After decades of operating largely behind the counter, pharmacists are playing a more prominent role in direct clinical care. They’re working with doctors and others to determine the best medications to treat patients—including the correct doses and forms—in addition to filling prescriptions and other traditional duties.
Hospital care teams have increasingly included/added pharmacists as the field has embraced more advanced training, including the early 2000s transition to the doctor of pharmacy (PharmD) as the sole professional practice degree in the US and the expansion of pharmacist residency training.
Hospitals and health systems, meanwhile, have focused more on patient outcomes, drug utilization, and risk reduction, said David Chen, assistant VP for pharmacy leadership and planning at the American Society of Health-System Pharmacists.
That shift “is good for the patient, and it’s good for the [healthcare] organization,” he argued.
Involving pharmacists in patient care can help reduce readmissions—a key metric for Medicare and hospital accreditation—and help prevent medication-associated errors, which cost health systems over $40 billion annually and result in thousands of deaths.
The role of hospital pharmacists
Like community or retail chain pharmacists, who spend much of their workdays filling prescriptions, advising patients on medications, and—more recently—inoculating patients, pharmacists who work in clinical settings often do all of that plus perform a wide array of other functions.
They work side by side with other pharmacists, pharmacy technicians, nurses, respiratory therapists, physicians, and others—sometimes assigned to specific units or specialties—in hospitals, emergency departments, and even ambulatory facilities. Clinical pharmacists evaluate patient drug histories, make prescribing decisions, and assist in drug preparation, dispensing and administration.
“It’s a team-based patient care activity: Everyone’s bringing in their expertise,” Chen said. “There’s no reason why the physician, who’s doing the diagnosing and doing a care plan, needs to do that part of the care when there’s someone that’s better trained.”
A large academic medical center, for example, could have 100 pharmacists working on any given day across acute care, the emergency department, and clinics—all of which Chen noted are “interconnected” when it comes to total patient care management.
Pharmacists can also influence what drugs hospitals stock and use to treat patients, though most of those decisions are based on a hospital’s drug formulary—a regularly updated list of routinely stocked medications, as well as use policies and evaluations, among other things.
Hospital drug formularies
Most hospitals rely on pharmacy and therapeutics committees, which are composed of medication system experts, often including pharmacists, when determining which medications to include in their formularies—or when to use experimental drugs to treat patients.
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The panels examine a drug’s safety, efficacy, cost, and effect on quality of life. They also consider whether a medication sounds or looks too much like another drug—which could lead to dispensing or administration errors—or if there are too many drugs in the same therapeutic class. And sometimes they include restrictions on how certain medications can be prescribed.
“You need a body of [professional] peers to evaluate the literature, to evaluate the evidence, to evaluate the patient and then make the decision, especially when there’s exceptional cases,” Chen said. “Most facilities will have a pathway for that.”
The future of pharmacy
Pharmacists are expected to become even more involved in direct patient care in the coming years, particularly as workforce shortages exacerbated by the Covid-19 pandemic threaten other professions within the healthcare industry.
A 2022 study from Columbia University’s Mailman School of Public Health and Express Scripts Pharmacy found that “pharmacists are positioned to fill more direct patient care gaps” by 2030.
More than eight in 10 pharmacists surveyed agreed that they would likely take on more patient counseling, have a greater role in preventive care measures, and be more integrated in care management teams, according to the report. More than three-quarters of patients surveyed (77.3%), meanwhile, said they saw pharmacists as playing an “integral” role in the care process.
“The results of the report are clear. Most people trust pharmacists to play a greater role in providing their care,” John McHugh, an assistant professor in the health policy and management department at Mailman, said in a January 2022 statement. “As the shortage of doctors and nurses persists, and as complex new therapies and digital healthcare technology solutions are developed, the role of the pharmacist will continue to evolve.”
The findings included survey data from 1,000 pharmacists, 500 medical providers, and 3,000 patients.