Transition of care: The challenge for pharmacists

Pharmacists have been handed a golden opportunity to engage in a cognitive service distinct from distributing “the product.” It is an opportunity that can move us from sale of medications to provision of pharmaceutical care review and patient counseling, with the additional benefit of payment for these services.

See also: The pharmcist's role in transitions of care

Not the first time

This opportunity arises from the need for services during the stage of patient management currently known as transition of care. Other names have characterized these services in the past. You may remember the buzz about “continuity of care,” “disease management,” and “medication management.”

To its credit, the profession of pharmacy as a profession has recognized these previous opportunities clearly and identified our roles in connection with them.  But our follow-through has left something to be desired.

Yes, as a profession we have given these activities much rhetorical attention under the banner of speeches, writings, and blog posts on “the role of the pharmacist in….” But when the rubber met the road, most pharmacists did not vociferously, forcefully, or unrelentingly exert their professional influence to enforce these services as standards of practice. Nor did the profession demand and effect systemic change that would ethically mandate such services and incorporate them into practice … and into a professional fee. As always, when the debate became intense or contentious, or when personal sacrifice was required, pharmacists - true to their underlying nature as “rule-followers” - skulked away and went back to work, giving great customer service at the lowest possible price. 

Back at the crossroads

The question now, at yet another “crossroads” for our profession, is how well will pharmacists respond - not organized pharmacy or pharmacies (places can’t do things, remember) or non-pharmacist pharmacy companies, but individual pharmacists? How will we respond?

Will we each nod our head and agree, “Yes, pharmacists are responsible for safe and effective use of medications by their patients” and then put on a pensive face and lament, “But the company I work for won’t allow me time to do anything but fill prescriptions and call for refill alerts”?

Or will we individually start to identify patients who need transition-of-care services, provide those services, and then bill for them?  

Will we, one by one, insist that this is what we should be doing?

Will you and your colleagues at the local city/state pharmacy association start a conversation about banding together to meet with employer representatives to come up with a strategy to meet this need?

The survival of the profession may depend on it.

How will you respond?

We always seem to talk loudly to ourselves. We constantly tell others outside the profession that pharmacists are The Medication Experts and that our skills have value beyond cost-of-goods. We have been doing this since I was in undergraduate school in the 1970s. Yet our message is simply not getting through. Either that, or it is being dismissed or drowned out by others. 

In a recent article on the key players in the transition-of-care model posted at the website of the company Right at Home, pharmacists were not mentioned, not even once.¹ Doctors (presumably physicians), nurses, case managers, nutritionists, and psychologists were all mentioned, but despite the fact that medication errors were high on the list of stated concerns, pharmacists, the self-proclaimed experts in the main modality of care - prescription medications - were ignored. 

In another recent article, posted at the Managed Care magazine website and widely circulated on myriad talking-to-themselves pharmacy blogs, it was reported that in most ACOs, which are a fundamental component of care-transition programs, pharmacy was most ill-prepared to engage patients.²

I repeat, we are in it for the survival of our profession as a profession, rather than as a customer-service provider. How will YOU respond?

References

1. Right at Home website, http://www.rightathome.net/care/care-transitions/what-is-care-transitions/

2. Managed Care website, http://www.managedcaremag.com/archives/2014/2/acos-pharm-management-not-snuff

Salvatore J. Giorgianni Jr.is a consultant pharmacist and president of Griffon Consulting Group, Inc., an advisory board member for Pharmacist Partners, LLC and Drug Topics, and chair, American Public Health Association Men’s Health Caucus.