Pharmacists ready to fill new role Drugstore clinics for shots, blood tests may be headed to Md.

January 20, 1998|By Marcia Myers | Marcia Myers,SUN STAFF

It's an ordinary sort of waiting room, filled with patients who have stopped by to get flu shots, blood tests and intravenous treatments.

But this clinic is decidedly different from most doctors' offices. For one thing, it's located in the rear of a drugstore in Jackson, Miss. For another, there aren't any doctors.

What's going on here is a medical trend that may be headed to Maryland soon: pharmacists providing services traditionally handled by doctors.

"When you have chronic ailments that cost a tremendous amount of money to manage, you want to go to the place that gives the highest quality care at the lowest cost," said William L. Stevens, executive director of the Mississippi Board of Pharmacy. "That place is not the physician's office or the emergency room at a hospital."

Not surprisingly, not having a physician around when medical services are provided makes some people nervous. Although the nation's largest physician association supports the idea within limits, many doctors groups are solidly against it.

"If pharmacists want to be physicians, they can go to medical school," said Dr. Albert Blumberg, an oncologist and board member of the Medical and Chirurgical Faculty of Maryland (Med-Chi). "Pharmacists don't have the training to analyze people the same way physicians do."

But across the country, there is growing acceptance of a more formal and direct role for pharmacists in patient care.

More than a dozen states, including Florida, California, Washington and Virginia, have passed laws governing "collaborative practices" between pharmacists and physicians, according to the National Association of Boards of Pharmacy. In such arrangements, doctors delegate some duties to pharmacists on a patient-by-patient basis. Another dozen or so states, including Maryland, are expected to weigh similar proposals this year.

A draft bill in the works by the Maryland Board of Pharmacy would permit pharmacists to adjust prescriptions, administer medication and monitor patients, but only within limits established by each patient's doctor. Any agreement between a doctor and pharmacist would first go before a state panel for approval.

"The opponents feel it's a form of practicing medicine," said Dorothy Levi, a member of the Maryland Board of Pharmacy. "We chose to write this within very tight management constraints. There are controls."

State law now prohibits pharmacists from changing prescriptions or administering medication.

But in recent years, most pharmacy schools in the country have shifted toward what they call "pharmaceutical care," a role that moves beyond the dispensing of drugs to include direct patient care. As part of that shift, the national standard for graduating pharmacists has increased from a bachelor's degree to a Ph.D. The training routinely involves collaborative work with doctors in hospitals and clinics.

Retail pharmacists say that being restricted to counting and dispensing pills makes them the most overeducated professionals in health care.

"Pharmacists have more to contribute," said David S. Roffman, associate professor at the University of Maryland's department of pharmacy practice and science. "At our school, we are training everybody to graduate from the program to practice pharmaceutical care."

Convenience, preventive care

Advocates say the idea means:

Convenience for the patient, because most neighborhood pharmacies are more accessible than doctors' offices and are usually open in the evening and on weekends. Patients with chronic illness, such as asthma or diabetes, can be monitored more closely.

New business opportunities. Since 1990, declining reimbursements for drugs have meant sizable cuts in pharmacy profits. Meanwhile, doctors with chronically ill patients are under pressure from many insurers to limit the number of times a patient can visit per month. The pharmacy could provide an alternative.

Preventive care that can save billions of health care dollars by catching medication problems early and averting emergency-room visits and serious side effects. According to a study at the University of Kansas, 28 pharmacies saved almost $4 million in four weeks by examining patient drug interactions and adjusting therapy. A 1995 study comparing two groups of patients reported savings of $4,072 per patient per year for those with chronic illnesses who received pharmaceutical care.

In Calvert County, pharmacist Leo Mallard is so convinced of this future that he isn't waiting for a decision by the General Assembly. In the past year, he has spent more than $30,000 in staff training, computer equipment and drugstore renovations to prepare the four-store chain he co-owns. Three of the stores now have waiting areas and private consultation and treatment rooms.

Eventually, Mallard hopes to concentrate on helping patients with asthma and diabetes, and to offer cholesterol screenings.

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