PHARMACY

Granting provider status could improve health outcomes

BY DSN STAFF

The mounting shortage of primary care physicians across the United States and the growing recognition that patients’ health care often is best delivered by a team of professionals working together are fueling a nationwide movement to give more pharmacists provider status.

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“As the healthcare system undergoes a major transformation in both finance and the delivery of services, states are focusing on improved quality and health outcomes,” National Governors Association executive director Dan Crippen said earlier this year when the group released “The Expanding Role of Pharmacists in a Transformed Health Care System,” a white paper suggesting ways states can make pharmacists a more integral part of the country’s healthcare delivery system.

Because medication management plays a central role in treating illness, the report stresses that making pharmacists part of chronic care delivery teams could go a long way to improving outcomes and reducing costs.

According to the National Alliance of State Pharmacy Associations, as of last September, 37 states grant pharmacists some degree of provider status. Thirty of these states provide payment to pharmacists for their services, with 17 covering services provided to Medicare patients and nine paying for Medicare medication therapy management. In addition, a handful of state-run Medicaid programs cover the cost of pharmacists’ services.

Pharmacy advocates say that lawmakers in Nebraska and North Dakota — two of the states that do not currently recognize pharmacists as providers — are considering legislation to give them this designation, while several other states are looking at extending pharmacists’ scope or allowing them to be more involved in patient care through collaborative practice agreements.

“The amount of patients having difficulty accessing health care has increased,” American Pharmacists Association SVP of pharmacy practice and government affairs Stacie Maass said. “It has created opportunities for other healthcare providers, and we think pharmacists are the perfect group to do this.”

“Pharmacists can help with many of the known problems in the current healthcare system,” she said. “When pharmacists are involved access is increased, quality is improved and costs are reduced.”

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PHARMACY

Telepharmacy is ‘next frontier’ of pharmacy practice

BY DSN STAFF

As community pharmacists take on a greater role in patient care, people living in remote rural areas often are unable to take full advantage of the services these professionals offer.

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In an effort to remedy the situation, a handful of pharmacy providers, technology companies and educational institutions have been developing sophisticated telepharmacy systems to ensure that even those living hundreds of miles from the nearest drug store can consult with a pharmacist.

Currently, about half of the states and Washington, D.C., allow telepharmacy, while more than a dozen others states are either considering it or have pending legislation to allow the practice.

“Telepharmacy services produce the same quality as the traditional mode of delivery and provide some value-added features that are not found in traditional pharmacy practice,” said Charles Peterson, dean of the North Dakota College of Pharmacy, Nursing and Allied Sciences and the director of the school’s decade-old ND Telepharmacy Project.

More than 80 pharmacies across North Dakota, and a portion of neighboring Minnesota, offer telepharmacy services, including more than 50 retail pharmacies and nearly nearly 30 hospital pharmacies.

One of the most active drug chains in the project is Thrifty White. The 91-store chain began offering telepharmacy in 2003 with a single site. Since then, it has expanded its effort to include eight sites in North Dakota and Minnesota. Operating in communities with populations of fewer than 1,000, Thrifty White’s telepharmacy sites offer patients the opportunity to video conference with a pharmacist and get medication therapy managment. Prescriptions at the telepharmacy sites are filled by technicians and verified by the consulting pharmacists at the central location.

Pharmacy executives and the providers of the techology behind telemedicine systems say the telehealth services have allowed patients living in these small towns to get a level of care they would not have otherwise been able to receive.

“Telepharmacy represents the next exciting frontier in the practice of pharmacy,” said Mike Coughlin, president and CEO at ScriptPro, one of the first companies to offer telepharmacy systems.

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Patients look to pharmacists for POC testing

BY Richard Monks

With the United States expected to face a growing shortage of primary care physicians over the next decade, support for point-of-care testing in community pharmacies is growing.

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“While patients continue to look to their pharmacist as a steward of medication safety and effectiveness, more and more patients are looking to their pharmacists to provide innovative services that further help maintain their health-and-wellness, including point-of-care testing,” National Association of Chain Drug Stores president and CEO Steve Anderson said this spring after the association kicked off its Community Pharmacy-Based Point-of-Care Testing certificate program.

According to a study published last year in the Journal of the American Pharmacists Association, one of the most immediate impacts that point-of-care testing in pharmacies can have is helping prevent and treat such infectious diseases as influenza, group A streptococcal pharyngitis, HIV and hepatitis C.

Proponents of point-of-care testing in pharmacies said providing these services could help ensure a bright future for pharmacies across the country.

“It’s a matter of being prepared to meet the opportunities presented to us,” said Stephanie Klepser, clinical director at the specialty pharmacy Optimed LLC; Michael Klepser, Ferris State University College of Pharmacy professor; and Emily Burley, a PharmD candidate at the school, in a story in the group’s journal Michigan Pharmacist. “A pharmacy work force skilled in physical assessment and use of POC tests, and that is eager to enter in to collaborative disease management programs with physicians, is just what the profession needs.”

However, those pushing for more point-of-care testing in pharmacies admit that there are hurdles to be cleared before testing in pharmacies can become widespread.

Regulations concerning testing vary from state to state and are often vague, experts said. Only eight states address point-of-care testing in their pharmacy practice acts, and only five of those specify which tests pharmacists are allowed to perform.

Data from healthcare researchers suggested, however, that a growing number of community pharmacies are finding ways to offer point-of-care testing. Since 2004, for instance, the number of pharmacies with a certificate to offer services waived under the Clinical Laboratory Improvement Amendments of 1988 — including point-of-care testing — has nearly tripled.

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