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June 29, 2009
Pharmacists need a place at the health reform table
By Natalie D. Eddington
To help guarantee health care reform that reduces costs and builds "health care teams that work" (to use President Barack Obama's words), pharmacists must play a key role in the planning process being undertaken by the federal government.
The health care reform principles being considered are well grounded in developing strategies to promote the prevention and management of chronic diseases. Essential to the success of those strategies is the fully integrated role of pharmacists, the country's most accessible health care professionals.
Patients' easy access to their pharmacists results in adherence to medications, a critical issue in disease management and control. In the United States, medications comprise approximately 10 percent of health care expenditures, and a staggering $117 billion of this is attributed to medication misuse and patient noncompliance. Adherence to, or the appropriate use of, medications is especially problematic for patients with chronic diseases such as diabetes and hypertension.
In addition to their role in dispensing medications, pharmacists provide chronic disease management programs that promote patient wellness, reduce costs and prevent medication errors. With extensive expertise in appropriate medication therapy and an understanding of adverse effects of medications, pharmacists can identify drug interactions, administer lifesaving immunizations and alert patients if they need more urgent care.
In community pharmacies in almost every state today, pharmacists customize their roles in direct patient care, coaching patients on disease, diet, health goals and the importance of properly taking their medicines. In groundbreaking programs, such as the Asheville Project in North Carolina and the P3 (Patients Pharmacists Partnerships) Program in Maryland (both diabetes management programs) pharmacists foster appropriate medication therapy management for the patients, complementing the treatment and counsel provided by a patient's physician.
The American Pharmacists Association Foundation's Ten City Challenge Project, which followed the Asheville model, showed a decrease in health care costs of $1,079 per patient compared with projected costs if the program had not been implemented. It also showed an increase in the number of patients achieving health care goals established by the American Diabetes Association.
In Maryland, the innovative P3 Program, launched by the University of Maryland School of Pharmacy, has also shown a reduction in health care costs and improvements in specific health care clinical endpoints while reaching populations with long histories of lack of access to health care. Pharmacists have proved that their expertise in drug therapy and their active engagement in chronic disease management programs improve health and reduce costs.
Recently, thought leaders from the pharmacy profession representing academia, industry, community pharmacies and professional organizations gathered at the University of Maryland School of Pharmacy for a round-table discussion on pharmacists' potential role in the federal government's health care reform plans. The group was greatly disappointed that the White House had neglected to invite a representative of the pharmacy profession to sit at the health care reform table. There was a clear and strong consensus in the group that pharmacists must play a key role in that reform.
Based in community pharmacies on nearly every street corner in the country, and in hospitals, clinics and long-term care settings, pharmacists have clearly demonstrated their impact on improving health and reducing costs.
The federal government is now in the process of defining the details of health care reform, and from the pharmacy perspective, successful reform must include insurance reimbursement for pharmacist services beyond dispensing, including chronic disease management, medication therapy management programs and the administration of lifesaving immunizations.
A successful health care reform package must also include community-based programs delivered by pharmacists that have proven track records, programs that have amassed evidenced-based data on pharmacy services' impact on those goals of improving health care and reducing costs.
Pharmacists must be included as reimbursable providers under any health care reform, and patients should have access to these services without restrictions.
Natalie D. Eddington, dean of the University of Maryland School of Pharmacy, is a member of the American Pharmacists Association, the American Association of Colleges of Pharmacy, the American Society of Health-System Pharmacists and the National Community Pharmacists Association. Her e-mail is firstname.lastname@example.org.