Convenience Or Compromise? More People Are Receiving Heathcare At Pharmacies

A bill moving from the state House to Senate this week would expand the number of vaccinations Indiana’s pharmacists may give to patients. It’s the latest evidence of the profession’s growing role in the healthcare industry, but the possibility the question: Are patients sacrificing quality for convenience?

Pharmacies used to simply be a place where you could pick up your pills — and maybe a cane or a page of stamps. But these days, pharmacy services are expanding.

“The role of the pharmacist has absolutely changed,” says Jennifer Buehrle, a patient care coordinator for Kroger pharmacies — that means she’s in charge of ensuring Kroger pharmacists administer all their procedures properly.

“I think we’ve gone from a traditional dispensing role where we had no involvement in the care, other than giving the patients exactly what was ordered, to having more responsibility, where there’s actually shared responsibility between the pharmacist and the prescriber,” she says.

For example, Kroger now offers more preventative services, such as cholesterol or blood pressure screenings-a growing trend.

A recent report from consulting company Avalere Health, a DC-based firm that focuses on healthcare business and policy, found: “pharmacists’ roles have expanded to include more direct patient care, such as primary care and disease management.”

In Indiana, pharmacists may also — with a doctor’s go-ahead — give flu shots and shots for shingles, pneumonia and whooping cough.  A new bill, which passed the state Senate and in now in the House, would add five more vaccinations to the list.

Thirty-two states allow pharmacists to deliver any vaccine approved by the CDC. Other states, such as Indiana, can administer a limited list of vaccinations.

But that’s sometimes created a tension between physicians and pharmacists.

“'When does access create more issues than good' is the question that needs to be asked, says Scott Gartenman. Gartenman is the Director of Healthcare Policy at the Indiana State Medical Association, which represents thousands of the state’s doctors. ISMA has spoken out against attempts to expand pharmacist immunizations.

Gartenman says it’s not about whether a pharmacist knows how to give the vaccine correctly — students learn how to do the procedure in school, and every person administering vaccines needs to be certified. Rather, it’s about a missed opportunity.

“If they’re able to obtain these vaccines at a pharmacy, perhaps they don’t go to see a physician and something else is missed that is more pressing, you know, than getting your MMR shot or your hepatitis shot, that a doctor would recognize in that visit,” he says.

Preventative care trips are the basis of doctor-patient relationships, he says, and a la carte treatments from pharmacists just don’t cut it.

But pharmacists say it’s not “either or” — instead, it’s “this, and.”

Purdue Pharmacy School Head of Pharmacy Practice Alan Zillich says when pharmacists get more involved, the resulting care is more comprehensive and holistic. That particularly true, he says, when it comes to the growing collaboration between doctors and pharmacists, who have begun working in cooperative teams.  

“We really provide an extension of that physician’s care,” says Zillich. “We can follow up with that patient more frequently, that physician may be able to, and do it in a way that continues to communicate back to them.”

All sides do agree on one thing: pharmacists are just a lot easier to get to. Practically every town has a CVS or Walgreens. In contrast, the number of general practitioners is shrinking. A recent study found 25 percent of Hoosiers are living in an area with a doctor shortage.

“Pharmacies are much more accessible than any medical office,” says Zillich. “They’re in small towns and big towns and on lots of street corners.”

One can see a pharmacist without scheduling an appointment, and they’re usually open outside of regular office hours. There’s an undeniable ease to a retail pharmacy — one can pick up their Vicodin in the same place where they buy an avocado or an umbrella.

Buehrle agrees with Zillich. She doesn’t see the two professions as rivals.

“I think it’s more just adding the individual visit in between versus necessarily taking an entire visit away,” she says.

However, if doctors want to maintain a stronghold on providing treatment, they might need to focus on becoming as easy to access as the corner pharmacy. 

Reporter's note: An earlier version of this story misidentified Zillich as the Dean of the Purdue Pharmacy School. We apologize for the error.