The growing role of pharmacists within patients pathway: what implications for pharma companies?

The evolving role of the community pharmacists

The empowerment of the pharmacist is often part of the larger effort to lighten the burden of the overstretched primary care services. While primary care services remain the preferred first point of contact for many patients, such model is getting less sustainable in the context of an aging population and a growing prevalence of chronic diseases associated with a limited number of physicians. To reduce the pressure on primary care, European countries start to delegate more responsibilities within the patient pathway to pharmacists.

Thus, the role of pharmacists is being extended beyond medicines distribution to screenings and consultations. Some of the most popular services provided by community pharmacists include general health screening (i.e. blood sugar, body mass index, blood glucose, and cholesterol) and support for smoking cessation, which is available in 20 European countries [2]. In addition, in more than half of European countries, community pharmacists offer chronic disease management programs for diabetes, asthma and hypertension to improve patient follow-up. Education for rational use of medicines through brochures specifically designed for new patients and those already on treatment is another example of the range of services offered by the pharmacist. Finally, in some countries, patient consultation is an increasingly common service, e.g. 90% of all UK community pharmacies have a private consultation room [3].

In addition to these new roles, the pharmacist is also being given more and more responsibility in the patient pathway, such as seasonal vaccination and prescription renewal. For example, during the pilot flu vaccination campaign in Nouvelle-Aquitaine and Auvergne-Rhône-Alpes regions in France, 5000 pharmacists were trained and they delivered 150 000 vaccinations during the flu season over 6 months in 2017 [4]. The French pilot was inspired by the experience of European countries where flu jabs at the community pharmacies are becoming commonplace, such as the UK, Ireland and Portugal. Besides, in 17% of countries, the pharmacists can administer other vaccines, for example for travel and against pneumococcal [2]. Finally, some countries such as the UK go as far as allowing trained pharmacists to prescribe medicines within the limits of their clinical competence [5].

The new pharmacist’s role has already demonstrated its benefits. For example,  the UK New Medicine Service has been shown to improve the patients’ adherence by 10%. Furthermore, the patient satisfaction of certain pharmacy level services is high, e.g. New Medicine Service in France has received an average score of 8.7/10 [1].

“We observe that some of the pharmacists are willing to play a larger role in the patients’ pathway, for instance by providing advice on how to properly take multiple medications, or by explaining the risks and adverse effects that might be associated with a medication. However, pharmacists often lack time necessary to have profound discussions with every patient,” comments Maryia DVARETSKAYA, Project Manager at Alcimed.

The lack of or insufficiency of reimbursement and the limited resources available slow down the expansion of pharmacy services in practice. In order to provide the service to a client, the pharmacist takes time away from dispensing medicines. The opportunity cost of providing services is especially high in smaller and rural pharmacies with only one pharmacist. Besides, to provide advanced services, pharmacists need to spend time training. Thus, the pharmacist or their managers must receive a financial compensating for the time spent providing the service and training. Some countries have tackled this issue by developing advanced schemes of reimbursement for pharmacy services at the national level (e.g. the UK), while in other places the reimbursement is perceived as too low (e.g. France), or does not exist at all (e.g. Germany), constituting an obstacle for the development of services.

Opportunities and challenges for the pharmaceutical companies

The expanding role of pharmacists can be leveraged by pharmaceutical companies in patient-centric initiatives. According to Maryia DVARETSKAYA, “pharmaceutical companies start looking into the potential of improving the patients’ pathway by empowering pharmacists”. The pharmaceutical companies are interested to improve the experience with their medicine and consider deploying such pharmacy level initiatives as awareness campaigns, enrollment in patient support programs or pop-up messages in the pharmacy software on the posology.

However, specific legal and structural elements are essential to constitute a successful partnership. First, the companies need to respect the European, national laws and rules of self-regulation limiting the communication on prescription drugs to the public and describing how the companies should go about informing the pharmacists. Next, the structure of pharmacy ownership and the level of liberalization of the sector have serious implications on the best way to reach out to the community pharmacies, possibly via working with pharmacy groups and pharmacy chains. Finally, many pharmaceutical companies may not have a long history of working with pharmacists and thus lack experience and resources, considering that various types of initiative imply different costs and return on investment.

The expanding role of pharmacists across local and accessible community pharmacies in the EU increases their importance in the patient pathway and makes them a potentially valuable key stakeholder. Pharma companies will need to identify and seize opportunities by developing initiatives with added value, taking into account jurisdiction-dependent constraints, pharmacist’s point of view, and patient centricity.

[1] https://www.oecd.org/els/health-systems/Item-2b-Overview-Community-Pharmacy-Services-Svarcaite%20.pdf
[2] https://www.federfarma.it/Documenti/Rapporto_annuale2016.aspx
[3] https://www.england.nhs.uk/primary-care/pharmacy/stay-well-pharmacy-campaign/
[4] https://www.pgeu.eu/wp-content/uploads/2019/04/PGEU-AR-2017-WEB.pdf
[5] https://www.pharmacyregulation.org/education/pharmacist-independent-prescriber