US
Pharm. 2006;
Remember a few years back when
pharmacists and their associations were in an uproar about physician
dispensing? It seemed like every trade journal you picked up had an article or
two about physicians who were taking money out of retail pharmacists' pockets
by installing prescription-dispensing units within their practices.
Thankfully, the number of physician dispensaries was fairly small, and the
trend never really caught on. Primarily, in my belief, there were two major
reasons why physicians did not want to be in the pharmacy business: economics
and stringent regulations. Most physicians learned pretty quickly that any
return on their investment would take some time, considering the expense of
maintaining a costly drug inventory (even if it represented only the top 100
most prescribed drugs) against the time it took to sell the drugs. This
reason, combined with many states insisting that physicians dispensing
prescription products from their offices had to be licensed by the state's
Board of Pharmacy and follow the same regulations as retail pharmacies, was
enough for many physicians to think twice about opening up a pharmacy business
in their office.
Pharmacy associations argued
that physicians should do what they do best, diagnose and treat sick patients,
and pharmacists should continue to do what they do best, dispense
prescriptions and consult patients on their use. At the time, I personally
thought this was logical thinking. That's why I was surprised to learn that
several large chains have now entered into the business of running medical
care clinics within their stores, and others are seriously considering it. But
the more I think about it, the more it makes sense to me.
Running medical clinics
within the walls of a drugstore is not the same as physicians dispensing
prescription medications in their practices. For one thing, pharmacists are
not administering medical care in the drugstore. Depending on the location,
medical treatment is being provided by a physician, nurse practitioner, or
physician assistant. In many cities and small towns, the number of drugstore
locations certainly makes them more accessible than freestanding walk-in
clinics or doctors' offices, with their restrictive patient hours. Pharmacists
can interact readily with patients to provide pharmaceutical care by
counseling them on medications being prescribed by the health care
practitioners running the clinics. From a patient's perspective, it eliminates
a trip to the doctor, then another trip to the pharmacy to get a prescription
filled. People get their medications quicker, which means they are on the road
to recovery sooner.
Most importantly, I believe
housing medical clinics within drugstores offers retail pharmacists the
opportunity to practice pharmacy to its fullest by being an integral member of
a health care team, similar to what is done in most health system settings,
instead of being relegated to behind the prescription counter. While there is
no question that checking prescriptions before they are given to the patient
is an important part of the pharmacist's responsibilities, so are compliance
issues and making sure patients are educated about their prescriptions.
Of course, none of this can
happen without the support and commitment of drugstore management. I hope that
a portion of what they are charging patients for in-store medical treatment
would go to the pharmacist and that more pharmacy personnel would be hired to
allow the pharmacist to have a vital role in a patient's medical and drug
therapy. I like this new twist in health care and hope it becomes a mainstay.
Harold E. Cohen, R. Ph.
Editor-in-Chief
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