I am not opposed to collaborate my patients care with pharmacists but we are missing the point.
By including additional providers in the health care delivery process we may inadvertently contribute to greater fragmentation and costs of care because we fail to coordinate such care. We may share the e-prescribing system with the pharmacists but not the entire medical record. We have to continue emphasizing that the patient centered medical home is not a loose collaborative of multiple provider. All health care professionals withing the PCMH will coordinate health care delivery along the horizontally and vertically structured health care delivery system to achieve, among others , the following goals: improved quality of care, decreased medical costs of care and to ascertain the outcome of care rendered.
Therefore, I do NOT agree with the position stated in the Op-Ed.
Looking forward to your comments.
Yours
Bernd
How to Care for 30 Million More Patients
Pharmacists can help fill the gap and save money, too.
By R. PETE VANDERVEEN
Many worry there won't be enough physicians to care for the estimated 30 million more patients who will be insured under the health law passed earlier this year. The Association of American Medical Colleges estimates a shortage that could reach 150,000 doctors by 2025.
Pharmacists, who number almost 300,000 today, could help fill the gap. The men and women who complete a four-year graduate professional program are trained to master complex medications—including more than 10,000 prescription drugs and dozens of new, more sophisticated ones approved annually by the Food and Drug Administration.
For patients with chronic diseases such as diabetes, hypertension and asthma who typically must take multiple drugs, pharmacists' knowledge of drug interactions can be life-saving. Yet pharmacists typically do little to help these patients. If they were allowed to take on some oversight duties, they could help alleviate the burden on physicians.
Pharmacists could review test results such as the blood glucose levels of patients with diabetes. They could adjust the dosage of prescribed drugs to achieve the goals for these patients set by physicians. They could keep an eye on patient use of other medications to avoid complications. And they could teach patients how to conduct self-administered tests, order lab tests when indicated, and monitor compliance with medication, diet and exercise regimens.
Considering that 40% of Americans have at least one chronic disease during their lifetime that requires regular oversight, the time savings for physicians could be substantial. And so might the costs of care.
This is not an untested theory. Pharmacists already manage some patients with chronic diseases. In 1996, the city of Asheville, N.C., a self-insured employer, began paying pharmacists to work with its diabetic employees. Known as the Asheville Project, the goal was to improve worker health and lower treatment costs for both employee and employer.
The results exceeded expectations. From 1997 to 2001, the city of Asheville reported that annual direct medical costs per worker dropped, on average, by $1,200 to $1,872—even as 15% more enrollees came within reach of their therapeutic goal.
The project has since been expanded to cover other chronic diseases, and Asheville estimates it has saved $4 for every $1 invested. Some 80 employers nationwide have adopted the treatment model, including Mohawk Industries, the national carpet manufacturer in Dublin, Ga.
At safety-net clinics in Los Angeles, Minneapolis and Pittsburgh, pharmacists have teamed with physicians to care for patients with chronic diseases while saving hundreds of thousands of dollars in treatment costs. This is remarkable because many of these patients struggle with homelessness, low literacy and unemployment. Now the federal Health Resources and Services Administration's Patient Safety and Clinical Pharmacy Collaborative is pushing for the presence of pharmacists at every community clinic in the nation.
Still, these projects are limited in scope because pharmacists are not considered health-care providers by Medicare and Medicaid. Private foundations or grants underwrite services at some safety-net clinics, while other clinics pick up the tab.
The next, critical step is to change the reimbursement codes of the Center for Medicaid and Medicare Services to allow pharmacists to play a larger role in patient care. Doing so may initially increase overall medical costs. But in the long run, as the Asheville Project demonstrates, it will save money and improve patient health.
Pharmacists are not spoiling for a turf war with physicians. The two professions already team up under "collaborative practice" agreements as in Asheville and Los Angeles that clearly define what the pharmacist can and cannot do.
The traditional medical model—in which a single physician provides all recommended care to patients—has run its course. With an aging population and millions of expected new patients, chronic disease rates are expected to rise. What we need is a new health-care delivery model in which the primary-care physician is complemented by a team of professionals and providers. Congress should enable pharmacists to become part of that team.
Mr. Vanderveen is the dean of the School of Pharmacy at the University of Southern California.
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