Community Pharmacy: The Prodigal Son of Healthcare?
Updated: Jan 14, 2020
Like many kids that grew up in the South, I attended youth group in middle school. At the youth group meetings, the pastor would teach us life lessons through parables and stories. One particular lesson that has always stuck in my mind is that of the prodigal son. I am sure many of you know the parable: a son asks his father for the father’s fortune. The father obliges but the son squanders it away until he is left with nothing. The way that the story was presented to me in this particular instance was having extreme potential versus wasting that extreme potential; having all of the opportunities at your fingertips, and doing nothing with those opportunities.
From 2005-2015, I worked at an independent pharmacy in my coastal hometown of Morehead City, NC. This pharmacy, very aptly named Community Pharmacy, is the pharmacy where I “grew up” as I worked as a clerk, then technician, and then intern as I went on to pharmacy school. The owners, Mike and Mark, taught me nearly everything I know about what it means to be a pharmacist, like how to interact with other healthcare providers, how to serve my community, and most importantly, how to care for patients as if they were your family. In fact, many of their patients are my actual family and I still keep up with the care that they provide for our little community, even now that I’ve moved to Mississippi.
In the last 15 years, I have spent significant time in six or so pharmacies, just like Community Pharmacy, through school, residency, and now as a faculty member. During this time, I have witnessed hundreds, if not thousands, of interactions of community pharmacists with their patients. Interactions such as helping a new mother dose their child’s first antibiotic, an older couple who has trouble managing their multiple medications, a widower who needs to dispose of their spouse’s unused medications, a 61-year-old woman who has been newly diagnosed with high blood pressure and is starting a new medication for the first time in her life, or a patient with mental illness who has trouble remaining adherent to their medication regimen. If you work in a pharmacy, these are familiar stories to you. I am sure many of you reading this have met these exact patients in your pharmacies.
In the world of pharmacy, nearly every reimbursement dollar is associated with dispensing a prescription drug product. This makes it difficult for a traditional pharmacy to provide anything extra beyond dispensing. Because of this, we are often so busy filling prescriptions that we forget to document when we take care of the person standing right in front of our face. We provide care through these thousands of interactions and we do not tell anyone about them. The mother leaves and we move on to the next person and forget all about it. The 61-year-old woman gets a blood pressure check and a few minutes of advice and walks out. These encounters are so valuable, not just to the individual receiving them, but to the healthcare system as a whole.
As I have traveled to different pharmacies in my career, every one cites “not enough time” as the reason for not documenting their patient care activities. We have lost perspective of the value that we provide. We practice in our own silo away from the other members of the healthcare field. We fill as many prescriptions as fast as we can, get them out the door, and provide little or no healthcare.
Wasting that extreme potential.
Fortunately, there is hope for community pharmacy. Flip the Pharmacy (FTP) is a Practice Transformation effort that promises to aggregate data and help truly revolutionize the way that we provide and document our patient care services. In the first three months of FTP, the fifteen Team Mississippi pharmacies have documented almost 3,000 patient care interventions. These pharmacies have begun seeing patients with hypertension and following up with them on a regular basis, while also utilizing pharmacy technicians in enhanced roles to further support the practice transformation efforts.
Imagine a patient who goes to their doctor and their blood pressure is uncontrolled at the visit so the doctor adds a new medication and tells them to try that. Now, imagine how different that interaction with their doctor would be if the doctor had an adherence report card from the patient’s community pharmacy plus a monthly blood pressure value in their chart. Perhaps the patient has white coat hypertension in the office visit. Maybe the patient could not afford their medication and the pharmacy worked with a local group to get their copays covered. All of this is valuable for the doctor to have a full picture of how to treat this patient.
At the end of the parable, the lost son returns home to beg his father for forgiveness and to allow him to work as a servant. The father instead welcomes the son back with open arms and celebration. The time of wasting the extreme potential that community pharmacy brings to the healthcare team is over. The time to celebrate is now.