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___________________________________________________________353 Brief communication THE ROLE OF THE PHARMACIST IN HEALTH CARE REFORM To the editor: The conference proceedings on health care reform and the underserved [Vol. 4, No. 3] were illuminating and far-reaching. The discussion touched on the contributions of many health professionals, from physicians to occupational therapists, but one topic that was missed was the role of pharmacists. Pharmacists are the third largest group of health professionals in the United States; nurses and physicians are first and second, respectively.1 There are approximately 190,000 licensed pharmacists in the nation, of which some 150,000 are in active practice. About five percent of these are African-American.2 But nearly eight percent of the 30,000 students enrolled in the nation's 76 colleges of pharmacy are black.3 Most states have statutes designating pharmacists as the primary health professionals who dispense medications under prescription. Some two billion prescriptions are dispensed annually; 1.5 billion are dispensed through 55,000 community pharmacies.4 A pharmacist is one of the most accessible of all health professionals. One can visit any practicing pharmacist and obtain free of charge information on drug products, even if medication is not dispensed. Pharmacists collaborate with other health professionals in the full spectrum of pharmacotherapeutic activities: 1. Identifying the patient's health problem; 2. Determining the patient's history of drug use; 3. Participating in the decision to choose a drug; 4. Selecting the drug product; 5. Dispensing the drug; 6. Counseling the patient; 7. Administering the drug; Journal of Health Care for the Poor and Underserved · Vol. 4, No. 4 · 1993 354___________________________________________________________ 8. Monitoring a patient's drug therapy; 9. Reviewing drug use; 10. Educating health professionals and the health care system.5 However, the health care system generally lacks an overall coordinator who is responsible for minimizing the inherent pitfalls associated with pharmacotherapy, including drug-related illness and thereby an undesired health outcome. There is mounting evidence that drug-induced health problems are a cause of hospital admissions, are linked to increased hospital stays, and are significant factors in morbidity and sometimes mortality. Evidence also suggests that in most cases, the incidence of drug-related illness could have been minimized.6 Because the cost of these drug-related problems is no small matter, they are a suitable target for health care reform. In 1992, some 14 percent ($820 billion) of America's gross domestic product supported health care costs.7 But the cost of prescription medication represents only seven to 10 percent of the health care dollar. One could therefore estimate that nearly $57 to $80 billion were spent on pharmaceuticals during 1992.1 The average cost of a prescription is just over $24. When compared to the average cost of one day in the hospital ($650), prescriptions emerge as a less costly alternative to care.4 But unmanaged drug therapy has dire consequences, with estimated hidden costs in the range of $30 to 40 billion per year, not including the cost of personal suffering. (R. Penna, personal communication) Pharmacists can help minimize drug-related health problems. For this reason, many segments of the profession are reconsidering the role of the pharmacist as the debate over health care reform advances. Indeed, pharmacy has responded to the changing needs of America's health care system for the last three decades. In the mid-1960s, Brodie advanced the idea that drug-use control is a key function of pharmacists.10 In the 1970s, there was discussion within the public health arena on the pharmacist as a qualified but underused member of the health care team.8 The pharmacist's role within patient care and in relation to health outcome was identified asa significant function in health care delivery; thus the federal government raised the issue in a method used to evaluate federal community health programs.9 In 1987, Hepler coined the term "pharmaceutical care," defined as "the responsible provision of drug therapy for the purpose of achieving specific outcomes that improve a patient's quality of life."10 In 1990, the concept of pharmaceutical care as a mission of the profession was furthered by Penna.10 The federal government estimates that when used properly, the...


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