Pharmacy-physician synergy
Collaborative models for patient care in which pharmacists and physicians work closely together
in the best interest of patients have proven effective but are often elusive.
The accessibility of community pharmacies, pharmacists’ expertise around medications and the conditions they treat make them ideal venues for monitoring patient health in coordination with physicians.
A report from the Centers for Disease Control and Prevention about the potential for deeper pharmacist-physician collaboration noted that community pharmacists are often much more accessible to patients than doctors, mainly because 86% of Americans live within five miles of a community pharmacy. By providing medication assessment and counseling and lifestyle management recommendations, pharmacists can improve patient outcomes, especially when it comes to chronic conditions such as cardiovascular disease or diabetes, the CDC reported.
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Among other opportunities for collaboration cited by the CDC were:
- Health assessment in the pharmacy and subsequent referral to a physician for diagnosis or treatment;
- Physician referral of patients to the pharmacist for assistance with medications or chronic condition management, and;
- Pharmacist triage of patients into primary care after identifying medication-related problems or other health conditions that arise or worsen.
Another recent report from consulting firm Deloitte outlined opportunities for pharmacists to play a greater role in public health, in part through better collaboration with the physicians who treat their patients.
“If more pharmacists were to operate to the full potential of their professional education and skill sets, they could play an important role in elevating the well-being of health care consumers, in alignment with Deloitte’s ‘Future of Health’ vision,” the Deloitte report concluded. “In this future, we expect health care to emphasize prevention over treatment, and care to increasingly take place in the home or community. As some of the most accessible and trusted health care professionals, pharmacists can help people stay healthy, better manage their chronic conditions, and age in place.” Rick Gates, chief pharmacy officer at Walgreens, echoed this perspective on the key role that pharmacists play in providing holistic patient care.
“As the most accessible healthcare providers in thousands of communities, Walgreens pharmacists are uniquely positioned to help improve patient outcomes and fill critical gaps within the U.S. healthcare system,” he said. As frontline healthcare providers, pharmacists have demonstrated that their support is critically needed, Gates added. The COVID-19 pandemic shone a spotlight on the greater role that pharmacists can play in patient care, he said. “During the pandemic, our community pharmacies were the front door to healthcare, bringing patients into the public health system and Walgreens ecosystem and exposing them to care opportunities they may not have previously known or experienced firsthand,” said Gates.
Keys to Collaborative Success
Creating better avenues for two-way communication and information sharing are among the keys to the success of pharmacist-physician partnerships, according to retail pharmacy leaders.
“Communication can sometimes be a challenge, especially when we are limited to phone calls or faxes with a provider’s office,” said Sara Couture, manager of pharmacy clinical programs, Hannaford Supermarkets. “It takes time and resources to make the outreach and keep each other informed. However, we know it’s a worthwhile investment.”
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Access to patient records is another challenge that retail pharmacists face when collaborating with physicians. “In general, pharmacies and pharmacists have the least amount of information from the electronic health record of their customers available to them,” said Karen Staniforth, senior vice president and chief pharmacy officer, Rite Aid. “Most pharmacies do not have access to electronic health records, and this lack of information can make it difficult to engage with prescribers as fellow clinical experts.” Advancements in technology are helping to solve these communication- and information-sharing shortfalls, she said.
“Communicating between pharmacies and physicians’ practices continues to be an area of opportunity,” said Staniforth, noting that Rite Aid has implemented technology to help close this gap through secure electronic messaging between Rite Aid and physicians’ practices. “This helps the pharmacy team communicate issues with prescriptions directly to providers for clarification or required changes.”
Another key challenge to more coordinated care among pharmacists and physicians is that both doctors and their patients may not fully understand the role that pharmacists can play in patient care, according to the CDC report. “Pharmacists’ education and training fully prepares them for participation in and contribution to team-based care, disease management and the provision of wellness services,” the report concluded. “However, pharmacists’ skills may be underused, as patients and physicians are not always aware of the extent of pharmacists’ training and qualifications.”
Payment silos inherent in the system—the distinction between medical insurance coverage and pharmacy insurance coverage—are another key barrier to collaboration, according to Deloitte.
“Existing payment models that assign greater value to the product dispensed than to clinical services that improve patient outcomes are perhaps the biggest barrier to pharmacy business model innovation,” Deloitte concluded in its report. “The segregation of medical and pharmacy benefits creates disincentives for payers and providers to consider pharmacy as a component of care.”
Retailer Efforts Around Collaboration
Retail pharmacies continue to advance their efforts to establish more cooperative relationships with the doctors who issue prescriptions for their patients. Staniforth said Rite Aid’s pharmacists collaborate with other medical professionals in a variety of ways. She described pharmacists as a “critical liaison” between Rite Aid’s customers and physicians, especially older customers or customers with chronic health conditions. Among the ways Rite Aid pharmacies and pharmacists
collaborate with physicians:
- Rite Aid’s specialty pharmacy, Elixir, dispenses medications to members with complex conditions and works closely with manufacturers and physicians on correct usage.
