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New phase for pharmacists

As the health care landscape shifts, U faculty lead the way toward a more collaborative system.

November 26, 2013

Pulling up her sleeve for a flu shot in Coffman Union, a veteran U of M staff member looked at the young man filling the syringe.

“Hi,” he said, and gave his name. “I’m a third-year pharmacy student.”

The staffer wasn’t surprised, since giving flu shots is just one of many skills that may seem off the beaten track for pharmacists, but that the University of Minnesota routinely teaches its pharmacy students.

Pharmacists and other health professionals with skills beyond filling prescriptions are in increasing demand, now that the Affordable Care ACT (ACA) is expected to bring 30 million to 46 million new people into the health insurance system. Moreover, the Association of American Medical Colleges predicts that absent prompt action, the United States faces a shortage of 90,000 physicians in 10 years.

Action is the name of the game for the U’s Center for Leading Healthcare Change (CLHC). Housed in the College of Pharmacy, the center is leading the charge for reform of Minnesota laws regulating pharmacy practice. Extending the scope of what these pharmacists are allowed to do will take pressure off doctors and other health professionals.

“The last major update to the Pharmacy Practice Act—and similar laws for medicine, nursing, and so on—was in 1937,” says CLHC co-director Lowell Anderson, a professor of pharmaceutical care and health systems. “Practice acts don’t leave a lot of room for innovation in care. We want to remove restrictions on innovation and allow consumers to take full advantage of the skills of pharmacists we’re graduating from this college.”

A hopeful sign: ”The ACA says, ‘You’re free to innovate’—this is an innovator’s paradise,” Anderson says.

A new wave of care

The center’s roles are broad but simple: develop the leadership skills of pharmacists and advance the practice of pharmacy. For example, CLHC was behind the expansion of the University’s UPlan health care system’s medication therapy management (MTM) network to other health plans and employer groups in Minnesota.

The need for MTM comes from the growing complexity of medication therapy and demand for health care professionals to help patients manage their care. The MTM model is highly collaborative, with physicians still playing vital roles in hands-on treatment and prescribing medications, but as part of a team that includes professionals like pharmacists, nurses, and nurse practitioners.

To illustrate, imagine a patient whose diagnosis has just left him or her dazed. The diagnosing doctor may prescribe medications and explain at length what they do and how to take them, but the patient may be too off balance to absorb the information. But a pharmacist could handle the explanations at a later point, freeing up physician time and helping the patient take the medication correctly.

Pharmacists can also keep track of whether patients are following their regimen. For example, if they note that an important prescription was not refilled, they can question the patient about the reasons for the apparent noncompliance and help resolve any issues that may lead to it. Also, with a patient’s permission, they can discuss potential changes in dose or schedules, or new drugs, with the patient’s doctor and then help the patient manage the new routine to improve outcomes.

“Considering that many patients receive prescriptions from multiple prescribers, a pharmacist can rationalize medication use,” says Anderson. “MTM can save the patient and the delivery system money, reducing other health-care costs and improving outcomes and patient satisfaction. Further, pharmacist-provided MTM can free up the physicians so they can spend more time with their patients.”

Enrollees in the University’s UPlan health care system have access to a network of pharmacists credentialed to handle these services. A physician can refer a patient to a pharmacist, or the patient can walk into an MTM pharmacy and enroll in the network. A list of UPlan MTM providers is available. 

The next generation

The College of Pharmacy supports the leadership development efforts of CLHC with a whole leadership track. says Marilyn Speedie, dean of the college.

Starting this fall, a new curriculum gives students real-world experience in bringing about beneficial change. For example, students in the 18-credit leadership track do a project in which they identify a particular situation or practice that needs improvement or change, then work with leaders and community pharmacists to apply what they’ve learned.

“By getting feedback, and after previous work on their own strengths, they’re much more confident in leading change,” says Speedie. “It’s about acquiring skills, and also confidence.”

Contact the writer at morri029@umn.edu

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