Pharmacists Expand Role to Help Educate and Coach
Senior citizens may be helped the most by new drug
education, chronic disease coaching by druggists
Michelle Andrews, Kaiser Health News
15, 2011 - The average adult fills about a dozen prescriptions and
refills every year; after age 65, they fill more than 30 prescriptions
annually. For many people, their local pharmacist may be as familiar as
their doctor and often a lot easier to get time with. Some pharmacists
are building on that position, expanding their role from drug dispenser
to drug educator and chronic disease coach. By doing so, they may fill a
void created by the shortage of primary-care physicians while boosting
Janis McGannon has heart
disease, Type 2 diabetes, high blood pressure and high cholesterol. A
few months ago she accepted an offer from a nurse at the Bay Street
Pharmacy near her home in Sebastian, Fla., to join a new "healthy heart"
program at the pharmacy.
At a meeting of the program's
participants, Theresa Tolle, a pharmacist and the owner of Bay Street,
gave a talk to about a dozen customers about cholesterol: what it is,
how it works and how it can be managed. After everyone was weighed and
measured, they received a goody bag that included a pedometer to
encourage them to walk 10,000 steps a day.
The next month, the topic was
blood pressure. In addition to having their pressures checked and
discussing the medications they were taking, participants learned about
using light weights and stretchy bands for exercise.
In between monthly meetings,
McGannon, 74, logs onto a website to record what she's eating and how
much she's walking. Tolle and the nurse e-mail her regularly to check on
her diet or offer tips to keep her on track. Medicare doesn't cover the
$20 monthly fee for the program, but McGannon thinks it's worth it.
"Most of us need to be
reminded to do these things, and I'm reminded every day," she says.
"It's right there on the computer."
Pharmacists are perfectly
positioned to help address the drug "adherence" problem: Research shows
that only about half of people take their medications as prescribed.
They may fill a prescription but not take the drugs as instructed, for
example, or they may discontinue a course of treatment before it's
completed; often, people such as McGannon who take multiple pills for
multiple chronic conditions simply forget. Lack of drug "adherence,"
costs $290 billion in medical costs annually, according to a
study by NEHI, a health research organization.
Bay Street is one of 50
independent pharmacies offering the heart program nationwide. It and a
diabetes management program launched two years ago available at more
than 400 independent pharmacies were developed by Augusta, Ga.,
pharmacist David Pope, who is working in partnership with drug
wholesaler Cardinal Health. "We're providing a communication tool to
allow pharmacists to step into a coaching role," says Pope.
In recent years, both
independent and chain pharmacies have come under pressure from
mail-order pharmacy services, in part because some insurers require that
their members get their drugs through the mail. (In 2009, mail-order
prescriptions made up 6.6 percent of all retail prescriptions, according
to the national association of chain drug stores.) Drug chains and
mass-market retailers such as Walmart have
fought back with some success, offering $4 generic prescriptions,
for example, and 90-day supplies. As for independent pharmacists, "it
makes so much sense ... to offer services beyond just filling
prescriptions," says Steve Lawrence, a senior vice president with
In the past year, Walgreens
has rolled out a diabetes education program that provides customers in
10 cities with one-on-one sessions about the drugs they're taking, how
to use a blood glucose meter and other issues. The program is provided
through insurers or employers; more than 1,000 people have participated
so far, says Colin Watts, chief innovation officer for Walgreens.
In January, CVS Caremark
kicked off a
program that identifies insured diabetes patients who aren't getting
the drugs they need. The company contacts these patients and invites
them to talk with a pharmacist by phone or in person at the store. The
company plans similar programs for heart disease, high blood pressure
and high cholesterol.
Primary-care physicians are
generally supportive of such efforts as long as the pharmacists
coordinate care with doctors.
"Answering questions about
prescription drugs is important," says Roland Goertz, president of the
American Academy of Family Physicians. "But with the time pressures
physicians are under, they can only accomplish so much."
For many patients, pharmacists
are the easiest to access and the most trusted medical professional they
know. In a
Gallup survey released in December, pharmacists ranked third among
professions for honesty and ethics. That put them behind nurses (No. 1)
but ahead of doctors (No. 5).
When pharmacists reach out to
patients, patients may find themselves turning to them for advice and
information more frequently.
That's what's happened in
Janis McGannon's case. Now that she knows Thesesa Tolle and the nurse at
Bay State, she calls them or stops by when she has a question about her
"Theresa's very willing to sit
down with you and talk about how to take [a drug] and how it will affect
you," says McGannon.
That's not always the case
with doctors, she says: "Sometimes they just gloss over things. They
just say, 'You'll be fine. Call my office if you have problems.'"