- Rite Aid is collaborating with Department of Health physicians to help expand access for critical conditions such as testing and prevention related to sexually transmitted infections, as well as flu, strep and COVID rapid testing.
- The retailer partners with local physicians to help customers convert their medications to 90-day supplies and encourage medication adherence.
- Rite Aid also partners with health plans on value-based care models to provide customers with increased access to high-quality health care in the appropriate setting at the right time. Through these collaborations, Rite Aid seeks to address gaps in care, leverage technology to track care, communicate with physicians and share data securely to deliver positive customer outcomes.
- Rite Aid pharmacists collaborate daily with physicians to help answer medication questions, clarify medications and help ensure customers have access to medications that are affordable and meet their therapeutic needs.
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Staniforth noted that pharmacists could also flag concerns around a patient’s prescriptions to physicians, such as potential drug interactions or how a different dosage might have a different outcome on a patient.
“These pharmacy-provided services help physicians focus on more chronic, complex care, especially in areas or practices that may have physician staffing shortages,” said Staniforth. “By collaborating, Rite Aid pharmacists ensure customers have access to their medications and get the most out of their treatments. Rite Aid pharmacists are embedded in the communities we serve and are a valuable part of the health care delivery team.”
Staniforth said Rite Aid will continue to seek out opportunities to strengthen relationships with
other healthcare providers. “This may include further integration into the medical records with providers or direct partnerships—collaborative practice agreements—with Rite Aid pharmacists managing customer’s medications,” she said.
Likewise, Couture of Hannaford Supermarkets said the chain’s pharmacies collaborate with
physicians to assess patient adherence and understanding of their medications. “Pharmacists sometimes have data that is not available at a physician’s office, such as how often a patient is taking their medication or requesting refills,” Couture said. “We are also well positioned to identify and help close gaps in areas like vaccinations. This is especially important since we saw a decrease in vaccination rates during the pandemic.”
The most important benefit derived from pharmacist-physician collaboration is improved
patient care, said Couture. “It benefits a patient to have conversations with their pharmacist and become more knowledgeable about their health conditions and medications,” she said. Meanwhile, physicians can see benefits from collaboration by gaining more understanding about their patients’ adherence to prescriptions and how it impacts their condition. This ultimately provides information that enables physicians to determine whether or not to make changes to the patient’s treatment.
“The biggest opportunity is for a better understanding of the impact that a pharmacist has on patient care,” said Couture. “Pharmacists are well equipped to counsel and complete check-ins for patients to ensure they are getting the care they need.”
Medical Services Become More Routine
Gates of Walgreens said that additional medical services beyond vaccinations are becoming more routine at pharmacies. These include testing for HIV, COVID-19 and other conditions; mental health screening; and education on protective health measures.
“Walgreens pharmacists interact with many types of physicians and medical professionals— primary care, specialty care, emergency care and others—giving pharmacists even deeper insight into the healthcare continuum,” he said. Walgreens Boots Alliance also has a majority stake investment in VillageMD, which recently acquired Summit Health-CityMD, creating one of the largest provider networks in the nation, Gates said.
“Walgreens is the first pharmacy chain to offer full-service primary care at large scale at Village Medical at Walgreens practices,” he said. “These co-locations allow physicians and the pharmacy team to work together closely to offer patients cost-effective, expert care for chronic conditions, as well as everyday illnesses and injuries.”
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The retailer’s partnership with VillageMD is focused on driving healthcare outcomes, Gates said, and Walgreens sees “great value” in coordinating care between physicians and pharmacists to improve the quality of care and lower its costs. Examples include flu immunization referrals, medication adherence and medication reconciliation consultations and collaborative practice agreements between Walgreens Pharmacy and Village Medical, allowing pharmacists to conduct bridge refills, prior authorizations and formulary interchanges.
Additionally, Walgreens collaborates with several payors to make preventive health and wellness services available to their members at Walgreens Health Corner locations in California, New Jersey and Ohio. Health Corners are dedicated spaces in Walgreens stores where licensed clinicians provide a range of health support and clinical services to complement the care members receive from their network of primary care physicians and specialists, Gates explained.
“The Health Corner locations help patients stay on track with their health, especially when they’re between doctor visits,” said Gates. “Members’ existing providers receive the results and outcomes from these services in order to have the most accurate, up to date and complete information about
a patient’s individual health.”
Gates sees more opportunities to expand collaboration among pharmacists and physicians in the future, leveraging Walgreens’ nearly 9,000 locations, its partnerships with VillageMD and others.
“With these opportunities, we can expand the scope of services pharmacists offer and grow the pharmacist-physician relationship, helping make the healthcare system easier to navigate by delivering trust, convenience and expertise for a more connected care experience,” said Gates.