Growth of the pharmacy profession in recent years makes perfect sense given the trends that are driving health care in the US. Fifty years of proliferation of basic and translational biomedical research programs, in both the public and private sectors, has created an enormous infrastructure for research and intellectual capital that are unparalleled anywhere else in the world. This capacity has produced a massive rise of pharmacological agents that effectively address acute maladies, prevent the onset of chronic conditions and manage them once they emerge.
As the general population ages, the number of individuals suffering from chronic disease and disability will grow, demanding more of precisely this type of care. Infrastructure, resources and capacity, matched with growing demand, has created a refocused pharmacy profession which effectively manages clinical care of individuals, as well as entire systems of care, by using more drug product to ensure the highest level outcome for the lowest possible cost. Not surprisingly, over the last two decades, the US has witnessed seemingly inexorable growth in expenditures for pharmacy and less drastic increases in physician and hospital care. Even with this growth, there are still calls for more pharmacists in order to meet demand.
To project these trends into the future without substantive change in the pharmacy practice model will not only create a long-term shortage in the profession, but will also lead to a sub-optimal use of drug products to manage the disease burden of the nation. While the pharmacy profession has made the most significant attempt of any health profession to realign itself with the changing needs of the public and the health care environment, most of its practitioners remain stuck in the old dispensing mode for the bulk of their professional activity. To address this, pharmacy will need to complete the revolution it began over two decades ago.
First, the profession must bravely embrace the technology and alternative workforce that can assist in dispensing drug products. This will mean changes in state practice acts that allow for the wider use of technicians and a different role for pharmacists in relationship to this dispensing team.
Second, working with all entities of the health care system that deliver drug products, pharmacists must create new business models and practices that demonstrate the value to patients and payers of the pharmacist’s new services. These models can and should change the role of retail pharmacy, in-patient hospital and ambulatory clinic in the organization and delivery of health services. But this effort should push beyond what is familiar in order to develop new practice sites in the community, in home settings, and in cyber space. If these models are not established and advanced aggressively, then the temptation will be for the profession to stay stuck in the old pattern of dispensing.
Third, educators must refine the revolution of the recent past to ensure that their students have both the clinical and scientific skills, as well as the leadership and management skills, to both shape and deliver these changes.
Finally, while the profession of pharmacy should lead this change, it must be joined by key stakeholders. Perhaps most critical are the institutions which now deliver drug products in community settings. These retail and chain operations will need to develop strategies that position them to offer new types of health services. The other key stakeholder in this transformation will be pharmaceutical firms which wield enormous influence in how drug products are integrated into the health care system and marketed to patients. This structure and the relationships that it has encouraged are fraught with conflicts. Increasingly it will be in the interests of these firms to assist in the emergence of new models in which pharmacists play different and more central roles.
Americans will continue to use more pharmaceutical products to manage what ails them. The number of drugs they use and the complexity of their health needs will grow over time and the consumer will increasingly demand that these products and services be delivered in efficient, consumer-responsive and useful ways. Existing and newly formed systems of care will need to meet the growing demands for cost accountability, patient safety and quality. Those that have organized the delivery of drug therapy - pharmacies, clinics and hospitals - and those that develop and market new drug products will find that their interests will be served if they align their business models with these broad trends.
The pharmacy profession can lead this process or it will find itself following the ways in which other actors remake this vital part of the US health care system.