The cooperation between healthcare professionals contributes to timely healthcare delivery and effective treatment. The interdisciplinary collaboration suggests the priority of advanced nursing. Given the shortage of healthcare staff, ageing of the U.S. population, and increase in the prevalence of costly and life-long diseases, the establishment of effective cooperation between nurse professionals and pharmacists may constitute an effective option to improve the provision of the targeted healthcare. It should be taken into account that gaps in understanding of the work of other professionals exist for both nurses and pharmacists. Consequently, the paper aims to discover the partnership possibilities between pharmacists and nurses that will contribute to cost-effective and patient-centered healthcare.
Pharmacist Role in the Patient-Centered Care
Pharmacists are healthcare professionals that enable the treatment to occur. Counseling is a primary tool for the provision of effective treatment, where pharmacists are the leaders. The interview with the pharmacist confirmed the significance of his role in the maintenance of the continuous chain of treatment. While there is sufficient evidence for benefits of physician-nurse partnership, there is a lack of studies witnessing the significance of pharmacist-nurse collaboration. Alongside, patient safety, medicine adherence, and health-related well-being are all the issues that pharmacist can contribute to. Moreover, such relationships result in the cost-effectiveness of the provided care (Supper et al., 2014). The report by Mencia points to the importance of pharmacists in promotion of disease management programs (2015). Participation in patient education and monitoring of adherence to the prescribed medicine constitute the major functions of pharmacists during the treatment process. To improve the quality of healthcare gaps in the healthcare system should be revealed, as well as the specific missions of every healthcare provider should be addressed.
The Gaps in the Understanding of the Pharmacist Mission
The disconnection between pharmacists and other primary healthcare providers complicates the establishment of the most appropriate and accessible medications, as well as interferes with and patient’s trust. In the interview, the pharmacist indicates the need for closer partnership between physicians and nurses. The reason for that concern is insufficient knowledge of the pharmacists’ competence and their range of services, and lack in clear prescriptions and diagnoses added to the prescription list. The pharmacist acknowledges that their job is complicated, when primary healthcare members are unaware of medication regulations. Conflicts of interests are another barrier to the recognition of the pharmacist role. The pharmacist states that the roles of the main actors in the healthcare system are not clear enough. However, trustworthiness is a key principle for effective team building, involving pharmacists (Mencia, 2015). Therefore, the current state of collaboration between healthcare workers is not satisfactory.
Alongside, the pharmacist acknowledges that there is pharmacy-related information that should not be discussed with patients in details. He suggests that detailed discussion with patients about side effects of medication may decrease patient compliance. On the other side, the pharmacist also reports lack in counseling provided by physicians to their patients about medication use and insurance coverage for specific drugs. As a result, the pharmacist faces challenges, when he has to explain, why and what is the usefulness of using a separate type of drugs. Besides, the interview with the pharmacist contributes to understanding of the prescription process, which may be helpful in nursing career while generating treatment plan for the patient.
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The most effective and safe medication regimen concerns the problems, with which the modern advances in the healthcare system are associated. Here, the role of the pharmacist is pivotal, as the pharmaceuticals may bring both curing and harm. For instance, the cost of harm related to inappropriate medication use exceeds $ 200 billion that is higher than the cost of all the drugs used (Funk, Paffrath, & Anderson, 2017). Hence, medication evaluation, which is performed by the pharmacist, constitutes the most remarkable practice to follow.
On the way, the interview with the pharmacist appeared to be helpful in getting a deeper insight into regulation of medication use. The interviewee specifies the types of medication in response to their regulation and availability. In particular, the pharmacist highlights the problem of high accessibility of over-the-counter (OTC) medication. While there is a broad list of OTCs that simplifies patient self-care, the risk of misusing these drugs is high. Pseudoephedrine is one of those active ingredients that may cause drug abuse. Consequently, the pharmacist stresses on the necessity of the logbook identification to obtain these drugs according to the Patriot Act, while this medication should be behind the counter or locked.
