Disrupters or Exploiters?

As I ended my day, I was catching up on social media posts and was drawn to some discussions about disruption in pharmacy—a common theme right now. It seems everyone believes they have a better business model, better technology, better convenience, and of course, they can do everything at a much better price than anyone else. They also make claims that you can access an online remote pharmacist to answer your medication related questions. It’s the same story, different companies.

I find it difficult to believe all these companies are disrupters of the current system when their products are very similar. And I find it disheartening that their view of the pharmacist is simply answering medication-related questions. Really? Is answering questions all my comprehensive pharmacy education, advanced training, licensures, and certifications limits me to do? As far as I can tell, none of these companies have anything that is truly breakthrough. They only tout packaging, delivery, billing, advanced technology, and apps. 

They seem to be missing the one thing that really needs to be disrupted—patient medication optimization. It doesn’t matter that you can get a cheap medication to a patient in a timely manner if that patient is experiencing a medication-related problem. What my training and experience taught me is that building a “therapeutic relationship” with patients is the catalyst to pharmacists helping patients achieve therapeutic outcomes with safe and effective medications. 

We teach our students, residents, and staff that medication-related problems (MRPs) are prevalent within our health care system and it is our job - our professional responsibility - to identify and resolve them by working collaboratively with patients and prescribers. At our pharmacy practice, we go into every patient encounter expecting to find a MRP. And most times, we do.

In one year, at just one of our practices, we made nearly 17,000 clinical interventions for approximately 2,500 patients. Pharmacists made, on average, 6.8 interventions per patient with almost half of the interventions (49.7) addressing medication-related problems.1.  At the same practice, in collaboration with a commercial insurer, we determined that by providing these ongoing medication monitoring services, we improved adherence rates and reduced overall health care costs by approximately $300.00 per member per month.2.   

So, I ask - is the disruption in pharmacy about the medication, its delivery, and the newest technologies? Or is it about how we optimize health care outcomes related to our patients’ medications?

It should not be about exploiting our profession with companies that bring the newest widgets and make claims that are unproven. It should be about truly disrupting the system to improve the medication management of our patients. That begins with practice transformation in which pharmacists have time and resources to provide optimal care for their patients. And the ultimate disruption needs to be paying pharmacists to provide these important, PROVEN, cost-saving interventions.  

1.     Goedken AM, Butler CM, McDonough RP, et al. (2018). Continuous Medication Monitoring (CoMM): A foundational model to suppor the clinical work of community pharmacists. Res Social Adm Pharm. Jan;14(1):106-111. doi: 10.1016/j.sapharm.2016.12.008.Epub 2017 Jan 2.

2.     Doucette WR, McDonough RP, Fischer H, et al. (2107). Pharmacy performance while providing continuous medication monitoring. J Am Pharm Assoc (2003). Nov-Dec;57(6):692-697. doi: 10.1016/j.japh.2017.07.006.Epub 2017 Aug 24.