When 71-year-old “Tomás” visited a Walgreens pharmacy in Carolina, Puerto Rico, he was confused about his medications. Living with diabetes and hypertension, he had four different medications prescribed by four different physicians, but he didn’t know that he was supposed to take all of them. “His systolic blood pressure was over 180/120 mm Hg. I told him he had to go the hospital to get his blood pressure stabilized immediately and then come see me for follow-up,” recalled Nicole Quiles Alves, PharmD, MPH, who is Pharmacy Manager and an Assistant Professor of Pharmacy Practice at the University of Puerto Rico.
Quiles Alves knew that a patient in Tomás’s situation needed more than just acute care. He needed ongoing disease state management. “He was confused. He’d stopped taking his diuretic. And he thought that only taking one of the pills would be good enough to control his hypertension,” she said. But there was a problem. Tomás’s health plan doesn’t cover clinical pharmacy services. As other articles in this series note, any other health care provider, such as a physician, nurse, or physician assistant, gives patients the care they need and bills insurance for it. But few health insurers recognize pharmacists as health care providers. Their beneficiaries must pay out of pocket for pharmacist-provided care, or get care from another provider.
‘He trusted me now’
Tomás chose to continue to see Quiles Alves for his care, regardless of the out-of-pocket costs. “I explained to him that he could get these services with a health care provider approved by his insurance, but he trusted me now,” Quiles Alves said. The patient knew as well that another health care provider would likely bring a long wait leading up to the appointment and a long stint in the waiting room on the day of the appointment.
Establishing a plan for lowering blood pressure
Many Americans do not have the luxury of choosing to see a pharmacist regardless of the cost. And given the barriers to accessing other health care providers—compounded by the growing number of insured Americans—many would fail to follow up on their blood pressure management all together.
Indeed, more than one-half of the nearly 70 million Americans with hypertension are uncontrolled, according to CDC. Community pharmacists, available on nearly every block, could bear some of this burden. An article in Pharmacotherapy called community pharmacists “the most accessible of all health care professionals in the United States,” stating that most Americans encounter their community pharmacist at least once a month.
Nicole Quiles Alves
Perhaps this is why Tomás trusted Quiles Alves more than a provider he might seek through his health plan. In their sessions together, Quiles Alves and Tomás established a plan for lowering his blood pressure.
Quiles Alves counseled Tomás on the meaning and the importance of a blood pressure reading; lifestyle factors that contribute to blood pressure; how each of his medications work; and the importance of taking all of them.“He was really happy and thankful. He said no one had ever answered his medication questions like that before. I know he is now conscious of his role in managing his hypertension,” Quiles Alves said.
Making an impact
Quiles Alves is not alone in her ability to make an impact on patients’ hypertension. Numerous studies have shown that community pharmacists can help improve blood pressure control when they assist with education, blood pressure monitoring, medication management, and compliance assessment. But until they have the means to provide this care to all patients, they won’t be able to make the most possible impact.
“We cannot have some patients pay and others not. If we get reimbursement, we can really take care of all of the needs of all of the patients.”
Provider status stories
Pharmacists are health care providers. In a series of profiles appearing in Pharmacy Today and on pharmacist.com, pharmacists explain how their patients would benefit from provider status. And as part of our campaign for provider status, APhA has asked pharmacists to share their story of how they provide care to their patients, and how provider status will improve health care. These stories are collected on the APhA YouTube channel at https://www.youtube.com/user/aphapharmacists/playlists. If you would like to share your story, please visit PharmacistsProvideCare.com.