As a pharmacist care coordinator in Kroger Pharmacy’s Columbus–Ohio division, Brigid Long, PharmD, MS, oversees the pharmacy’s transitions of care programs. It’s her job to help ensure that patients recently discharged from the hospital stay at home and don’t return to the hospital. She provides in-person and telephone-based medication reviews and reconciliations to eligible patients who accept the service.
“Community pharmacists really are your health care provider in the community,” Long said. “We’re ideal to improve access and resolve medication issues just because of our location, our constant contact, and our ability to work with that patient.”
Long helps resolve numerous potentially dangerous medication issues for patients when she has access to their health information and cooperation from their health care providers. But until Long, like the other pharmacists profiled in this series, gets federal recognition as a health care provider, there will always be barriers to providing optimum care for her patients.
In a postdischarge consultation, Long learned that her patient was preparing to return to the hospital in the coming weeks for a scheduled hip replacement—a procedure unrelated to the patient’s most recent hospitalization. She had been taking Tylenol 1,000 mg every 4 hours for the last 2 days to preemptively address pain and swelling. The patient was following what she believed were her doctor’s orders. Knowing that this was well over the recommended limit for acetaminophen, Long called the physician and discovered that the orders had been to take Advil, not acetaminophen.
“A family member had inadvertently gotten her acetaminophen instead of Advil because they both began with ‘A,’” Long said. “So I was able to clarify everything with the physician and with the patient and make sure that she stopped taking acetaminophen and didn’t harm herself or her liver.”
Long’s transitions of care program has helped her identify patients with chronic obstructive pulmonary disease who were discharged from the hospital without a rescue inhaler. She has prevented patients from taking duplicate blood pressure medications, among other drugs. And she’s helped patients get prescriptions for affordable medications when the original prescription was too far out of their budget.
“These are issues that the community pharmacist is clearly able to resolve, but some of these things don’t come up until you take the time to sit down face to face with the patient or talk to them on the phone,” Long said. “I was actually calling the woman who was having hip replacement surgery about a different unrelated discharge.”
But without provider status, Long can only spend the necessary time with a small fraction of the patients who could use her help. Through an agreement with a local hospital and health plan, Kroger pharmacists in her region receive eligible patients’ discharge summaries and are reimbursed for reviewing and reconciling the patients’ medications after a hospital discharge. Yet when Long has tried to take this model to other facilities, they’ve turned her away.
“Even though I have these examples of how a community pharmacist can improve a patient’s care, they’ve told me that we aren’t seen as health care providers, since we work in a grocery store, for example,” Long said. “And therefore there’s no way for them to share any information through their EMR [electronic medical record] with us.”
Until pharmacists gain federal recognition as health care providers, Long believes she and her colleagues will continue to face prejudice when they attempt to expand patient care services.
“If pharmacists had provider status, more payers would see the benefits of pharmacist-provided care and justify including extra pharmacy services in the benefits provided for their patients,” Long said. “It would also encourage other providers in different settings to recognize that pharmacists in all different areas are providers, and it would motivate them to participate and try different service delivery models for our patients.”
Pharmacists are health care providers. In a series of profiles appearing in Pharmacy Today and on pharmacist.com, pharmacists explain how their patients would benefit from provider status. And as part of our campaign for provider status, APhA has asked pharmacists to share their story of how they provide care to their patients and how provider status will improve health care. These stories are collected on the APhA YouTube channel. If you would like to share your story, please visit PharmacistsProvideCare.com.