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.
Many signs are evident that our health care system is not only strained, but reaching a tipping point where everyone agrees on the need for change. A quote from Edward H. O'Neil, MPA, PhD, FAAN, director of the Center for the Health Professions at the University of California, San Francisco, sums it up: "The reason for this transformation is simple: the system that we have is no longer sustainable for those who pay, those who consume, and even those who provide." The prospect of change raises concerns for many of us, but change also could provide opportunities, to define a new role for community pharmacy.
This new role could emerge as the result of a transition that is already taking place, with the increasing number of health services provided directly by pharmacies and by in-store clinics. Many of us have already demonstrated that we can effectively provide vaccination services. Clinics associated with pharmacies are starting to handle routine medical treatments and minor ailments. More pharmacies could take responsibility for providing vaccinations and also could expand services such as medication therapy management. Changes like these could enable the pharmacy to become a community health center with a focus on management of chronic diseases.
It is not always easy to implement change, however. If we expand to offer services traditionally performed by others, we can expect them to react—and perhaps to also attempt to take on some of our traditional roles, such as dispensing, in return. We have already seen an example of this here in North Carolina, where a major payer and a physician group are trying to drive patients back to physicians' offices for their vaccinations.
Let's remember the interests of the patients, however, and the economics that are driving the need for changes. Many patients who obtain vaccination services at clinics and pharmacies do not have regular physicians, for example. For these patients, pharmacies may be the best option for obtaining these important services—something that should be encouraged in the interest of public health.
There is a growing consensus that health care reform will take place because the current system is simply not delivering what is needed. Our experiences tell us that a demand exists for more services from pharmacies and clinics. This presents us with an opportunity to position the pharmacy as a community health center, helping patients by providing a broad range of services. Doing what is right for the patient will, in the long run, ensure our survival.
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