Managing U.S. population health — pharmacy steps into frontline role
For decades, the pharmacy profession labored under a widespread, but inaccurate, public perception of pharmacists as little more than dispensers of prescription medicines and givers of basic counseling on their use. No more. Pharmacists today are highly trained, clinically engaged patient-care specialists making a huge and rapidly growing impact on population health management in communities all over America.
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“The vast majority of pharmacists today are already doing much more than simply filling prescriptions,” noted Dr. Harry Leider, chief medical officer for Walgreens. “They’re helping patients manage chronic disease, providing medication management services, conducting health tests to diagnose conditions like diabetes or high cholesterol, and administering a wide range of immunizations. They’re also partnering with healthcare providers working in nearby health systems and hospitals, serving as part of care teams to help improve patient health and outcomes.”
It goes without saying that medication dispensing and counseling remain a critically important part of successful health outcomes. That’s even more the case in an era of increasingly specialized, highly targeted biotech drugs requiring careful administration, dosage management and monitoring of their effects.
“Medications play such an important role in the treatment of acute and chronic illnesses, but treatment regimens can be complex and patients often don’t understand how and why to use their medications appropriately,” noted Anne Burns, VP of professional affairs for the American Pharmacists Association.
“Increasingly, pharmacies provide vaccinations, health education and disease state testing and management,” the National Association of Chain Drug Stores reported. “Through personal in- teractions with patients, face-to-face consultations and convenient access to preventive care services, pharmacies are helping to shape the healthcare delivery system of tomorrow — in partnership with doctors, nurses and others.”
As the practice of pharmacy has expanded and evolved, so too has the public’s perception of the pharmacist as a highly skilled, clinically trained frontline health provider. A large majority of Americans embrace the idea of getting vaccinations, point-of-care testing and other preventive health services from their local pharmacist, according to public polling.
In a nationwide survey of consumers sponsored by NACDS in 2015, 79% of respondents voiced support for pharmacists as a resource for “administering vaccinations and immunizations for preventing or treating illnesses, such as the flu, hepatitis, pneumonia and tetanus.” More than 7-in-10 also expressed support for using pharmacy-based retail clinics for primary healthcare services, and nearly two-thirds of those polled said pharmacies should be allowed to administer blood, urine or strep tests.
U.S. consumers also are voting with their feet. Hundreds of thousands of Walmart customers flocked to the company’s first-ever chainwide wellness and screening event — held last October and dubbed “America’s Biggest Health Fair” — for free health tests, low-cost flu shots and counseling. “We did nearly 300,000 screenings, with [more than] 50,000 customers processed per hour,” said Alex Hurd, senior director of product development, growth and payer innovations at Walmart health and wellness. “We had nurses doing the screenings, and our pharmacists did about 52,000 immunizations.”
Among those screened were some 7,000 customers who had little or no insurance coverage. And some 3,000 of those screened were shown to be diabetic or at risk of having diabetes, according to the Walmart executive.
Pharmacy chains also are providing cost-effective and accessible healthcare solutions through a growing network of in-store walk-in clinics staffed by nurse practitioners and physician assistants. More than 2,000 pharmacy-based retail clinics are now open nationwide, according to the Convenient Care Association. They’re offering acute-care services for minor injuries, upper respiratory ailments and other conditions, along with an expanding menu of services to treat chronic disease, with no appointment necessary, at a fraction of the cost of a visit to a doctor’s office or emergency room.
Americans’ new vaccination resource
One of the primary ways community pharmacies now contribute to public health is through vaccinations against a wide variety of diseases. Tens of millions of Americans now get their annual flu shots at their local pharmacy, saving time and money and relieving the stress on the nation’s overburdened family physicians and clinics.
Costco Wholesale’s pharmacies alone provided some 700,000 vaccinations last year for influenza, shingles and other conditions, according to Michael Mastromonica, assistant VP of pharmacy for the wholesale club giant, and this year its pharmacists have begun providing travel vaccinations, as well. He sees immunization and vaccination services as the point of the spear for the whole spectrum of retail health services now offered at community pharmacies around the country.
