Tagged: community pharmacist


The convenient quality healthcare revolution

  • Demand for primary care services outstrips supply
  • People want affordable convenient, quality healthcare
  • The retailization of healthcare is large and growing fast
  • US Minute Clinics in CVS retail outlets expect 6 million visits in 2015
  • Traditional health providers can’t stop the convenience healthcare revolution, but they can encourage it 

“It” is larger, and growing faster than most people think. “It” is driven by the combined burdens of heightened patient expectations, disproportionate growing and ageing populations, and finite resources. “It” will significantly impact healthcare systems throughout the world. “It” . . . . is the ‘retailization of healthcare’, which uses pharmacists, and nurse practitioners to provide a range of healthcare services in diverse retail locations.

A convenience revolution

In 2010, Rite Aid, the US retail pharmacist, partnered with American Well, a company providing online access to doctors 24-7; 365 days a year, to test a service, which allows consumers to interact directly with Rite Aid pharmacies for medication advice, and results in an electronic record, which is shared with primary care doctors.

Larry Merlo, the CEO of CVS, the second largest drugstore chain in the US, which has 100 million customers each year, is leading the charge to create more healthcare services in CVS stores. Already, CVS has 960 walk-in Minute Clinics staffed by pharmacists and nurse practitioners. The clinics are open on nights and weekends with no appointments. Prices are between 40% to 60% lower than traditional US doctors, and a fraction of the cost of A&E. This year, Minute Clinics expect some six million visits, and CVS plans to open a further 500 such clinics by 2017. In 2014, at CVS stores, more than 700 million prescriptions and five million flu injections were administered. 

Walgreens, the largest drug chain in the US with 8,217 stores in 50 states, has also set-up healthcare clinics, and similar initiatives, are afoot in the UK. These, together with other retail initiatives, constitute a convenience revolution in healthcare. 

“US and UK healthcare systems will go bankrupt if they don’t change their current healthcare delivery models,” says Devi Shetty, world renowned heart surgeon, founder and chairman of Narayana Health, India, which provides affordable quality healthcare. 

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Adherence to medication

People like the fact that pharmacists are accessible friendly health professionals, and over time grow trusting, personal and valued healthcare relationships with them, which enhance adherence to medications. Non adherence is costly, and can lead to increased visits to A&E, unnecessary complications, and sometimes death. According to a New England Healthcare Institute report, Thinking Beyond the Pillbox, failure to take medication correctly, costs the US healthcare system $300 billion, and results in 125,000 deaths every year. 

Rajiv Dhir a senior prescribing pharmacist working for NHS England describes the importance of patients being able to discuss their drug regimens with pharmacists:

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Primary care environment 

In the UK and elsewhere the demand for rapid and convenient primary care, outstrips it's supply. For instance, the UK is experiencing an exodus of GPs. In just five years, 40% have left to work abroad, and around 22,400 GPs – more than half of England’s 40,200 family doctors – want to retire before the usual age of 60. Younger doctors are not filling the gaps, with up to one in eight GP training posts unfilled. They are instead either choosing careers as hospital specialists or going to work abroad. Today, some 1,063 GPs are needed in England just to return to the patient-doctor ratio of 2009.

Coordination between primary and secondary healthcare

Walk-in retail clinics can provide a valuable link between primary and secondary care. CVS has partnered with over 50 secondary health providers including the Cleveland Clinic, which offer their Minute Clinics follow-up services, and answer questions a nurse practitioner might have over the telephone. Such relationships are well positioned to be enhanced by increased electronic sharing of patient data.


Traditional health providers can’t stop the convenience healthcare revolution, but they can encourage it.

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Expanding the role of community pharmacists

As efforts to integrate community healthcare falter, access to primary care becomes more difficult, and A&E departments become over-burdened with minor aliments, increasing attention is being paid to innovative ways to mine the vast, and easily accessible clinical expertise of pharmacists in order to increase the quality of healthcare and reduce costs.
An untapped reservoir of clinical excellence
Various reports describe how patients are increasingly tapping into the professional expertise of community retail pharmacists. However, the vast reservoir of pharmacists’ clinical knowhow and expertise is not optimally utilized in the provision of healthcare, and is not fully appreciated by the general public and healthcare providers. 
An underutilized clinical knowledge bank
Pharmacy is the third largest health profession in the UK, with universally available and accessible community services. In England about 6,000 pharmacists work in hospitals, some 3,000 are employed in the pharmaceutical industry, and about 32,000 work in 13,000 community retail pharmacies. All are highly trained graduates, who have undergone competency training, and a registration examination, which enables them to practice. 
In contrast to GPs, pharmacists have a significant high street presence, and long opening hours. They are also open at weekends, and no appointment is required for their services. According to a 2014 Royal Pharmaceutical Society report, 99% of the UK population can reach a pharmacy within 20 minutes by car, and 96% by walking or using public transport. Community retail pharmacists help people stay well, and use their medicines effectively. Each year, the NHS spends some £12bn on medicines; £100m of which is wasted on their ineffective use.
A 2014 Care Quality Commission review of 8,000 GP surgeries in England, uncovered overly long wait-times for appointments, and poor care of the elderly. Forty per cent of GPs questioned in England by the magazine PULSE, said that they expected two-week wait-times for non-urgent appointments in 2015.
Expanded role of pharmacists
Pharmacies are extending their services to patients’ homes, residential care, hospices, and primary care offices. This provides a significant opportunity for healthcare systems.
Pharmacists can play an expanded role in out-of-hours primary and urgent healthcare, and are well positioned to raise disease awareness, deliver educational information at multiple points of contact, and offer sexual health services. In 2013, more than 16,000 free Chlamydia tests were carried out in pharmacies. In 2010 NICE recommended that pharmacists should offer a full range of contraceptive services to tackle the exceptionally high under 18 conception rate in England.  
However, the core business for 21st century healthcare systems is to meet the large and growing needs of people with life-long chronic conditions, such as diabetes, cancer, heart disease, and respiratory conditions. Community retail pharmacists are well positioned to monitor and manage such conditions to alleviate their symptoms, and reduce the need for invasive, costly and disruptive interventions. This role would be significantly enhanced if pharmacists had access to patient records. 
There is an urgent need for community retail pharmacists to expand their range of clinical services. Working with other health professionals, pharmacists have an expanding role in optimizing the use of medicines, providing a national minor ailment service, and playing a larger role in the on-going management of patients with long-term chronic conditions.  
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