The three major factors acting to forever change future healthcare delivery are: technology, demographics, and consumer/patient demand. Of these three, technology has had its greatest effect on the profession of pharmacy.
From the traditional role of compounding drugs, spanning hundreds of years, suddenly post WW 2, the manufacturing function was industrialized resulting in the massive pharmaceutical industry which exists today.
Since that time, pharmacists have been searching for a new role in the healthcare delivery spectrum. This journey has been difficult, with the result that the verdict on the importance of pharmacy today, certainly at the community level, has had mixed review.
Overriding all of these factors, and which is a bane to the professional community pharmacist, is the overwhelming influence and control of the profession by big business interests, aka Big Pharmacy Retail (BPR). The control of pharmacy by non-pharmacists has served to further confuse the emerging role of 21st century pharmacists as the competing imperatives of patient care and business interests (profits) struggle to co-exist.
The challenge for pharmacists today, is to create a professional identity separate from drug delivery. Pharmaceuticals today play a critical and important part in patient care; they are also very expensive and are largely funded by governments, corporations, and insurance companies. Growing by 8% a year or more, the present rate of uptake is unsustainable. Tremendous pressure by governments worldwide is being exerted to lower the price of drugs. Canada continues to be on the high end among OPEC countries in terms of drug costs. There is much room for further cost reduction as systems drive further in the direction of generic drug utilization.
As pharmacist compensation has been largely tied to drug costs, this dynamic of cost reduction has had a profound effect on the pharmacy profession as a whole.
The current trend by the profession to provide “professional services” separate from actual drug handling is a direct reaction to this dynamic. As well, it is recognized that pharmacists are highly trained government funded university graduates with tremendous pharmaceutical/pharmacological knowledge which hitherto has been largely wasted. It is high time to employ this knowledge and expertise to improve healthcare outcomes. The statistical and evidence based data is extensive; poor medication management and non-adherence is a major contributor to hospital admissions and healthcare costs.
What are these so called “cognitive” or ‘professional” services, and how effective are they?
Simply put, the need for patients to adhere to their medication regimen, to understand the rationale of drug use in combination with the many other factors which affect human health is critical. The pharmacist plays a critical role in ensuring that this knowledge is transferred, and through follow up, is continuously employed.
Not all pharmacists are comfortable employing these new and evolving functions. Generally speaking, they are embraced more by newer graduates, and maybe less so by older graduates who are more comfortable in their traditional role as purveyors of drugs and other associated drug store type merchandise, sometimes referred to as retail pharmacists.
The impact that BPR has had on this changing role of pharmacists has been profound. There is an inherent conflict between the selling of merchandise, much of which is the antithesis of health, like junk foods, candy, pop, frozen pizzas, chips etc. and the delivery of healthcare services by pharmacists.
This conflict is being played out at present, and the jury is still out as to whether pharmacists will eventually breakout of their traditional image as merchants and become true independent professionals with no conflict of interest.
Until such time as pharmacists discover a way of regaining control of their profession the future remains uncertain.
Unlike physicians, pharmacists lack a powerful pharmacy association protecting the profession’s interests. In addition, the regulatory bodies have shown reluctance to take on big corporate interests in the interest of protecting the role of the independent pharmacist.
The future of pharmacy now is in the hands of a new generation of highly capable professionals. Time will tell whether the zeal and determination of this new breed of pharmacists will create the future in their own image and take their rightful place, along with physicians, as true members of the healthcare delivery team.