Our healthcare system remains in a constant state of flux. Our physicians are spending lesser time with patients than ever before, and are relying increasingly on personnel such as physician assistants and nurse practitioners to bridge the gap. In the absence of meaningful global healthcare reforms, the ratio of medical personnel to patients is expected to worsen.
Enter the new superhero, the clinical pharmacist. When we think of a pharmacist, we visualize a person at a drug store filling prescriptions and providing us instruction on how to take them. A clinical pharmacist works at a completely different level, operating in a team-based environment in close association with medical professionals and patients. This requires a doctor of pharmacy degree and a license to practice. The clinical pharmacist’s advanced understanding of pharmacotherapy puts them in a knowledgeable position to prescribe medication and monitor patients, a burden that is steadily shifting their way as our healthcare environment continues to evolve.
Today, we have over 117 million people in the United States suffering from at least one chronic disease, and those numbers are rapidly increasing. These disease conditions are complex, requiring multiple medications, detailed instructions, and long-term monitoring to ensure continued medication adherence. Medication non-adherence is an increasing problem that is already costing the healthcare system $100 to 300 billion every year in North America alone. A 2013 NCPA study puts our nation at a C+ rating on the non-adherence scale, with 36% of the diseased population essentially claiming to be almost, if not completely, non-adherent.
A clinical pharmacist can effect positive change by helping patients get better educated about their disease and medication regimens. Doctors can give the pharmacists control on prescribing drugs and monitoring patient condition. Studies have shown that access to a licensed pharmacist can result in lower costs, and improved patient safety and medication adherence. Medication Therapy Management (MTM) services that afford a comprehensive review of medication programs have been shown to improve outcomes.
In 1995, the University of Pittsburgh established the Grace Lamsan Pharmacy Program run by volunteer pharmacists and students that provides free services to its local impoverished population (90% of the patients have an income below 150% of the poverty level). A study conducted there in 2007, identified diabetes, hypertension, and hyperlipidemia as the major disease concerns, and non-compliance as the biggest treatment problem. Intervention by the clinical pharmacy resulted in a sizable net savings of approximately $243 per month per patient. Not only that, key health statistics such as blood pressure, A1C, and LDL values were all shown to improve.
This example clearly demonstrates that the clinical pharmacy has a defined place in our world of healthcare, and is part of the solution as we grapple with the greater challenges ahead of us.