NEWS

Pharmacists restructure jobs to better serve patients, adapt to managed care

By KAREN STINNEFORD
UNC-CH News Services

CHAPEL HILL -- Because health care is changing so dramatically, the role pharmacists fulfill is changing as well. It's Fred M. Eckel's job to make sure pharmacists are ready to face those changes head-on.

Eckel is a professor in the division of pharmacy practice at the University of North Carolina at Chapel Hill School of Pharmacy. The school and state pharmacy organizations are launching a pilot program to train practicing community pharmacists to do more than dispense medicine -- and instead, to work as clinical educators who help patients take care of themselves, thus saving money for everyone.

“As managed care becomes part of the landscape, there's a real need to show how pharmacists can contribute something valuable to the health-care delivery system, and how our role can be a cost-effective one,” Eckel said.

For years, pharmacists and doctors had a tacit understanding: Doctors prescribed the drugs, pharmacists dispensed them and then the doctor made sure the patient took the drugs correctly and that his or health benefited as a result.

In the past decade or so, all that's changed. Because of the growth of managed-care companies, doctors are being asked to treat more patients in less time. Because of advancements in medicine, patients with complex diseases are often treated as outpatients.

For patients with chronic diseases such as diabetes, asthma and epilepsy, being able to manage their illnesses at home saves money, offers freedom and flexibility and can reduce complications, if done correctly. But there are risks, too -- so someone with an understanding of chronic disease and medications must follow them closely to make sure they're OK.

Doctors, Eckel said, don't always have time to thoroughly educate patients or check on them frequently. He warns that as more outpatient drug therapies become available, and as doctors are less able to spend time with patients who have increasingly complex health problems, the combination could be lethal.

“Each year in the United States, we lose about 120,000 patients through drug misadventures,” Eckel said. “There's a growing realization that drugs used inappropriately are dangerous, and that potentially, payers could spend almost as much money treating drug complications as they do the actual illness.”

Enter the pharmacist. Not only do pharmacists understand drugs -- their uses, their combinations and their dangers -- but many pharmacists can spend the time needed to adequately educate patients about chronic illnesses and how to care for themselves, Eckel said. Pharmacies are being redesigned to allow pharmacists to do this more effectively.

“For a long time, our profession focused on getting drugs from point A to point B -- the actual dispensing of prescription drugs,” he said. “Now it appears that much of that activity could be replaced through mechanization and robotics and the better use of pharmacy technicians.”

To help promote the concept of “pharmacist-as-educator” in the health-care industry, the N.C. Society of Hospital Pharmacists and the N.C. Pharmaceutical Association formed a nonprofit foundation called the N.C. Center for Pharmaceutical Care. The UNC-CH School of Pharmacy agreed to donate 25 percent of Eckel's work week to the project; he is now the foundation's executive director. North Carolina's other pharmacy school at Campbell University also is participating in the project, along with the N.C. Chapter of the American Society of Consultant Pharmacists.

The foundation's pilot project in Asheville will demonstrate whether pharmacists make good clinical educators at less cost to insurance companies, Eckel said.

The Asheville project is being coordinated by Dan Garrett, pharmacy director at Mission-St. Joseph Health System, in cooperation with local pharmacies and the Mountain Area Health Education Center, which is affiliated with the UNC-CH School of Medicine. The City of Asheville has encouraged its employees with asthma and diabetes to work with participating pharmacists who specialize in managing those chronic diseases. Not only will the pharmacists teach patients how to care for their disease, but the pharmacist can flag problems that require a doctor's attention and recommend changes in medication.

After six months, researchers will compare the cost of managing each patient's disease before and after working with the pharmacist educators. If the project proves that pharmacists reduce doctor's office visits or hospitalization rates, insurance companies might be willing to pay for the pharmacists' time, Eckel said. Patients enrolled in the pilot project already have been overwhelming supportive about having someone to talk to about their disease and medications, he said.

In addition to the pilot project, the pharmacy foundation will look at other ways to reach out to community pharmacists. For example, pharmacists accustomed to working as education specialists or who are comfortable in a clinical environment could act as mentors to pharmacists who aren't, he said. The foundation also could offer support-group-type meetings, he said. As pharmacists are encouraged to change their vision of how best to serve patients in the future and redesign their practices, their colleagues in the support group can advise them.

Eckel said he hopes to roll out these and other programs in each one of the state's 10 Area Health Education Centers. Already, groups are meeting in six of the centers. There are 6,000 licensed pharmacists in North Carolina, of whom at least 4,000 work in community pharmacies. Most of them were trained in the drug-distribution model, Eckel said.

“For someone doing it the old way for a long time, change doesn't happen overnight,” he said. “Initially, many pharmacists were reluctant for economic reasons -- `no one is paying me for this, so it must not be important,' ” he said. “But I sense that the profession is ready to buy into this concept so they can better meet their patients' needs.”

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Note: Fred Eckel can be reached at (919) 962-0034.

Contact: Karen Stinneford (email: kstinnef@email.unc.edu)