The Right Prescription
By Michael Avaltroni
Illustrations: Michael Byers
It’s time for pharmacists to stand up, step up and lead the charge. As the national firestorm of debate around health care continues to swirl, several issues are set to permanently change the way Americans access care in the years to come.
A confluence of events seems to be coming to an alarming crisis point and will tax the health care system like never before. A shortage of up to 90,000 primary-care physicians is projected over the next 10 years, according to the Association of American Medical Colleges. Over that same 10-year span, it is forecast that one out of every five dollars of the American economy will be spent on health care, while more than half the United States population will be diagnosed with chronic diseases such as heart disease, diabetes, asthma or cancer, according to Health Affairs journal and the Partnership to Fight Chronic Disease.
What this means is that there will either be a tremendous portion of the population without a place to seek care for an increasing number of medical problems, or we need to change the way we prevent, manage and treat chronic disease in the United States.
Pharmacists have long been thought of as pill and medication dispensers, and a pharmacy, unfortunately, as just a place to buy cosmetics, toiletries and other necessary items while waiting for prescriptions to be filled. This model needs to change — taking pharmacies from the perceived “glorified convenience store” to a community access point for the diagnosis, management and treatment of disease.
Pharmacists are well positioned to take on this role as community health practitioners; and, in many cases, are already doing so in a wide variety of settings as members of a primary-care team. In fact, they are the only health practitioners who are accessible to patients 24-hours-a-day, seven-days-a-week without the need for appointments, insurance or any additional credentialing. Nearly 95 percent of Americans live within five miles of a community pharmacy, according to the 2010–2011 Chain Pharmacy Industry Profile from the National Association of Chain Drug Stores (NACDS). The vast majority of Americans have sought the free advice of a pharmacist on an over-the-counter remedy, assessment of symptoms or whether to pursue medical care for a condition.
Over the past decade, pharmacists also have taken on a critically important role as immunizers, creating a significant impact on prevention and public health. In fact, tens of millions of Americans now get annual flu vaccines administered by pharmacists at their local community pharmacy, reports Forbes magazine, and a recent study showed that more than half of Americans who walked into pharmacies did not have the intention of receiving the vaccine until after being counseled by the pharmacist. A combination of convenience, patient education and access provide a convergence of contributing factors that impact the health of both individuals and the population.
While this is a good start, there is a great deal more that pharmacists can do. Diseases such as diabetes and asthma have a critically important maintenance aspect to their management. Simply put, those who are compliant with medication regimens, regularly have access to follow-up care and understand the parameters of controlling their disease symptoms have better health outcomes. Often, a deterrent to these maintenance steps is a matter of convenience. Patients don’t want to wait for hours to seek medical care, and often leave the provider’s office confused and unsure of what to do and how to do it.
The time is right to begin to equip and empower pharmacists to take on increased roles in both the management of chronic diseases and the medication regimens that patients are currently on. This can include walk-in access to the pharmacy as a clinical site for advice, basic assessment of medical condition, medication-therapy management (MTM) and basic advice and instructions on symptoms, side effects and strategies for dealing with chronic disease.
As we built the pharmacy program at Fairleigh Dickinson University, we were trying to “predict the future” and the great potential for the pharmacist as a navigator and manager of chronic disease. As such, we provide all of our students with American Pharmacists’ Association (APA) training in three key areas: pharmacist-based immunization delivery, delivering medication therapy management services and the pharmacist and patient-centered diabetes care.
These are the key areas in which we believe our graduates can make an immediate impact, and having them credentialed in each will provide opportunities for our alumni to practice at “the top of their pharmacy license.” The impact that pharmacists can make in these areas is huge, and their role in addressing access to care issues cannot be understated. For example, the cost of medication non-adherence is projected to lead to 125,000 deaths, 10 percent of all hospitalizations and a total cost to the health care system of nearly $300 billion, according to the NACDS.
Educating pharmacists who are knowledgeable about the diseases they manage and who understand the social, psychological, cultural and economic challenges that often lead patients to make poor health decisions or neglect their medication regimen is critically important in improving overall health outcomes and quality of life for patients living with chronic diseases.
It seems that in every aspect of society, the rate of change and evolution is increasing by the day. Health care is certainly no stranger to this phenomenon. Primary-care offices have been replaced by “minute clinics”; primary-care physicians are now practicing alongside other health practitioners such as physician assistants and nurse practitioners; and the fee-for-service system is quickly being overhauled to a payment system built on health outcomes.
Amidst all of these changes, there is a huge decline in the overall health of the American population, as evidenced by projected decreases in life expectancy and alarmingly low health-outcome statistics when compared to other nations in our socioeconomic peer group. The solution to this problem must be multifaceted and must utilize every member of the health care team. This must include pharmacists, whose skills and expertise make them well equipped to make inroads in the area of medication adherence, chronic-disease management, education on health care and medical literacy, and the promotion of public health. With their proximity to the American populous and accessibility, the time is right to begin incentivizing, rewarding and channeling resources to pharmacists to enable them to have a bigger impact on the patients they already serve.
If the role of the pharmacist continues to evolve into a community-health advocate, we will all benefit from better health outcomes, decreased costs and an effective path to address the nation’s most challenging and vexing issue — how to manage the care of its people.
About the Author
The dean of the School of Pharmacy and Health Sciences, alumnus Michael Avaltroni, BS’99 (Flor), joined the FDU faculty in 2003. He has worked in a number of different capacities, including as a professor and chair of the department of chemistry and pharmaceutical sciences, and was one of the leaders who helped establish the pharmacy school. He was named dean in 2012 and has been instrumental in securing the school’s accreditation, funding for several key program initiatives and earning a number of program honors, including a 2017 award as the “Best Place to Work in New Jersey,” in the small/medium category, from NJBIZ.
After graduating from FDU, he completed his master’s degree in chemistry in 2001, and a PhD in chemistry in 2003, both at Princeton University. His area of research interest is surface science, specifically focusing on biomedical devices. This has led to multiple publications and 10 U.S. patents.