The ever expanding role of pharmacists

Lately I’ve found myself thinking about how pharmacists are involved in healthcare. Despite popular belief pharmacists do more than simply work in the pharmacy.

Throughout my career I’ve become accustomed to people viewing pharmacists as the stereotypically person behind the counter at the drug store “counting pills”. While that’s not all pharmacists do, I’ve learned to live with the general publics simplistic view. I don’t think most people realize that pharmacists are involved in every aspect of a patient’s care. If you’ve ever been in a hospital, received a prescription medication, had a loved one in a long term care facility, received intravenous medications at home like total parenteral nutrition (TPN) or antibiotics, received an albumin or intravenous immunoglobulin (IVIG) infusion in an outpatient infusion center or met with a pharmacist in a clinic setting for a medication therapy management (MTM) session, then you’ve been touched by a pharmacist.

So, what are some of the roles filled by pharmacists? That’s a good question, and one that I take a look at in more depth below.

Traditional roles filled by pharmacists in healthcare:

Operations
I don’t believe that a pharmacist needs to see every single item dispensed from the pharmacy, but I do think global oversight is necessary. Many believe that working in operations doesn’t constitute clinical work, but I believe that’s a false perception. There are opportunities for interventions in all aspects of pharmacy practice. I began my career as a “operational specialist”. I spent about a year in this role and found great value in the lessons learned through trying variations on the age old themes of cart fills, ADC replenishment, IV batches, etc. I believe I made several valuable contributions to patient care along the way.

The need for a pharmacist trained in automation and technology with additional skills to manage people and workflow is not uncommon in the acute care setting. After all, it is still important that patients receive their medications as safely and efficiently as possible.

You’ll find operational pharmacists in acute care pharmacies, outpatient pharmacies, home health pharmacies and long term care pharmacies. That’s pretty broad coverage.

Benefits of using an operational specialist:

• Increased efficiency via better use of technicians, workflow and automation and technology.
• Increased safety via pharmacist oversight
• Cost reduction via increased efficiency and inventory management

Clinical specialists
Pharmacists are taught that their role in healthcare is to provide safe, effective and economically sound drug therapy for their patients. Organizations like ASHP have continually advocated for pharmacists to be more involved in direct patient care, and we’ve seen this area of pharmacy practice grow significantly over the past two decades. Today pharmacists actively participate as a valued member of the healthcare team in many healthcare systems throughout the country.

Clinical pharmacists not only work in the acute care setting, but have spilled over into long term care and outpatient areas as well. They’re called “consultant pharmacists” in long term care, but their role is to evaluate a patient’s drug therapy and make recommendations when change is necessary. And pharmacists in the outpatient setting have been slowly involving themselves in a more active clinical role by offering services such as medication therapy management (MTM) where they’re making a positive impact on patient care.

Benefits of using a clinical specialist:

• Saved dollars via decreased errors, decreased adverse drug reactions, rational medication choice. These things are well documented in the literature.
• Increased safety via medication therapy oversight
• Better patient care via involvement in the medication selection process at the bedside. The simple act of telling a physician that something isn’t on the hospital formulary before the item is ordered will save the physician, the pharmacy and the nurse time and prevent unnecessary phone calls.

Automation and technology / informatics
Pharmacy informatics continues to grow. It’s more of a hybrid position at the moment as IT pharmacists tend to be involved in operations as well as automation and technology. But as clinical decision support, rules engines, computerized provider order entry, and so on become more prevalent it will become necessary to create new roles to embrace the speed at which technology is impacting pharmacy. In fact there may be a time when pharmacists need to be involved not only in operations and informatics, but be further split into two separate IT specialties; one for clinical pharmacy software and another for pharmacy automation and technology. There’s plenty going on in pharmacy informatics to justify such a design.

Similar to pharmacists that have chosen to specialize in Cardiology or Infectious Disease, I think we’re headed for a time when informatics pharmacists will begin to tease out specialized roles in healthcare information technology. Whatever the future, it’s clear that pharmacy informatics has become a necessity rather than a luxury in larger healthcare systems. However, what remains unclear is where IT pharmacists will make the biggest impact. Currently acute care seems to be their playground, but I see the need in long term care and outpatient pharmacy as well.

Benefits of using an IT pharmacist:

• Increased efficiency, increased safety and reduction in cost via better use of automation and technology.
• World domination. Just threw this one in to make sure you were paying attention.

Non-traditional roles filled by pharmacists in healthcare

I’ve met some pharmacists lately that don’t fit the stereotypical roles mentioned above and I think it’s worth mentioning their expanded roles in healthcare.

Drug Trials
Even though pharmacists have historically been involved in drug trials I’m starting to see expanded roles in this area, and it makes perfect sense as pharmacists are very good at managing patients and their medication regimens. Pharmacists as a group tend to be meticulous and detail oriented, and are starting to leverage these qualities along with their expertise in a role that screams for a pharmacist, i.e. as the person in charge of drug trials for a pharmaceutical company or academic research center.

Formulary management/purchasing
Pharmacists have always been involved with drug formulary selection in hospitals, typically as a member of the Pharmacy and Therapeutics Committee. However I’ve met a couple of pharmacists lately that have a primary responsibility to control both formulary selection and purchasing for the healthcare system. I’m not sure how I feel about this role yet, but it makes sense on the surface. Pharmacists have a unique view of medication selection based on both economic and therapeutic value. It’s more than just buying the cheapest thing on contract. Selection of a therapeutic agent requires literature review and due diligence to ensure patient safety and the best possible outcomes.

The value of a pharmacist in this role has yet to be determined. I’d be interested to see a study looking at how this role impacts not only the economics of a healthcare system, but patient outcomes as well.

Leaders
Pharmacists typically stop advancing through the ranks of administration when they reach the pharmacy directors role. With that said I’ve now met several pharmacists that have gone above and beyond the role of pharmacy director and taken a more active role in directing the vision of an entire healthcare organization. Involving pharmacist in the hierarchy of the healthcare leadership structure is important because, as previously mentioned, pharmacy is involved in many aspects of the healthcare model. This will become more important in the future as the ACO model is expanded, perfected and implemented. Patient outcomes are often linked to medication management, lack of adherence to medication regimens and adverse drug reactions, and there is no one in healthcare better suited to oversee these issues than a pharmacist.

And that’s what’s going on in the world of pharmacy as I see it today. If you know of any pharmacists that are working in non-traditional or expanded roles in your healthcare system I’d love to hear about it.