Three Reasons Why Recognizing Pharmacists as Providers Can Help Solve Public Health Crisis in the United States

Three Reasons Why Recognizing Pharmacists as Providers Can Help Solve Public Health Crisis in the United States

Here are three ways pharmacists can help address the two most pressing problems of healthcare in the United States.

BY SOOJIN JUN, PHARMD ’13, BCGP, CPPS, CPHQ

Dr. Soojin Jun is a board-certified geriatric pharmacist in Illinois and Wisconsin. She is also a certified professional in patient safety (CPPS) and a certified professional in healthcare quality (CPHQ). After losing her dad to many gaps in healthcare as a minority caregiver, one of them a medication adverse event, she changed her career from a wedding videographer to a pharmacist. Currently, she works as an inpatient pharmacist and also a Salk Health Activist fellow at Jewish Healthcare Foundation. She is a cofounder of Patients for Patient Safety U.S., a group of patient safety activists who are committed to activating U.S. healthcare according to the Global Patient Safety Action Plan 2021–2030 of the World Health Organization. She specializes in medication therapy management and believes empathy in healthcare can make healing possible in any relationship of healthcare. She has experience in both inpatient and outpatient pharmacies and has worked as a population health pharmacist for heart failure patients. She is also an ambassador for the Patient Safety Movement Foundation, a nonprofit organization dedicated to patient safety worldwide. She passionately speaks up about patient safety, patient rights, health equity, the expansion of roles of pharmacists in public health and policy, and patient advocacy for voiceless patients.

After losing my dad to medical gaps and adverse events from medications as a minority patient, I decided to change careers and went from being a videographer to being a pharmacist. Through my naive yet passionate endeavor, I thought I could improve healthcare one patient at a time. I was so eager for change that I created a business plan with my friends for a pharmacist-mediated digital health solution that would allow patients and caregivers to coordinate care together with doctors and hospitals, an idea directly inspired by my personal experience as a caregiver before graduation.

I interacted with entrepreneurs from StartUp Health, PillPack, and incubator 1871 (now Matter) as well as venture capitalists and competed in different competitions, including South by Southwest. I enrolled in the health informatics graduate program to make the app a possibility with a targeted clinical trial for minority patients in mind. I could not continue after I became pregnant with my third child, but I gained valuable lessons and observations from this experience.

There were not many pharmacists in the middle of this innovation movement and conversation because we could not bill as providers; innovators did not look to pharmacists, with whom they could and should partner, to bring changes.

At the time there was a petition going around started by Sandra Leal, now the president of the American Pharmacists Association (APhA), asking for federal recognition of pharmacists as providers under Medicare. I decided to help spread the word with another student in Texas, Steve Soman. We created a Facebook page, “Recognize Pharmacists as Providers,” and posted the efforts on the Facebook pages of other colleges of pharmacy. The original Change.org petition was moved to the White House petition site, gained traction, and received a response as promised after reaching the target of 25,000 under the administration of Barack Obama. Although federal recognition was not achieved and the response was far from what we were looking for,

it created a conversation. California became the first state to recognize pharmacists as providers in 2013. Since then, we have 37 states recognizing pharmacists as providers. However, lack of federal recognition still slows innovation that we desperately need, especially in cutting costs and optimizing therapies for chronic illnesses. I know billions of dollars are often attributed to a lack of “compliance” with medications. To me, this is a tunnel-visioned estimate of the cost. (By the way, patient advocates cringe over that word, compliance, so if your organization claims to be patient-centric, please consider avoiding the word.)

The first and foremost value of recognizing pharmacists as providers is that we can help deprescribing medications and guide patients to healthier lives for many chronic illnesses. Many insurance and government sponsored programs are wasting money by “restricting” how pharmacists should practice under their laws and regulations when they can better use the time and money by “guiding” how pharmacists could practice as providers.

There are many pharmacists who are burnt out of practicing in the boxed set of rules that clearly do not bring the real results we want to see in patients. Many functional medicine pharmacists who look at patients as a whole, for example, have created their own practices. However, because pharmacists are not providers in many states, the results pharmacists can bring are more regional than widespread. With telehealth and digital health tools, this is changing. Still, too many barriers continue exist for pharmacists.

The second equally important value of recognizing pharmacists as providers is that we can guard patient safety more effectively. Traditionally, nurses and doctors have been in the main roles of patient safety and still are. However, as Lucian Leape, the renowned father of the patient safety movement, had written in his published paper, pharmacists’ participation in intensive care unit rounds reduced medical errors significantly. This only makes sense considering pharmacists’ extensive education. We are the last guards of patient safety before medications go into the bodies, especially in outpatient settings, not to mention monitoring and adjusting the doses. Despite the beneficial evidence, pharmacists are still not considered as main players in many settings outside of the Department of Veterans Affairs. The VA has long been supportive of pharmacists as providers. Pharmacists’ scope of practice is much wider in the VA setting, and it is growing significantly in rural areas and in outpatient clinics due to many benefits in this setup. When the third leading cause of death in the United States is medical error—although it could very well be the first as there is no way to track the real number with current healthcare model—we desperately need more pharmacists dedicated to patient safety, guarding patients, and advocating for changes in policies. We need more pharmacists to speak up for patients.

The third equally important value of recognizing pharmacists as providers is cutting the cost of

healthcare in conjunction with the first value, which brings the second value to be realized. Not all chronic diseases need medications. Many medications should be viewed as temporary measures until patients can get back on their feet again. Yet, getting prescriptions has become an expectation from patients and what providers provide when patients come in for treatments without proper assessment and followup. We probably all know friends and families going from one doctor to another, not finding answers but getting more prescriptions. By empowering pharmacists as care coordinators and patient advocates, patients will have someone to look out for in their unorganized and dangerous care. Many pharmacists also specialize in pharmacogenomics (discipline of medicine and genes) and nutrigenomics (discipline of nutrients and genes) that can guide selecting the right treatment and identifying the right nutrients to supplement. Now, ordering these labs also requires provider status in many states.

You get the idea.