“You’re starting to see all sorts of changes in the healthcare system that take advantage of the convenience of the pharmacy, with the low cost of a pharmacy relative to a doctor’s office or hospital — and the whole process, I think, is driven by immunizations,” Mastromonica said. “It’s a high-touch [service]. It’s one-on-one in a room, where you’re talking privately about the patient’s health. That whole scenario makes people think of pharmacists differently than they did previously.”
Such pharmacy chains as Costco, Walgreens Boots Alliance, CVS Health, Rite Aid and Walmart have spent enormous time and capital to train and certify their pharmacists to deliver immunizations.
“Walgreens has 27,000 pharmacists, in addition to Healthcare Clinic nurse practitioners and physician assistants, who are certified to provide all CDC-recommended vaccinations, along with other healthcare services, such as blood-pressure testing,” said a company spokesman.
In addition, he said, “Walgreens works with employers and employer groups across the country to have our pharmacists administer flu shots at work site locations. By offering flexible schedules, we can reach the largest number of people and ensure they get vaccinated.”
According to the American Pharmacists Association, more than 200,000 of the nation’s roughly 300,000 practicing pharmacists are already certified to provide immunizations.
In a national survey of practicing pharmacists, APhA found that “the availability of immunizations in pharmacy practices has increased, with 8070 of practice sites offering immunizations on a walk-in basis, compared with 7770 in 2013.”
An expanding role in disease prevention
The positive impact that pharmacy-based immunization programs have had on preventive health efforts can hardly be overstated. With their ability to reach millions of Americans every day at retail pharmacy counters nationwide, drug, supermarket and mass merchandise chains have become the chief source for influenza vaccinations in the United States outside of doctors’ offices. And besides their widespread availability, those vaccinations also are significantly cheaper when delivered in a pharmacy: an average of $31 cheaper, according to one study.
Pharmacy retailers also collaborate with federal, state and local public health agencies, accountable care organizations and other entities to improve pandemic vaccine preparedness, noted NACDS president and CEO Steve Anderson. “Health authorities have credited pharmacies for improving the accessibility of immunizations, in times of public health emergencies and in meeting ongoing health needs,” he said. The goal, he added, is “to drive population health by leveraging and magnifying the success of accessible, pharmacy-based immunizations in collaboration with other healthcare professionals for the good of patients nationwide.”
In October, the Centers for Disease Control and Prevention commended the pharmacy profession for its efforts to advance immunizations through its pharmacist training and certification efforts. “Over the last 20 years, pharmacists have played an expanding role in reducing the risk of vaccine preventable illnesses,” wrote Anne Schuchat, assistant surgeon general and principal deputy director of the CDC.
A reputation for honesty, trustworthiness
In the nation’s hierarchy of most-trusted professions, where does the community pharmacist stand? Near the very top of the list.
Again in 2015, pharmacists ranked second only to nurses among all professions in Gallup’s annual Honesty and Ethics survey. That makes the 13th year in a row that Americans have ranked pharmacists among the top three of all professions in terms of trustworthiness and ethical standards.
The annual poll was conducted Dec. 2 to 6, 2015, with a random sample of 824 adults, ages 18 years and older, living in all 50 U.S. states and the District of Columbia. More than two-thirds of all respondents gave pharmacists “very high/high” marks for honesty and ethical dealings, slightly ahead of medical doctors, high school teachers and police officers.
“Nurses, pharmacists, medical doctors and high school teachers remain untarnished at the top,” according to the Gallup poll.
“The survey results reflect the remarkable trust that patients continue to place in their pharmacists, and for strong and important reasons,” said National Association of Chain Drug Stores president and CEO Steve Anderson. “Pharmacists are highly educated and highly accessible professionals. They are highly valued in neighborhoods across America, and particularly by those in the greatest need.”
In addition to the latest Gallup poll, “NACDS’ own opinion research shows another interesting finding: that those who have more first-hand experience with pharmacist-provided services feel even more strongly about their value,” Anderson added.
“These positive attitudes are translating into ever-stronger bipartisan support for pro-patient and pro-pharmacy initiatives in the U.S. Congress, as well as an expansion of the pharmacists’ scope of practice in the states,” added NACDS’ top executive.
