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Pharmacists to the Rescue in Addressing U.S. Primary Care Coverage Gap

America is experiencing a doctor shortage that is expected to get much worse before it gets better. This has exposed a dire need for primary care services, especially in many rural communities. And not surprisingly, the nation’s pharmacists are stepping up to fill the void, offering an increased number of services and expanding their role in patient healthcare.

How severe is the doctor shortage? “An urgent crisis” is how American Medical Association President Jesse M. Ehrenfeld, M.D. described the situation in an October 2023 national address. “The physician shortage that we have long feared – and warned was on the horizon – is already here,” he told an audience at the National Press Club. “It’s an urgent crisis… hitting every corner of this country – urban and rural – with the most direct impact hitting families with high needs and limited needs.”

Research by the Association of American Medical Colleges (AAMC) projects a shortage of as many as 48,000 primary care physicians by 2034, although the effects are already being felt in communities across the country. A September 2023 report by NBC News profiled the community of Lafayette, Alabama, which is currently served by a single primary care physician. “The only one,” the report notes, “within a 30-mile drive.” The community’s dedicated physician is 68 years old, and would like to retire. She has vowed though, to continue to serve until replacements arrive. “They will come,” she said, “and we will be here until then.”

In a separate study, the National Association of Community Health Centers determined the shortage has resulted in over 100 million Americans – nearly one-third of the U.S. population – not having access to a “usual source of primary care.” These individuals include Americans “from all income levels, locations, ages, races, ethnicities, and insurance status.” In fact, the research found only one-in-10 of medically disenfranchised Americans are uninsured.

There are many reasons for the physician shortage, with the AAMC offering a list that includes:

  • An aging workforce. More than two-of-every-five active doctors in the U.S. will be 65 or older within the next decade. As these individuals retire, their departure from the workforce will have an impact on the communities they serve.
  • Demographics. Population growth and aging are the “primary drivers” of increased demand for physician services. The AAMC research found that while the U.S. population is projected to increase by 10.6% during the 2019 to 2034 period, those aged 65 and older is projected to grow by 42.4%. This includes a 74% increase in the size of the population aged 75 and older – the group that most utilizes physician services.

Additional reasons cited by AMA President Ehrenfeld include:

  • Physician burnout. Two-in-three doctors “admitted to experiencing burnout during the pandemic,” the highest rate ever noted by the AMA. This has contributed high rates of physicians saying they plan to either leave medicine entirely in the next few years, or reduce their hours.
  • Paperwork. The typical doctor spends roughly two hours on paperwork for every one hour spent working with patients.
  • Debt. The average doctor graduates from medical school with more than $250,000 in debt. This has caused many to bypass primary care practices in favor of higher paying specialties.
  • Administrative Challenges. The AMA cites “an increasingly impersonal and bureaucratic health care system,” that puts “enormous administrative hassles and burdens in our lap each day,” and often leaves physicians powerless to impose meaningful change.

Whatever the reason, the physician shortage is affecting care, and has increased patient reliance on community pharmacies for primary care-type services. In early 2023, National Community Pharmacists Association (NCPA) CEO B. Douglas Hoey referred to this shift as a “land grab for primary care,” as healthcare entities fill the void created by the physician shortage.

Pharmacists are stepping up. An October 2023 report by Surescripts found pharmacists are increasingly helping care for patients with chronic conditions – with an increased number of pharmacists issuing prescriptions for blood thinners and medications to treat diabetes, as well as for mental health conditions including depression and anxiety. The number of pharmacists on the Surescripts network of e-prescribers more than doubled from 2019-2022, compared with an increase of just 0.6% among primary care prescribers.

While these pharmacists are taking advantage of state-authorized prescribing authorities, additional clinical services offered at the pharmacy include:

  • Immunizations: Almost 90 percent of pharmacies offer influenza immunizations, with NCPA noting that “most” also offer at least one other vaccine such as shingles, pneumococcal, or travel vaccines. Pharmacies increased their stature as “immunization destinations” during the pandemic when, according to IQVIA, more than 90 percent of COVID-19 vaccinations were administered at pharmacies during both 2021 and 2022. Patients have become increasingly comfortable receiving immunizations in the pharmacy setting, with IQVIA reporting more adults were vaccinated in pharmacies than in medical settings between 2018 and 2022.
  • Point of Care Testing: NCPA reports that 67 percent of community pharmacists are currently eligible to offer CLIA-waived tests, based on applicable state law and/or board of pharmacy guidance. Among those that offer CLIA-waived tests, common offerings include influenza (54 percent) and strep throat (44 percent). Other offerings may include glucose (37 percent), hemoglobin A1C (19 percent) and lipids (18 percent).
  • Screenings and Counseling: Patients increasingly rely on their local pharmacy for guidance and counsel in managing conditions including diabetes, high blood pressure, weight management, stress and anxiety, and tobacco use.
  • eCare Plans: More than 3,300 community pharmacists participate in the CPESN USA network of local care providers, which seeks to improve patient outcomes by connecting all healthcare providers. As members of patient healthcare teams, pharmacists have a seat at the table and a voice in advocating for patient treatments and services.
    Pharmacists create an eCare Plan for each patient, which is updated with each interaction and can be seamlessly shared with other members of the care team. In addition to improved patient care, eCare plans help pharmacists demonstrate the scope of services they provide, improving their viability to payers and other reimbursors.

