By: Joshua Bliss, PharmD Candidate c/o 2016

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Doctor – a word often utilized by both professionals and the general public alike to describe a physician. “Doctor” finds its origins in the Latin word for “teacher.” The word “physician,” however, carries a more complicated origin. It is derived from Latin’s “physicum,” meaning remedy.¹ In Luke 4:23 of the Bible, “Vicision heale thy selfe” or “physician, heal thy self” can be found in a parable utilized to explicate the fundamental philosophy of managing one’s own faults before attempting to correct the faults of others. “Physician” eventually came to refer to a university-educated person who prescribed drugs. It is also interesting to note that “surgeons” were seen as inferior to physicians for some time. Surgeons worked with their hands and knives while physicians diagnosed and provided therapeutic remedies, a much more respected methodology.¹ Today, we are subjected to a world of immense and unprecedented complications, especially in regards to healthcare. The expansion of healthcare is tremendous and exponential. In the United States, healthcare costs are rising, and the number of people in need of healthcare will continue to grow as the baby boomer population ages to retirement.

The future of healthcare is blurred by the unresolved ideologies so overtly apparent in Congressional debate over the controversial Affordable Care Act. Many of these issues are highly subjective and inconclusive in the face of stark healthcare insufficiency. Through the trees of subjectivity, a forest of underutilization of non-physician healthcare professionals is manifested. The pharmacist stands as one of the most underutilized healthcare professionals currently practicing in the institutional setting. A plethora of studies have revealed the utility of pharmacists in improving patient health outcomes in the community setting, including the now famous Asheville study.² The public, healthcare providers, insurance companies, and the US government have recognized the value of community pharmacist expansion insofar as improving healthcare outcomes and trimming costs.³ This same philosophy can be carried over to the institutional setting, where the pharmacist stands as an incredibly valuable asset to the healthcare team.

A recent study presented at the American Society of Health-System Pharmacists Summer Meeting in June 2013 elucidates the value of increasing pharmacist involvement in patient care.⁴ In this study, physicians at Mission Hospital in Asheville, NC followed a conventional routine for two weeks while researchers recorded data on prescribing errors, drug costs per discharge, and the use of pharmacy consults. After the first two weeks, pharmacists joined physicians on a mutual and equal practicing basis for another two-week period, where the same data parameters were recorded. The results showed that a smaller percentage of patients receiving team-based care were readmitted to the hospital within 30 days. The pharmacist team saved $62.60 per discharge, which extrapolated to over $2.5 million in annual savings for Mission Hospital. The pharmacist-physician team model was found to increase clinical interventions, decrease readmission rates, increase drug savings, and improve physician satisfaction.⁴

Another four-week study conducted by Patel et al.⁵ focused on pharmacists’ clinical efficacy in rounding with a physician versus indirect clinical intervention work. Pharmacists either physically rounded with the physician or worked from a computer making clinical interventions. The results of this study were surprising, as they evinced a dichotomous philosophy on the optimal utility of pharmacists. Physical rounding carried with it a greater percentage (93%) of interventions being accepted by the physician (as opposed to just 76% of interventions made by pharmacists not rounding). However, the non-rounding pharmacists were able to conduct a higher number of interventions per day and save approximately $300 more per intervention compared to the rounding pharmacist. It was argued that the pharmacist was better utilized clinically when not present during the physician’s physical assessment, where the pharmacist was limited in scope of practice. In any case, the pharmacist was able to save the hospital an average of $16/hour/pharmacist due to clinical interventions made as part of the pharmacist-physician team.⁵ Whether or not the healthcare team should include the pharmacist on physical assessment rounds remains up for debate. There are a many studies evincing the best use of pharmacists directly on the floors.

The Hospital of the University of Pennsylvania (HUP) conducted an efficacy analysis of its pharmacist-patient connection program.⁶ HUP pharmacists meet with patients within 24 hours of admission and review current medication regimens, as well as determine the level of knowledge the patient has about his or her medication therapy. In this way, the pharmacist is able to establish an integral relationship with the patients and build trust, the cornerstone of a successful patient-practitioner relationship. The utility and value of the pharmacist as a more integrated part of the healthcare team was made clear. One example cited by HUP is a case in which a patient had been admitted and discharged from two hospitals within the past two months. Upon building a relationship with the pharmacist, the patient explicated that she had limited physical ability to travel to any pharmacy near her residence and thus had not taken her medications since her last discharge. The pharmacist worked directly with the unit’s social worker to find a pharmacy in the patient’s neighborhood that offered delivery services. Before this pilot program began at HUP, pharmacists reported 7000 interventions per year. With this new program, pharmacists now report 8200 interventions per month! Patient satisfaction surveys correlated with this tremendous success as well.⁶ Other studies showing the efficacy of pharmacists being included as a central player on the healthcare team include improvements in hypertension management and reduction in adverse drug events.⁷

Healthcare is manifesting itself as a great challenge of the 21^st century. The United States is experiencing an increasingly older population, a future of economic uncertainty, and a predicted physician shortage in the magnitude of thousands. Solutions that have been proposed include opening new medical schools and increasing admission percentages. Once again, we are failing to see the forest through the trees. The pharmacist, with an advanced education and clinical residency opportunities, stands as the obvious solution to the impending shortage of physicians. By welcoming the pharmacist as a more integral part of the institutional healthcare team, quality of care will increase while simultaneously decreasing overall costs. The evolution of the role of the pharmacist is analogous to the once superiority complication evident in the relationship between physicians and surgeons. Today, pharmacists offer a different, complementary, and integral form of healthcare practice that can be expanded significantly. As in the Book of Luke parable, “Vicision heale thy selfe,” perhaps our healthcare team needs to manage its own faults before attempting to treat the patients we all work so diligently for.

SOURCES:

1. “Science Diction: The Origin Of ‘Physician’.” Science Friday. January 2011. http://www.sciencefriday.com/segment/01/28/2011/science-diction-the-origin-of-physician.html. Accessed October 5, 2013.
2. Bunting BA, Cranor CW. The Asheville Project: Long-Term Clinical, Humanistic, and Economic Outcomes of a Community-Based Medication Therapy Management Program for Asthma.  Journal of American Pharmacists Association. [2006]. 46(2):133-147. Accessed October 4, 2013.
3. Boulton G. Pharmacists play key role in program to trim health care costs. The Sentinel Journal. [2010]. http://www.jsonline.com/features/health/93517939.html. Accesses August 30, 2013.
4. Simone A. Physician-Pharmacist Team Improves Hospital Care. Pharmacy Times – Practical Information for Today’s Pharmacist. [July 23, 2013]. http://www.pharmacytimes.com/news/Physician-Pharmacist-Team-Improves-Hospital-Care. Accessed September 25, 2013.
5. Patel, Reena, Butler K, et al. The Impact Of A Pharmacist’s Participation On Hospitalists’ Rounds. Hospital Pharmacy 45.2 [2010]: 129-134. Accessed October 1, 2013.
6. Sapega S. “Pharmacists on the Front Line of Care” Inside Penn Medicine. [March 14, 2013]. http://news.pennmedicine.org/blog/2013/03/pharmacists-of-the-front-line-of-care.html. Accessed October 5, 3013.
7. Kucukarslan SN. Pharmacists On Rounding Teams Reduce Preventable Adverse Drug Events In Hospital General Medicine Units. Archives of Internal Medicine. [2003]. 163(17):2014-18. Accessed September 25, 2012.

Published by Rho Chi Post