A sometimes-overlooked part of an interprofessional healthcare team is the pharmacist, though in recent years that has begun to change, given patients’ increasing needs and the interdependence of those teams, which typically consist of a medical doctor but can also include nurses and various other specialists.
The role of the pharmacist cannot be overstated, however, as it involves pain/disease management, medication procurement and management, the interpretation of data, and the administration of tests. The pharmacist serves not only as an advisor to other healthcare professionals, but as an advocate for the patient. He or she can educate those in need of care, and also prevent administrative errors on the part of the team.
These responsibilities have become that much weightier, given the increased prevalence of chronic diseases. According to the Centers for Disease Control and Prevention, 60 percent of Americans are living with at least one chronic condition, and heart disease and cancer are the nation’s two leading causes of death. Moreover, the CDC reports, 90 percent of yearly U.S. healthcare spending — a sum of $3.42 trillion — goes toward those suffering from chronic conditions, whether physical or mental.
The pharmacist, more involved in a patient’s direct care than ever before, thus has an “incredible opportunity … to improve patient outcomes” in the estimation of one observer. Those pharmacists within a hospital have shifted from a distribution- to service-based role, and those not within a healthcare facility are more accessible than ever, as reflected in the fact that 90 percent of Americans live within five miles of a pharmacy. Moreover, one 2020 study showed that pharmacists devote 15 hours a week to patient-care services.
Another study, completed this year, ascertained that there are five dimensions to the pharmacist’s role on the care team:
The study, like others before it, identified one of the pharmacist’s crucial roles as collaborating with other members of the team — the doctor foremost among them — to identify the best care journey for the patient. That has become an even greater challenge, given the strength and complexity of the medications used to treat those suffering from chronic conditions, as well as problems with adherence relating to cost, side effects and other factors.
It falls upon the pharmacist, as the team member most familiar with the drugs and presumably the one in whom the patient places the most trust on the topic, to enlighten that person and identify next steps.
This involves drug procurement and management, the study notes, and is especially crucial given the overlap between pharmacists and other members of the team, as well as the potential for error. Other studies have concluded that oversight on the part of a pharmacist (as opposed to that of a clinician) results in fewer prescription errors; one, undertaken at St. Elizabeth Healthcare in Edgewood, Ky., showed that they were reduced from 2.8 discrepancies per patient to 0.5 per patient.
It is vital for the pharmacist to perform an initial assessment of the patient, monitor his or her response to medication therapy, and modify if need be, all while documenting the care journey and communicating with the rest of the team.
The pharmacist can set the tone for the team by helping everyone see the care journey with the same set of eyes, and tailoring treatment accordingly. This has been notably evidenced at a pharmacist-run hypertension clinic in Springfield, Mass., where patients can consult directly with pharmacists about their medication regimens.
Another example is the Kaweah Delta Medical Center in Visalia, Calif., which features a pain-management consultation program for patients on the medical and surgical floors, enabling them to meet with pharmacists who in turn can make recommendations to the healthcare team. In addition, pharmacists perform daily reviews of data on patients using opioids, especially those designated high-risk users.
This manifests itself in several ways — pain management, understanding the interactions between medications, extending or deprescribing medications when the need arises, and making sure patients are educated about all they are experiencing, throughout the chain of care.
A particular example is a manner in which a pharmacist can close gaps in medication management, particularly during transition care. That can be done by providing an up-to-date medication list to the patient and provider at discharge.
Such is the nature of chronic disease that patients often must use multiple medications. One expert told the New York Times in 2019 that two of every three older adults are taking at least five drugs a day, and nearly three in 10 are taking at least 10. Studies have also shown that 30 percent of seniors fill prescriptions that need not be refilled, leading to concerns about falls and cognitive impairment.
The Times piece noted that physicians don’t always have a full picture of patients’ medication usage. Studies have concluded that those patients closely monitored by pharmacists — pharmacists who can communicate their needs to the healthcare team — achieve better outcomes.
It is clear, then, that pharmacists perform an integral role on the healthcare team — that by managing a patient’s medication, educating the patient, and keeping physicians informed, they make a marked difference. And that is especially true in the case of those patients suffering from chronic diseases.