The Epicenter of Care: Expanding Public Access to Community Pharmacy Services Beyond the COVID-19 Pandemic, Part 3
The following is part 3 of 6 in a series of articles titled, "Expanding Public Access to Community Pharmacy Services Beyond the COVID-19 Pandemic" by Jason Ausili, PharmD, MSLS, Head of Pharmacy Transformation for EnlivenHealth.
The Epicenter of Care
Community pharmacies are uniquely positioned to be the "epicenter of care." They are a key asset in combating health inequities and preventing health disparities. Pharmacists and their teams are entrenched in their communities and are uniquely suited to identify social determinants of health (SDOH), which accounts for up to 90% of health outcomes.
According to a session at the Pharmacy Quality Alliance (PQA) 2020 Annual meeting, "the conditions in which people live, learn, work, and play can affect their health risks and outcomes ", and pharmacy staff can play a pivotal role in addressing food and housing insecurity, social isolation, and issues related to transportation by connecting those in need with relevant resources within their communities.
The Importance of Proximity
Most of the population is located within a short distance of their local pharmacy and can conveniently access cost-effective pharmacist-driven public health services outside of normal physician office hours without an appointment. According to research published by the CDC, more than 90% of the population lives within five miles of a community pharmacy.
Another report by the National Community Pharmacists Association (NCPA) highlights, "Seventy-four percent of community pharmacies serve population areas of 50,000 or fewer," positioning them as uncommonly accessible to medically underserved and rural populations. In communities like these, the local pharmacy may be the only convenient access to a healthcare provider. Walk-in visits for pharmacist-provided services serve as important touchpoints for screening and identification of SDOH and uniquely position community pharmacies ahead of less accessible destinations when considering health equity.
Game-Changing Accessibility
In addition to being distinctively accessible to patients, pharmacists routinely see their patients more frequently than PCPs. One peer-reviewed research study analyzed data from over 680,000 active Medicare beneficiaries and found that "patients visited community pharmacies approximately twice as frequently as they visited primary care offices." Another pilot program focused on high-risk Medicaid patients found that these patients visited their community pharmacy 35 times a year compared to four visits to their PCP.
The higher-touch and walk-in friendly model offered by community pharmacy has been game-changing in the wake of a global pandemic. During a time of extreme demand for COVID-19 tests, vaccinations, and treatment, patients were able to get the care needed at their local pharmacy when physician's offices, urgent care centers, and emergency rooms were unreachable.
The negative impact of COVID-19 on racial and ethnic disparities — resulting in increased risk of COVID-19 infection, hospitalization, and death — would have been dramatically amplified if these services were not available at a pharmacy. How is it appropriate for groups like the American Medical Association (AMA) to challenge the expansion of public health services available in community pharmacies in the face of a pandemic and growing PCP shortage?
A Pivotal Role in Vaccination
Since COVID-19 vaccines became more widely available in May of 2021, pharmacies across the country have been a principal destination for the U.S. population. As of June 23, 2022, more than 41,000 pharmacy locations participating in Center of Disease Control's (CDC) Federal Retail Pharmacy Program have administered more than 256.3 million doses of the vaccine.
Outside of COVID-19 vaccinations, pharmacists and their teams have played a pivotal role in helping close the gap on childhood vaccine schedules as they fell drastically behind during the pandemic. Although pharmacists have been routinely administering vaccines to the public for more than two decades, state variances restricted certain vaccines from specific age groups, preventing widescale and consistent childhood vaccine administration in pharmacies prior to the pandemic. A Public Readiness and Emergency Preparedness (PREP) Act declaration authorized pharmacists to order and administer (and pharmacy technicians and interns under the supervision of a pharmacist to administer) all childhood vaccines recommended by CDC's Advisory Committee on Immunization Practices (ACIP) for children ages 3-18. This privilege is at risk upon future expiration of the PHE.
Point-of-Care Testing
In addition to providing vaccinations to the public, pharmacists have played a key role during the pandemic by providing convenient access to COVID-19 tests and therapeutics. Pharmacists have been performing point-of-care testing (POCT) — including diagnostic tests waived under the Clinical Laboratory Improvement Amendments (CLIA) of 1988 — to identify conditions such as influenza (Flu) and group A streptococcus (Strep) infection for years prior to COVID-19.
(FYI: The National Community Pharmacists Association defines point-of-care testing as "performing a diagnostic test outside of a laboratory that produces a rapid and reliable result, aiding in identifying or managing chronic diseases and acute infections.")
I believe that greater access to high-quality POC testing, performed and evaluated in a matter of minutes by community pharmacists, is an important key to combating health disparities. Consumers and public health alike relied upon this community pharmacy-based service heavily during the pandemic for the identification of COVID-19 in symptomatic patients, for proof of a negative result (required prior to travel or recreation), and simply for peace of mind.
Research provided by leading community pharmacy-based POCT experts unveiled that there was a massive surge in the number of pharmacies across the country becoming CLIA-waived laboratories during the pandemic. The experts highlighted that pharmacies are now the "nation's second-largest provider of CLIA-waived tests by the total number of locations with more than 15,000 credentialed facilities, trailing only physicians' offices." The research pointed out a 45 percent increase in the number of pharmacies with CLIA certificates of waiver from 2015 to 2020, with a sizable portion of the growth happening in the initial stages of the pandemic. In combination with convenient walk-in access, growth of POCT in community pharmacy directly addresses health disparities related to the availability of testing for communicable diseases.
The Emergence of Test-to-Treat
The advent of CLIA-waived diagnostic testing in community pharmacy practice gave way to an important "Test to Treat " model with substantial public health significance. Pharmacists have been using this model to help their communities fight infectious diseases like influenza and strep for many years.
Imagine the convenience of arriving at a pharmacy (with or without an appointment) to receive a rapid diagnostic test that produces a result in approximately 15 minutes. If the test result comes back positive, the pharmacist provides the appropriate treatment on the spot.
Unfortunately, patients do not get to choose at their leisure when they come down with symptoms of this nature. Where does a patient go if they come down with flu-like symptoms at 4:00 PM on a Saturday afternoon? Is there a chance they will get into see their PCP spontaneously for a Saturday visit? They are more likely to visit an urgent care center, the hospital emergency room, or not receive care at all in the absence of convenient access to community pharmacy.
Two research studies evaluating "Test to Treat" for both Flu and Strep in community pharmacy found that 43 – 54 percent of patients using the service did not have a PCP to begin with, and 38 – 44 percent visited the pharmacy outside of normal physician office hours. By taking advantage of the accessibility and convenience of receiving these important public health-based services at a pharmacy, more people in the community will be able to get timely treatment needed to accelerate the recovery process and prevent further spread of communicable diseases.