November 30, 2009

USA: Pharmacists are a vital, if under-used, part of healthcare

. LOS ANGELES, California / Los Angeles Times / Living / November 30, 2009 One physician says their years of training make them 'walking encyclopedias' on drug effectiveness, side effects and interactions. By Karen Ravn There's an old Jerry Seinfeld joke many pharmacists know all too well. It's the one in which he describes their "whole job" as taking pills from a big bottle and putting them in a little bottle. "I think that's how a lot of people see us," says Jeff Goad, an associate professor at the USC School of Pharmacy, with both frustration and good humor. Expert advice: Especially if you take more than one medication, a pharmacist can help sort out any potential risks, even if questions crop up after you've left the drugstore. Alex Gallardo / Los Angeles Times But pharmacists' long years of training -- at least six and as many as eight -- prepare them for much more than repackaging pills. "In terms of the number of hours spent studying drug effectiveness, pharmacists are better trained than physicians," says Julie Donohue, an associate professor of health policy and management at the University of Pittsburgh. Gone are the days in which pharmacists wouldn't even tell patients what was in their medications, Goad says. Pharmacists now can help patients get the most good from their medications, manage side effects, avoid interactions, even save money. Today, most, if not all, states have laws requiring pharmacists to give patients specific information. Pharmacists in California are required by state law to offer counseling to patients about every new or changed prescription they fill. Pharmacists and other public health experts call this an offer no one should refuse. "It's the last critical safety check," Goad says. Too often, this safety check doesn't happen. Many customers sign away their right to the service. In 2004 and 2005, the Center for Health Improvement, an independent nonprofit health policy organization based in Sacramento, examined the prescription counseling process in California for patients 65 and older. The statewide survey of pharmacists found that 50% of patients waived counseling either "sometimes," "often" or "always." Some patients are in a hurry. Or they're embarrassed. Or they don't want to bother the pharmacist. Or they'd rather just read the written information that pharmacists are required to give (though it's not clear how often -- or how well -- they really do read it). Some turn down counseling without even knowing it, simply by signing a form that their pharmacists (or maybe the pharmacists' assistants or clerks) hand them with no explanation. "Good pharmacists should almost force themselves on patients," says Steven Chen, associate professor at the USC School of Pharmacy. "They should definitely never say, 'If you don't want counseling, just sign this line.' But that happens with too many pharmacists." Warning signs California law specifies the basic format for prescription counseling: One, pharmacists should give patients directions for how to use and store their medications, making clear that it's important to follow those directions. And two, they should warn patients about possible side effects or interactions that occur frequently and may be severe. Other issues to be discussed are optional, left to the pharmacist's discretion. The Center for Health Improvement study found that even the required elements are sometimes given short shrift. When asked about an average counseling session with senior patients, 93% of pharmacists said they "often" or "always" gave directions for medication usage (though only 81% said they "often" or "always" discussed how important it was to follow the directions), and 87% said they "often" or "always" gave appropriate warnings. Pharmacists were much less likely to cover optional issues. For example, only 39% said they "often" or "always" discussed what patients should do if they miss a dose of their medication. More than 50% of the pharmacists in the survey blamed time pressure, at least in part, for any deficiencies in prescription counseling. When 10 patients are waiting (impatiently) in line, a pharmacist may secretly hope none of them will accept counseling -- and may feel compelled to rush through counseling with any who do. "There's such a high demand for drugs," Chen says, "and not always enough staff." Pharmacists are generally paid simply on the basis of how many prescriptions they fill, so they get paid the same regardless of whether they counsel patients about their prescriptions. And patients themselves are often most concerned about whether the medication is covered by their insurance, says Kathy Besinque, an associate professor at the USC School of Pharmacy who also works part time at Patton's Pharmacy in Santa Monica. "If it's not, sometimes they just won't get it at all." Time to talk As pressed as they may be for time, pharmacists generally have more of it to spend with patients than physicians do. "These days physicians have to see three patients an hour," says Dr. Paul Gregerson, chief medical officer for the JWCH Institute in Los Angeles, a clinic that serves uninsured homeless people. "It relieves so much stress for them to know pharmacists are there to talk with patients, to educate and explain." If and when pharmacists don't fill this role well, it may be because their customers don't give them a chance. Still, some pharmacists are bound to be more skilled than others. "You should choose your pharmacist as carefully as you choose your physician," says Anne Burns, vice president for professional affairs for the American Pharmacists Assn. That means checking out someone's training, experience and ability to communicate, says Ken Thai, owner of El Monte Pharmacy. "Ask, 'Hey, how did you get here? What do you know?' . . . Find someone you'd like to trust your life to." Physicians wholeheartedly agree about the importance of the pharmacist's role. "Pharmacists know more about medications than anybody else in the healthcare system," Gregerson says. "That's what they went to school for. . . . They're like walking encyclopedias." At the institute where Gregerson works, physicians and pharmacists collaborate closely on patient care. So he has seen firsthand what pharmacists can do and has found that their unique skills can save time, money, even lives. But, he believes, "pharmacists are totally under-utilized by society in general." [rc] Copyright © 2009, The Los Angeles Times