Drugs are the most efficient way to treat most diseases and conditions. Prescription drugs account for just under 12% of health care expenditures. Hospitals, by contrast, are the most expensive way to care for patients. About 37% of medical spending is on hospitals, while one-quarter (24%) is on doctors and clinical services. The best deal in health care by far are over the counter (OTC) drugs, accounting for only about 1% of health care expenditures. Over the years I have often cited the figure that more than 60% of care, at least initially, is self-care when patients treat themselves with OTC drugs. As an aside, if we really want to boost access to care we need to force the FDA to move more prescription drugs to over the counter, or even behind the counter. A behind-the-counter drug is a drug that pharmacists are authorized to dispense without a prescription. Over the counter drugs, behind the counter drugs and prescription drugs are all available at pharmacies. Perhaps there should be more care available at pharmacies. More on this below:
Greater use of pharmacists to treat minor illnesses could potentially save millions of dollars in health care costs, according to new research. The findings also indicate a way to improve healthcare access by expanding availability of pharmacists’ clinical services including prescribing medications, amid an ongoing shortage of primary care providers. The study found that care for a range of minor health issues — including urinary tract infections, shingles, animal bites and headaches — costs an average of about $278 less when treated in pharmacies compared to patients with similar conditions treated at ‘traditional sites’ of primary care, urgent care or emergency room settings. Follow-ups with pharmacy patients showed that almost all their illnesses had resolved after the initial visit with a pharmacist.
This is not the first time researchers have found pharmacists can provide high quality patient care at bargain prices. The Asheville Project enlisted pharmacists to work with physicians to better manage diabetes for Ashville, North Carola city employees. The experiment worked well. More about the recent Washington study:
For this study, published in the journal ClinicoEconomics and Outcomes Research, Akers’ research team analyzed data of nearly 500 patients who received care from 175 pharmacists at 46 pharmacies across the state of Washington from 2016 to 2019. The team also followed up with the patients 30 days after their pharmacy visits to assess treatment effectiveness. They then compared these cases with insurance data of patients from the same time period with conditions of the same type and level who had sought care at a doctor’s office, urgent care facility or emergency room.The researchers found that for almost every minor illness in the study, pharmacy care was not only effective but cost much less, sometimes dramatically so. For instance, the study found that for an uncomplicated case of urinary tract infection, normally treated with antibiotics, a first visit to an emergency room cost on average $963, a primary care physician’s office, $121 — at the pharmacy, the average was $30.
To reiterate the previous sentence: treating a UTI at a pharmacy costs one-fourth what it did at a primary care physician’s office. Treating a UTI at the pharmacy costs about 3% of what it costs at the ER.
Primary care providers are in short supply and millions of Americans lack access to primary care. This research, and other studies like it, illustrates that a partial solution to the primary care provider shortage is found on just about every street corner in my town: a local pharmacy. I have heard pharmacists referred to as the most overeducated, underutilized professionals in health care. An easy way to boost access to care is to allow pharmacists to treat minor conditions.
Some additional ways to boost access to care that are not in the Washington study includes allowing pharmacists to access more drugs (from behind the counter) that they can dispense without a doctor’s prescription. Also, for the FDA to switch move more prescription drugs to over the counter. It should go without saying that more states should make provisions to allow foreign-trained physicians to practice medicine in the United States if they have already gone through residency abroad. And of course, find a way for all those medical school graduates who did not match to a residency to work with physicians caring for patients. For that matter, boosting primary care residencies would help as well.
There are numerous simple reforms that would improve access to care for millions of Americans. Some of these should start at the local pharmacy.