Integrating Family Medicine and Community Pharmacy to Improve Patient Access to Quality Primary Care and Enhance Health Outcomes

Health care in the US remains dysfunctional despite well-intentioned efforts to revitalize the system. Delivery is fragmented, per capita investment is the highest of any nation in theworld, and the return on the health care dollar ranks as one of the lowest of industrialized nations. Efforts to revitalize the system have focused on integration of high-value health care that places the family physician as a central component. In concert with this effort is the underlyingmovement toward bringing health care closer to the patient. Being able to help patients understand and deliver their own self-care through personalization and prediction of disease, thereby helping them to prevent or preempt their own disease progression is paramount to this movement. Community pharmacies are numerous throughout the US, located in rural, suburban, and urban centers, and are the most frequently visited health care setting. As such, they provide an opportunity to focus on preventive, self-care and chronic disease management strategies that can deliver highquality health care. Closer integration of family physicians with community pharmacists could enhance the capacity of both practices to perform their missions, thereby providing a common link to improve health throughout the country. Recently, a large, comprehensive patient-centric U.S.-based population study to model the demand for community pharmacy advanced services was conducted. There were 9,202 participants who provided valid responses to a 30-minute survey in a Discrete Choice Experiment (DCE) model, where they indicated which pharmacy theywould prefer frommultiple pairs that varied in the degree of services offered. The optimal pharmacy that maximized the switch rate (the probability of adult patients changing from their current baseline pharmacy) offered an integrated health electronic record system, a comprehensive level of point-of-care diagnostic testing, and some level of physical examination procedures. A similar survey was offered to 292 community pharmacists. Responses were similar to patients; however, the switch rate was fourfold higher from their current base pharmacy to this optimal pharmacy configuration. The optimal pharmacy was then shown to 50 public and private reimbursement decision-makerswhowere involved in an advisory or leadership role in decision-making within the organization regarding coverage and reimbursement policies and/or protocols for various types and locations of primary health care services. Two-thirds of payers were very likely or likely to reimburse for the optimal pharmacy services. This study provides empirical support for convenient primary care services in the community pharmacy setting. Since 1967, primary care has been promoted as the foundation for improved health care system. Developing strategies to foster closer integration of family medicine with community pharmacy is a potential partnership to this end. One potential strategy would be to build on existing relationships between family practitioners and community pharmacists, and partnering to deliver a broader range of primary care services in the communities where they live and work. Delivering a broader array of primary health care services in a convenient community pharmacy setting, with family practitioner oversight and teaming could improve the quality of health care services, as has been shown in community pharmacist-family medicine collaborative studies. This could occur especially in places where health care access is lacking and improve value in terms of better health outcomes through improved access and quality. Better leveraging synergistic interactions around the education, skills, and service of physicians and pharmacistsmay assist in ameliorating challenges presented by trends in the national shortage of family physicians. There are currently 67,000 community pharmacies in theUSwith 92% of the population living within 1.6miles of a community pharmacy.Buildingmodels of enhanced local care by Corresponding Author:Mark A. Munger, University of Utah College of Pharmacy, 30 South, 2000 East, Room 4958, Salt Lake City, UT 84112-5820. Tel: 801-581-6165. Fax: 801-5813716. E-mail: mmunger@hsc.utah.edu American Journal of Pharmaceutical Education 2018; 82 (4) Article 6572.