Pharmacists' Contributions to Primary Care in the United States Collaborating to Address Unmet Patient Care Needs: The Emerging Role for Pharmacists to Address the Shortage of Primary Care Providers

Primary care is the foundation of the U.S. healthcare system. The Institute of Medicine (IOM) defines primary care as “the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community”.1 When optimally delivered, primary care fosters wellness and prevention of chronic diseases and problems. Primary care often serves as the point of entry for patients who require medical care and attention. In addition to the diagnosis and treatment of acute and chronic illness, primary care practice encompasses activities such as health promotion, disease prevention, health maintenance, counseling, and patient education. Medications play a critical role in primary care and their effective management is essential to patient safety and quality care. Primary care activities occur across a variety of health care settings.2 Patient involvement and empowerment are key components of primary care practice – which require effective two-way communication and the recognition of the patient as a partner in their own health care. IOM defines patient-centered care as “providing care that is respectful of and responsive to individual patient preferences, needs, values, and ensures that patient values guide all clinical decisions”. The American Academy of Family Physicians asserts that primary care practices should be located in “the community of patients”, thereby facilitating access to health care. Unmet Chronic and Preventive Public Health Needs Nearly half of all Americans—and over three-fourths of adults aged 65 and older—live with at least one chronic condition that requires medication therapy.3 Chronic diseases are appearing with increasing frequency in younger adults and even children, likely a direct result of societal trends including unhealthy diets, oversized serving portions, and inactivity, which collectively contribute to early development of type 2 diabetes, dyslipidemias, and obesity. Likewise, preventable complications from each of these conditions are also on the rise. As a result, 75 percent of our nation's $2 trillion in annual health expenditures are attributable to management of problems associated with chronic diseases.4 While chronic diseases are common and costly, many are also preventable—through strategies such as healthy eating, being physically active, avoiding tobacco use, and using medications safely and appropriately. The current Presidential Administration is committed to reforming the U.S. healthcare system and has proposed the largest federal investment in promoting and providing preventive care. It is clear that preventive care is one of the best ways to keep people healthy and reduce the costs of healthcare. Wellness and prevention are hallmarks of primary care and offer expanded opportunities for improving access to care for millions of U.S. citizens, many of whom have been disproportionately affected by the lack of care including the elderly, low income, minority populations, and those located in areas with little or no access to primary care providers.