Written By: Michael E. Klepser
November 5, 2021
The USA struggles with many of the same problems with respect to access to health care services as the rest of the world. Thousands of rural and urban core communities lack access to local primary medical services. Many of the residents in that live in these areas are often forced to travel outside their communities when seeking care. Whether this journey is measured in the number of miles or bus stops that it takes to reach a provider, the fact is that the trip often takes an entire day and deposits the patient in unfamiliar surroundings. The fear, anxiety and logistical complexity associated with something that should be as simple as going to a clinic is often enough to dissuade individuals from interacting with the health system. I believe that this problem has grown appreciably during the pandemic. Over the past year, numerous clinicians have stopped seeing patients in person. Some have transitioned to telemedicine consultations. Others have greatly reduced their patient volumes. This has left some our country’s most vulnerable individuals with few reasonable options when seeking medical care.
Regardless of the region of the country, pharmacies are considerably more accessible than medical clinics. It is often stated that every individual in the USA lives within two miles of a pharmacy. Additionally, most pharmacies are not just located in communities: they are part of communities. They are staffed by people who know the cultures, languages and traditions of the community. Pharmacists and their staff are trusted by the community. For decades, patients have sought advice about medical conditions and their health from pharmacies. My colleagues and I worked to increase accessibility to care for all populations by leveraging the skills and training of pharmacists and pharmacy technicians to develop disease management programmes that utilise new laboratory technologies. These devices allow pharmacists to collect specimens and run tests to help diagnose many infectious diseases and monitor various body systems.
A few years ago, the city of Flint, Michigan experienced a problem with its water supply that caused thousands of residents to be exposed to lead in their drinking water. The magnitude of the problem, coupled with a mistrust of government by the residents in this largely black and economically disadvantaged population, resulted in a serious public health emergency. The state and local health departments noted that residents were sceptical of their outreach and screening efforts and were fearful of the possible health outcomes that might result. At this juncture, I was approached and consulted about possible solutions to the problem. I noted that there was a blood lead test that could be done in pharmacies and suggested that local pharmacies be used to do lead screenings. Residents in the affected communities embraced the programme. I believe that this programme was successful because of the accessibility of the pharmacies and the relationships that individuals had with the pharmacists.
This is only one example of the many cases I can think of that demonstrate how impactful the relationship between pharmacists and their patients can be. I know of a child care centre in a rural community that was able to remain open because the caregiver was tested and treated for acute pharyngitis in a pharmacy. Because she saw the pharmacist at the weekend, when no other providers were available, she was able to initiate antibiotics and offer child care on Monday. This seemingly mundane event likely impacted several families in this small community. Another time, I was able to provide HIV testing to a young woman on a Friday afternoon. When I gave her the results of the test she broke down and cried because she was so relieved. She confided to me about the how scared she had been about being exposed to HIV. She explained that had she not been able to get tested in the pharmacy she would have had to wait for several days to be seen in the clinic.
These are just of few of my stories about how accessibility to a pharmacist improved patient care. If all pharmacists had the ability to use point-of-care tests in their practices and provide appropriate follow-up care, the impact of expanded access to healthcare services would be profound.