Another issue of medication availability concerns prior authorization that complicates the procedure of medication prescription while increasing the time for assessment by the insurance companies. Despite of the cost-effectiveness of medication use within the U.S. healthcare system, prior authorization means additional tasks for healthcare professionals (Epling, Mader & Morley, 2014). The interview with the pharmacist reveals how to handle with prior authorization in order to make the process faster and more effective. The pharmacist stresses on the significance of the option, while it enables to evaluate appropriateness of the prescription and medical necessity. The latter is the major determinant, when using brand medically necessary drugs. Still, in the case of medication, which is not covered by the insurance company, the pharmacist can consult the treatment plan and ask for alternative accessible drugs to adhere to the planned treatment. The latter means the importance of closer partnership with the pharmacist to design the most accessible healthcare plan.
The closer collaboration with the pharmacist also involves detecting substitutes, generic and brand medically necessary medications that require the specific knowledge of regulations in the field. The pharmacist offers the treatment options, following the guidelines in the Orange book, approved by the U. S. Food and Drug Administration (FDA), while choosing drugs with similar bioequivalent formulation. The awareness of such possibilities helps physicians and nurse practitioners to offer treatment that is possible and still effective despite of using substitutes. Moreover, the interviewee recommends looking for generic medications first, while the expertise of brand medically necessary medications is more durable. Tang et al. argue that cost-sharing together with prior authorization and step therapy increase the rate of the generic medication applications, while they are cost-effective (2014). The pharmacist also recognizes that he cannot change the prescribed medication without counseling with the prescriber. Thus, the physician or the nurse practitioner can be sure that the appropriate medication will be used by the patient. The only case, when changes are possible, is when it is mentioned in hospital protocol. While discussing the relationships within the healthcare professional team, the pharmacist also identifies areas, where the collaboration of advanced registered nurse practitioners (ARNP) and pharmacists will be advantageous.
The Scope of Pharmacist and Nurse Practitioner Collaboration
Throughout the interview, the willingness of the pharmacist to participate in the healthcare management is revealed. The systematic review by Supper et al. (2014) supports high interest of pharmacists in interprofessional collaboration. The pharmacist considers his professional skills to be beneficial in improving healthcare of patient and his professional well-being, though he feels a relatively lower level of professional authority. Perceived hierarchy is another barrier on the way to effective communication with primary healthcare providers (Supper et al., 2014). Even in the nurse-led hospital, the pharmacist work is equal to 0.4 of full care (Funk et al., 2017). Still, here the role of ARNPs may be the most appropriate to initiate and facilitate interprofessional collaboration since they also feel underestimated from the perspective of professional potential (Hurlock-Chorostecki et al., 2016). Thus, there are some psychological problems based on hierarchy principle, which can arise during a collaboration between different healthcare professionals.
In turn, the interviewee stresses that the scope of ARNP practice in response to medicine prescription is also limited. In particular, the prescription of controlled medication, signed by ARNP, is not the ultimate decision for pharmacist to follow. However, in some states, such as Florida, ARNPs have the right to prescribe medication from Schedule II, III or IV. In turn, usage of controlled substances from Schedule II follows the written prescription of ARNP. The pharmacist also specifies that in emergency cases, such drugs may be prescribed orally once and only for a 72-hour period.
Another benefit of collaboration concerns the educational and self-management programs, as well as monitoring of patients. The interviewee mentions that he often faces the need for explaining the drug usage protocol and side effects to the patient, as well as and counseling about access to it. These issues can be involved in the interprofessional collaboration for the continuous management of patients, while ARNP possesses a leading role in sharing expertise and enhanced communication across the professions as a result (Erickson, 2016; Hurlock-Chorostecki et al., 2016). The study by Mencia (2015) points to the newly diagnosed patients and the ones under poor control as the group, for which control of treatment by pharmacist is preferred. In addition, collaborative practice agreements (CPAs) and comprehensive medication management (CMM) are evidence-based practices, contributing to the effective collaboration with pharmacists (Erickson, 2016; Funk et al., 2017). Thus, the interaction between different healthcare professionals suggests sharing patient education functions with respect to disease cases and situations.
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Therefore, the analysis of the pharmacist interview contributes to the recognition of his role in healthcare delivery. The pharmacist’s expertise turns out to be significant in development of the optimal treatment plan. He possesses pharmacology knowledge that can help in choosing the accessible and effective medication, acknowledged by the official U.S healthcare organizations. The interviewee points out the gaps in provision of timely and continuous healthcare, while omitting the counseling role of the pharmacist. Taking into account the leading role of ARNP in encouraging interprofessional collaboration, the pharmacist-ARNP partnership serves as an example, where effective communication results in a high-quality healthcare system.