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Scope of Practice: A Look at the Expanding Role of Independent Pharmacy

Scope of Practice: A Look at the Expanding Role of Independent Pharmacy by Elements magazine |

June 15, 2016

Pharmacists today are taking on larger roles thanks to expanded scopes of practice.

They can administer some vaccines and immunizations in all 50 states, and can administer any vaccine in 45 states, according to the American Pharmacists Association (APhA).

Recently, California and Oregon adopted groundbreaking laws enabling pharmacists to prescribe birth control without a doctor’s prescription, and other states are expected to pass similar legislation. Fifteen states have also expanded pharmacists’ role in fighting opioid and heroin abuse by making naloxone, the overdose-reversal medication, available without a prescription.

The expanding scope of practice for pharmacists is spurred by a deficit of primary care providers, and Russell Melchert, Ph.D., dean of the School of Pharmacy at the University of Missouri–Kansas City in Kansas City, Mo., said pharmacists are well positioned to help fill this shortage and to take on a larger role in managing patients’ health.

“Pharmacists are the second-most highly trained, second-most highly trusted and the most accessible health care provider,” Melchert said. “And, nearly 30 years of published scientific literature has shown that for every $1 we spend on pharmacy services, it saves $4 on health care costs.”

“Why not expand the role for somebody who is highly educated and highly respected, and on top of that, the most accessible health care provider?” he said.

Future outlook for pharmacists

Melchert said pharmacists’ scope of practice will continue to expand.

“I think it’s only going to grow,” he said. “We will see some publications documenting the benefits of pharmacists providing services, and then once that happens, policymakers can’t really turn away.”

Melchert said he expects pharmacists to take on a larger role, particularly in regard to patients with chronic conditions.

“Diabetes, cardiovascular disease, and heart failure, all of these chronic conditions, they’re not getting cured. We need to expand the scope of practice to help pharmacists better care for those patients,” he said. “That will relieve some of the burden on the health care system at large and improve outcomes.”

Improving outcomes of patients with chronic conditions has captured the interest of the federal government, third party payers, and policymakers, and Melchert said increasing pharmacist intervention with these patients benefits all parties.

“Outcomes are better; patient satisfaction is better; and cost in the grand scheme of the health care system will go down for everybody involved, but profitability on the pharmacy side will go up,” he said. “Not only does it make business sense, but it makes good sense in the quality of care and the continuity of care for patients and their outcomes.”

Melchert said pharmacists might also take on a larger role in smoking cessation counseling and blood pressure monitoring, which could include being able to prescribe smoking cessation aids, or modifying blood pressure medication therapies.

What you can do

Pharmacists’ scope of practice has grown substantially, but there’s still work to do.

Melchert recommends joining your state’s pharmacy association to advocate for the expansion of your profession’s scope of practice.

“They carry the torch for pharmacy and advancing the profession,” he said. “We encourage our student pharmacists and our faculty to join state pharmacy organizations that are involved in advocating for the profession.”

Regardless of changes to pharmacists’ role as providers at the federal level, Melchert said states still have to expand their scope of practice, and state organizations are essential to that end.

“We’ve got to have that scope of practice expanded at the state level,” he said. Melchert also urged pharmacists to start offering the services allowed under their state’s current scope of practice.

“The more you do, the more you build loyalty and satisfaction with the care you’re providing,” he said. “It’ll be traction from these examples that will further build trust and relationships with the skills and the knowledge base of pharmacists.”

If your pharmacy training didn’t prepare you to offer services recently added to your state’s scope of practice, Melchert said you can still learn the latest skills through continuing education (CE) sessions, or by getting involved with a pharmacy school.

“We have programs available to help people get up to speed,” he said. “And, one of the best ways to learn something new is to get involved with teaching.”

Melchert said increasing stakeholders’ awareness about the value of pharmacists’ care is key to expanding scopes of practice and gaining provider status.

“We continue to be the best kept secret in health care,” he said. “What we need to do is to start with our communities, our state and our country, and tell the world about the value of pharmacy services.”



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