Expanding the role of the Pharmacist?

According to an October 1, 2007, USA Today article, federally funded health centers are piloting a program that allows pharmacists more “hands on” patient care. In fact, in this program, the focus of the pharmacist is not limited to the actual filling of prescriptions, but now has expanded to ordering lab work, monitoring lab work and actually writing prescriptions.

Testing this program on primarily indigent and homeless patients at the JWCH Medical Clinic at the Weingart Center on Los Angeles’ Skid Row certainly has some dispassionate appeal. This expansion of a pharmacist’s role is a bi-product of Congress’ Medicare Modernization Act of 2003, which created a drug benefit for Medicare patients. However, the phrase “sounds good on paper” comes to mind. In the wake of recent cases and media reports of serious injuries and deaths (Hippely and Gerhke cases) arising out of prescriptions filling errors, one wonders whether expansion of a pharmacist’s role is wise. We need a clearer picture as to just how effectively the industry is managing its current responsibilities.

In an ABC 20/20 exposé in April 2007, a spokeswoman for large retail pharmacy chains indicated that they do not believe that the tracking of errors is a good idea because highlighting errors might scare consumers. Statements like this leave consumers worried and angry. Additionally, the pharmacy industry suggests that the shortage of pharmacists has necessitated the need to expand the number and the role of non-licensed pharmacy technicians. There is an inherent conflict in my mind. Big corporate pharmacies put profits first. Quotas are a part of that business. According to the recent “undercover” ABC 20/20 investigation, many pharmacists in retail chain drugstores do not have sufficient time to counsel patients as required by law. Due to the pressures to fill as many prescriptions as quickly as possible, they also lack the time for patient inquiry and prescription evaluation. Interestingly, it sounds like the smaller independent chains apparently have a more managed work environment that may be better suited to handle the pharmacist’s expanded role. Perhaps that’s why these larger chains can’t attract or retain some of the more “hands on” and skilled pharmacists?

Maybe bigger and faster is not always better? Wherever this trend leads, let’s hope the appropriate focus on existing challenges is not lost in an overzealous effort to expand the pharmacist’s role to even well intentioned programs such as this one. At the very least, government and consumer oversight of the pharmacy industry is warranted, now more than ever.