Are Pharmacists Your Competitors or Your Collaborators?

Lola Butcher

Disclosures

April 11, 2018

In This Article

Pharmacists' Scope of Practice Is Expanding

As America's physicians struggle to keep up with demand for their services, one group of healthcare professionals is rushing in to pick up some of that business. Pharmacists are offering an increasing array of primary care services, from immunizations to laboratory tests to birth control prescriptions to tobacco cessation drug therapy.

Many physicians are comfortable with this arrangement and feel glad that some patients are getting help through a different channel, allowing doctors to concentrate on more serious or chronic conditions. However, for other physicians, there is some tension surrounding pharmacists' expanding roles.

Until fairly recently, many physicians saw this trend as an incursion into their realm of responsibility.[1] And some still do. But the roiling changes in healthcare delivery are changing that, prompting health systems and large practices to embed pharmacists into their care delivery teams, while individual physicians enter into formal agreements with community pharmacists to share patient care.

Pharmacists' scope of practice is controlled at the state level, either through legislation or health departments, pharmacy boards, or other state-designated bodies.[2] The spectrum of allowed duties ranges widely, but states do share one thing in common: All have been steadily expanding the tasks that pharmacists can perform.[3]

All 50 states and the District of Columbia allow pharmacists to administer influenza vaccine, and many permit other vaccinations as well. At least 40 states allow pharmacists to dispense naloxone (which blocks the effects of opioids), and six states allow pharmacists to prescribe and/or administer oral contraception.

Most significantly, perhaps, pharmacists are being encouraged to play a bigger role in chronic care management in the hopes that they can improve patients' health status and reduce the need for high-cost emergency and hospital care.[4]

Do Physicians Think Pharmacists Have Too Much Responsibility?

John Cullen, MD, president-elect of the American Academy of Family Physicians (AAFP), practices in Valdez, Alaska—population 4000—where he works with hospital-based and community pharmacists. "They are absolutely a part of the team," he says.

That said, he thinks that community pharmacists' growing list of primary care services may have some downside. For example, while insurers may incentivize patients to receive vaccinations at a community pharmacy, doing so fragments their care. For one thing, patients' vaccination records are maintained in the electronic medical record at the doctor's office. For another, the physician may know more about a patient's medical situation that should be considered in the decision about whether to immunize.

Beyond that, the official position of the AAFP, which represents 129,000 physicians and medical students, is that only licensed doctors of medicine, osteopathy, dentistry, and podiatry should have the statutory authority to prescribe drugs.

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