Pharmacists Play Key Role in Complex Medication Management

Pharmacy TimesJune 2024
Volume 90
Issue 6

Pharmacy experts can provide transition interventions tailored to individual patients

Pharmacists are critical in ensuring medication safety across the continuum of care by reducing medication errors, improving prescribing practices, and augmenting patient monitoring. Medication therapy has become increasingly complex and must be individualized based on patient age, medical condition, physiological status, and other factors such as allergies.

A doctor hands over a strip of pills to an elderly patient, ensuring proper medication management - Image credit: sommersby |

Image credit: sommersby |

In all pharmacy settings, pharmacists are responsible for improving patient safety concerning medication use. They do this in several ways.

Ensuring Access to Medication

There has been a significant increase in the number of medications that have become unavailable in recent years. This may be due to a shortage of ingredients, a recall, or regulatory laws. Pharmacists can be instrumental in contacting the prescriber and recommending a suitable replacement for the patient.

The cost of medications has increased significantly, as well, and can be a significant barrier to access. Pharmacists can work with patients to bill insurance, work with prescribers to obtain prior authorizations, and recommend assistance programs that the patient can contact for financial assistance, coupons, or vouchers. Some assistance programs can be found on manufacturers’ websites and pharmacy discount cards.1

About the Author

Kathleen Kenny, PharmD, RPh, earned her doctoral degree from the University of Colorado Health Sciences Center in Aurora. She has more than 25 years of experience as a community pharmacist and works as a clinical medical writer based in Homosassa, Florida.

Providing Medication Information

Pharmacists, through their knowledge and expertise in the use of medications, are better placed among all health care professionals to counsel and educate patients on the safe and effective use of their medications. The impacts of pharmacist counseling include improving treatment outcomes, reducing risk of adverse drug reactions, improving medication adherence, increasing patient satisfaction, improving patient quality of life, and reducing health care costs.2

Evaluating Medication Appropriateness

Evaluating a prescription involves assessing the appropriateness of clinical drug usage according to relevant laws and technical specifications. This includes drug indications, drug selection, route of administration, dosage, drug interactions, and contraindications. By evaluating prescription appropriateness, pharmacists can identify potential problems and implement interventions to promote appropriate clinical drug use.3

Improving Medication Adherence

Optimal medication adherence can be summarized as taking the right medication at the right time, in the right dose, for the correct duration of time. Optimal adherence will help provide positive outcomes and improve quality of life.4

Pharmacists can identify barriers to medication adherence by examining the factors that affect a patient’s ability to take their medications. These barriers may be complex and include factors such as socioeconomics, health care system structures and processes, severity of comorbidities, complexity of medication and nonmedication therapies, and patient concerns. Pharmacists can then employ shared decision-making approaches to help patients eliminate or manage these barriers.5

Providing Health and Wellness Services

Pharmacists can provide several health and wellness services, including health screening, chronic disease state management, immunization, COVID-19 testing, and medication therapy management (MTM). In some cases, pharmacists can write prescriptions for needs such as contraception and some test-and-treat programs.

Performing MTM Services

MTM is a systematic process of obtaining patient-specific information regarding medication therapies to identify medication-related problems and create a plan to resolve them. Medication therapy reviews can be comprehensive or targeted to a specific medication-related challenge. Whether comprehensive or targeted, the patient’s medications are evaluated in the context of the patient, taking into consideration all their conditions and therapies.6

Assessing Patient Health Status

Patient assessment is essential to identify drug-related problems, monitor or manage patients requiring chronic drug therapy, and enable the pharmacist to diagnose and treat common minor acute illnesses. Assessment also allows pharmacists to appropriately refer patients who

require a higher level of care and enhances the pharmacist’s ability to educate patients about their disease, its presentation, complications, and management. Because communication among health professionals is often based on the patient assessment process, it enables the pharmacist to communicate with other providers more effectively.7

Coordinating Care Transitions

Pharmacists can tailor complex transition interventions to individual patients, including comprehensive medication review, patient counseling, and direct collaboration with providers. Challenges include identifying patients at high risk, establishing cost-effective strategies, and creating methods to increase the potential impact of these interventions.8

Preventing Drug Diversion

The American Society of Health-System Pharmacists recommends a framework for preventing drug diversion driven by 4 key principles. These principles center on creating a collaborative approach, establishing clear processes for accountability and responsibility, implementing standard processes, and encouraging an overall culture of continuous readiness and quality improvement.9

Advancing Medication Stewardship

Antibiotic stewardship programs have been effective at improving outcomes, reducing adverse events, and reducing antibiotic resistance. Given the success of the antibiotic stewardship model, pharmacist involvement in other medication stewardship programs may increase. Pharmacists offer a unique skill set to advance pain and opioid stewardship programs as well as other therapeutic areas such as glycemic control and thrombotics.10

1. Drug assistance program. Asthma and Allergy Foundation of America. Updated January 2024. Accessed April 14, 2024.
2. Eze UIH, Fasanya MO, Babalola OC, Onwuchuluba E, Ajayi AI, Eze AG. Patients’ perceptions of medication counseling and education provided by pharmacists. Am J Pharmaco Pharmac Sci. 2023;2:9. doi:10.25259/AJPPS_2023_009
3. Bian J, Li Q, Li J, et al. Guideline for the evaluation of prescription appropriateness. Ann Transl Med. 2021;9(16):1352. doi:10.21037/atm-20-7502
4. Medicines adherence. Royal Pharmaceutical Society. Accessed April 14, 2024.
5. Tailored pharmacy-based interventions to improve medication adherence. CDC. February 24, 2023. Accessed April 14, 2024.
6. American Pharmacists Association. Accessed April 14, 2024.
7. Herrier RN, Apgar DA, Boyce RW, Foster SL. Introduction to patient assessment for pharmacists. In: Patient Assessment in Pharmacy. McGraw-Hill Education; 2015.
8. Slazak E, Cardinal C, Will S, Clark CM, Daly CJ, Jacobs DM. Pharmacist-led transitions-of-care services in primary care setting: Opportunities, experiences, and challenges. J Am Pharm Assoc (2003). 2020;60(3):443-449. doi:10.1016/j.japh.2019.11.016
9. Clark J, Fera T, Fortier C, et al. ASHP guidelines on preventing diversion of controlled substances. Am J Health Syst Pharm. 2022;79(24):2279-2306. doi:10.1093/ajhp/zxac246
10. Dopp AL, Hall KK, Fitall E. Pharmacist role in patient safety. Patient Safety Network. February 21, 2020. Accessed April 14, 2024.
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