Behind the Counter: Unveiling the Multifaceted Role of Pharmacists


Pharmacists in community and retail practices are stepping out from behind the counter and becoming more involved in patient care.

For so many years, the professional behind the counter at your typical pharmacy was often perceived as a dispenser of medications and not much more. The last decade, however, has seen a significant expansion of the scope of pharmaceutical practice, as the role of pharmacists continues to evolve to meet the needs of our patient population in different ways.

Pharmacists in community and retail practices are stepping out from behind the counter and becoming much more involved in patient care. As health care professionals, pharmacists have always been deeply engaged in their communities of practice, and now we see this engagement expanding in an official capacity through medication therapy management (MTM), as pharmacists are now able to bill for these services. During an MTM encounter, the pharmacist performs a comprehensive medication review with the patient to ensure therapeutic efficacy, prevent the occurrence of adverse drug reactions, and answer any questions or concerns the patient may have about their medications. MTM services are generally offered to high-risk patients such as those who are taking a large number of medications or patients with multiple advanced disease states who require frequent monitoring.

Ten years ago, the landscape of pharmaceutical practice in California changed drastically when Senate Bill 493 (SB 493) was signed into state law. Certainly, one of the greatest contributors to the expansion of pharmacists’ roles, SB 493 officially recognized pharmacists as health care providers. As such, they became empowered to order and interpret tests, furnish hormonal contraceptives, and prescribe smoking cessation and travel medications. The implementation of this law also created a new category of professionals called advanced practice pharmacists, who are given additional authority in patient care. Although these expanded functions undoubtedly unlocked new patient care opportunities in various pharmacy practice settings, SB 493 had a the most impact in community practice by virtue of the fact that the pharmacist is one of the most accessible health care providers in the community.

As we all know, the COVID-19 pandemic had profound effects on the practice of just about every health care provider, and as the front line in massive vaccination efforts, pharmacists have seen this facet of their profession dramatically grow. While vaccinations have long been available at community and retail pharmacies, the pandemic caused a large cultural shift in patients’ acceptance of the pharmacy. Patients now view the pharmacy as the default place they can go to receive vaccinations in addition to their primary care physician being an option.

Patients now view the pharmacy as the default place they can go to receive vaccinations in addition to their primary care physician being an option. Image Credit: © warodom -

Patients now view the pharmacy as the default place they can go to receive vaccinations in addition to their primary care physician being an option. Image Credit: © warodom -

In the hospital and clinic setting, we see the pharmacist’s broadening role in the continued evolution of integrated patient care. A strong example of this is in transitions of care. This is when patients transition their care from one setting to another, whether it’s from home to skilled nursing facility, home to hospital, between different levels of care in a hospital or from the hospital back home again. These transitions increase the patient’s risk of adverse events, and pharmacists can be immensely helpful in identifying medication discrepancies, reducing adverse drug reactions and medication errors, providing discharge medication counseling, reinforcing adherence, and preventing unnecessary readmissions. By collaborating with the patient and other members of the health care team, transitions of care pharmacists have been shown to greatly reduce readmission rates and improve clinical outcomes.

Another example of integrated patient care that has brought the pharmacist out from behind the counter is the development of the collaborative practice agreement with a physician. This is when a pharmacist can work with a physician closely to help manage a patient with a disease such as diabetes. Under this protocol, the physician makes a diagnosis and supervises patient care, but the pharmacist can perform patient assessments, order laboratory tests and initiate, modify, or discontinue medication regimens. Of course, they also continue to carry out that essential education to help improve patient outcomes.

As an academician, I am a firsthand witness to the many career paths available to pharmacy students as a result of the expanding scope of pharmaceutical practice. One example of this in the clinical setting is connected to the Board of Pharmacy Specialties (BPS), which currently recognizes 14 specialty practice areas and is working to add more. A pharmacist can now officially be recognized as a board-certified cardiology pharmacist, a board-certified critical care pharmacist, or a board-certified oncology pharmacist to name just a few. There is also a greater interest in pharmacy students pursuing careers in the industry where they can be involved in clinical trial development, medical communication, regulatory affairs, drug safety and risk management, health economic and outcomes research, and more.

As we can see, the role has progressed a great deal from the picture of a single individual dispensing medications behind the counter of a community pharmacy. While that remains an absolutely vital dimension of the profession, the practice of pharmacy has come a long way. The profession will continue to evolve as society and our patients’ needs transform.

About the Author

Diana X. Cao, PharmD, BCPS, BCCP, FCSHP, is an associate professor and chair of the Department of Pharmacy Practice in the College of Pharmacy(COP) at Marshall B. Ketchum University College of Pharmacy (MBKU COP). Cao worked as a lead critical care pharmacist and was on faculty at the Loma Linda University School of Pharmacy and California Northstate University College of Pharmacy prior to joining MBKU COP in 2019. She is a Board-Certified Pharmacotherapy Specialist with Added Qualification in Cardiology (BCPS AQ-Cardiology), Board Certified Cardiology Pharmacist (BCCP) and a fellow of the California Society of Health-System Pharmacists (FCSHP). Cao’s current research primarily focuses on cardiovascular pharmacotherapy.

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