8/21/2023 0 Comments Your Medicinal HavenJacqueline Wiley is a 2023-2024 Xavier COP graduate who credits her education from the university with preparing her to be a successful pharmacy leader. She spoke about pharmacy’s significance to healthcare and its vital impact on community health. Haven hasn’t yet proven it has enough market power to wrest lower prices from providers. But the company may use its expertise in primary care and telehealth to try again. The History of Pharmacy The practice of pharmacy is as old as civilization itself. It can be traced back to the ancient Greek myth of Hygieia, who was delegated by Asclepius, the god of healing, with the task of compounding his remedies. Clay tablets recording prescriptions for medicine can be found in the 4th millennium BC in Sumeria, and early Chinese herbal manuals such as the Shennong Bencao Jing dated to the 1st century AD are also evidence of early pharmacy. The Industrial Revolution brought unprecedented change to all industries, and pharmacy was no exception. As factory-produced medications became more prevalent and nonclinical pharmacist work grew, the profession found itself questioning its identity and role in healthcare. In an effort to stay relevant, pharmacists resorted to front-end sales to generate revenue. Candy, household items, fountain-poured soda pops, and -- especially during Prohibition -- medicinal alcohol became profit drivers for pharmacies. But as the pharmacy industry began to shift, a national pharmacopoeia was established and the first professional schools of pharmacy were founded in the United States. By 1820, the Philadelphia College of Pharmacy opened its doors, and in that same year, the American Pharmaceutical Association was formed. Historically, the duties of the pharmacist and physician were distinct. However, by the 17th century, as European influence increased and the Arabian influence in Europe waned, a separation of roles developed between physicians, who were the healers, and pharmacists, who prepared and dispensed the medicines they prescribed. Benjamin Franklin played a crucial role in maintaining this distinction as he appointed an apothecary to Pennsylvania Hospital in the 1680s. In the 1950s, a 6-year doctor of pharmacy degree was proposed to elevate the profession and place pharmacists firmly in the ranks of healthcare professionals. This proposal was opposed by pharmacist educators and deans of pharmacy schools who feared it would disrupt the traditional 4-year Bachelor of Pharmacy program. This rift remains a source of controversy in the field today. Despite these schisms, pharmacists have continued to evolve as healthcare has changed. For example, in the past, pharmacists handwrote patients' prescription orders on index cards that were then transferred to receipts; today, pharmacies keep electronic patient records. The Role of the Pharmacist The pharmacy plays a key role in the community’s health. The profession’s traditional services include checking prescriptions, dispensing medications and providing information to patients about the drug’s effects, side effects and proper usage. In addition, pharmacists can be a valuable resource during an emergency or public health outbreak as they are trained to recognize and react to the presence of disease-causing agents. In the era of chronic diseases (such as hypertension, diabetes and infectious diseases including HIV and tuberculosis) which require lengthy medication treatment regimens, pharmacists are vital to a patient’s overall health care. Patients with long-term illnesses and their families depend on the pharmacist for advice, support and education to ensure they follow the prescribed regimens and avoid adverse reactions. Pharmacists also play a role in public health at the macro level through advocacy and policy. Many local, state and federal agencies recognize the value of having a pharmacist on their staff or as a member of their leadership team. They provide valuable background data, legislative content and exposition of pending and implemented laws and regulations as they are uniquely qualified as medication-use experts. Moreover, the pharmacist has an opportunity to promote lifestyle changes that will prevent the development of certain conditions which can be prevented or managed with early interventions. As such, the role of the pharmacist is one of the most valuable contributions to public health. As healthcare moves from episodic to longitudinal care, pharmacies must evolve with it to provide the services and expertise required. A major shift in the responsibilities of the pharmacist is needed, including an increased emphasis on care transitions and consideration of non-clinical factors such as social determinants of health. With technological advances such as e-prescribing and robotics for central prescription processing, and national prescription monitoring programs, pharmacists can provide greater patient access to the medicines they need to improve their quality of life. However, the profession must not forget its core mission – ensuring the safe and effective use of medicines to improve the community’s health. A broader scope of pharmacist responsibility will help to enhance patient safety, improve outcomes and