Biotechnology and Pharmaceuticals
Just What the Pharmacist Ordered?

Dispensing drugs is just one item on a contemporary pharmacist's lengthy "to do" list. Although they can't independently prescribe medications, pharmacists today do far more than fill orders.

From giving flu shots to monitoring the effectiveness of medications, pharmacists are expanding their roles and improving the health of their communities. "Pharmacists are becoming much more patient-focused," says William Ellis, R.Ph., M.S, executive director of the American Pharmaceutical Association Foundation (APhA). "They are working more collaboratively with their patients and patients' physicians."

Technological advances have streamlined the process of dispensing and packaging medications, freeing pharmacists' time for clinical services and counseling patients, Ellis says. Pharmacists are increasingly helping physicians manage patients' chronic diseases -- such as asthma and diabetes -- by monitoring the efficacy of medications. In some states, pharmacists can now administer tests that detect the risk of osteoporosis or measure cholesterol or blood sugar levels at the time of a prescription refill. Physicians sometimes grant pharmacists the discretion to adjust the dosage of patients' medications or to fill standing orders for emergency contraception.

Shots Across Texas
In Texas and several other states, pharmacists have collaborated with physicians to launch immunization programs in their communities. After attending training through the APhA, Rudy Davila, R.Ph., began vaccinating adults against influenza, tetanus, hepatitis B and other diseases at his family's neighborhood pharmacy in San Antonio, Texas. The city's health director, an M.D., wrote the protocol allowing Davila, his sister and his father to immunize patients.

Davila Pharmacy, which is located near a large public housing facility, is easily accessible to customers and open in the evenings, when many clinics are closed. "We're filling a gap and immunizing a population that previously hadn't been immunized," he says. According to Davila, local residents know and trust his family's pharmacy, which was established in 1955. "We're the first line of defense for many of our patients. They value our opinion."

Davila's situation is common, Ellis says. "The Harris Poll has shown that pharmacists are the most trusted health professionals for 10 years now. And we're also one of the most available health professions, in both rural and urban areas," he continues.

Turf Trouble?
The medical community is still considering the ramifications of pharmacists' expanding roles. Many physicians say a team approach to patient care is desirable, as long as the physician retains a leadership position.

Others say they are concerned about fragmenting a patient's care among several health providers, none of whom gets the complete picture of the patient's health. "We have to be sure that all the facets of a patient are being taken care of. Our concern is the total healthcare of the patient. We don't want to divide the patient into disease states," says Leah Raye Mabry, M.D., R.Ph., who is on the public health commission of the American Academy of Family Physicians. For example, a pharmacist who helped a diabetic monitor his or her disease wouldn't understand the total picture of the patient's other conditions or health needs, explains Dr. Mabry, who was a pharmacist before becoming a physician. And the patient might think that because his or her diabetes is under control, there would be no point in going in for regular physician visits.

Isolating an immunization from the rest of a patient's healthcare could present similar problems. A patient could suffer from a disease or condition -- unbeknownst to a pharmacist -- that makes an immunization unsafe, experts say.

Pharmacists and physicians have made positive strides in collaborating, but the steps haven't come easily, Mabry says. While many pharmacists are pushing for more responsibility, some physicians don't want to give an inch. "I think if we keep what's best for the patient the number-one issue, then pharmacists and physicians can sit down and figure out all the other issues," says Mabry.