Endorsing pharmacists as healthcare providers
“The positive, reverberating news about pharmacists marks a great beginning of the year for pharmacists, and gives well-deserved credit for the essential and expanding part they play as trusted healthcare providers, bridging gaps to care for the patients who need it most,” NACDS reported. “The professional validation comes at a time when pharmacists are positioned extraordinarily well to fill gaps in patient access to care.”
Indeed, national opinion surveys conducted on behalf of the pharmacy organization show that a large majority of Americans strongly embrace pharmacists’ expanding role as healthcare providers for a wide array of walk-in services.
The most recent such poll, conducted via the Internet among 1,000 informed likely voters in late July 2015, asked respondents whether they thought a pharmacy should be allowed to offer several types of health services, and whether they would seek out those services within a pharmacy. The results were eye-opening: 83% of respondents view pharmacies as appropriate settings for basic health services, and nearly 8-in-10 voters see them as a source for vaccinations and immunizations. More than 7-in-10 of those polled support the use of pharmacy-based primary healthcare clinics.
“There continues to be overwhelming support for allowing pharmacies to offer … new healthcare services, with notable increases since 2013,” according to the polling organization, Public Opinion Strategies.
A separate poll last year also showed strong support among Americans for legislation that would give pharmacists full status as healthcare providers, with 82% of those surveyed expressing support for provider status legislation.
To see the full report, click here.
Pharmacies emerge as centers for health screenings
One of the most promising recent developments in the nation’s search for a more accessible and cost-effective healthcare system has been the rapid rise of health events and free testing services at chain and independent pharmacies. The events have boomed in popularity over the past few years, to the benefit of millions of Americans.
These “non-traditional mechanisms to engage patients,” said Alex Hurd, senior director product development, growth and payer innovation at Walmart health and wellness, are helping hundreds of thousands of Americans spot potentially dangerous conditions like diabetes and high blood pressure early.
“Knowledge is the first step in your personal journey to health improvement, and you can’t take action unless you know that you have issues,” Hurd pointed out. “It’s about early … detection and prevention, and providing access points for health services for millions of Americans who normally don’t engage with the system, either because they lack health insurance, lack the time or simply because they don’t go."
“We’ve heard hundreds of stories of customers who sought out medical professionals [after being screened],” he added. “And from a public health perspective, if you look at the sheer amount of traffic we see, [with] 140 million customers every week … it just makes sense.”
Indeed, the positive impact that these health screenings are clearly having on population health are spurring companies like Walmart to expand the scope and frequency of the events. “They’re not just important for Walmart; I think they’re critical to the health of our country,” Hurd asserted. “They represent one of the most exciting trends in health care in the last decade, and one of the simplest mechanisms out there for spreading massive health awareness. I am absolutely convinced that these types of community-based health programs will play a key role in creating a more sustainable health system for our country.”
Added a spokesman for Walgreens, “the main focus … is to bring needed healthcare services to where people live and work. The response has been extremely positive at events within our stores, as well as those we host within the community.”
Here’s a look at what just a few pharmacy chains are doing:
• Between October 2015 and January 2016, CVS Health hosted nearly 750 Project Health events at select stores in 20 markets, “delivering more than $10 million worth of free health services to multicultural communities with a significant number of uninsured or underinsured individuals across the United States,” said David Casey, the company’s VP of workforce strategies and chief diversity officer. ”Since 2006, Project Health has delivered more than $80 million worth of free healthcare services to more than 845,000 people,” Casey added.
• Walgreens hosts or participates in a variety of health events throughout the year, often in partnership with other national or local community health providers — and even with the federal government. “When appropriate, and as often as we can, we utilize our own providers for health events,” a Walgreens spokesperson explained.
• Rite Aid rotates monthly health fairs through many of its more than 4,200 stores, offering screenings for conditions like osteoporosis, diabetes, hyperlipidemia and skin diseases, as well as counseling on healthy eating, heart health and smoking cessation. The chain also sponsors mobile screenings with specially equipped buses, staffed by physicians and nurses, that will park at store locations to offer free tests for skin conditions and diabetes, as well as free annual wellness screenings for patients age 65 years old and older.
• Costco Wholesale’s pharmacy team organizes hundreds of individual store health events each year, offering free screenings for osteoporosis, heart and lung health and, most recently, diabetes.
To see the full report, click here.