Retail Pharmacists Doing Care Management Coaching? Doubtful.

Can retail pharmacists take the lead in care management-style patient coaching? To answer that, check out this New York Times article and this description of Asheville Project (more details here). Pharmacists receive extensive instruction in patient education and consumer surveys consistently show high levels of trust in community pharmacists. Pharmacists also have the advantage of "teachable moments" when consumers return to renew their prescriptions, especially if value-based insurance designs are incenting patients to pay attention. There are oodles of studies that show that, compared to usual care, pharmacists can increase health care quality and/or reduce costs (for example, here, here and here).

Full steam ahead, right?

Maybe not. The methodologically nudninky DMCB notes the Asheville data (here, here and here again) seem to be based on more than a fair share of suspect pre-post study designs and use approaches that aren't necessarily generalizable to all community/retail settings. The DMCB also worries that:

• Next to physicians, pharmacists are among the most expensive health care professionals. Education can be done more cheaply by other highly trained, credentialed non physicians.


• Despite the logic of using retail setting, setting up a separate window or a cubicle between the foot insole displays and the reading glasses tower isn't really conducive to patient engagement


• While some retail pharmacists embrace patient education, most got into retail pharmacy because they, well.... like fill the pills n' bill retail pharmacy. Pharmacists in other settings with a greater emphasis on patient education/coaching -- such as hospital-based consulting services (which work quite well in the area of anticoagulation), disease management programs, the medical home or within pharmacy benefit management companies -- are there because their professional goals may be different.

It may be that the DMCB is wrong. It may be that retail pharmacies are retooling for a new wave of disruptive innovation, that there are generalizable and prospective randomized trials that have been overlooked and that, when the DMCB went to its community pharmacy window, joked about getting some educatin' and the pharmacists chuckled along, it misread things.

If so, it'd like to hear from some readers.