How Pharmacists Alleviate Primary Care Shortages

Many in community pharmacy worry that there are too many pharmacists for not enough jobs-whether it’s true or not is up for debate. Physicians, however, face the opposite problem: the Association of American Medical Colleges (AAMC) predicts a shortage of 122,000 physicians by 2032.¹

This has led some to ask if both problems could create a solution.

Jennifer Palazzolo, RPh, is the owner of Flatirons Family Pharmacy in Longmont, Colorado. Tracy Mahvan, PharmD, BCPP, is an associate professor of Pharmacy Practice at the University of Wyoming School of Pharmacy. Several years ago, Mahvan introduced herself to Palazzolo at the pharmacy (Mahvan precepts at the Salud clinic, a few miles away from Flatirons Pharmacy) and the 2 pharmacists started brainstorming-they both wanted to bring more clinical services into the community pharmacy.

They wondered, “How can an independent community pharmacy partner with providers to offer care management and follow up to their patients?”

Knowing that there was a significant primary care physician shortage, Palazzolo and Mahvan wanted to bridge the gap between pharmacists and physicians. They wanted to show that pharmacists could perform significant services in a physician’s office to free up the physician’s time, so the physician would be able to perform services that only he/she could perform.

According to AAMC, demand for physicians exceeds supply: the population is growing and aging, people are living longer, and 33% of currently-practicing physicians will be over 65 in the next decade and beginning to retire.¹

To help solve this problem, Mahvan applied for a Community Pharmacy Foundation (CPF) grant, knowing the 2 pharmacists would be a great fit for the project. CPF, led by executive director Anne Marie (Sesti) Kondic, PharmD, is a non-profit organization dedicated to advancing community pharmacy practice and patient care delivery through grant funding and resource sharing.

Palazzolo and Mahvan worked in a local physician’s office once a week, performing annual wellness visits and physical exams covered by Medicare, as well as chronic care management. Patients were eligible if they were 65 years of age or older with three or more chronic conditions and receiving primary care at the site.

Before the wellness visit, the pharmacists would look at the patient’s electronic health record to analyze lab tests, medications, and compliance. After taking vitals, the pharmacist would explain that the purpose of the visit was a chance to make sure the patient is up to date on labs, exams, and medications.

Then, pharmacists went through questionnaires that included questions for fall risk, early signs of dementia, and general questions about socioeconomic and demographic information. For example, 1 question asked if patients have access to the food and care they need. Palazzolo says that some do not have money but are too proud to admit that they are struggling financially.

The pharmacists also evaluated the patients’ living conditions and transportation situation. A patient who smokes might become a candidate for chronic care management (which could be performed by the pharmacist over the phone, billing under the physician) with smoking cessation counseling. Other evaluations included checking the feet of patients with diabetes to look for swelling. Essentially, the pharmacists were evaluating if the patients were well and cared for, Palazzolo explains.

By reviewing records and talking to patients, pharmacists also made recommendations to the prescribers. For example, going by the Beers list, an 80-year-old on benzodiazepines could be a fall risk.

Palazzolo said she feels that pharmacists are still “not really viewed as a member of the health care team.” Despite having a great relationship with a physician’s office, the partnership requires constant communication of expectations, and having the physicians let the pharmacists work independently. “It’s a learning curve. Some providers see us as a benefit, while others may feel threatened,” she says.

Overall, the study concluded that despite the challenges, the partnership between pharmacists and physicians helped providers to see more patients every day and led to improved clinical outcomes, more patient care opportunities, and an expansion of billable services. “It opens doors to providing clinical services at the pharmacist level,” Palazzolo says.

Experiences from the CPF grant allowed the pharmacy to expand services that are financially sustainable through billable opportunities or direct patient payments.

If you are a pharmacist and want to explore an opportunity like this, Palazzolo advises networking with successful partnerships already in place.

“This is a great opportunity and niche for pharmacists to add revenue, contribute to patient care, and build relationships,” Palazzo says. “Be prepared for challenges; have a very clear plan. Communication is important-show that you are there to use your skills and help free up the office staff. Be clear about fee payments. All of these things sound easy, but can get complicated and every office and office dynamic is different.”

Palazzolo suggests that if an office is reluctant, offer to start with just a handful of patients and show your value. “You want the office to see you can free up the physician to do higher-level visits.”

Flatirons Family Pharmacy is also part of Flip The Pharmacy. This project, which is a collaboration of the CPF and CPESN (Community Pharmacy Enhanced Service Networks), is working toward transforming community pharmacy by improving patient care and clinical services. The program aims to graduate 1,000 pharmacies over the next five years

Palazzolo’s call to action for pharmacists is to prove their worth. “As the profession of pharmacy continues to change and evolve and face challenges with job availability, pharmacists (especially those of us with a passion for community pharmacy) need to think beyond what we know or what we thought our job would look like. [We need to] be willing to grow into new roles that prove we are an intricate part of any patient's health care team and always deserve a seat at the table, not [be] stuck behind the counter.”

References:

1. New Findings Confirm Predictions on Physician Shortage [news release]. Associtation of American Medical Colleges' website. https://www.aamc.org/news-insights/press-releases/new-findings-confirm-predictions-physician-shortage.