Expanding Point-of-Care Responsibilities for Pharmacists Still a Consideration

JANUARY 29, 2018
Practicing at the top of their license. I cannot count the number of times that I have heard executives and company representatives state this at meetings or in the news regarding what pharmacists 'should' be doing. I mean, it makes sense, expanding pharmacists capabilities is an issue we have been facing for over a decade now. Medication Therapy Management (MTM) hasn't exactly taken off, and reimbursement isn't that big. So what's left?
 
Well, following where the money comes in for other medical practitioners may be a solution. The pharmacy profession demonstrated we could perform immunizations, and we see the population we can vaccinate expand across multiple states and now includes some pediatric populations and expansions of what type of vaccines can be given. While not a cash cow itself, it does help increase revenue. But there could be more, and pharmacy businesses recognize this. 
 
Recently Kevin Hourican, executive vice president of retail pharmacy and supply chain of CVS Health, mentioned at a meeting that he wants to see more responsibilities given to pharmacists.1 He sees point-of-care testing being a rational area to grow into, with testing performed in the pharmacy leading into possible pharmacist prescribing by collaborative practice models. Business wise, this makes sense in several aspects at this time for CVS. MinuteClinics can serve such services, but they're not going to put a such a clinic in every pharmacy. But every pharmacy has a pharmacist, and in rural areas, this could prove something to leverage. 
 
The other item to consider is the possible Aetna acquisition. While not finalized, if this goes through, CVS will likely push for more pharmacists' clinical responsibilities and roles to maximize patient reach and profit, I would suspect. So start small. Train pharmacists to perform POC, then expand to several small niches for prescribing (with antibiotics and other areas most likely being most accessible and of high patient interest) and then go from there for other clinical areas and add-on MTM as a more worthwhile endeavor.
 
Now, some small independent pharmacies already offer such services or those that have an academic pharmacist that has the time, but no significant business has made this work. NACDS currently provides a POC certificate program. I have attended it, and also the certificate program to train other pharmacists, and for an 8-hour course, it could be a good jumping point. The program is more geared towards educating pharmacists about the rules and procedures for CLIA waivered testing and how to integrate it into a workflow and profit from it, which the later material is more geared for small pharmacy venues.
 
CVS or Walgreens, I suspect, would take care of the business component overall, and how to work it into the pharmacist workflow. (Whether this means more coverage, I do not know. Worse case scenario, it leads to a pharmacist having to dispense/verify medications, conduct calls, do vaccinations, and POC/Prescribing.) So, the onerous component for pharmacists would be catching up with doing a new practice many have never done or have been out of the loop of regarding best-practices for treatments, potentially. I would wager that this would be the significant training that would come about, and see a massive growth in CE and workshops geared at pharmacists in the community setting, to get them ready. The other components would be regulations and state laws that would need to change or adapt, as well, for a larger scale. This could probably be seen similarly to what has occurred for states that have expanded birth control access laws for pharmacists to provide to their population.
 
So should you sign up for a POC certificate program? At this time, I would say if you have the time or hear anything internally that this is something that may be coming to your region or state it would be worth the investment and time, but not every pharmacist needs to right away. 

Reference
 
  1. Enabling patient-facing care: Pharmacists at the top of their licenses. Drug Store News. www.drugstorenews.com/news/enabling-patient-facing-care-pharmacists-top-their-licenses/. Published January 8, 2018. Accessed January 29, 2018.


Timothy Aungst, PharmD
Timothy Aungst, PharmD
Timothy Dy Aungst, PharmD, is an associate professor of pharmacy practice at MCPHS University. He graduated from Wilkes University Nesbitt School of Pharmacy and completed a PGY-1 Pharmacy Practice Residency at St. Luke's University Hospital, and then a Clinical Geriatric Fellowship at MCPHS University. He is passionate about the rise of technology in health care and its application to pharmacy. He has published primarily on the role of mobile technology and mHealth, and made multiple national and international presentations on those topics. He blogs at TheDigitalApothecary.com, and you can find him on Twitter @TDAungst.
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