Pharmacists are taking on these primary care responsibilities at a time when their plates are already quite full – overflowing in many cases. Consider findings from the 2021 Pharmacist Workforce Survey which, according to the Washington Post, reported that 75 percent of responding pharmacists “disagreed with the statement, ‘Sufficient time is allocated for me to safely perform patient care/clinical duties.’”

Increasingly though, pharmacists are looking to technology for assistance in managing their added responsibilities. And they have not been disappointed. Comprehensive software solutions, including the PrimeRx pharmacy management system, pinpoint the precise needs of today’s busy pharmacies, and provide much-needed relief.

PrimeRx automates all pharmacy workflows including prescription intake, dispensing, labeling, bin management, inventory, claims processing, and inventory management, to name a few. Each of these critical workflows operates seamlessly, requiring minimal staff time. This frees up resources to spend on patient interactions, and other pharmacy matters.

With regard to non-dispensing services, pharmacies can rely on PrimeRx for capabilities including patient communication, records management, documentation, regulatory compliance, and claims submissions. A few examples include:

  • Comprehensive Patient Records. PrimeRx allows the pharmacist to maintain detailed records for each patient. Records include detailed medication information along with patient health history, family information, immunization and screening updates, and complete payment records. PrimeRx allows the pharmacist to record notes and observations after each patient interaction. All records are stored within PrimeRx and can be easily accessed.
  • Immunization Reporting. PrimeRx provides direct integration with the automated immunization solution by Script Management Partners (SMP) which allows pharmacies to electronically report immunization records to state/local immunization information systems (IIS). In addition, the system identifies immunization opportunities among pharmacy patients. The solution allows pharmacies to help build their immunization programs and stay compliant with mandatory reporting requirements.
  • eCare Plans. As mentioned above, the CPESN network of local pharmacy providers has become a prominent platform for improved patient outcomes. Healthcare team members are able to exchange patient information and discuss treatment options. Technology-based eCare plans serve as the basis for each patient’s record, and are carefully maintained to reflect all services provided. Pharmacists can quickly create eCare plans within PrimeRx – by simply clicking a button located on the PrimeRx home screen. As easy as that!
  • Automated communications. PrimeRx facilitates critical patient communication via automated texts, phone calls and/or emails. A pharmacy can automatically generate notifications to individual patients when a refill is due, or when a prescription is ready for pickup. With regard to clinical services, the system generates messages with reminders about flu shot availability or blood pressure clinics. The system can also send targeted notices to groups of patients with diabetes, for example, about available educational materials or in-store supplies.
  • Report Generation. Pharmacies capture what seems like an infinite amount of data related to a wide range of pharmacy activities. But without a process for organizing and making sense of that data, much of it is meaningless. PrimeRx™ provides the functionality required for prioritizing key metrics, and generating meaningful, customized reports. Report topics can include patient-related issues including adherence rates, outstanding refills, and patient demographics, along with business issues including DIR fees, employee performance, inventory metrics, and accounts payable/receivable. With extensive report capabilities, pharmacy managers gain critical visibility across all pharmacy operations, and the ability to identify opportunities for improvement.

American Medical Association President Jesse M. Ehrenfeld has been clear in his belief that the current doctor shortage is going to get worse before it gets better. That’s the bad news. But the good news is that the nation’s pharmacies are ready to help. And patients seem willing to give them a try with research by Wolters Kluwer finding an impressive 81 percent of Americans say they trust a pharmacist, nurse, or nurse practitioner to diagnose minor illnesses and prescribe medications to treat them.

As pharmacies continue to embrace their role as “Primary Care Coverage Gap,” they will find innovative technology-based solutions are there to help.  This includes the PrimeRx software system, which provides comprehensive pharmacy management. Among its many capabilities, PrimeRx allows pharmacists to easily track and record all patient interactions, manage pharmacy services, submit payer claims, oversee compliance, and ensure meticulous recordkeeping. Best of all, the system is highly-user friendly, and recognizes that pharmacists’ time is better spent interacting with patients.

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