editor's NOTE: Change May Be Boon for Pharmacies

Mr. Eckel is professor and director ofthe Office of Practice Developmentand Education at the School ofPharmacy, University of NorthCarolina at Chapel Hill.

Many signs are evident that ourhealth care system is not onlystrained, but reaching a tippingpoint where everyone agrees on theneed for change. A quote from Edward H.O'Neil, MPA, PhD, FAAN, director of theCenter for the Health Professions at theUniversity of California, San Francisco,sums it up: "The reason for this transformationis simple: the system that we haveis no longer sustainable for those whopay, those who consume, and even thosewho provide." The prospect of changeraises concerns for many of us, but changealso could provide opportunities, to definea new role for community pharmacy.

This new role could emerge as the resultof a transition that is already taking place,with the increasing number of health servicesprovided directly by pharmacies andby in-store clinics. Many of us have alreadydemonstrated that we can effectively providevaccination services. Clinics associatedwith pharmacies are starting to handleroutine medical treatments and minor ailments.More pharmacies could take responsibilityfor providing vaccinations andalso could expand services such as medicationtherapy management. Changes likethese could enable the pharmacy tobecome a community health center with afocus on management of chronic diseases.

It is not always easy to implementchange, however. If we expand to offerservices traditionally performed by others,we can expect them to react—andperhaps to also attempt to take on someof our traditional roles, such as dispensing,in return. We have already seen anexample of this here in North Carolina,where a major payer and a physiciangroup are trying to drive patients back tophysicians' offices for their vaccinations.

Let's remember the interests of thepatients, however, and the economicsthat are driving the need for changes.Many patients who obtain vaccinationservices at clinics and pharmacies do nothave regular physicians, for example. Forthese patients, pharmacies may be thebest option for obtaining these importantservices—something that should beencouraged in the interest of public health.

There is a growing consensus thathealth care reform will take placebecause the current system is simply notdelivering what is needed. Our experiencestell us that a demand exists formore services from pharmacies and clinics.This presents us with an opportunityto position the pharmacy as a communityhealth center, helping patients by providinga broad range of services. Doingwhat is right for the patient will, in thelong run, ensure our survival.