As the COVID-19 pandemic continued to evolve, a call-to-action was issued by the US Department of Health and Human Services, Assistant Secretary for Health, Brett P. Giroir, M.D. His office issued an authorization under the Public Readiness and Emergency Preparedness Act (PREP) allowing licensed pharmacists to order and administer COVID-19 tests that the U.S. Food and Drug Administration (FDA) has authorized.  The statement issued by HHS Secretary Alex Azar read: “In an effort to expand testing capabilities, we are authorizing licensed pharmacists to order and administer COVID-19 tests to their patients. The accessibility and distribution of retail and independent community-based pharmacies make pharmacists the first point of contact with a healthcare professional for many Americans. This will further expand testing for Americans, particularly our healthcare workers and first responders who are working around the clock to provide care, compassion and safety to others.”

This PREP Act authorization has been followed by similar state-level executive orders from the governor of Florida, Governor Ron Desantis, and the governor of New York, Governor Andrew Cuomo, among others.   This allows pharmacists, especially at the community level, to provide greater accessibility for people to receive COVID-19 testing. It is universally agreed that significant expansion of testing is necessary to assist the identification of potentially infected individuals.  Contact tracing can then occur more efficiently, and isolation of infected persons can become more targeted and precise.  This also places an additional responsibility upon pharmacists to further engage in the fight against COVID-19 beyond what has already been accomplished.

Expanded COVID-19 testing by pharmacists must also achieve proper reporting mechanisms to regional departments of health, as well as other primary care providers if known.  This moment also offers an opportunity to establish necessary platforms to accomplish interprofessional interoperability between patients, pharmacists, and primary care providers.  Necessary exchanges of pertinent clinical information between health providers is long overdue.  A theoretical model of newly emerging roles for pharmacists is shown below (Figure 1):

Figure 1 – original from Kevin B. Sneed, PharmD, FNAP, FNPHA

In previous posts I have fervently advocated for the expanded utilization of mobile health technologies (mHealth) as a means of implementing a new type of data collection for medication therapies. Pharmacists can play a major role in the measurement and monitoring of medications, leading to more complete optimization of medication therapies.  In a recent conversation with a physician colleague, I stated that just because a medication was prescribed, and the patient took the medication, does not mean it worked, or achieved a metric-driven outcome.   During this COVID-19 pandemic event, numerous reports of patients suffering strokes or myocardial infarctions have been documented. (¹Zhang J, Wang X, Jia X, et al. Clin Microbiol Infect. 2020; ² McMichael TM, Clark S, Pogosjans S, et al.  MMWR Morb Mortal Wkly Rep. 2020;69(12):339-342; ³ Roncon L, Zuin M, et al. J Clin Virol. 2020;127:104354.). The increased internal vascular bio-inflammatory status of patients is likely a strong contributor to these events.  I would suggest that if mHealth technologies were already in widespread use, concomitant with enhanced implementation of telehealth platforms, the incidence of severe morbidity and mortality of patients with chronic diseases requiring multiple medications may have been fewer in number.  Further, facilitated implementation of mHealth and telehealth in underserved/ underrepresented communities may have attenuated the severe negative clinical impact in these populations. (Coronavirus And Health Equity- Again This (Too) Is Predictable – KBSneed)

Expanded COVID-19 testing is necessary to succeed in providing proper public health surveillance of viral spread containment strategies.  Community pharmacies are keenly positioned to contribute meaningfully to these community strategies.  Issues of PPE for pharmacists and staff, as well as costs of the tests remain key items to be figured out. The enhanced engagement of pharmacists during this COVID-19 pandemic will be essential in providing needed support to already strained health systems. There can be little disagreement that pharmacists should, and must, enhance our engagement in healthcare activities beyond purveyors of medicinal product and join the other health care clinicians in the war against COVID-19. The public health, societal, and economic implications are too great for anyone not to engage.

A decade later, we have improved, but is it enough to treat the 100 million people staring at us over the next 2 decades?

Scenario: A patient has been in the hospital for (1 day; 1 week; 1 month), and has been discharged.  While in the hospital the patient receives multiple I.V. medications, and several of their oral medications were changed.  Upon discharge, they are told that there are four new medications to take. Medication Reconciliation procedures are implemented, the patient and their (careprovider/spouse/adult son/daughter) are counseled about the medications, and provided instructions about the medications. The patient opts to have the medications electronically delivered to their neighborhood retail pharmacy. The pharmacy has received the prescriptions, which are reviewed by the pharmacist, and filled.  The (patient/careprovider/spouse/adult son/daughter) arrives at the pharmacy within 12 hours of discharge to pick up the medications. They are counseled about the medications, and leave.  The pharmacist, who has advanced clinical training, has no idea of why the patient was in the hospital, no clue of the medications administered by IV in the hospital, and has no knowledge of the laboratory values of the patient in the hospital, or upon discharge.  The (patient/careprovider/spouse/adult son/daughter) is tired, and is a poor historian.  No additional information is available.

No matter how we look at it, that pharmacist is blind to the recent health status of that patient.

This is a significant gap in care provided to the patient. We can do better.

It is not the pharmacist’s fault, or the hospital, or the physician in the hospital.  However, it is the fault of the current healthcare system. We can do better.

This is a serious chasm in care. This must stop. We can do better.

This is just one of countless scenarios that exists.  Many of you have your own stories. I know many will say that this does not happen in their system.  Problem is, there are far more that cannot say that it does not happen in their region, city, town, or system. We can do better.

I have witnessed this scenario on the back end as a primary care clinical pharmacist in a Department of Family Medicine for many years.  And I know for a fact that there are current technologies that could prevent this scenario altogether. I have seen the technology. I know it exists.  The healthcare system is too slow to change, as various interests put their needs in front of the patient’s needs. Scope of practice skirmishes (or fights) over “territory” prevent us from providing the best available care to patients. Entire health systems rely upon claims data to see if a medication was filled, but ignore if the medication made it into the patient’s body. Silos prevent the sharing of needed information. We can do better.

I know many will challenge these thoughts.  But I talk to my colleagues across America, and I read the national reports. I listen to my current patients. I watch how health systems and third parties direct their money to their priorities. I know better.  And I know we can all do better.

I am proud that USF Health and the USF College of Pharmacy are having these conversations internally, and sincerely want to fix these problems, and countless others.  And there are answers; but USF Health cannot do it alone.  Nobody can.  Integrated healthcare must occur, and soon.  75 million Baby Boomers are either here, or on the way. They want better.  They Deserve better.

It is time to include pharmacists as recognized health providers in the Social Security Act. (AMCP link). Nationally. Not just at the state level. To not do this is the same as penalizing patients. We can do better!  Not the total answer, but a big part of the answer.  It provides a pathway so that we will ALL do better.

Patients are Waiting!