Research from Washington State University (WSU) suggests that expanding availability of pharmacists’ clinical services is a good way to address an ongoing shortage of primary care providers.
A study in ClinicoEconomics and Outcomes Research found that the cost of caring for minor health issues (e.g., urinary tract infections, shingles, animal bites, and headaches) was, on average, about $278 lower when treated in pharmacies compared with patients with similar conditions treated at primary care, urgent care, or emergency room settings. Most of the illnesses resolved after the initial visit with a pharmacist, according to the study’s follow-up.
The study team calculated that if all of the illnesses in the 3-year study that were treated at a traditional site of care had instead been treated by community pharmacists, an estimated $23 million in healthcare expenses would have been saved.
“The findings show that pharmacists, especially in the outpatient community setting, are a viable solution to part of our patient access to care problem in our state and country,” said lead author Julie Akers, PharmD, a WSU pharmacy researcher. “Pharmacists are trained and qualified to do this work, and unfortunately in many settings, highly underutilized. And they could have a huge impact on how fast patients access care, which can minimize the complexity and the progression of their condition.”
Data for nearly 500 patients who received care from 175 pharmacists at 46 pharmacies across Washington State from 2016 to 2019 were analyzed, and treatment effectiveness was determined by follow-up with patients 30 days after their pharmacy visits.
Cases were then compared with insurance data for patients from the same time period with conditions of the same type and level who had sought care at a physician’s office, urgent care facility, or emergency room.
For nearly every minor illness in the study, the study authors stated that pharmacy care not only was effective but also cost considerably less. In one example—an uncomplicated case of urinary tract infection normally treated with antibiotics—a first visit to an emergency room cost an average of $963 and an average of $121 at a primary care physician’s office but cost an average of $30 at the pharmacy.
The study was conducted by a team of pharmacy researchers in coordination with an advisory board of physicians. “The findings highlight the advantages of expanding the physician-pharmacist collaboration that allows some pharmacists to directly prescribe medications,” the authors explained.
As part of their education, pharmacists are trained in clinical evaluation of common illnesses and, as Dr. Akers noted, regularly make recommendations for conditions that can be treated with OTC medications. With prescribing authority, pharmacists could take their current practice to the next level if OTC medicines are not enough, she pointed out.
Pharmacists also understand when to refer patients to different providers for conditions that are complex, need further testing, or cannot be resolved through medication alone, Dr. Akers added.
“We’ve seen over time, more and more patients struggle to get access to care,” Dr. Akers said. “Over the past couple of decades, we’ve seen inappropriate use of urgent cares and emergency departments for things that really didn’t need go to that level of service.”
The researchers stated that Washington State was selected for the research owing to “pharmacist delegated prescriptive authority through collaborative drug therapy agreements having been in place since 1979, with no limitation on patient eligibility, disease state, or medication prescribed. Many pharmacists included in the study were experienced in providing patient care services such as for immunizations and POC testing. In addition, pharmacists in Washington state are recognized as medical providers with billing authority, although at the time of this study the authority was new and not implemented in any of the study pharmacy locations.”
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