“I have an appointment with my insulin doctor.”
“I’m seeing my pharmacologist today.”
My patients assigned these titles to me when they checked in at the front desk of the ambulatory care clinic where I practiced as a primary care pharmacist.
However, these terms of endearment contrast with the longstanding public perception of pharmacists.
Traditionally associated with a product or brand, TV commercials from 10 years ago depicted pharmacists recommending specific over-the-counter brands as their “#1 recommended choice” or the “only U.S. Pharmacopeia verified vitamin” on the market.
Often commercials tout the cost savings patients could obtain at a community chain pharmacy by talking to their neighborhood pharmacist, and not the services they provide.
More recently, pharmacists make the news for negative actions including a case in Minneapolis of a denied prescription or the conviction of a Florida pharmacist for selling opioids.
Current TV ads feature pharmacists providing vaccinations for flu or COVID-19 and other emergency services during and post-pandemic.
This newer brand messaging trend has arisen due to the national recognition of the crucial frontline role pharmacists played in COVID-19 relief, acknowledged by the Department of Health and Human Services under the Public Readiness and Emergency Preparedness Act.
What these ads do not show are diverse pharmacists historically as an integral part of the healthcare system providing care beyond vaccinations and dispensing medications in both inpatient and outpatient settings.
Services they provide include drug utilization review to make sure a medication is appropriate (and making interventions if the drug therapy is not), and medical therapy management that optimizes therapeutic outcomes for patients.
To that end, some states allow collaborative practice agreements between a physician and a pharmacist so that pharmacists can prescribe and adjust medications as well as order lab tests.
Twenty years ago, early in my career as a primary care pharmacist, I worked in a multispecialty physician group practice where I independently managed patients with diabetes, high cholesterol and high blood pressure under such an agreement.
I would see these patients in my office, analyze their blood glucose or blood pressure diaries, order and evaluate lab work, assess drug therapy regimens and adjust insulin or medication doses, teach patients and caregivers how to properly use insulin devices and glucometers and what optimal goals were, counsel on adverse effects (medication or disease-related), discuss lifestyle modifications and carbohydrate counting, and provide referrals to dieticians, ophthalmologists or podiatrists.
I could spend more time with patients on their visits; 45 minutes for new patients and 30 minutes for returning ones. This was standard practice for patient visits with the pharmacist, compared to the 15 minutes or less they had scheduled with their physician.
The pharmacist-patient and pharmacist-physician relationships were highly valued at this clinic, and the outcomes were beneficial. A 2012 study shows significant clinical improvement in patients seen by pharmacists at that time.
Pharmacists are considered drug experts and one of the most accessible and trusted healthcare providers in the community. A recent 2020 study found patients visit pharmacies twice as often as they visit their primary care provider.
Community pharmacists today are finding themselves in prescriber and diagnostician roles more and more with the pandemic having accelerated needs for services including immunizations and point of care testing (such as for influenza, strep, RSV, and COVID), oral contraception, and HIV pre/post exposure.
Despite the valuable services pharmacists provide and the documented improved health outcomes achieved in various health settings, they still do not have provider status at the federal level. Without recognition as medical providers under the rules of Medicare part B, pharmacists face barriers when seeking reimbursement for the services they provide.
Some hope may be on the horizon.
The Pharmacy and Medically Underserved Areas Enhancement Act is a new bill that was introduced in Congress last May that would allow pharmacists in underserved areas to bill for services within the pharmacists’ state scope of practice. Currently referred to the Committee on Finance, it is still being considered before sending on to the House and Senate.
With only a 1% chance of being enacted, it is incredibly discouraging.
In the New Year and beyond, it is imperative that patients, customers, healthcare providers, professional organizations and policy makers unite in advocating for legislation that acknowledges the pivotal roles of pharmacists.
Recognizing pharmacists as trusted medical providers and for the significant impact they have in improving patient health and outcomes is long overdue.
As providers, pharmacists stand poised to tackle the impending national primary care physician shortage by helping manage chronic conditions and medication regimens.
It is time messaging aimed at the public becomes more personalized, driving authentic, inclusive narratives of the patient’s journey and the health care providers they engage with.
It is also time that messaging about pharmacists emphasizes affordable, accessible, streamlined care they provide that effectively enhances public health and wellness.
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