Fred M. Eckel, RPh, MS; Pharmacy Times Editor-in-Chief
If an in-store clinic has not appeared
near you, it probably will soon.
Hundreds of these mini-clinics are
already operating in the major chain
drugstores and other retailers, and thousands
more are scheduled to open in the
next few years.
Many chains already seem convinced
that these clinics, typically staffed by
nurse practitioners and physician's assistants
and offering basic medical services,
can increase revenue and drive more
business through the pharmacy. Some
estimates suggest that around 90% of
the prescriptions generated at these clinics
are filled at the in-store pharmacy.
Yet, will employers continue to value
pharmacists as highly if services can be
provided by clinics at lower cost? Could
increasing reliance on clinics threaten
potential growth areas for pharmacy, such
as medication therapy management?
A second concern is whether the
trend will change the way patients view
pharmacists. If patients rely on the clinic's
nurse practitioners for diagnosis, will
they also rely on the clinic for advice that
would previously have been provided by
pharmacists? Will they be less likely to go
to the pharmacy for advice about OTC
drugs, for example?
These concerns are understandable.
They do not mean, however, that miniclinics
should be seen as a bad thing. On
the contrary, the surging growth of these
clinics could be a positive development.
It is clearly necessary, however, to examine
what the pharmacist's role should be
and how we can best adapt to the clinic
phenomenon.
We can start by developing a good
working relationship with the clinic,
encouraging the clinic's staff to refer
patients with drug therapy management
questions to us, for instance.
On a larger scale, we need guidelines
for the relationship between the pharmacy
and the clinic. Today, the American
Medical Association (AMA) has a set of
principles for store-based health clinics,
covering such areas as clinics' responsibility
to refer patients to physicians when
the patients' needs are beyond the
scope of the clinic's services.
In a similar way, each store with a clinic
should establish principles and protocols
that define when clinics should refer
patients to pharmacists. Perhaps pharmacy
associations might develop guidelines
for this.
Handled the right wayso that pharmacists
and clinic staff offer complementary
services and clearly understand their
respective rolesthe result could benefit
everyone.
Mr. Eckel is professor and director of
the Office of Practice Development
and Education at the School of
Pharmacy, University of North
Carolina at Chapel Hill.