Have you ever talked to your pharmacist about a treatment, a drug side effect, or a cheaper alternative drug? Pharmacists can do a whole lot more than count pills. There is an old saying that pharmacists are the most overeducated, underutilized health care professionals. They know far more about drugs and pharmacology than your doctor. They have an in-depth knowledge of drug therapy and have successfully been part of a health care teams managing chronic conditions like diabetes.
The United States is experiencing a physician shortage, especially in primary care. There are a variety of reasons for this. The American Medical Association convinced Congress back in 1997 to freeze residency slots necessary to train physicians, claiming there would soon be a too many doctors. Why would Congress trust the AMA regarding physician supply? There is also the problem that many physicians do not want to work in primary care. Procedures like surgery, radiology and anesthesia pay better than treating the flu, managing diabetes and performing annual physicals. So-called midlevel providers (nurse practitioners and physician assistants) can provide primary care but more needs to be done to boost access to primary care. Pharmacists are the obvious choice, according to an article in the journal, Health Affairs:
Pharmacists represent the most obvious example. More than 300,000 licensed pharmacists work in the United States, with doctoral-level training concentrated specifically on medication management and chronic disease therapeutics. And the evidence that pharmacists can manage these conditions is not anecdotal. A global meta-analysis of 22 randomized controlled trials found that pharmacist-managed diabetes care improved HbA1c by an average of 0.85 percent over the usual standard of care, well above the 0.50 percent threshold considered clinically meaningful for reducing long-term complications. A multistate cluster randomized trial published in JAMA showed that pharmacist-physician teams reduced systolic blood pressure 9.7 mmHg at 12 months beyond usual care, with blood pressure control achieved in 57.2 percent in the pharmacist group compared to 30.0 percent in the usual care group. A 2016 systematic review of 63 US studies found that pharmacist-led chronic-disease management significantly increases the proportion of patients achieving glycemic (HbA1c), blood pressure, and lipid goals compared with usual care. Pharmacist-led anticoagulation management services significantly reduce bleeding complications, with the American Society of Hematology recommending specialized anticoagulation management services over usual care. Taken together, these findings make one thing undeniable: Pharmacists are fully capable of managing the medication-related aspects of chronic diseases that are currently overwhelming primary care. This isn’t theoretical. This is proven. And, it doesn’t require physicians to work harder, accept less pay, or abandon their training. It simply requires them to share territory.
The AMA had a hand in causing the physician shortage when it lobbied Congress to cap residency training positions in 1997. Health Affairs goes on to explain that the AMA is heavily engaged in protecting turf from other health care professionals who could manage patient diseases and conditions. The organization spent more than $500 million in the past 28 years apposing ‘mission creep’, lobbying state legislatures to oppose other professionals from treating and managing patient care.
There are other things policymakers could do in the short term to allow pharmacists to provide more patient care. In the United States there are two official classes of drugs: over-the-counter drugs (OTC) that are considered safe enough to self-medicate and prescription (Rx) drugs only a doctor can prescribe. Some countries have a third class called behind-the-counter drugs that a pharmacist can dispense without a doctor’s prescription, but that patients cannot access without speaking with a pharmacist. Over the years there has been some talk about creating a third class of drug in the U.S. that pharmacists could dispense on their own authority. These efforts have stalled partly because major retailers like Walmart and the trade association for OTC drugs are afraid a risk-averse FDA would supplant OTC with behind the counter.
Information on diseases and conditions has never been more readily available than today. AI platforms perform as well as physicians in many ways, while allowing consumers to learn more about their health than their doctors would ever have time to discuss. Increasing access to primary care is a worthy goal, especially with 70 million Baby Boomers joining Medicare. It is time to explore alternatives to waiting 45 days for a physician visit or driving across town to the only doctor willing to accept new patients.
Read more at Health Affairs: Stop Pretending Pharmacists Can’t Meet Primary Care Needs