Q&A: Pharmacists’ Play Key Role in Alleviating Primary Care Gap

Between their expertise in medications and an ever-increasing gap in the primary care workforce, pharmacists are specifically positioned to assist prescription regimentation and be key members of a primary care team. With real-world evidence showing pharmacists’ accelerated capabilities within prescription drugs, health systems can utilize pharmacist expertise to alleviate primary care gaps and improve patient outcomes.

“We're seeing that…outcomes are superior when we have pharmacists involved in designing and optimizing the medication regimens. We really see that that leads to superior outcomes, and it makes sense. As the medication specialists, they just have more expertise on what the implications are, what needs to be added, what needs to be reduced,” said Jonathan Watanabe, PharmD, MS, PhD, BCGP.

Watanabe co-authored “Addressing the Gap in Primary Care,” a subsection of the American Society of Health-System Pharmacists (ASHP) 2025 Pharmacy Forecast. He joined us to explore the pharmacists’ role in addressing primary care gaps and their unique expertise that sets them apart as providers. In part 1 of our interview with him, Watanabe discussed how providers have identified primary care gaps and the potential legislation that could address those gaps.

READ MORE: Q&A: The Importance of ASHP’s 2025 Pharmacy Forecast

Drug Topics: How can a collaborative care program address gaps within pharmacy?

Jonathan Watanabe: That's going to be a key component. Think what we've learned through outcomes. Basically, team-based care translates to better outcomes, if we could just really find ways to make it more efficient in terms of teaming the partners where they can have superior outcomes, where it plays to their expertise. We can shore up gaps so more people can have the appropriate time, whether it's the primary care physician as sort of the quarterback for the team. But that shores up time if you can have the pharmacist more involved in managing [and] designing the medication regimen. That alleviates pressure on other members of the health care team to do what's best in their expertise.

I think we're seeing that more and more in the data that outcomes are superior when we have pharmacists involved in designing and optimizing the medication regimens. We really see that that leads to superior outcomes, and it makes sense. As the medication specialists, they just have more expertise on what the implications are, what needs to be added, what needs to be reduced. How do we make regimens less complex? What are the moments where we do need to add medications? Oftentimes, that's what we're seeing as well. It's not always just a case of deprescribing. I think we're seeing that there's more and more situations where gradual dose reduction [and] deprescribing could be had. But there's plenty of realms now, particularly with the advances we're seeing in medications, where there's medications that are missing and only a pharmacist can be involved in that. [It’s] really just finding ways to better organize the team so we can have superior outcomes.

There's been several studies that have shown that that benefits other members of the health care team, particularly the physicians. That's translated to a reduced work burden, potentially improving patient satisfaction, reducing burnout. Those are aspects that a pharmacist can assist with. But the caveat is, we just have to make sure that that's done almost always with the wellness of the pharmacist in mind. When we really think about the provider, the pharmacist [should] not [be] left out of that dialog, because we saw that also during the pandemic. Pharmacists took on this heroic role, but that role, that emotional toll, the time, and the fatigue, those components weighed heavily. We have to be really strategic about incorporating that, otherwise the gains that we're going to have, potentially for pharmacists being involved, are going to be short lived. We just have to be really mindful of how we can do this in the long game to make sure that it leads to long-term population-level gains.

Finally, we have to be wise about how we make this sustainable, and that means economically sustainable. All this can't be done without finding ways that we reimburse for those activities, whether it's global payment, value-based arrangements. How do we make sure that we make pharmacists whole for these contributions that they're making to primary care? I think a lot of that really needs to be looked at and there's groups that are doing it, but I think we need to enhance that.

Drug Topics: How exactly are pharmacists positioned to address gaps within primary care?

Jonathan Watanabe: I think some of those are still being really delineated. Really, I think we're just getting more and more information. We've been doing it for a long time in so many different settings. Think about what we do in the [Veterans Affairs], or some of the roles for clinics like Kaiser Permanente. These have been long-standing, where pharmacists have been charged with running clinics. But in many settings outside of that, beyond vertically integrated systems, that's still sort of being developed. In academic health systems, oftentimes, you see these pharmacist-led clinics that are very successful with demonstrated outcomes, but there's a lot of variability. If you've got rural settings, other settings that are less robustly situated, that are not a part of large health systems, how do we organize there? How do we make sure that these gains can be deployed in different settings. Protocolizing [and] coming up with how we right-size these for different clinics and different settings still needs to be developed. I think we see that there's success from almost anywhere we've looked when we have pharmacists involved in looking at the medication regimens. There's been opportunities for improvement in outcomes. That's sort of always been there.

I think, in some hospital settings recently, they looked at trials [that] didn’t improve some of the mortality outcomes. Even when those ones weren't statistically significant, they still saw an improvement in terms of reduction in inappropriate medications. So, there's almost always gains, but how do we deploy those in such a way that it makes sense for the setting, for the care team, given that we have seen a reduction in people entering pharmacy school? All these things, I think, make it really important that we're deliberate about how we're going to approach it. This can't be done in a cookie-cutter way. I think we're getting better at understanding how collaborative practice agreements can be best developed to maximize. I think it's almost the implementation science of it is now becoming very important. We know that it works, but how to do it in a way that's going to meet the needs of the setting, of the population, that we could show the benefit, that we can make it sustainable even when the grant that's supporting it dries up. I think all those things become more and more relevant as we understand this.

I was a part of a committee that looked at medications for opioid use disorder, and that was from the White House Office of National Drug Control Policy. It was a physician that spurred that effort. But when I was looking on the 4 items, the second or third item was ‘How can we better integrate pharmacists and pharmacies in alleviating the opioid use disorder crisis?’ So, people know that pharmacists are going to be the best tool, [in] many ways, to try to address these problems, but how to do that in a way that makes the most sense? How do patients, if they want to see a pharmacist and they're at a rural setting, how do they do that? I think that those are questions that still need to be better delineated, understood, and then addressed.

READ MORE: Health System Resource Center

Stay tuned for more from our conversation with Watanabe and other ASHP 2025 Pharmacy Forecast authors. Drug Topics will be posting weekly podcast episodes from our conversations with forecast panelists, all available on our Over the Counter platform with new episodes coming out every Thursday.

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