The WEBBlog: A Series of Occasional Commentaries on Policy, Politics, and Practice in the World of Clinical Pharmacy
Why a Pharmacy Team is Essential to Achieving Optimal Medication Use for Patients and Their Health Care Team
November 29, 2017
C. Edwin Webb, Pharm.D., MPH
Washington, DC -- A little more than 50 years ago, I walked into the independent community pharmacy three miles from my house in Tucker, Georgia with a newly issued driver's license and a smile on my face. I was looking for part-time work after school so I could buy the newly released Beach Boys album (Surfer Girl) and to have my own gas money for the 1960 Chevy Corvair that my mom occasionally let me use.
I met Mr. Cheek, the pharmacist/owner. We talked for several minutes and I told him I'd be happy to do whatever jobs needed to be done. He said, “...well, that's a good thing because there is no job too big or too small for employees in a pharmacy. Whether dispensing people their 'pills,' flipping hamburgers on the grill [yes, there was a full lunch counter!] or taking out the trash, I have to occasionally do it all myself. That's our approach here...we expect everyone to be willing, and able, to do it all.”
I got the job. I got to buy the Beach Boys album (with my first paycheck). I dented the fender on the delivery car once, learned how to make burgers on the flattop grill, and, over time, got to spend more and more time working behind the prescription counter with Mr. Cheek. I watched him stay true to his word. I saw him take out the trash, frequently. I saw him educate patients (yes, he called them his patients!) and provide advice. I saw him give patients a week's worth of their medication “on credit” until they got their paycheck the following week. I worked for him until the week before I headed off to college almost two years later. By then, my curiosity about “all things pharmacy” was becoming fully developed. But in no way did I appreciate then how much more there was to learn...and how much more diverse and complex the profession would become.
Fast forward fifty years. The profession's purpose has dramatically changed – and truly needed to – within an increasingly complex health care delivery system. Medication optimization for all patients is now the core purpose of our profession as a whole. Tens of thousands of clinical pharmacists are board-certified in one of 11 currently-recognized pharmacy practice and pharmacotherapeutic specialty areas. Differentiated knowledge, training, experience, expertise, and functions are essential to the optimal use of the thousands of FDA-approved medications now available for patient care.
Technical support, information systems, and robotics have revolutionized the processes of both health-system and community-based pharmacy enterprises, improving efficiency, accountability, and safety. Other health care professionals, themselves highly specialized, expect pharmacists to contribute to their own work success AND to their patients' care in many meaningful and differentiated ways. This happens with increasing frequency as pharmacists become fully-imbedded within interprofessional practices. Designing and managing optimized and evidence-based medication regimens is now a full-fledged team sport.
At the same time, expanded and re-invigorated community-based pharmacist services enhance medication access and link patients to social support services. Vaccination and other health promotion/disease prevention programs are increasingly available. Assistance in accessing and supporting adherence to an optimized regimen are vital elements of the “enhanced services” provided by a growing number of progressive, community-based, independent pharmacy practices.
Collaboration between practice-based and pharmacy-based pharmacists is becoming an essential partnership for patient-centered care – and a necessity for pharmacy's own successful future. We are increasingly aware that a perfectly optimized medication regimen – evidence-based and tailored to individual patients' conditions by the clinical pharmacist – provides less than full value if the services that assure patients' ability to access, afford, understand, and appropriately engage in medication use are not also provided and supported at the community level. At the same time, well-meaning adherence, special packaging, refill synchronization, and related services can be problematic and may even result in wasted effort/expense if they are implemented indiscriminately in support of a sub-optimal or insufficiently managed and adjusted regimen.
In short, optimizing medication use requires the full spectrum of services and professional expertise that reside in our evolving and astoundingly diverse profession. Helping build and deploy effective and functional PHARMACY TEAMS comprising pharmacists and pharmacy technicians with truly diverse skills, abilities, knowledge, and interests is an emerging objective of ACCP as an organization. We hope to partner on this issue with interested, serious partners in the months and years ahead. To view this team concept through the lens of a fairly simple graphic, see the depiction below, which was introduced during last month's ACCP Annual Meeting in Phoenix.
Successfully achieving medication optimization for our patients will require the profession to EMBRACE, USE, and CELEBRATE its diversity. The time has come for the “tribal mentality” of pharmacy to be set aside once and for all. It no longer serves us well – and it certainly doesn't serve our patients.
I like to think that Mr. Cheek, if he were still with us, would be both amazed and proud of what his profession has become. And I think, because he was a very bright man, he would have evolved his own thinking about the expectation – or ability – of any individual pharmacist in 2018 and beyond to realistically “do it all” for the patients she serves. It's a belief whose time is long past.