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Watch your step, PCPs – mission creep is tripping up primary care

May 15th, 2019

As any regular reader of this blog knows, I’m a big booster of the pharmacy profession and have been committed to   maximizing the skill level and reach of pharmacists when it comes to primary care. That’s why our organization was among the first Patient Care Organizations (formerly PO’s) in Michigan to actively recruit pharmacists into care management training programs and to seek out pharmacists to serve as care managers at large primary care practices within our network. It’s been gratifying to see other Patient Care Organizations follow suit. 

Still, I was taken aback when I read a recent Detroit Free Press article with the headline, Flocking to pharmacies instead of the family doctor. Yes, it’s fitting and overdue to see pharmacists getting the recognition they deserve for the invaluable role they play in the health care continuum. With newer pharmacy service offerings like vaccines and treatment for relatively simple ailments via the Minute Clinic type model, much needed access to care has been enhanced because of pharmacists and the large consumer-driven entities that support them. That’s to be applauded.   

Yet, pharmacists and pharmacies are not equipped to offer integrated care that treats both behavioral and physical health; they are not set up to coordinate care between physicians, specialists and other providers and likely have no interest in pursuing this aspect of primary care; they are not tracking quality scores, nor are they positioned to assess social determinants of health impacting the patient’s overall health and wellbeing once the acute situation has been addressed.

Michigan is a leader in the Patient-Centered Medical Home (PCMH) model, designed to provide comprehensive, coordinated primary care under the direction of a primary care physician. There is an important place for pharmacies within this model, but it does not come at the exclusion of the primary care doctor. 

I have a friend who likes to quote advice columnist Dear Abby in saying, “Nobody takes advantage of you without your permission.” I think that saying applies here. Disruptive technologies entered the vernacular several years ago, but now we are witnessing disruption that, while perhaps driven by an environment of profound and rapid technology advances, is not necessarily technology-based. Amid the expanding healthcare roles for pharmacies and pharmacists and any other allied health professional for that matter, the primary care community should not cede its leadership in the disruption process.

While it may be dramatic to say that primary care is under assault, it does appear to be low hanging fruit for large drugstore chains and, as I’ve written about previously, urgent care clinics; both retail sectors eager to dip their toe into the primary care space.  Millennials are said to prefer urgent care clinics rather than have a primary care physician. That may be a blip, or it may not. (I’ve also read that urgent care clinic usage is down. If true, is that because more people are seeing their PCP? Or are they going to a pharmacy chain as an alternative to both?) Whatever the reality may be, it’s hard to deny that primary care physicians need to individually and collectively reassert the importance of their leadership in helping to maintain our health and well-being. No other member of the healthcare community, including specialty physicians, has the power to impact a patient’s whole health better than his or her trusted PCP. In our quest for more healthcare, let’s not sacrifice what works with primary care: patient/physician relationships based on trust and continuity. Yes, we need a team, but we need a physician as the captain whenever possible.

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