Shirley Davis struggled with diabetes for 30 years before she understood how to keep it under control.
Doctors, she said, told her to watch her weight, improve her diet and sent her home with a prescription for insulin. The visits were brief and the follow-up minimal. Davis, 74, ignored doctors' advice and her diabetes advanced.
Then, she began seeing pharmacist Jeffrey Brewer. Part prescription manager, educator and coach, Brewer collaborated with Davis' doctors on her care, taught her the relationship between insulin and blood sugar and convinced her to avoid her weakness - lemon meringue pie.
"Hardheaded old people like me think we know more than young people sometimes, but he got through to me in a nice, but stern way," she said. "I took heed to it because he showed a concern about my health and a whole lot of doctors I have been going to hadn't."
Brewer's work embodies a new brand of pharmacy known as medication therapy management, in which pharmacists counsel patients on managing chronic diseases and are core members of the medical team.
In a nation with a large aging population, a staggering array of prescriptions on the market and increasingly complex drug therapies, pharmacists say their medication expertise is needed more than ever. Unlike busy primary care physicians, pharmacists say, they have the time to advise patients about medications. Such advice is critical to patient safety, they point out, and can reduce health care costs.
"I describe myself as the first mate and the doctor as the captain of the ship," said Brewer, who sees patients at the internal medicine division of Johns Hopkins Community Physicians at Wyman Park. "One person cannot manage a patient in today's complex medical world."
But some insurance companies don't cover such services by pharmacists, maintaining that relatively few patients ask for them. And some physicians fear the trend could erode the role of the primary care doctor as the coordinator of a patient's care.
"If you basically start carving out certain sections of the primary care responsibility and assign them to other practitioners, then you sort of endanger the entire concept," said Stephen Johnson, interim executive director of MedChi, the state medical society. "The idea is that every patient has a place that is their home where a physician knows them and knows their problems and can manage their care."
