What are the Roles of Pharmacists in the United States?

In this research, the varying and expanding roles of pharmacists in the United States are explored. These expanding roles position pharmacists to have greater impact in the shifting landscape of health care and public health. Beyond the most widely accessible role of medication dispensing, pharmacists’ engagement in patient care includes a consultative role whereby they fill in gaps in clinicians’ knowledge, and collaborative and integrative roles in settings such as patient-centered medical homes through formal agreements. However, pharmacists’ services vary depending on the setting and state scope-of-practice laws. At the same time, research evidence shows the effectiveness of engaging pharmacists as part of the direct patient care team. It is believed that improving patient awareness of these potential roles would help to more effectively incorporate them into a greater number of health care teams and lead to improved patient outcomes and safety.

Number of Pharmacists by Setting

  • According to the U.S. Bureau of Labor Statistics (BLS), for the 321,700 pharmacist jobs in 2019, the main work environments are:
    • Community pharmacies/drug stores — 42%,
    • Hospitals (state, local, private) — 26%, and
    • Commercial retail stores such as food and beverage stores (8%) and general merchandise stores (5%).

1) Widely-Accessed Services

The most widely accessed services offered by pharmacists, according to the literature, are medication dispensing, medication therapy management (MTM) and chronic disease management.

Medication Dispensing

Medication Therapy Management (MTM)

Chronic Disease Management

2) Lesser-Known Services

The services in this part of the research appear to be lesser-known to the public, according to the literature. This is because broad access to patient care services delivered by pharmacists is controlled by policy and compensation barriers. They include the specialty certified pharmacists described above, collaborative practice agreements (CPAs), the administration of vaccinations, transition of care and general patient education.

Collaborative Practice Agreements (CPAs)

Administration of Vaccines

Transition of Care

General Patient Education

Special Case — U.S. Opioid Addiction Epidemic

  • A pharmacy presence on national, state, and local levels is helping to address the opioid epidemic. As of January 2019, all states allow pharmacists to “dispense or distribute naloxone without a patient-specific prescription from another medical professional.”
  • Due to the dire urgency of the opioid epidemic in the United States which in 2019 alone was responsible for 71,000 deaths, “pharmacists are beginning to be embedded in addiction clinics, in medication-assisted treatment clinics, where pharmacists there are helping to initiate suboxone, and also doing a lot of the monitoring of that process as well.”
  • Furthermore, pharmacists can also play a role in educating both the patient and other health care providers about non-opioid pain treatment options to reduce the potential of addiction.
  • However, expanding pharmacist roles to be involved in patient opioid addiction treatment teams relies on legislation that allows pharmacists to bill for these services.

3) Expanded Services due to COVID-19

  • According to the CDC, community pharmacists are in a key position to deliver priority pandemic responses including point-of-care testing for chronic disease management, vaccinations, and COVID-19 testing, especially as the health care system was overtaken by COVID-19 cases.
  • The pandemic has highlighted the important role that community pharmacists make during an infectious disease outbreak. In rural areas or areas with higher concentrations of people of lower socioeconomic status, pharmacists have been able to effectively and safely maintain patient access to essential medicines through curbside pickup, larger refill quantities, and home delivery.
  • Hospital pharmacists contribute to COVID-19 management protocols by participating in inpatient rounds, ensuring sufficient medication supply to support ICU beds while managing critical drug shortages through the implementation of conservation strategies and sourcing alternatives.
  • Additionally, pharmacy advocates suggest that preparedness efforts for future outbreaks need to begin well in advance of a crisis, with pharmacists being fully integrated in preparing for an emergency in order to ensure efficient delivery of public health resources.

Novel Disease Testing and Vaccinations

Routine Vaccine Administration to Children

The Positive Impact of Pharmacists on Healthcare

Leading medical advisers at the Centers for Disease Control and Prevention have definitively stated that expanding the role of pharmacists can lead to increased quality of care, improved patient control of disorders and illnesses, and reduced healthcare costs. Furthermore, pharmacist-provided services and clinical interventions have been proven to reduce the risk of potential adverse drug events and improve patient outcomes as a result of the increasing number of pharmacists who have been allowed to work in clinically advanced roles. These positive impacts have been demonstrated through the results of numerous studies, some of which are highlighted below. It should be noted that the research included older studies (more than 10 years) if they provided detailed statistics or metrics that measure the positive impact of expanded pharmacist-provided services.

1. Improved Patient Outcomes

2. Patient Safety

3. Reduced Healthcare Burden — Fewer Visits

4. Cost Savings

  • A long-quoted figure is nearly $300 billion — that is, the estimate of the cost of medication non-adherence annually in the United States, primarily as a result of hospital readmission rates.
  • Medical non-adherence results in these costly readmission visits because it refers to the fact that almost 50% of all prescribed medications are not taken properly and nearly 25% are never started.
  • The authors of the study responsible for the cost above found that improved medication adherence was associated with pharmacist-led high blood pressure management.
  • A case study by Allina Health, a non-profit health system, on the effects of pharmacists performing medication therapy management (MTM) to a group of Medicaid patients discovered a $2,085 mean total cost of care reduction per patient in the six-month period after the first pharmacist encounter. This would mean a $590,000 cost savings over the 283 patients.
  • Separate case studies from seven states that offer Medicaid-supported medication management (MM) programs have found that these pharmacist-led programs resulted in improved patient treatment goals and reduced hospital costs. Selected states and the outcomes are:
    • Connecticut — a 28% increase in achievement of patients’ treatment goals and an estimated annual savings of $1595 per beneficiary in total health care costs,
    • Minnesota — a reduction in medical and pharmacy costs of approximately $800 per MM recipient, and
    • Maine — a decrease in hospitalizations from 114 to 96 at 6 months post-MM intervention and emergency department (ED) visits decreased from 384 to 347, as well as a decrease in inpatient hospitalization costs from $1,076,394 to $830,353.

Other Related Findings

The following findings are included as further evidence from reputable research publications to support the claim that expanding the role of pharmacists leads to a positive impact on the healthcare system, however, they do not include any discrete data points or statistics.

  • A widely-cited 2002 study found that pharmacist-conducted medication histories were more accurate and resulted in cost savings as well as increased patient safety in hospitals.
  • Although not based in the United States, a more recent study published in 2013 confirmed similar findings. It concluded that a pharmacist-acquired medication history in an emergency department reduced discrepancies that had the potential to cause moderate discomfort or clinical deterioration by 33%.
  • The University of Washington’s literature review found the evidence showing that pharmacists can optimize medicine use, lower medication-related costs and improve overall efficiency in care when they work as partners on health care teams with patients and providers.
  • The review also stated that shifting pharmacist roles to deliver more value-based and preventive care can reduce healthcare spending since current practices means pharmacists are largely reimbursed based on volume (i.e. dispensing more drugs results in higher revenue for the pharmacy).
Glenn is the Lead Operations Research Analyst at The Digital Momentum with experience in research, statistical data analysis and interview techniques. A holder of degree in Economics. A true specialist in quantitative and qualitative research.

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