Let pharmacists empower patients and save lives

Patients don’t take their medications as prescribed, and it’s a deadly problem. In Jane Brody’s recent piece, “The Cost of Not Taking Your Medicines” (New York Times, April 17, 2017), she writes that an estimated 125,000 deaths a year are caused by nonadherence.

Why would any patient blindly follow orders to take a single drug—let alone 5 or 10 or even 15 drugs in combination—without a real understanding of the drug?

In the 15 to 20 minutes health care providers have to access and treat patients, monitor their conditions, order and interpret tests, discuss lifestyle issues affecting health, and meet quality measures, they scarcely have time—as they write out their prescriptions—to say the minimum: “Take this three times a day.” “Drink plenty of water with these pills.” “This should lower your blood pressure.”

When it comes to medication adherence, stripped-down instructions are not enough.

Educating and empowering patients

Most patients don’t understand what their medications actually do in the body. They don’t realize that most medications travel throughout the body—not just to those areas where they are needed—often resulting in serious side effects. They might not know if their medications are actually effective in treating their health problems. Patients also may not fully grasp the impact of taking their individual medications incorrectly or the effects that other medications, food and alcohol, exercise, age, weight, and genetics have on safety and medication effectiveness.

If patients are very lucky, their health care providers will simply ask in a follow-up visit (assuming there is follow up) if they are taking their medication. End of story.

Helping patients to understand their medications can go a long way toward better adherence and improved outcomes. But our health care system doesn’t empower patients with the knowledge they need to be medication savvy.

It’s not the fault of the physician or nurse practitioner. There’s no time in today’s health care system set up for them to counsel and follow up with each patient about each patient’s individual medications and—in most cases—no way to be reimbursed for this service.

Unless something changes, patients will continue to die because of medication nonadherence. They will also continue to die due to ineffective and unsafe drug therapy.

The way forward is clear: When patients are being prescribed medications, an evaluation of all medications must be a part of the care plan and comprehensive medication counseling must be the norm.

And who better to implement this change than the pharmacist—as part of each patient’s close-knit health care team?

Pharmacists are medication experts

Pharmacists know how drugs act and interact in the body. They are experts regarding medication choice and side effects. And they know how to work with insurers on behalf of their patients. Their mission is to ensure the individual patient is receiving the right drug at the right time; that the drug is safe, effective, and affordable; and that the patient is willing and able to take the needed medication. Pharmacists have the credentials and training to do all of this. They carry doctoral degrees and must be licensed to practice.

Pharmacists are highly visible in retail pharmacies, but mostly invisible to patients in hospitals, where—often as specialists in fields ranging from pediatrics to oncology—it can be hard to identify the white-coated pharmacist from among all the providers in white coats.

Elisabeth Fall

Patient learns about his medications from UCSF student pharmacists, under the supervision of Dean B. Joseph Guglielmo, PharmD.

Now, pharmacists are slowly beginning to share their expertise in physician practices and clinics and in new practice models in retail community pharmacies.

Then what’s the problem? Why aren’t the patient’s medication needs being met with the pharmacist’s expertise? Why aren’t they in every physician practice and clinic?

You guessed it, it’s the bottom line. And this relates to how pharmacists are paid.

Staff pharmacists in hospitals are salaried to provide care. Retail pharmacists are salaried, but they face the need to maximize the filling of prescriptions; there’s only so much time in a shift.

In settings such as physician practices and clinics, most pharmacists still can’t bill insurers for their services because they don’t have what’s called provider status.

This is slowly being addressed nationally through legislation. In 47 states and the District of Columbia, pharmacists can now practice under an expanded scope of practice, complementing the diagnostic skillset of the physician or nurse practitioner, focusing on the safe and effective medication for the diagnosed condition.

Provider status for pharmacists improves outcomes

Imagine this: As a patient with chronic diseases, such as diabetes and high blood pressure, you go to your physician for a periodic checkup. But you spend as much or more time with your clinic pharmacist, who:

• Makes sure you are receiving the most appropriate drugs for your diseases and your circumstances.
• Empowers you with information about your medications, such as how they work and any possible side effects they might have.
• Makes sure you are taking your medications correctly and at the right time.
• Follows up with you to learn how you are responding to any new medicines to ensure they are effective, addresses any side effects, and adjusts doses.
• Works with your physician or nurse practitioner when you need any medication changes.
• Works with you to eliminate any barriers to your adherence, which can include insurance obstacles.

This kind of scenario puts you, the patient, at the center of the conversation regarding your medications.

The value of provider status for pharmacists is evidenced repeatedly through more appropriate medication choices, better medication adherence, improved patient outcomes, increased patient satisfaction, and decreased health care costs. And the need for highly trained pharmacists on patient care teams beyond the hospital will only increase with the increasing complexity of medications and our rapidly growing knowledge of genetics and drug response.

How do we give patients ready access to the expertise of pharmacists? How do we empower patients with medication knowledge? By making provider status with associated reimbursement available to pharmacists in all states. The sooner the better—for patients everywhere.

B. Joseph Guglielmo, PharmD
Dean
Troy C. Daniels Distinguished Professor of Pharmaceutical Sciences
School of Pharmacy
University of California, San Francisco