reduce costs. The Pharmacy’s Impact on Community Health Pharmacists’ contributions to community health have been demonstrated in a wide range of interventions. They can improve patient outcomes and reduce costs in interprofessional teams, and they can perform screenings and referrals to support a more holistic approach to care. In addition, pharmacists’ roles in promoting social determinants of health have improved public health and population health outcomes. But, despite the potential for pharmacy to deliver these services and to participate in community-based prevention initiatives, there has been little research on the effectiveness of these types of activities, primarily due to the difficulty of evaluating non-dispensing interventions and their impact on health. Community pharmacies are well placed to make interventions to promote health and prevent disease, particularly in disadvantaged communities. They are accessible to populations with limited access to traditional health care services and provide a low-cost, convenient entry point to the health system. In recent years, pharmacists have begun to rethink their role in the community, moving away from traditional dispensing services and into new roles that advance both patient and public health. These innovations have largely been driven by the COVID-19 pandemic and a desire to address unmet needs in our society. These innovations include facilitating access to medication through innovative delivery models, such as the “Flip the Pharmacy” program at Wolkar Drug in Baxter Springs, Kansas, which provides a virtual business model of patient-level care. The “Flip the Pharmacy” program has inspired other pharmacy practices to make similar changes in their service offerings. Another example is the collaboration between New Mexico Department of Health and community pharmacists to administer latent tuberculosis treatments in pharmacies, with high completion rates and cost savings for the state. Other examples include pharmacists providing hepatitis B vaccine in a rural area considered to be a medical desert and educating students about opioid misuse in the classroom. As the evidence base for pharmacists’ involvement in public health expands, it is critical that these efforts are formally evaluated. However, the existing literature is limited in its use of process evaluations, which are an essential component to understanding whether these types of interventions are working as intended. Process evaluations are necessary to determine if the activities being performed are those that were originally planned, who is performing them, and how they affect patients and the community. The Pharmacy’s Impact on Health Equity In a world where health disparities have become increasingly evident, the pharmacy is in an ideal position to make positive impacts on these issues. By remaining intentional about decreasing unconscious biases and seeing past medications to the individual to identify potential barriers, pharmacists can bolster the movement toward health equity. Pharmacies can address health inequity by focusing on the social determinants of health (SDOH). SDOH are the factors that directly influence a person’s ability to thrive and reach their full health potential. These include economic stability, neighborhood and built environment, social and community context, education access and quality, and health care access and quality. (2) The pharmacy’s location in the community and its role as a primary healthcare provider makes it an important partner to work with communities on addressing these issues. The pharmacy can provide community education, promote health screenings, and deliver vaccinations. It can also help to connect people with other providers and resources. In addition, the pharmacy can support patients to navigate health care. This can be done by connecting people with other healthcare professionals, assisting with insurance applications, and helping to find financial assistance for medication. The pharmacy can also serve as a point of contact for pharmaceutical manufacturers’ patient assistance programs. This can improve a patient’s ability to afford their prescription medications and help them meet their medication goals. During the COVID-19 pandemic, these efforts were brought to the forefront. In the midst of this attention, it is important to keep in mind that the need for community-based care and access to pharmacies is a continuing concern. Increasingly, people are seeking out decentralized healthcare and relying on their local pharmacy for guidance. It is critical for the profession of pharmacy to continue to support and grow these efforts, as well as seek ways to mitigate the gaps that remain. By fostering collaboration with other health and social science disciplines, such as anthropologists, and non-health sector professionals like policymakers and lawmakers, the pharmacy can better serve the needs of all our communities. The College of Pharmacy is dedicated to putting health disparities front and center through research, practice, and education to explore how the pharmacy can be part of the solution.
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August 2023
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