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I listed medication therapy management (MTM) as one of the 10 megatrends that could transform pharmacy during this decade. Many would say that this is a no-brainer because MTM is already part of pharmacy’s vocabulary and practice. I agree that it is getting a lot of lip service, but to be practiced properly I believe that a lot of changes need to take place in pharmacy. Some changes may have started, but much more is needed.
First, the pharmacy payment model must change. The 2011 report by the Office of the Chief Pharmacist to the US Surgeon General, “Improving Patient and Health System Outcomes Through Advanced Pharmacy Practice,” makes this point. The report states that “physician-pharmacist collaboration has demonstrated that patient care services delivered by pharmacists can improve patient outcomes, promote patient involvement, increase cost-efficiency and reduce demands affecting the health care system.” It then points out that “for pharmacists to continue to improve patient and health system outcomes as well as sustain various roles in the delivery of care, they must be recognized as health care providers by statue via legislation and policy, and be compensated through additional mechanisms commensurate with the level of services provided (and with other practitioners providing comparable services).”
Once payment for cognitive services becomes commonplace, another change is likely to occur. Pharmacists will be more willing to delegate drug distribution to qualified and trained pharmacy technicians, thus freeing up the pharmacist to render cognitive services. It is difficult for a pharmacist to jump back and forth from delivering care to a specific patient and then provide drug distribution services. Of course, pharmacists may retain oversight of the process, but will not spend a dominant amount of time in this activity. This scenario will represent dramatic but necessary changes in the way pharmacists practice.
Why aren’t pharmacists recognized by most payers as providers? There are probably many reasons, but the most important one, I believe, is that most pharmacists are not integrated into a health team. Many other providers do not really know what we know and what we do.
I was talking to a colleague recently about an innovative chronic disease management program that includes pharmacists working collaboratively as part of a health team. The medical director admitted that, at first, he was reluctant to include a pharmacist on the team because he had had no experience working with a pharmacist before. He now realizes the valuable contributions a pharmacist makes and now fully supports having a pharmacist as an integral member of his team. It took knowing a pharmacist—and actually experiencing the pharmacist’s contributions—before he was willing to truly consider the pharmacist as a provider.
To become integrated into a health team will require another change in pharmacy practice—documentation of interventions into a patient medical record. Such a pharmacist who is integrated into a health team will focus primarily on care delivery, managing outcomes, and documenting interventions in an electronic health record. Sometimes this care be delivered in the clinic where other health team members practice, and sometimes it will be done in the pharmacy with the pharmacist being part of a virtual team. This represents a major change in how most pharmacists practice today.
These changes are necessary before MTM becomes commonplace. In fact, documentation may be the key change. One reason physicians accepted pharmacists so easily in the Asheville Project, for example, was that pharmacists documented the plan and actions taken to implement that plan. More than one physician said at that time, “I know more about my patient than I ever did because the pharmacist shared information with me that I didn’t have before.” Pharmacists were accepted because of the value they offered, and that value was easily recognized by other team members when the documentation of care delivered was shared. Electronic medical records will enable this to occur easily.
Mr. Eckel is a professor at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He serves as executive director of the North Carolina Association of Pharmacists.