Although pharmacies play a key role in the healing process, the impression of patients about pharmacists and their drug store is often that they offer a type of commercial/business-like service. The doctor prescribes the appropriate medicine with the appropriate instructions, and the pharmacist provides it in exchange for money. A clear business.
However, as the medical technological revolution tumbles down the clear-cut roles of singular actors in the healthcare system – for example through empowering patients, it balances the previously asymmetric patient-doctor power relationship – pharmacies have to redefine their place in medicine as well. Thus, a simple drug dispenser will not be enough in a shared and community-based economy.
The Royal Pharmaceutical Society published a report of their Commission on future models of care delivered through pharmacy about the future of the institution, and they formulated several recommendations truly worth considering.
In their view, pharmacists
- should shift their focus away from the distribution of medicines towards providing a broader range of services
- should see helping people get the most from their medicines and keeping them healthy as their ultimate goal
- should take initiative and drive change at the local level – not wait for national solutions
- should collaborate with each other across community, social, secondary and tertiary care and with other healthcare professions
To sum up, the basic concept of the future pharmacist covers the ancient mediwitch combined with the 21st century tech-guru and scientific professional. A mediwitch who has a special place in a given community, knows his or her “patients’” histories and provides basic care for their illnesses with appropriate medicine (or in the middle-ages: herbs or infusions). A tech-guru who knows how to decipher data from health trackers and wearables and is able to provide the necessary care based on the data, and of course a real scientific professional who knows the basics as well as the latest developments in pharma and medicine in general.
Such a mediwitch-tech-guru would come in handy in rural, remote or smaller communities that have significantly less access to pharmacies. This phenomenon has an impact even on the readmission data of hospitals. In rural areas, where people cannot find open pharmacies as often as necessary, researchers found that the readmission data was higher than in urban areas. If the ultimate goal is the improvement of the quality of healing, this phenomenon has to be changed as well.
And technology is at our disposal to help.
So let’s see potential future scenarios and technologies that could have a big impact on pharmacies.
1) Health management centres instead of drug distribution machines
The postmodern pharmacies cannot solely act as institutions for drug distribution, as with the help of technology they will have more time, they will gain more importance in filtering patients. They will act as health managers helping healthy patients as well as patients with medical conditions manage their treatment, they will manage medicines for people taking multiple drugs, they will provide advice for minor ailments, and deliver public health services.
For being able to arrive at the scenario where pharmacies could concentrate on health management tasks rather than medicine distribution, organizational and also technological advancements have to be put in place.
Technologies such as computer system for labelling and stock control, and automated patient pack and unit dose dispensing facilitates which are already used in US and UK hospitals for decades should be used more widely, thus, the working hours devoted to carefully selecting and stocking medicine could be dropped significantly.
With the spread of wearable sensors and health trackers, pharmacies could take on other health management tasks instead of dealing with drug dispensing – helping patients in interpreting their data from their wearable devices – which in my experience is quite demanding – and recommending small health corrections or medication based on the input.
The appropriate organisation of work-load and skill-based distribution of tasks could also help in transforming the old-fashioned pharmacies into 21st century health management facilities. For example, the technical dispensing of medicine or the health sensor and tracker data decoding might be done by different specially trained members of the pharmacy team, and where skill mix is used effectively alongside technical innovation, this has the potential to release pharmacists’ time to provide other services – for example basic care to patients.
2) Health consultancies instead of drug distribution machines
Did you ever got into a huge line in the pharmacy, so when you finally arrived at the counter you only handed over the prescriptions to the seemingly overwhelmed pharmacist or assistant, just waited until your medicine was brought, paid and left – although you would have had some questions about the drug itself? And about the vitamins and the brands you were checking before arriving to the pharmacy counter? However, you decided not to ask and rather leave because the line was so huge and the pharmacists did not have time anyway?
It is high time to turn pharmacies into health consultancies instead of simple drug distribution machines. As technology and organisational schedule enables it, pharmacists will have the opportunity to provide basic care to patients with simple problems and/or provide health management consultations. This way pharmacies rise to almost the same level of primary care practices.
One of the most important factor for this development is the grass-root approach to healthcare, which means healthcare professionals – so pharmacists as well – have to provide pro-active patient care in the location that is most convenient for the patient. When the actual presence of pharmacists is not possible, such solutions as telemedicine fall into place. For example, Intouch Health and its telehealth network patients in remote areas of the US have access to high-quality emergency consultations for stroke, cardiovascular, and burn services in the exact time they need it. Moreover with telehealth, medical professionals in such towns and rural areas also have access to specialty services and patients can be treated in their own communities.
This is part of the so called point-of-care diagnostics, which allows patient diagnoses in the physician’s office, an ambulance, the home, the field, or in the hospital. The results of care are timely, and allow rapid treatment to the patient. Such health sensors as Scanadu Scout which measures among others heart rate, breathing rate, blood oxygenation percentage, and body temperature or Viatom Checkme which measures ECG, pulse, oxygen saturation, blood pressure, body temperature, sleep quality, and daily activity, can significantly help health professionals diagnose illnesses more precisely and easily – for example in a pharmacy.
3) Personalizing therapies and printing out drugs on demand
Let’s take one step further in imagining the future of pharmacies: the obsolete institutions were transformed successfully into health management centres and health consultancies with the help of technologies and organisation. How else could pharmacies take on a more effective role in healing?
I believe pharmacies might get total freedom in personalizing therapies. By having access to cloud-based algorithms and digital health solutions, they can get the same amount and quality of medical information physicians can, and also they can even print out drugs on demand. Maybe even running clinical trials.
It is not impossible! Last year, the FDA just approved an epilepsy drug called Spritam that is made by 3D printers. It prints out the powdered drug layer by layer to make it dissolve faster than average pills. Imagine how fast the distribution of medication could be with a 3D printer in every second or third pharmacy.
Also, with the help of artificial intelligence, clinical trials will require significantly less time and they might be brought closer to the pharmacies and patients themselves. For example the company, Atomwise uses supercomputers that root out therapies from a database of molecular structures. Last year, Atomwise launched a virtual search for safe, existing medicines that could be redesigned to treat the Ebola virus. They found two drugs predicted by the company’s AI technology which may significantly reduce Ebola infectivity. This analysis, which typically would have taken months or years, was completed in less than one day. Imagine how efficient drug creation would become if such clinical trials could be run at the “ground zero” level of healthcare, namely in pharmacies.
Either way, I want to empower pharmacists to embrace disruption and bring technologies to their practices upgrading what they have been doing. Good examples are out there to demonstrate how these can decrease costs and increase the quality and range of the service pharmacies provide today.