Provider status would bring recognition of pharmacists as full members of the team

Pharmacist in rural Ohio believes lack of provider status creates barrier to continuity of care

 

When “Elaine” quit smoking, she called her pharmacist, Brandon Craig, PharmD, to tell him the good news.

“It was fantastic that she’d quit, but also, that she felt the need to tell me,” Craig said. Elaine is a patient in the SYNC your MEDS program at Discount Drug Mart in rural Lodi, OH.

SYNC your MEDS is a free program that allows patients at Discount Drug Mart who take multiple medications to schedule a monthly appointment to pick up all of their prescriptions at once. Using computerized patient information and face-to-face interactions during clinical encounters, pharmacists identify patients who might be good candidates for the program based on the number of prescriptions they take or prior lapses in adherence. Elaine takes some 15 medications for multiple chronic conditions, and she was one of the first patients enrolled in the program.

“She refers to me as her personal pharmacist. It’s really wonderful to see that I’m having an impact on patients’ lives and that people appreciate the support and education and extra things that we can do,” Craig said. For the past few years, Craig has helped Elaine manage her chronic obstructive pulmonary disease and diabetes, recommended and administered necessary vaccines, and left the door open for her to discuss smoking cessation when she was ready.

In monthly SYNC your MEDS appointments, pharmacists can reinforce the importance of adherence, offer vaccines, talk about lifestyle changes and disease management, and reconcile medications as needed. Arguably, all of the preemptive services that Craig and his colleagues at Discount Drug Mart provide can help keep patients out of hospitals, yet Craig often struggles to get the full partnership of other health professionals in this effort. He feels that lack of provider status creates a barrier between pharmacists and other members of the allied health professions. His story is not unlike others in this series.

As oftentimes the only health care provider with a complete and accurate record of all the medications an individual patient takes, pharmacists have the ability to identify potential problems, such as duplicate or interacting prescriptions, that other providers may never see. However, when Craig calls prescribers to right these wrongs, his calls are often ignored or his requests are denied.

“Sometimes we hear back, sometimes we don’t. Sometimes it’s in a timely fashion, sometimes it’s weeks later,” Craig said. “We’ve had hesitation based on HIPAA. Prescribers’ offices have said, ‘You’re the pharmacy. This is not information you need.’”

Craig believes that provider status would bring recognition of pharmacists as full members of the health care team.

“Other health care providers may not realize everything that the pharmacist is trying to help with. So there’s a barrier to continuity of care,” he said. “If pharmacists had provider status, we would be considered providers on the same playing field with nurse practitioners, physicians, and physician assistants. We could make drug therapy recommendations and work under collaborative agreements to monitor labs for efficacy and safety, and order refills.”

Provider status would also allow Discount Drug Mart to bill payers for the services that its pharmacists provide. Without that mechanism, the program is provided at no cost. It is presently cost-justified based on increasing refill rates and streamlining pharmacists’ workflow. But Craig and other Discount Drug Mart pharmacists know there is so much more that could be done to help patients with complicated medication regimens and coach them about ways to remember to take all the medications regularly.

Including pharmacists as full members of the health care team is particularly important in rural areas, where doctor shortages are as insidious as chronic disease. Fewer than 10% of U.S. physicians practice in rural areas. For this reason, rural Americans often go directly or exclusively to a pharmacist for health care questions and assistance with self-care.

“In this small farming village, patients rely more heavily on pharmacists because it’s difficult to get an appointment with a doctor, and they don’t want to go to urgent care,” Craig said. “Patients trust pharmacists more because they are able to take the time to talk with them about their medications.”

Craig stresses that pharmacists are uniquely trained to address the sorts of problems with medication adherence and medication therapy management that he sees every day at Discount Drug Mart, but lack of provider status often limits what he can do.

“We are a very underutilized profession, and I think patients are struggling and feeling that in turn.”