I have posted a series of previous blog notes about the emerging role of retail pharmacy stores in the healthcare delivery network, particularly in relationship to drop-in clinics. I have also emphasized the role of pharmacists in hospital-based clinical programs such as coagulation clinics operating in the Geisinger Health System. A key element in the growing importance of retail pharmacies in relationship to the clinical lab industry has been the LabCorp initiative of opening blood drawing sites in about 20 Duane Reede drug stores in New York City. In this same vein, I recently encountered an article in the NYT (see: New Job Title for Druggists: Diabetes Coach) that discusses the emerging role of pharmacists in monitoring and educating patients with diabetes (boldface emphasis mine):
For the past 10 years, the city of Asheville has given free diabetes medicines and supplies to municipal workers who have the disease if they agree to monthly counseling from specially trained pharmacists. The results, city officials say, have been dramatic: Within months of enrolling in the program, almost twice as many have their blood sugar levels under control. In addition, the city’s health plan has saved more than $2,000 in medical costs per patient each year....For every dollar spent on medicines or counseling about diet, exercise and lifestyle, he said, the city saves $4 by preventing emergency room visits, dialysis, amputations or other common complications of diabetes....The fifth deadliest disease in the nation, diabetes costs more than $130 billion per year in medical expenses and lost productivity in the workplace. While there is no cure, patients can delay or prevent complications by using medications properly and adjusting their diet and exercise routines....GlaxoSmithKline and Sanofi-Aventis, which make diabetes drugs, have jointly given about a million dollars in the past five years to the American Pharmacists Association Foundation, a nonprofit research group, to help promote and replicate the program....
In my opinion, retail neighborhood pharmacies will now rapidly emerge as important links in our healthcare delivery system, particularly relating to the care of chronic diseases such as diabetes. Here are the primary reasons why I think that this will happen:
- Our large modern drug stores are staffed by highly trained pharmacists and are also conveniently located for a large percentage of the population. These stores are usually open seven days a week for 12 hours per day -- some are even open around-the-clock.
- Pharmacists are anxious to expand their scope of professional practice and the national chain executives will support this effort because they will seek to increase store traffic.
- Many primary care physicians are overworked and our reimbursement system does not always reward time-consuming and repetitive attention to patients' chronic diseases such as diabetes. Endocrinologists also do not want to bother caring for uncomplicated cases.
- The neighborhood pharmacies are already an important locus for dispensing medications and other medical supplies. Generally speaking, consumers are well-disposed toward these facilities and view them as an integral part of their neighborhoods.
From the lab perspective, it seems to me to be inevitable that the neighborhood pharmacies will expand from blood drawing stations, as is currently the case in New York City, to POCT labs similar to those located in multispecialty physician clinics. At the present time, the national reference labs would seem to be the obvious candidates to manage such decentralized lab operations, but they may not want to cannibalize their central lab operations. With test results generated in such POCT labs readily at hand, pharmacists will continue to evolve as a type of practitioner for patients with chronic diseases, addressing not only the care of diabetes and the anti-coagulation status of patients but also other problems such as congestive heart failure.