The Evolving Scope of Practice for Pharmacists

Pharmacists are facing a shift in the scope of their roles as they’re given more autonomy to provide care for their patients.

A photoghraph depicting a pharmacist and a patient

Patients view pharmacists as a necessary and trusted resource in their path to living healthy lives. This recognition of expertise makes it crucial for pharmacists to not only provide information and recommendations, but to act and administer care when it is in the best interest of the patient.

States are observing the importance of pharmacist involvement in the patient journey, and are taking legislative action to expand the abilities given to pharmacists. The result is better clinical decision-making and improved care through elevated patient engagement.

In this article, we will highlight some of the key themes that pharmacists can expect to see and what it means for patient care.

Vaccination Administration

Vaccinations have proven to be an enormous factor in improving public health through eradication, local elimination and prevention of disease and related illnesses.1

A 2018 report by the Pacific Research Institute (PRI) states, “Ensuring that there is adequate vaccination coverage against Adult Vaccine-Preventable Diseases (VPDs) is an important public health issue in the United States, including diseases such as influenza, shingles, and pneumonia.”2 Despite the importance of these life-saving therapies, adult vaccination rates remain low. Each year millions are hospitalized and thousands of lives are lost due to VPDs, resulting in costs of billions of dollars annually.2

An icon depicting three figures working together

Many believe the key to solving the vaccination problem in the United States could be the 300,000+ pharmacists.8

Two common reasons that patients avoid vaccinations are a lack of information and understanding of the importance, as well as the cost of the vaccine. Pharmacists are highly knowledgeable of the topic and are able to efficiently educate and advise patients as an effort to alleviate concerns. Pharmacists are also able to administer vaccinations at a lower cost than providers’ offices or other medical outlets.2 Establishing pharmacists as a more sanctioned point of access for vaccines can help improve vaccination rates and reduce the economic burden felt due to existing attitudes toward the system.

To first establish pharmacists as a more sanctioned point of access, they need greater freedom to establish themselves as an authority in the vaccination space and other parts of healthcare.

"In many states, outdated state laws unjustifiably limit patients’ access to vaccinations from providers who may be more convenient and less expensive. By reforming the laws, patients can get their next shingles or pneumonia shot at their neighborhood pharmacy." 3

- Wayne Winegarden, PhD of PRI

Legislators around the country understand this sentiment and have acted on legislation to improve pharmacists’ vaccination efforts. While all 50 states and the District of Columbia allow pharmacists to administer vaccines (with varying limitations pertaining to patient age), in 2017, seven states (HI, IN, KS, KY, MO, NH and WV) expanded pharmacists’ capacity to provide certain immunizations, including influenza, zoster, Tdap/Td, pneumococcal or HPV.

Forward movements in pharmacy legislation will help build momentum that results in a better patient experience and help improve public health.

Greater Prescribing Abilities

An important matter to address in health care is medication discrepancies resulting from transfer of patient care. According to the NACDS, up to 70 percent of these transfers of care cause medication discrepancies, "with one-third of these being serious enough to lead to adverse drug events."4

up to 70 percent of transfers of care cause medication discrepancies

one-third being serious enough to lead to adverse drug events

Adverse drug events result in more than 700,000 emergency room visits and cost the United States health care system more than four billion dollars annually.5

Advances in health care IT have positioned many pharmacists with a birds-eye view of a patient’s holistic medical treatment plan, giving them unique insights that allow a pharmacist to recognize a conflict in the patient’s drug regimen. With this viewpoint and the proper prescribing authority, a pharmacist has the potential to alter a patient’s drug therapy.5

This could in turn help to eliminate some of the 30 percent of adverse events that are caused when a patient has a transfer of care.4

Increased prescribing responsibilities for pharmacists could have additional benefits for patients, including faster time to therapy. By prescribing a medication themselves or changing a medication without the delay of obtaining a new script – thus eliminating the barrier of time – fewer scripts could be abandoned at the pharmacy. Legislation supports this logic for several drug classes.

An expanded range of prescribing abilities for pharmacists can help improve patient safety, reduce time to therapy, and reduce the number of prescriptions abandoned at the pharmacy.

Forty-one states have legislation of varying allowances that gives pharmacists the ability to dispense interchangeable biologics without getting a new script from the doctor.6 This will be important to pharmacists as the specialty medication space continues to grow.

All 50 states allow pharmacists to dispense naloxone to a person at risk of opioid-related overdose, helping to mitigate the growing number of incidents caused by the opioid epidemic.9

Six states (CA, CO, HI, MD, NM and OR) have active regulation that allows pharmacists to prescribe and dispense oral contraceptives. New Hampshire also allowed the creation of a commission to study pharmacists’ authority on this topic. This can provide easier access to medications that assist in reducing the number of unwanted pregnancies.

Six states (CA, ME, AZ, NM, ID and CO) allow pharmacists to prescribe and dispense smoking cessation aids, helping to reduce the number of people with tobacco dependencies.

An illustration depicting a computer surrounded by various pharmacy-related items

Changing Day-to-Day of Pharmacists

The evolution of the scope of practice for pharmacists means the responsibilities and daily tasks performed in the pharmacy will transform as well.

Expanded vaccination administration by pharmacists will offer them more opportunities to educate patients about preventative measures while the patient is in the pharmacy. Rather than directing a patient to discuss a vaccine with their doctor, pharmacists can expect to have the full conversation and provide vaccination administration on-site, in real time. The result of this streamlined process, in addition to elevated patient care, is an opportunity to lift pharmacy revenue.

As more drug classes are added to pharmacists’ prescribing repertoire, they can expect to have conversations that require a more involved look at a patient’s medical conditions and history. With the power to change or prescribe therapy, pharmacists can also expect to face questions from patients about their reasoning and the differences between various options.

An icon depicting three figures working together

Having these conversations with the pharmacist, as opposed to returning to a doctor’s office, can help improve the likelihood of a patient leaving the pharmacy with a medication in hand that they feel confident about.

This increased engagement with patients is the result of momentum started by putting more clinical responsibilities in the hands of pharmacists by state legislature. Some states have even proposed laws, such as Ohio’s SB 265, to officially and legally recognize pharmacists as health care providers.7 Continued support of these initiatives can bring better care to patients at more convenient points.

An illustration depicting various pharmacy-related items and a gavel

The importance of pharmacists in the health care journey of patients is evident and continuously growing. As our health care system continues to advance and modernize, adjusting the way that patients have access to care will be imperative to its success.

By including pharmacists in this movement, patients will have an easier path to the clinical services that they need to live healthy lives.

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