The Vital Role of the Pharmacist as Medication Manager

Pharmacists are more than dispensers of prescription medications.  The word "pharmacist" may bring to mind a vision of your friendly neighborhood community pharmacist.  However, the weight of scientific research has convinced me that pharmacists are an underutilized segment of the health care workforce and should play a larger role in health care reform.

Pharmacists work in a wide range of settings: hospitals, skilled nursing care facilities (SNCFs), hospices, health care maintenance organizations (HMOs), and a wide variety of retail settings like supermarkets and large discount stores. Their education is impressive too. To get a feeling for what is on the horizon for "specialty pharmacy", the Board of Pharmaceutical Specialists offers certifications in pharmacotherapy, oncology, nutrition, psychiatry and nuclear pharmacy.

Clinical pharmacists, who occupy a growing segment of the profession, provide several key services for patients, including medication management therapy services (MMTS). When patients do not take their medicine, they get poorer results from their medical care. And, its pricey.  Failure to adhere to medication therapy costs the US an estimated $290 billion dollars a year in avoidable health care spending, or 13% of total health care expenditures, according to a 2009 Report of the New England Health Care Institute. The weight of recent scientific research demonstrates that MMTS improves therapeutic outcomes and reduces hospitalizations among Medicare Part D beneficiaries, improves blood pressure and lipid management of diabetic patients, improves patient outcomes for heart failure patients, improves adherence to antiretroviral therapy for HIV Patients and improves patient results in treatment of Hepatitis C.

And, by the way, we cannot blame the patients for medication non-adherence. We are only beginning to understand why patients don't take their medicine. A 2013 Study by Avalere Health identifies the major barriers to medication adherence as cost, access and complexity of the medication regimen.

There is no doubt that the US population is aging. Within our lifetimes, the number of persons over 65 will double, and those over 85 will triple. How is this relevant? Doctors acknowledge that medication non-compliance is a major problem among the elderly.  When we put the pieces together, we should get the picture: medication adherence will become a growing concern in the near future.

Health care policy may facilitate the pharmacist's expanded role in health care, or, it may stifle pharmacists by additional new regulations which may stifle their potential contribution. As the New England Health Care Institute recommends, lets think "outside the pill box." Out with antiquated patient care models, and in with including pharmacists on the team. 

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