A Series on Medication Safety in the United States: Underutilization of Pharmacists

In the final installment of this series, Dr Munger discusses why pharmacists are uniquely equipped to employ strategies that improve medication safety.  

Effective strategies to enhance medication safety are centered on 3 major themes: the recognition that medication safety is an unmet clinical need, the appropriate use of medication experts armed with artificial intelligence that identifies high risk patients’ medication profiles, and reimbursement for medication safety oversight.

Pharmacists are central to meeting the unmet clinical need of medication safety in the United States. Pharmacists are the third largest group of health care providers.1 Pharmacists have the foundation from their education and training in basic pathophysiology, physical assessment, basic and complex diagnostic testing, pharmacotherapy, diagnosis of ailments requiring over-the-counter medications, information technology systems, and wellness services, making them valuable parts of the primary care workforce.  

Preventive care guidelines are part of the education pharmacists receive in all schools of pharmacy.  Pharmacists are well trained to use advanced therapy management (ATM) strategies—including the identification of patients at risk of medication safety issues and the provision of medication reconciliation. They can also identify medication-related problems, formulate an action plan, and transmit the action plan effectively to patients and providers. Pharmacists have demonstrated improved outcomes using these strategies.^2-6

These strategies provide a framework to move the profession forward. First, value-based remuneration for pharmacists’ expertise must be foremost. Bipartisan legislation has been introduced in California⁷ which would enable the use of pharmacogenomics testing to ensure that patients receive appropriate medications based on genetics.

Senate Bill 1191 (Utilizing Pharmacogenomics to Greatly Reduce Adverse Drug Events Act) would include accredited pharmacogenomics testing as a covered benefit under Medi-Cal, thus allowing pharmacists to be reimbursed for ordering pharmacogenomics tests with clinically actionable decision-making. ATM should be reimbursed at ≥20% above pharmacists’ net dispensing profit per hour. This would assist the health care industry, placing focus on the pharmacist to provide care to improve drug-gene interactions and facilitating movement towards ATM practice.

Second, the profession should coalesce under the mantra of medication safety as an unmet need for their professional role in the next decade. Studies have shown that pharmacists prefer providing patient-centered services compared with distributive pharmacy services, as long as income and occupational satisfaction remained static or improved and comprehensive education was provided, where needed, to meet the new demands.^8-9

Third, the profession should work closely with physicians to implement these strategies. 

The time is nigh given that medication safety is an unmet clinical need in the United States. There are published, effective strategies and a defined underutilization of pharmacists who can address this important health care crisis. 

The first part of this series, where Dr Munger defines the problem of medication safety, can be found here.

The second part of this series, where Dr Munger shares strategies for providers and health systems to improve medication safety, can be found here.

References:

1. US Department of Health and Human Services. The Pharmacist Workforce: A Study of the Supply and Demand for Pharmacists. Health Resources and Services Administration, Bureau of Health Professions; 2000.
2. Jin H, Yang S, Bankes D, Finnel S, Turgeon J, Stein A. Evaluating the impact of medication risk mitigation services in medically complex older adults. Healthcare (Basel). 2022;10(3):551. doi:10.3390/healthcare10030551
3. Bankes DL, Jin H, Finnel S, et al. Association of a novel medication risk score with adverse drug events and other pertinent outcomes among participants of the programs of all-inclusive care for the elderly. Pharmacy (Basel). 2020;8(2):87. doi:10.3390/pharmacy8020087
4. Bain KT, Schwartz EJ, Knowlton OV, Knowlton CH, Turgeon J. Implementation of a pharmacist-led pharmacogenomics service for the Program of All-Inclusive Care for the Elderly (PHARM-GENOME-PACE). J Am Pharm Assoc. 2018;58(3):281-289.e1 doi:10.1016/j.japh.2018.02.011
5. Ratigan AF, Michaud V, Turgeon J, et al. Longitudinal association of a medication risk score with mortality among ambulatory patients acquired through electronic health record data. J Patient Saf. 2020;17(4):249-255. doi:10.1097/PTS.0000000000000829
6. Stein A, Finnel S, Bankes D, et al. Health outcomes from an innovative enhanced medication therapy management model. Am J Manag Care. 2021;27(16 Suppl):S300-S308. doi:10.37765/ajmc.2021.88755
7. Utilizing Pharmacogenomics to Greatly Reduce Adverse Drug Events (UPGRADE) Act, SB 1191, 2021-2022 Regular Session (Ca 2022). Accessed July 13, 2022. https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB1191
8. Grindrod KA, Marra CA, Colley L, Tsuyuki RT, Lynd LD. Pharmacists’ preferences for providing patient-centered services: a discrete choice experiment to guide health policy. Ann Pharmacother. 2010;44(10):1554-1664. doi:10.1345/aph.1P228
9. Munger MA, Gordon E, Hartman J, Vincent K, Feehan M. Community pharmacists' occupational satisfaction and stress: a profession in jeopardy? J Am Pharm Assoc. 2013;53(3):282-296. doi:10.1331/JAPhA.2013.12158