Physicians and pharmacists should be teammates in treating patients, though that's not often the case, one expert says.
Ada Stewart, M.D., this year stepped down as board chairperson of the American Academy of Family Physicians. Fierce Healthcare caught up with Stewart as she was in between treating patients at Cooperative Health, a community clinic in Columbia, S.C.
She points out that she’s both a primary care physician and a pharmacist, giving her a unique perspective of the evolving relationship between the two disciplines. She notes that they’re not always on the same page about exactly who’s responsible for what.
“I have two views and it’s important that pharmacists and primary care physicians work together,” Stewart told Fierce Healthcare.
But how, exactly?
The role and notoriety of the pharmacist increased greatly during COVID-19, data show. Pharmacists delivered over 266 million doses of vaccines, and according to a J.D. Power report in August, consumers have gotten very comfortable receiving other primary care services at pharmacies, including vision and hearing monitoring, physical exams, and routine lab tests. Should the scope of primary care services delivered by pharmacists be expanded even more?
“That’s something that could be a totally whole other interview,” Stewart said. “I really do not want to go down that rabbit hole right now. As a pharmacist and as a physician, that can take up a lot of time.”
Time seems to be on the minds of pharmacists, as well. The National Association of Chain Drug Stores wants the Biden administration to keep the Public Readiness and Emergency Preparedness (PREP) Act in place until October 2024. PREP provides liability protection to pharmacists, pharmacy technicians and pharmacy interns.
Stewart also wants to see some movement on the legislative front. “We need to ensure through either legislation or what have you that all the information that is done via our pharmacist colleagues is communicated to our physicians," she said.
An AAFP spokesperson recently told Fierce Healthcare that “care delivered outside of the patient’s usual primary care setting can be a component of patient-centered care but must work in coordination with the patients’ primary care physician to ensure that care is not further fragmented.”
Teamwork, in other words. Team is a word Stewart often uses when describing the physician/pharmacist relationship:
- “We’re one team taking care of our patients.”
- “I can’t say enough about how it is a team effort.”
- “It’s important, again, that we have a team approach to all of this.”
- “Again, we need to work as a team.”
The Agency for Healthcare Research and Quality defines team as consisting of “two or more people who interact dynamically, interdependently, and adaptively toward a common and valued goal, have specific roles or functions, and have a time-limited membership. During the temporal life of a team, the team’s mission is of greater value than the goals of the individual members.”
It’s the “specific roles” part of the definition that seems to cause friction between physicians and pharmacists.
“When the pandemic evolved and the vaccines became available, sadly enough pharmacies were the first to receive the vaccines, and then physicians followed,” said Stewart, who also served as the AAFP’s president in 2020 and 2021. “But when we look at the equity issue, we found that many individuals did not have access to the vaccines because they did not have pharmacies around them. Having a physician that was their normal source of healthcare was really important.”
She pointed to what she calls “pharmacy deserts” in the country. “I work in a community health center. There’s no pharmacy often within 20 miles of some of my offices, but there is a physician's office.”
That it’s easier to get an appointment with a pharmacist than it is a PCP is another idea bolstered by the pandemic that Stewart challenges. “When we talk about not needing appointments at a pharmacy, I’ve also tried to get my vaccines at some of the local pharmacies and have been asked, ‘Do you have an appointment?’ And you have to go online and schedule an appointment. And again, that information did not get to my primary care physician," she said.
Stewart is worried about the fragmentation of care that can occur when what happens at the pharmacy stays at the pharmacy and doesn’t make its way into a physician’s medical record. She said that during the pandemic too many patients received the same vaccine at both provider sites. This can lead to duplication of costs for patients as well as payers.
“Patients don’t get everything done in one place even as far as pharmacies go,” said Stewart. “They may go to this pharmacy at this time, and then another pharmacy at another time. We’re not able to see the full picture of that individual. As a family physician, I usually know my patients. I know the mom, the dad, the grandparents. I know their medications, the medicines that they receive from their specialists, which may not be all filled at the same place.”
Some pharmacists do a better job of communicating with PCPs than others, but Stewart believes that such communication should be consistent in terms of the information relayed and the way it’s relayed in all physician/pharmacist relationships.
“We need it across the board,” said Stewart. “That’s really important.”
Physicians should know not only what medicines their patients receive at what sites, but also when they receive them, she said. For instance, there’s a wait time between treatment with a monoclonal antibody and getting a COVID-19 vaccine in which many factors must be taken into account including age, weight, comorbidities, and a host of other considerations, according to the Centers for Disease Control and Prevention.
“Family physicians always talk about continuity,” Stewart said. “Comprehensive and continuous care that we can [facilitate because we’re] the first contact for our patients. And when we don’t have that full picture it’s not because of one pharmacist versus another. It’s the system we have right now where there’s no true way of communication through the pharmacies.”
That’s especially true in the attempt to foster herd immunity to COVID-19, a goal many experts believe can’t be attained, but Stewart suggests should at least be attempted. She talks about PCPs, pharmacists, and other providers in the healthcare system building a “community of immunity.”
That community needs to include the uninsured, a demographic that typically doesn’t interact that much with pharmacies.
“Many of my patients don’t have insurance or have little insurance,” said Stewart. “And so they can’t go to a pharmacy and get their shots, because they’re not covered. We see our patients regardless of their ability to pay, and so we’re able to ensure that all their immunizations and things like that are done and done in an equitable way.”
The conversation ends the way it began.
“It’s important that we work as a team,” Stewart said. “Pharmacists are our colleagues ensuring that our patients receive the highest quality and equitable care that they can. We need to work together to be able to really achieve our common goal and that is the health of our patients."