By Charles Lee, MD, internal medicine physician and founder, Polyglot Systems
Patient goes to the doctor. Doctor prescribes medicine. Pharmacist dispenses the drug. Patient takes the medication as prescribed. All is well.
Or is it? Typically, no one really knows what happens after the patient picks up his or her medications at the pharmacy, if they pick them up at all. And, therein lies the problem with the current pharmacy model in the U.S. healthcare system. Under this model, patient care falls short as:
- Healthcare professionals tend to do things “to” patients instead of engaging “with” them.
- Care is delivered in silos as primary care physicians, specialists, and pharmacists concentrate on isolated issues but do not treat the patient holistically.
- Information is not shared, making it impossible to develop a comprehensive view of the patient.
- Communication among providers, pharmacists, and patients is virtually non-existent.
- Medication management falls through the cracks, as physicians typically only see patients once every six months or so, making it difficult to monitor the impact of medications on overall health.
The emerging patient-centered pharmacy model, however, can remedy these problems. This model promotes a dynamic relationship among patients, pharmacists, and physicians. Communication among all parties is ongoing, making it possible to simultaneously create and leverage a more complete picture of the patient’s health.
In addition, the pharmacist moves beyond the typical medication dispensing role and engages closely with patients on clinical care. More specially, the pharmacist, who often sees the patient at least once a month, becomes responsible for medication surveillance and management. Instead of merely doling out prescriptions, the pharmacist works with patients to ensure they adhere to medication therapy and to monitor the results. As a result, the pharmacist can identify duplicative drugs or potential safety issues associated with drug interactions. In addition, if the patient is not responding optimally or is experiencing side effects, the pharmacist can then work with the physician to make adjustments.
In this model, the pharmacist also ensures patients become actively engaged in their own care. Through ongoing counseling, the pharmacist works with patients to make sure they understand instructions, the benefits of the medication, and the downsides associated with non-compliance. With this ongoing discourse, patients become comfortable asking questions and discussing medication therapy-related challenges.
The federal government has started to move toward a more patient-centered pharmacy model of care by supporting medication therapy management. Under this initiative, pharmacists check in regularly with patients to ensure they are taking medications as prescribed, verify they are following wellness guidelines, and monitor for adverse reactions or other problems. Currently, patients who have multiple chronic conditions are eligible to receive medication therapy management from pharmacists through Medicare Part D prescription drug plans.
While this is a start, I feel strongly more comprehensive patient-centered pharmacy services are needed. To move in this direction, the following needs to happen:
Payments need to be distinctly tied to pharmacy services. Pharmacists need compelling financial incentives to take the time to review and track medications with all patients — and to work toward optimal medication therapy. While some integrated delivery systems are financially supporting such services as they aim to improve population health under value-based care, the industry needs to find a way to loop commercial pharmacists into the model. And, while current medication therapy programs target high risk patients, financial reimbursement needs to expand so that pharmacists can provide more extensive services to all patients.
Physicians should embrace pharmacists as collaborative caregivers. Physicians need to acknowledge pharmacists can add value to the overall patient care process by more fully managing medication therapy. Instead of viewing this as a threat, physicians should embrace the opportunity to concentrate on other aspects of clinical care delivery.
Technology needs to enhance communication. Currently, physicians electronically order medications through e-prescribing systems. To support patient-centered pharmacy models, however, these systems need to expand to allow pharmacists to communicate directly with prescribing physicians. For example, if a pharmacist is working with a patient and the medication is not having the desired impact, or the patient is not taking drugs as prescribed, the pharmacist should be able to leverage a messaging function within the e-prescribing network to communicate these issues to the physician.
Technology that enables better communication with patients also could be leveraged to support the patient-centered model. For example, online programs that explain medication instructions in detail — and in the patient’s native language — could help to get patients more engaged in their therapy.
Once these challenges are met, patient-centered pharmacy can become the norm in the U.S. healthcare system. And, patients can experience improved overall clinical outcomes, as the model is apt to bring about a reduction in medication errors, improved patient safety and increased medication adherence.
About The Author
Charles Lee, MD, is an internal medicine physician and founder of Polyglot Systems with a mission to develop practical, affordable multi-language technology solutions to improve healthcare access and reduce disparities for underserved and limited English proficient patient populations. He is an adjunct assistant professor at UNC Chapel Hill Eshelman School of Pharmacy, a member of FDA’s Risk Communication Advisory Committee, and Co-Chair of the Louis W. Sullivan Institute for Healthcare Innovation’s Care Coordination Workgroup.