Integrating Pharmacists Into the Patient Care Team

Team-based patient care is an essential component of the evolving US health care reform that will revolutionize the way we deliver care to patients. Despite the theorized advantages and benefits of team-based care, the implementation of the model within many primary care practices is lagging due to challenges and uncertainties. Physicians have practiced with nurses for decades, but the addition to the health care team of counselors, pharmacists, and dietitians remains a work in progress. Before widespread implementation can occur, key questions to answer are, Which patients would benefit the most from team-based care, How do team members communicate with each other, Who is ultimately accountable to the patient for communication and follow-up, and (perhaps the most challenging) How will the team be paid to provide this high level of coordinated care and still be sustainable?

While these questions remain to be answered, we can start the integration process by determining how each team member can provide a unique contribution to the new model of care. We need to capitalize on the expertise of each team member and allow the team member to provide the best care that he or she is trained in and licensed to practice.

So, what is the role of the pharmacist on the patient care team? Medications are certainly the mainstay for treating many disease states and syndromes; however, when used inappropriately, they can lead to poor outcomes. Patients may not understand the purpose of a medication or its proper use. There may be adverse effects, drug interactions, or cost concerns. Patients may have trouble swallowing or a fear of becoming addicted to a medication. For a multitude of reasons, people fail to even fill a new prescription, let alone continue to take the medication for a lifetime. Rates of poor adherence are highest with medications for chronic conditions, asymptomatic disorders, and psychiatric diagnoses. These conditions are also among those with the lowest rates of treatment response.

Pharmacists are particularly well suited to be part of the team to address patients’ medication-related concerns. Pharmacists are trained in the safe, effective, and appropriate use of medications. Using a process called comprehensive medication management, pharmacists work one-on-one with patients to elicit their medication “experience,” listening to and addressing their health care concerns. Pharmacists explore patients’ health-related goals and priorities. They provide unbiased information to allow patients to make informed decisions about their own health care. They provide nonjudgmental assessment, planning, follow-up, and support. Pharmacists work in community health centers, Veterans Affairs systems, and public health services, among other settings, assisting physicians in managing their most complex patients. Pharmacists with training in psychiatric disorders have additional skills in working with patients with mental illnesses, which can be especially helpful in primary care settings.

Pharmacists are increasingly being integrated into the primary care setting, working side-by-side with physicians in collaborative care arrangements. They provide assessments, recommendations, and follow-up. The large hurdle to incorporating pharmacists within every health care team is their lack of recognition as health care providers in the Social Security Act. Unfortunately, this omission presents a significant challenge in pharmacists’ receiving payment for their patient care services. But, as new models of health care and payment evolve, it is vital that pharmacists be included as core members of the team. Pharmacists, with their unique knowledge and skills, have an indispensable role on the health care team.

Financial disclosure:Dr Cobb has no relevant conflicts to disclose.