Reflection statement for participants in this CME activity:

Pharmacies and pharmacists have been increasingly integrated into the U.S. healthcare system for the last several years. The roles of pharmacies and pharmacists have expanded significantly and more widely from roles highly focused on providing information and dispensing medications. The expanded roles and scope of clinical practice of pharmacists and pharmacies now involve public health, preventive health, and even some other contexts.

The stress test of the COVID-19 pandemic and some other issues with the U.S. healthcare system have revealed regulatory, logistical, and supply issues that affect healthcare outcomes. Access to care, health information, preventive health care,  and other types of health care issues are examples of stressors that currently impact the effectiveness, equality, quality, cost, resource utilization, public health, and other types of U.S. healthcare system outcomes.

The COVID-19 pandemic particularly stressed the ability of the U.S. healthcare system to supply health information to the populace and to develop and sustain distribution channels of sufficient scale to deliver, distribute and administer preventive health and public health interventions (i.e. protective equipment, diagnostic tests, human resources, vaccines, etc.) and still adequately meet the needs for diagnostic and therapeutic resources.

During the past several years the traditional preventive medicine model whereby physician practices provided vaccinations to eligible patients during preventive health visits has been waning significantly. Pharmacists have been progressively performing more and more of this work. The drivers of this transition are not fully clear but may involve economic issues, regulatory and health insurer changes, reduced acceptance of vaccines by patients or their guardians, or other reasons. The increasing use of pharmacies and pharmacists to provide many different types of vaccines may be impacting pharmacies and pharmacists in several ways. New sources of revenues from administering vaccines may be significant. The additional work load associated with broadening of the role and scope of practice being assumed by pharmacies and pharmacists may be producing very stressful work environments in some instances based on some reports of ‘understaffing’ and increased burnout among pharmacists and pharmacy technicians. The quality and safety associated with using pharmacy staff to administer vaccines seems generally good or better. But such information may be limited somewhat. Little is known about the ability of pharmacist to identify esoteric or poorly studied conditions that may be adversely affected by certain vaccines.

During the COVID-19 pandemic, pharmacies were further recognized as plentiful, well-distributed and well-established resources capable of augmenting public health and preventive medicine resources. Such augmentation  became particularly necessary during the COVID-19 pandemic (and some earlier public health challenges) when existing and emergency resources became overwhelmed with respect to distribution channels, human resources, diagnostic / preventive / therapeutic supplies, information, and administration of vaccines. (The system of caches of emergency disaster response supplies and supporting human resources were inadequate to meet the needs to deal with the COVID-19 pandemic response.)

The evolving role of pharmacies and pharmacists / technicians and other healthcare human resource in the U.S. healthcare system will probably continue as dwindling human resources and increasing patient loads persist. Costs of care will likely be significant drivers for increasing use of healthcare workers who can perform the needed services at lower cost.

While trying to adapt or even re-engineer various aspects of the U.S. healthcare system, even more impactful issues will continue to increase utilization, cost, and poor outcomes in the U.S. healthcare system. These include non-acceptance of health enhancing interventions by patients, caregivers, other stakeholders, and even some non-stakeholders. Examples include measures to reduce / eliminate tobacco use, gun violence, obesity, opioid abuse, and other leading causes of disability and death.

The changing processes in the U.S. healthcare system involving pharmacists, advanced practice providers, and other roles with changing scopes practice may cause blurring of roles from the  patient, caregiver, and other perspectives.

Increased blurring of role and responsibility lines among health care workers may result in some confusion and coordination of care issues also.