August 26, 2022 | WASHINGTON—A long list of clinical services, including point-of-care (POC) testing, could be implemented in the community pharmacies which, especially during the pandemic, have become public health destinations, according to Kenneth C. Hohmeier, PharmD, associate professor of clinical pharmacy and translational science at the University of Tennessee Health Science Center, during his presentation at this week’s Next Generation Dx Summit. He predicts 2022 will be a “banner year” for POC testing in community pharmacies and emerge as test-and-treat locations for infectious conditions beyond COVID.
The objectives of community pharmacies have considerable overlap with diagnostics, he notes, particularly in terms of access. Community pharmacists are also primed to reinvent the traditional business model due to evolving public perceptions and preferences, the changing reimbursement landscape, and their own doctoral-level training.
Consumer demand for healthcare services from community pharmacies is higher than ever, says Hohmeier, because they are viewed as accessible, convenient, and cost effective. Reimbursement for prescription products has also been declining as dispensing has transitioned to urgent care settings, creating a pressing need to “diversify the way pharmacies get bills paid.”
Credentialing requirements, meanwhile, have created a shift in pharmacy education such that most pharmacists “work at the bottom of what their training allow them to do,” he continues. Most Americans (94%) live within five miles of a pharmacy and visit it twice as often as a prescriber’s office.
A 2018 Deloitte survey points to the value of the community pharmacy to consumers, says Hohmeier. Their top criteria regarding where to get care is convenient location (46%), with a sizeable proportion (32%) voting for convenient hours. Reputation of the care provider was the second most important attribute identified by survey respondents (39%).
Over time, community pharmacists have taken advantage of “collaborative practice agreements” (CPAs) with prescribers to perform functions outside the typical scope of practice, Hohmeier says. The Centers for Disease Control and Prevention points out that pharmacists have long been identified as underutilized health resources, he adds.
The top public health impact of community pharmacists has been around medication therapy management (MTM), since as non-prescribers they are in a unique position to help patients get the best benefits from their multiple medications and reduce the risk of adverse events, says Hohmeier. “We can offer a second opinion, if you will.”
Pharmacists have been doing MTM since the 1990s in most states, and many private payers as well as the Centers for Medicare and Medicaid Services reimburse for the service, he says. Medicare Part D has an MTM program.
Tennessee’s Medicaid program (TennCare) has an MTM pilot underway that is now serving 400 covered lives, a population that is typically under-resourced without easy access to healthcare. Relative to the Medicare population, enrollees are younger and have different disease states and social determinants of health.
The objective is to scale TennCare by incorporating community pharmacies into the “patient-centered medical home” model of care, Hohmeier says. It’s feasible, appropriate, and acceptable to pharmacists because “we’re the most accessible healthcare professionals and MTM is what we trained for.”
In the future, more support personnel and technology will be utilized in community pharmacies to offload tasks that don’t require an advanced degree, he says. Pharmacists will be receiving more training in behavioral change management—skills critical for both medication adherence and patient resistance to being vaccinated.
Community pharmacies will continue to be involved in preventive care, as most are already, Hohmeier says. They are responsible for administering over 40% of all COVID vaccines, on par with flu shots, making immunizations their second most impactful contribution to public health. Pharmacies in all 50 states now administer vaccines.
Compared to pre-pandemic levels, social media sites are more often trusted sources of health information, he points out. The other reality is that community pharmacists, by virtue of being “trusted staples in the community,” have helped reduce vaccine hesitancy. They have both access to and influence with patients, a flip of the traditional ecological model where information was imparted by authoritative bodies at the national level.
Pharmacists are also well suited to provide acute and infectious disease care, continues Hohmeier, referencing the POC testing they have done in response to COVID-19. Public health access could be improved with a test-and-treat approach that combines a CPA with POC testing and prescription of an antiviral.
Hohmeier shares supportive evidence for this approach at one pharmacy where 40% of patients tested positive for flu, 63% of whom were prescribed oseltamivir (Tamiflu) and 56% of whom returned for follow-up and found to have successfully recovered. Across six pharmacy chains in six states, 93.8% flu-positive patients were able to obtain the antiviral per a CPA and 88% of the flu-negative patients instead received over-the-counter recommendations.
Scaling the test-and-treat approach will require procurement and purchasing solutions that meet the unique needs of pharmacies, which might have dozens of locations in a small geographic area, Hohmeier says. They would likely need turnkey toolkits, since they wouldn’t have time to create an implementation strategy, as well as training materials for pharmacy techs about how to use POC diagnostic devices and manage inventory. A consumer awareness campaign might help spread the word that the pharmacy is available for these services.