January 25, 2010
Should you be spending more time with your neighborhood pharmacist? Or less?
By Kim Painter
Recent studies suggest either could be true for people who take medicines for chronic conditions such as diabetes, asthma and high blood pressure. For example, one new study suggests people who fill prescriptions by mail are less likely to run short of medication. But other studies show those who meet regularly with druggists stay healthier and save money for their insurers.
The studies come as pharmacists try to find their place in a world where prescriptions can be filled more cheaply by mail but where people struggle to use their medications consistently and correctly.
"The role of the neighborhood pharmacist is undergoing a major transformation," says Edith Rosato, a senior vice president at the National Association of Chain Drug Stores in Alexandria, Va.
Case in point: One big chain, Walgreens, just announced a four-city pilot program in which store pharmacists and nurse practitioners act as medication coaches for customers with type 2 diabetes. Such programs augment, but do not replace, physician care, Rosato says. They are needed, she says, because about half of people with chronic diseases fail to take medications correctly, which costs the health system $290 billion a year.
"There's a lot more that can go on in a pharmacy than filling a prescription," says William Elllis, executive director of the American Pharmacists Association Foundation, a non-profit group in Washington, D.C.
Pharmacists in one program studied by Ellis' group counseled 573 diabetes patients for a year and helped them normalize blood glucose, lower blood pressure and improve cholesterol levels while saving $1,079 each in health care costs (compared with projected costs).
Pharmacists can "provide that face-to-face conversation that just doesn't happen enough" in today's fractured health system, Ellis says.
But right now, most busy neighborhood pharmacists can't spend long hours counseling patients, says O. Kenrik Duru, an internist at the University of California-Los Angeles. They are too busy, he says, filling pill bottles, dealing with insurers and doctors' offices and serving long lines of customers - many of whom show up for simple refills.
Efficiency vs. personal touch
In a new study, Duru and researchers from Kaiser Permanente Northern California found diabetes patients in that system who refilled most prescriptions by mail were less likely to run out of medicine than those who went to pharmacies.
That was true even when costs were the same and people could get the same number of doses in each refill (something not true under many insurance plans, which allow 90-day refills by mail but only 30-day refills in person).
Pharmacist counseling is often crucial for someone on a new medication, Duru says. But efficient delivery may matter more for many people on long-term regimens, who may have trouble getting to stores regularly, he says.
Scott Monte, a pharmacist in Buffalo, is trying a hybrid approach: He and some partners have just opened a local business that refills most prescriptions by mail but encourages customers to come in to talk or to get urgent refills. Sometimes, pharmacists hop in their own cars to deliver orders.
People often dislike mail order, he says, because "they're dealing with an 800 number with an anonymous person on the other end."
Right now, one-third of prescriptions for chronic conditions are filled by mail, Duru's report says.