Expanding the Clinical Pharmacist Role
The Affordable Care Act covers annual wellness visits for Medicare beneficiaries and pharmacists are perfectly positioned and have plenty of expertise to provide the service, according to Christina Sherrill, PharmD, BCACP, an assistant professor of ambulatory care at the High Point University Fred Wilson School of Pharmacy.
In North Carolina, where Dr. Sherrill works, pharmacists who are licensed as clinical pharmacist practitioners can perform the visits. We asked Dr. Sherrill about her recent study, which determined that Medicare beneficiaries were satisfied and comfortable with having someone other than their physicians conduct wellness visits. She also touched on how expanding roles of clinical pharmacists improves patient access to needed care in light of the growing shortage of primary care physicians.
Why should pharmacists be interested in meeting this patient care need?
According to the Affordable Care Act, wellness visits can be handled by licensed healthcare professionals working under the direct supervision of physicians. This presents an opportunity for pharmacists to work at the top of their license. Providing annual wellness visits is a great way for pharmacists to utilize their expertise in another area of patient care and bill for the services. We wanted to assess what patients thought about having pharmacists serve in this role and found they were very satisfied and accepting of the practice. Pharmacists are able to bill for the wellness visit, which is one of the key ways they can bring in significant revenue for their services.
What benefits can pharmacists provide during the visit that perhaps primary care physicians can’t?
Patients like hearing from a provider they don’t see on a regular basis — someone who can provide a different perspective. Specifically, patients often have questions about the medications they’re on and appreciate meeting with a provider who can address concerns they might have about prescribed therapies. Pharmacists often have flexible schedules and are typically able to spend more time with patients. They can sit down and talk with them for 30 minutes to an hour and gather a great deal of health information. That gives them more flexibility to address what needs to be covered during the wellness visit.
What patient care services do pharmacists provide during the visits?
The visits are all about personalized preventative care. That includes collecting clinical information, exploring risk factors for diseases, addressing behavioral and social issues, and assessing abilities to perform daily living activities. Pharmacists also determine if patients show signs of depression and alcohol abuse, and schedule needed screenings and vaccinations based on age and health history. Because wellness visits involve older individuals, pharmacists also focus on fall risks. Developing up-to-date medication lists during the visit is important. Pharmacists determine when patients can’t access needed therapies or have compliance concerns, and work to solve those issues.
What additional training or certification do pharmacists need before filling this patient care role?
They must have an agreement with primary physicians in order to meet with patients in this capacity and bill for the service. Here in North Carolina, pharmacists can be credentialed as clinical pharmacist practitioners if they have graduated from pharmacy school, have a certain number of years of experience and some residency training. Other states have similar credentialing processes in place. Essentially, pharmacists who are credentialed for this role are granted an extended scope of practice and enter into collaborative practice agreements with primary care physicians. The agreement lets physicians authorize pharmacists to provide specific patient care services, adjust specific medications, and order lab tests as needed.
Do you think many primary care physicians would be willing to share this patient care responsibility?
Based on my conversations with pharmacists who participated in the study, physicians were not providing the service or were experiencing a significant time burden. For those reasons, delegating the responsibility to pharmacists is a big positive. The primary challenge to making the program work involves establishing relationships with the right primary care practice and getting the physicians excited about having pharmacists handle the wellness visits. We’re currently faced with a primary care provider shortage, so pharmacists will be relied upon to provide auxiliary services. Clinical roles will be shifted, which will allow physicians and pharmacists to function better as a team, maximize their expertise, and divide the workload in order to provide patients with the care they need.
—Dan Cook
