The Challenge of Integrating Pharmacists Into Primary Healthcare Teams

Do you work closely with a pharmacist?  Recently, the emergency department where I work began placing a pharmacist in the ER.  I have to say, it has come in pretty handy.  Not sure which antibiotic is best for treating a UTI in a patient with renal failure?  Simply spin around in your swivel chair and ask an experienced pharmacist on the spot.  Easy access to a pharmacist is quite a luxury.

Unfortunately, there are some barriers to employing pharmacists as members of most healthcare team, especially in primary care.  Guest blogger and PharmD student Melanie Chen explains the problem in this post.

The Challenge of Integrating Pharmacists Into Primary Healthcare Teams

By Guest Blogger Melanie Chen

Pharmacists have yet to become substantially involved in primary healthcare teams, despite their expertise in drug interactions and safe usage of medications.  Certain inter-professional barriers between general practitioners (GPs), who diagnose patients and prescribe medication, and pharmacists, who advise both patients and providers on drug effects, prevent pharmacists from being fully integrated into patient-directed health systems.  Previous studies illuminate a number of these obstructions. 

The main barrier is the common perception of pharmacists as "shopkeepers", people whose sole job is to pick medications off a shelf, count pills, and hand vials over the counter to waiting patients.  In his NewScientist article, In the pharmacist's image, professor Ian MacKillop writes "To most members of the general public, the pharmacist remains a glorified shopkeeper who enters their consciousness only when they need a prescription filling or the weekend is coming up".  

A study conducted in 2003 by two members of the School of Pharmacy at Queen's University in Northern Ireland confirms Dr. MacKillop's opinion.  Dr. Carmel M. Hughes and Dr. Siobhan McCann surveyed 22 GPs and 31 pharmacists to explore the rift between these two professions.  The pharmacist's "shopkeeper" image emerged as the study's prominent theme and accounted for most of the concerns GPs had with extending prescribing rights to pharmacists.

One of these concerns regards the business side of pharmacy, with one GP saying "There is definitely a conflict between the NHS (National Health Service) primary healthcare team effort that we all feel we are involved in and with pharmacists and their role as the shopkeeper and their role in looking for profits themselves".  Other GPs mentioned this conflict of interest in the pharmacist's dual role as both a healthcare professional serving the patient and as a self-serving businessperson in their responses as well.  Many of the surveyed pharmacists felt indignant, citing that this kind of bias restrained their influence in healthcare and placed them lower on the healthcare hierarchy.

One pharmacist echoed the thoughts of his fellow pharmacists with his response, "...I think we have to be respected for what we do with medicines and I think at the minute GPs do not fully understand what we do.  I think they think that we just put it into a bag and throw it out.  I don't think they see the role".  A common thread among pharmacists' responses was that most GPs are unaware of the rigorous educational and clinical training all pharmacists go through, thereby contributing to the divide.

If these perceptions can be aside, including pharmacists within a health system could have widespread positive results such as those documented at Fairview Health Services at Minneapolis, St. Paul.  At FHS, pharmacists are an essential part of a team that includes not only GPs but also nurse practitioners and physician assistants.  They consult patients directly on how to take their medications and also work with other medical professionals as part of a multidisciplinary team.

A study conducted by the University of Minnesota College of Pharmacy looked at FHS's embedded pharmacist model over a 15-month period and found that drug-related morbidity and mortality was significantly lower at FHS compared to other statewide clinics. 40% of diabetic patients within pharmacist-integrated health systems at FHS, what the study called "innovation clinics", reached all performance treatment goals in 2009, compared to the statewide average of 17.5% in non-innovation sites.  In addition, over 4,000 drug therapy problems were reported to be resolved.  The FHS study concluded that pharmacist-integrated healthcare teams helped to achieve quality performance through collaborative efforts between GPs and pharmacists.

If inter-professional barriers arising from preconceptions and general unawareness can be mitigated, all members of the healthcare team- and especially the patient- can benefit.  But preconceptions do not exist in the medical world.  Everyone, from medical professionals to aspiring students, to the general public, can begin deconstructing these frameworks within their own minds.  Acknowledging the contribution every kind of healthcare provider makes to the community is one way to start integrating individuals together. 

 

A big thanks to Melanie for sharing her thoughts.  Bottom-line?  Pharmacists are much more that clerks handing out medications.  They serve as highly valuable members of our health system.  Let's use them accordingly.