Are pharmacists really “well placed”?

Fill in the blank: “Pharmacists are well placed to ___________.” You might have said, “help patients with medication adherence,” or “identify and manage hypertension,” or “provide COVID-19 vaccinations.” And it seems like every article aimed at pharmacists these days says that. Indeed, a crude Google search for the phrase “pharmacists are well placed. . .” turned up 276,000,000 hits.

It’s good to be well placed (or well positioned) for patient care, but let’s take a closer look at what “well placed” actually means.

Well placed might mean accessible. Certainly, pharmacists are known to be highly accessible in the community; we reported that the average patient with a chronic disease sees their pharmacist up to 10 times more frequently than they see their physician. ¹ You can “drop in” to see your pharmacist—now with longer and more convenient hours. During the COVID-19 pandemic, pharmacies stayed open. Accessibility means a lot in today’s health care.

Well placed might also mean “well suited,” that is, the health care professional who is the medication expert, one who can identify conditions requiring treatment, recognize suboptimal therapeutic choices, engage patients in decision making, identify medications for deprescribing, provide patient education, recognize adverse effects, assess and provide vaccinations, and so forth. And there is excellent high-level evidence for pharmacist care, especially with a full scope of practice. ²

Interestingly, physicians have caught on. Our research group is now getting calls from specialist physicians who see our role in the community as a way to identify and better treat patients. For example, we’re working with a cardiologist to have pharmacists screen for atrial fibrillation (which is often undiagnosed and often untreated) and then prescribe anticoagulation for stroke prevention. We’re also working with a hepatologist, whose idea is that we could better manage hepatitis C by engaging pharmacists to screen priority populations and prescribe the antivirals that will cure them.

So, yes, we are well placed. We should celebrate that.

It’s a simple formula:

Better Patient Care = Accessibility × Patient Care Skills

Or is it more complicated?

All of the accessibility and patient care skills in the world don’t mean much if patients don’t present to you for that care. If we don’t proactively identify patients who need our help, then we cannot provide that care. We cannot wait to be asked by the patient or by a referring physician. The reality is that many patients are unaware of their conditions, unaware that they need help and, unfortunately, many are unaware that their pharmacist can help them. In previous editorials, we discussed the importance of case finding and being proactive—a systematic approach to identifying patients who need our help.^3,4

Similarly, accessibility and patient care skills don’t mean much if pharmacies aren’t staffed adequately to provide this care. That means rethinking staffing formulas that are based on prescription volume only. And it means engaging the entire pharmacy team, especially pharmacy technicians. ⁵

So really, the “formula” is a little more complicated:

Better Patient Care = Accessibility × Proactive Case Finding × Patient Care Skills × Adequate Staffing

As with any formula, the result (better patient care) depends on all of these variables. If any of these components aren’t well established (poor access, lack of proactive case finding, unskilled pharmacists or inadequate staffing), then the result (better patient care) is poor.

For years, we have talked about the potential of pharmacy to improve patient outcomes. Being well placed is a good start, and unique to our profession, but to achieve our true potential for our patients, we also need to work on proactive case finding and appropriate staffing. ■