Archives editorial highlights pharmacist's role in chronic care

By Kristen Bole

B. Joseph Guglielmo, PharmD

An invited commentary in the Oct. 11 Archives of Internal Medicine, titled “A Prescription for Improved Chronic Disease Management,” highlights the current and potential role of pharmacists in preventing and treating chronic diseases.

The commentary by B. Joseph Guglielmo, PharmD, who chairs the Department of Clinical Pharmacy in the UCSF School of Pharmacy, first outlines the role clinical pharmacists have played in improving safety in the acute care setting, including reducing patient mortality, limiting medication errors and preventing adverse drug events.

The commentary also reviews two original research papers in the same issue of Archives: one demonstrating improved blood pressure control in ambulatory care patients managed by a physician-pharmacist team, when compared to those managed solely by a physician; the second showing that pharmacist-based smoking cessation education was not sustained in the community pharmacy setting.

Guglielmo writes that the success of the first study and failure of the second directly relates to the business model, presence of integrated care teams and availability of patient health care information. All of these factors were present in the clinic, but absent in the community pharmacy setting. He argues that pharmacists did not provide smoking cessation education because they were not paid for this function and suggests the potential solution of having Medicare give pharmacists “provider” status similar to that of physician assistants, nurse practitioners and others. That status would include a fee schedule for practitioner service.

The commentary concludes that those three elements—access to medical records, integrated care teams, and changes in the reimbursement model—would stimulate the nation’s widespread community pharmacists to “function at the top of their training,” while improving access to health care.

Archives commentary:

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