By Sandra Basu

WASHINGTON — Scope of practice for pharmacists in the private sector needs to be expanded to improve the quality and costs of healthcare delivery, according to a new U.S. Public Health Service report.

“There has never been a time when the healthcare demands and needs of the nation are so aligned with the capacity and capability of our pharmacy profession,” Rear Adm. Scott Giberson, RPH, MPH, an author of the report, told U.S. Medicine. Giberson serves as HHS U.S. assistant surgeon general and chief professional officer for pharmacy.

The report, “Improving Patient and Health System Outcomes through Advanced Pharmacy Practice,” was authored by USPHS pharmacists and supported by the U.S. Surgeon General. The report looks at how widely expanding the scope of pharmacy practice in the private sector — just as these roles already have been expanded in the federal sector and in some places in the private sector — can alleviate demands on the healthcare system.

“Healthcare delivery (including preventive or supportive care) in the United States is challenged by demands of access, safety, quality and cost,” the report states. “These challenges are amplified by provider work-force shortages and dramatic increases in primary- and chronic-care visits. Projections suggest worsening of this situation. New or additional paradigms of care must be implemented to reduce these burdens.”

Federal Pharmacists

While expanded pharmacy practice models are used in some nonfederal sectors, it is a hallmark of the federal sector in which pharmacists work in collaboration with other providers. For example, federal pharmacists often have the ability to perform physical assessments, order, interpret and monitor laboratory tests and provide care coordination through partnerships with patients for follow-up care, Giberson told U.S. Medicine.

“Additionally, federal pharmacists often have some level of prescriptive authority to help manage chronic disease through medications use. This is usually through collaborative practice agreements,” he said. “Outside of the federal sector, there are some states that have expanded policy, licensure and legislation recognizing pharmacists in a similar capacity. However, many states do not allow this type of model at this time.”

The biggest difference between pharmacy practice in the federal and nonfederal sectors, Giberson suggested, is that the federal pharmacy sector “has the advantage of reducing some of the potential barriers of scope, compensation and differing opinion to implement models that are best for the patient and health system.

“This has afforded federal pharmacists the ability to practice in a forward-thinking practice environment,” he said. “Some nonfederal health systems and practice environments have adopted these models with success, but wider implementation will require some changes, as noted in the report.”

Giberson said he believes that expanding the scope of pharmacy practice in the nonfederal sector, as the report suggests, would have a positive impact on access to care.

“If you include the anticipated shortage of primary-care providers, which could worsen over the next few years, there is a need to consider other alternate-delivery methods and healthcare providers.”

He also said the report is not advocating that pharmacists have physician privileges or in any way take away from the work of other healthcare professionals.

“The data collected suggest these expanded pharmacy models are evidence-based and successful – and have been across decades. I do believe that, if this model -- which includes expanded scopes of pharmacy practice -- were not successful, physicians would not have supported it for so long.”

Legislative Changes

Among the recommendations of the report is that the law be changed to recognize pharmacists as healthcare providers under the Social Security Act. Currently, pharmacists are not recognized in that way, despite the inclusion of other  healthcare professionals, such as physician assistants, clinical nurse specialists, nurse practitioners, certified registered nurse anesthetists, clinical social workers, certified nurse midwives, clinical psychologists and registered dietitians or nutrition professionals.

The report also advocates that compensation mechanisms for pharmacists expand and reflect the level of patient care provided similar to other healthcare providers.

Current compensation under Medication Therapy Management Part D may be adequate for providing certain pharmacy services, such as medication reviews, medication reconciliation and patient referrals/consultations, but are not always sufficient to sustain all levels of service, including more comprehensive chronic disease management, care coordination and follow-up care, according to Giberson. “The lack of adequate compensation is notably influenced by the fact that pharmacists are not recognized as healthcare providers in the Social Security Act,” he added.

Legislation to include pharmacists as healthcare providers in the Social Security Act has been introduced, but not passed, in Congress over the years. By adding pharmacists to the Social Security Act definition, they would then be eligible for additional reimbursement from the government.

An Arizona pharmacist is using the Change.org website to petition Congress to change the Social Security Act to include pharmacists. The petition had more than 18,000 signatures, as of last month.

“By changing the compensation structure allowed under Medicare, we can ensure that patients have access to the medication expertise of pharmacists,” the petition stated. “Studies have shown that, when a pharmacist is directly involved in patient care, patients have fewer adverse drug reactions, experience improved outcomes, and healthcare costs are reduced.”

The report, Improving Patient and Health System Outcomes through Advanced Pharmacy Practice, can be found at: http://www.usphs.gov/corpslinks/pharmacy/comms/sgreport2011.asp.

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