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Pharmacists Start Acting More Like Doctors -- and That's a Good Thing

Pharmacists are coming into their own as the availability of primary-care physicians dwindles in many areas. Both chain and independent pharmacies are offering programs to help patients manage various chronic diseases. In the process, the drugstores are helping patients, employers, and themselves.

Primary care physicians don't oppose the new assertiveness of pharmacists, who offer a type of patient education for which the doctors themselves don't get paid. In fact, pharmacists and other professionals who get into the advice business might take some pressure off of the primary care doctors.

In a "healthy heart" program offered by independent drugstores with support from drug wholesaler Cardinal (CAH), pharmacists invite people with heart conditions or cardiac risk factors to attend monthly educational sessions. A pharmacist gives talks about such topics as high cholesterol and high blood pressure and what to do about them. In between sessions, patients can record their progress on a special website and receive phone calls from a pharmacist who checks on their compliance and health status.

About 50 independent pharmacies have the "healthy heart" program and 200 offer a similar program for diabetes. Big pharmacy chains like Walgreens (WAG) and CVS Caremark (CVS) have also rolled out diabetes support programs. The difference is that they go through employers and/or pharmacy benefit managers to enroll patients rather than signing them up directly.

Walgreens has introduced its diabetes education program in 10 cities so far. Enrollees get one-on-one counseling about the drugs they're taking and devices such as glucose meters. In CVS Caremark's program, patients who aren't taking their medications as prescribed receive a call and can get phone or in-person counseling. CVS plans to expand this approach to other patients with heart disease, high blood pressure and high cholesterol.

Of course, the pharmacies aren't doing this just to improve the health of patients. By promoting compliance with medication regimens, they get more refills, and the educational programs also help them compete with mail-order houses that now account for 6.6 percent of all prescription drug sales. In this context, the educational programs are part of the same strategy that has spawned $4 generic drugs and 90-day supplies at the big pharmacy chains.

Nevertheless, these programs are a quantum leap beyond having your pharmacist ask you if you have any questions about the prescription. And they are part of a growing diversification of primary care that also includes retail clinics and worksite clinics. (Walgreens has expanded aggressively in these areas, and CVS owns many retail clinics.) Meanwhile, a rising number of midlevel practitioners work with physicians or on their own.

Pharmacists aren't going to go off on their own, because they aren't licensed to treat or prescribe drugs to patients. But, to the extent that they can support a doctor's treatment plan, they will serve a very useful purpose in primary care. They also supply additional feet on the ground to monitor the patient's health status and sound the alarm if they get sicker.

This collaboration of primary care doctors and pharmacists provides a useful model for the care teams that probably are the future of primary care. By combining the expertise of multiple professionals, care teams will serve chronic-disease patients better than any single physician can on his or her own.

Image supplied courtesy of Flickr.

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