Most people think of a pharmacist as the person behind the counter at the drug store, the one who counts out pills, per doctors’ orders, and puts them in a bottle.
But all along, the pharmacist has been a medical professional who might flag possible dangers — the interaction of prescription drugs with each other and with over-the-counter medications the patient may be taking. Pharmacists’ unique understanding of medications and the way they act on the human body has never been utilized to the fullest extent possible, says Mollie Ashe Scott, doctor of pharmacy and regional associate dean of the Eshelman School of Pharmacy’s Asheville branch.
“It used to be illegal for pharmacists to tell patients anything about any medication that wasn’t on the label,” Scott says. “Now pharmacists are being called to have more hands-on contact with patients.”
And more and more often, pharmacists have joined clinical teams, working directly with patients and physicians to manage chronic illnesses. Asheville area medical practices have pioneered the use of clinical pharmacists outside the hospital setting, and MAHEC is leading the way
The Asheville Project, a nationally recognized health initiative launched in 1997 by the city, paired pharmacists with patients to help them manage chronic illnesses and saved the city millions of dollars in health care costs, for example.
With that innovative project in mind, when the University of North Carolina was looking to open a new branch of its Chapel Hill-based Eshelman School of Pharmacy, the logical place was Asheville, says Scott.
At an Eshelman open house on March 20 at UNCA, she told a group of prospective students that their choices are much broader than ever before. They can be pharmacists in drug retail settings, work in hospital pharmacies or pharmaceutical companies, and even for insurance companies as they develop drug formularies. They can work in home care, hospice and palliative care, or education. She also noted in her presentation that clinical pharmacists are on the cutting edge of a new frontier. Scott worked with the Mountain Area Health Education Cooperative when it began developing its clinical pharmacist program.
“Pharmacists are becoming an integral part of the team in patient care,” she says.
An increasing number of medical practices are hiring clinical pharmacists to help them manage patients’ care, especially practices that deal with older patients, says Dr. Jeff Heck, a geriatrician and CEO of MAHEC.
“The Asheville Project introduced the notion that pharmacists can be part of the team that interacts with patients,” Heck says. “It serves to extend primary care by adding a team member with unique skills.”
He employs a clinical pharmacist in his own geriatric practice.
Stephanie Kiser, clinical associate professor and director of Rural Health and Wellness for the Eshelman School of Pharmacy, trained in patient disease management 20 years ago. The importance of a clinical pharmacist was driven home not long ago when her father developed a cough, and no one could find the cause. Since he lives several hundred miles away, Kiser relied on his health care team to find the cause, but as the months passed, the cough persisted.
On a recent visit, Kiser decided to look at all her father’s medications. She found one that sometimes causes a cough, and once the medication was changed, the cough went away.
The place where her father receives his care does not employ a clinical pharmacist.
The specialty is most important in rural areas, where there are fewer doctors, especially specialists, says Kiser. And 80 percent of North Carolina is classified as rural.
Add the fact that doctors are under pressure to see more patients, and having another set of eyes on the patient is important.
A 2011 report to the Surgeon General by the U.S. Public Health Service supports enhancing patient care with clinical pharmacists in collaboration with physicians and other providers. The report says clinical pharmacists can help manage illnesses, especially where medications are the primary method of treatment. They can perform basic assessments and collect data and coordinate care with other providers.
“Pharmacists are uniquely positioned (through their accessibility, expertise and experience) to play a much larger patient care role in the U.S. health care delivery system,” the report says.
One problem with clinical pharmacists, though, is that they are not widely recognized as providers of patient care, and their work is not reimbursed fully, Heck says.
The report to the Surgeon General agrees: Clinical pharmacist “must be recognized as health care providers by statute, via legislation and policy and be compensated,” as are physician assistants, nurse practitioners, certified nurse midwives, clinical social workers, clinical psychologists and registered dietitians.
The report also notes “evidence that medications are involved in 80 percent of all treatments (and impact every aspect of a patient’s life), and drug-related morbidity and mortality cost this country almost $200 billion annually.”
Heck sees the greatest benefit in rural health settings and for older patients, who average three chronic conditions each, and who take from three to 12 medications, on average. Plus, the number of people over age 65 in North Carolina is expected to double, from 1.1 million to 2.2 million in the next 20 years, Heck says.
“A clinical pharmacist is uniquely qualified to oversee these medications and help prevent adverse interactions,” he says. “There are some things that just should not go together, and adverse reactions can happen between prescription medicines and over-the-counter medicines or supplements.”
Heck said MAHEC’s residents in family practice, obstetrics and gynecology, psychiatry and general surgery are being trained to work with clinical pharmacists, and graduates are hiring them to be a part of the patient care team.
The addition of clinical pharmacists is growing, Heck says, and it is starting to catch on in other places.
“We are introducing something new here,” he says, “and it’s very exciting.”