administering a wide range of immunizations. They’re also partnering with healthcare providers working in nearby health systems and hospitals, serving as part of care teams to help improve patient health and outcomes.”
It goes without saying that medication dispensing and counseling remain a critically important part of successful health outcomes. That’s even more the case in an era of increasingly specialized, highly targeted biotech drugs requiring careful administration, dosage management and monitoring of their effects.
“Medications play such an important role in the treatment of acute and chronic illnesses, but treatment regimens can be complex and patients often don’t understand how and why to use their medications appropriately,” noted Anne Burns, VP of professional affairs for the American Pharmacists Association.
“Increasingly, pharmacies provide vaccinations, health education and disease state testing and management,” the National Association of Chain Drug Stores reported. “Through personal in- teractions with patients, face-to-face consultations and convenient access to preventive care services, pharmacies are helping to shape the healthcare delivery system of tomorrow — in partnership with doctors, nurses and others.”
As the practice of pharmacy has expanded and evolved, so too has the public’s perception of the pharmacist as a highly skilled, clinically trained frontline health provider. A large majority of Americans embrace the idea of getting vaccinations, point-of-care testing and other preventive health services from their local pharmacist, according to public polling.
In a nationwide survey of consumers sponsored by NACDS in 2015, 79% of respondents voiced support for pharmacists as a resource for “administering vaccinations and immunizations for preventing or treating illnesses, such as the flu, hepatitis, pneumonia and tetanus.” More than 7-in-10 also expressed support for using pharmacy-based retail clinics for primary healthcare services, and nearly two-thirds of those polled said pharmacies should be allowed to administer blood, urine or strep tests.
U.S. consumers also are voting with their feet. Hundreds of thousands of Walmart customers flocked to the company’s first-ever chainwide wellness and screening event — held last October and dubbed “America’s Biggest Health Fair” — for free health tests, low-cost flu shots and counseling. “We did nearly 300,000 screenings, with [more than] 50,000 customers processed per hour,” said Alex Hurd, senior director of product development, growth and payer innovations at Walmart health and wellness. “We had nurses doing the screenings, and our pharmacists did about 52,000 immunizations.”
Among those screened were some 7,000 customers who had little or no insurance coverage. And some 3,000 of those screened were shown to be diabetic or at risk of having diabetes, according to the Walmart executive.
Pharmacy chains also are providing cost-effective and accessible healthcare solutions through a growing network of in-store walk-in clinics staffed by nurse practitioners and physician assistants. More than 2,000 pharmacy-based retail clinics are now open nationwide, according to the Convenient Care Association. They’re offering acute-care services for minor injuries, upper respiratory ailments and other conditions, along with an expanding menu of services to treat chronic disease, with no appointment necessary, at a fraction of the cost of a visit to a doctor’s office or emergency room.
Americans’ new vaccination resource
One of the primary ways community pharmacies now contribute to public health is through vaccinations against a wide variety of diseases. Tens of millions of Americans now get their annual flu shots at their local pharmacy, saving time and money and relieving the stress on the nation’s overburdened family physicians and clinics.
Costco Wholesale’s pharmacies alone provided some 700,000 vaccinations last year for influenza, shingles and other conditions, according to Michael Mastromonica, assistant VP of pharmacy for the wholesale club giant, and this year its pharmacists have begun providing travel vaccinations, as well. He sees immunization and vaccination services as the point of the spear for the whole spectrum of retail health services now offered at community pharmacies around the country.
“You’re starting to see all sorts of changes in the healthcare system that take advantage of the convenience of the pharmacy, with the low cost of a pharmacy relative to a doctor’s office or hospital — and the whole process, I think, is driven by immunizations,” Mastromonica said. “It’s a high-touch [service]. It’s one-on-one in a room, where you’re talking privately about the patient’s health. That whole scenario makes people think of pharmacists differently than they did previously.”
Such pharmacy chains as Costco, Walgreens Boots Alliance, CVS Health, Rite Aid and Walmart have spent enormous time and capital to train and certify their pharmacists to deliver immunizations.
“Walgreens has 27,000 pharmacists, in addition to Healthcare Clinic nurse practitioners and physician assistants, who are certified to provide all CDC-recommended vaccinations, along with other healthcare services, such as blood-pressure testing,” said a company spokesman.
In addition, he said, “Walgreens works with employers and employer groups across the country to have our pharmacists administer flu shots at work site locations. By offering flexible schedules, we can reach the largest number of people and ensure they get vaccinated.”
According to the American Pharmacists Association, more than 200,000 of the nation’s roughly 300,000 practicing pharmacists are already certified to provide immunizations.
In a national survey of practicing pharmacists, APhA found that “the availability of immunizations in pharmacy practices has increased, with 8070 of practice sites offering immunizations on a walk-in basis, compared with 7770 in 2013.”
An expanding role in disease prevention
The positive impact that pharmacy-based immunization programs have had on preventive health efforts can hardly be overstated. With their ability to reach millions of Americans every day at retail pharmacy counters nationwide, drug, supermarket and mass merchandise chains have become the chief source for influenza vaccinations in the United States outside of doctors&