Fred Eckel, RPh, MS, is Editor Emeritus of Pharmacy Times and a professor emeritus at the Eshelman School of Pharmacy at the University of North Carolina at Chapel Hill. He serves as executive director of the North Carolina Association of Pharmacists.

Fred Eckel, RPh, MS

My initial pharmacy career was as a hospital pharmacist. Of course that was more than 50 years ago. A theme that I heard from many fellow pharmacists then was that I should be both grateful for and interested in preserving independent pharmacy. The primary reason given then was that the opportunity for a pharmacist to open a pharmacy and make a good income was the primary reason that hospital pharmacists made a good salary. That idea has continued to resonate with me till today.

Perhaps hospital pharmacists have become invaluable on their own and that ensures a good salary. It is also true that it is not easy to open a new pharmacy and making a good living is not guaranteed. But having access to a local community pharmacist, if that pharmacist is part of a virtual health team, is in a patient's best interest.  

In many areas, it is an independent pharmacy that makes the pharmacist care available to that community. In many cases those same individuals are part of the community structure, supporting sports teams and other communities events.

Today I hear too many pharmacists who do not think we need strong independent pharmacies. Am I wrong in my perspective or are they? The question that I ask is do we have to see them gone before we recognize the many contributions made by independent pharmacies?  Would we be able to bring them back once they go? 

" Dr. Daniel A. Hussar asked this question about independent pharmacists: "Can we keep them?"  He answered his question with a "we MUST," and then offered 10 recommendations of what the profession can do to keep them. He closed his editorial with "we must move forward in a strong and urgent manner to protect and promote independent pharmacists as if the future of the profession depends on it. BECAUSE IT DOES, AND WE MUST KEEP THEM!"  

2016 NCPA Digest: A Roadmap for Independent Community Pharmacies,

 noted "there was a net reduction in the number of independent pharmacies. Potentially related to that the number of prescriptions filled at these pharmacies also declined."

I accept that we should let the market place work and if a particular sector doesn't adapt we should let them go.  My concern is that the independent pharmacist is a hidden gem that makes many contributions that are under appreciated or even recognized. If we let them go, it maybe to late too get them back when we realize what was lost.

Articles

Several recent studies, blogs and articles have raised a question in my mind about how secure independant pharmacy practice is.

Where Is Independent Pharmacy Headed?

, recently reported that officials with Fruth Pharmacy announced they will offer a comprehensive pharmacogenetic program called Rxight.

The first thought that came to my mind as I read this news was whether now was the right time to add pharmacogenetics to any pharmacy's listing of patient care services. Behind my question is the understanding that timing is the critical element for the acceptance of an idea or service. This was brought home to me early in my career when I mentioned to my boss that I was perplexed why it seemed like sometimes my ideas were ignored by others, including the medical staff I was working with at the hospital.  His comment to me has stuck: "timing is everything," and he added, "even a bad idea is considered when the timing is right."  

With respect to pharmacogenetics, I am wondering if this new service is being offered at the right time because, if it is offered too early and people aren't ready for it there will be little uptake, but offered too late, and the opportunity to catch the first wave of support will be lost.

. Today many people want to take personal responsibility for their health care and pharmacgenetics will help them.

Lynn Fruth, president of Fruth Pharmacy commented in the article: “Pharmacogenetics information challenges this one-size-fits-all approach and opens the door to more personalized approaches to prescribing and using medication.” Fruth Pharmacy is working with a third party provider to implement this program.

I want to challenge every community pharmacy to consider when they need to increase their patient care services to meet their patient's need. That may require taking a risk but unless you do, you may miss out on an opportunity that your patients want or need. Maybe the time is right for pharmacogenetics.

Although I am not in the Fruth Pharmacy trading district and know none of their leadership or pharmacists, I do offer them my congratulations for taking a bold step toward advancing the role of the pharmacist, enhancing the image of the community pharmacy as a health center, and demonstrating to patients and other health team members that pharmacists are a real part of the health team. 

1.  New Genetics Test Can Reduce the Potential for Adverse Drug Reactions. 

http://www.pharmacytimes.com/association-news/new-genetics-test-can-reduce-the-potential-for-adverse-drug-reactions.

I want to challenge every community pharmacy to consider when they need to increase their patient care services to meet their patient's need.

Pharmacogenetics: Is Now the Right Time?

CDC officials report that more than 25% of influenza vaccines are administered by pharmacists.  It would be safe to say that the immunization role of pharmacists has become an important public health success. The American Pharmacists Association (APhA) has more than 300,000 pharmacists trained as immunizers.  

I would suggest that pharmacy-based immunization efforts have played an important role in making community pharmacies into community health centers. I think these efforts have helped strengthen the image already held by patients that pharmacists are health professionals and probably contribute to the high ranking of pharmacists as trustworthy.  Success as immunizers will make it easier for pharmacists to eventually be recognized by Congress as health providers under Medicare. 

Beyond the community, pharmacists themselves have also benefitted, growing professionally because they have begun to immunize patients. The hands-on interaction of an injection gives many pharmacists the feeling of being a "real health team member." It hasn't always been that way, however. I remember when some community pharmacists saw the interruption of their prescription-filling role to give an injection as inappropriate or even unsafe. I no longer hear that discussion.

The bigger question, however, is how important will the role of immunizer be in pharmacy's future? Is administering injections a technical or professional function? I think it is a technical function. The judgment is should this specific patient receive an injection? I believe you can develop a set of rules that a trained pharmacy technician can perform. If the patient passes, then the injection can be given. If the patient doesn't pass, then a pharmacist can be consulted for a decision to be made. I know this position seems outlandish, as we have fought so hard in many state legislatures to get permission for pharmacists to administer injections and there are many states where we need to get the role expanded. Many states still limit the role pharmacy technicians can play, so expanding the role seems wrong to some and impossible to others. 

As I look 20 years into the future, however, I don't see pharmacists giving immunizations because pharmacists will be practicing at the top of their license, managing chronic diseases, and treating many self-limited problems that cause patients to seek urgent care. We will look back then to today and see how important the role of becoming immunizers has been in advancing the profession.

APhA recently released a video celebrating 20 years of promoting pharmacist as immunizers.

Immunization Administration and the Future of Pharmacy 

	How should pharmacists view the recent news that prescription drug use is on the rise and polypharmacy has become more prevalent?

	On the one hand, it means that pharmacists have more prescriptions to fill. On the other hand, it could mean that direct-to-consumer advertising is leading people to take more drugs than they need. 

	Perhaps it means that more patients have health insurance and are therefore able to get the drugs they need. Or, could it mean that pharmacists are doing a better job promoting medication adherence?

	I like this last thought because it suggests that pharmacists are adding value to the drug distribution process. If we are adding value, rather than just being a “cost center,” then we have a future as health care reform occurs. 

	Another perspective is that the right drug therapy contributes to improved health care and that is being recognized by patients, prescribers, and pharmacists. 

	How do you explain the increased prescription drug use?

How should pharmacists view the recent news that prescription drug use is on the rise and polypharmacy has become more prevalent?