HealthJune 26, 2023

Health equity amid a decentralized care landscape: How pharmacists can adapt and prepare

As healthcare in the US continues to decentralize, pharmacists can prepare for delivering more equitable care to patients in their community.

Decades ago, the model for primary care was simple. You saw one doctor for most, if not all, of your healthcare needs, usually at a hospital or private practice.

But over time, this model has changed significantly. Today, care — especially primary care — has become increasingly decentralized, shifting away from traditional institutions toward dispersed locations like pharmacies and retail clinics.

According to a recently commissioned US consumer survey from Wolters Kluwer, more than half of respondents said they’d be likely to visit a local pharmacy for non-emergency health issues, with younger generations and those living in urban areas leading the trend.

Roughly 90% of Americans live within five miles of a community pharmacy, so these developments have obvious benefits when it comes to improving health equity. If clinicians and providers don’t take precautions as care decentralizes even further, however, patients from some populations could be left behind. Here are the important implications healthcare and pharmacy leaders should consider.

More consumer choice and discretion for primary care

Conducted among more than 1,000 adults and the second of the three-part Pharmacy Next series, Wolters Kluwer’s survey revealed some potentially tectonic shifts across the care continuum — most significant, the fact that consumers are becoming more comfortable seeking care in alternative places.

With 58% of respondents saying they’d try a local pharmacy first for non-emergency healthcare needs, and 45% saying they’d already done so within the past year, populations are expressing high discretion and openness for non-primary care providers.

But this enthusiasm isn’t the same across demographics. Younger people express more willingness to diversify where they get healthcare: 64% of Gen Z and 65% of Millennials say they’d first try the drugstore for non-emergencies, compared to 54% of Gen X and 49% of baby boomers. City dwellers are also more likely to embrace these trends, with 66% of urban residents saying they’d head to a pharmacy for non-emergent concerns, compared to 52% of rural residents.

Those demographic differences raise health equity concerns. Older generations, as well as those in rural communities, are among those at higher risk of healthcare disparities. When the populations most likely to benefit from decentralized care are also those least likely to engage in it, gaps in care may continue.

Even so, it may be just a matter of time before these populations turn to care alternatives that offer better cost and convenience benefits. Exactly one in three consumers (33%) said convenience is more important than credentials in non-emergency situations, and in a previous Pharmacy Next survey, more than half of respondents (56%) said they’d trust a pharmacist to prescribe them medications if it meant lower costs.

Healthcare access gains across populations

Overall, experts agree that decentralized care — including the shift toward community health center partnerships and pharmacies for certain care needs — is a good thing for health equity.

In one Pharmacy Next webinar, Natasha Petry, PharmD, MPH, BCACP, explained that community and ambulatory care pharmacists “are very well-positioned to perform certain point-of-care screenings and testing, along with making lifestyle recommendations.”

That positioning can in turn benefit communities with limited local options for care, such as rural areas known as “medical deserts.” Almost 80% of rural America is considered “medically underserved,” and that number could grow with the looming closures of community hospitals in a post-pandemic future.

Clinical pharmacy expert Stacey McCoy, PharmD, MS, BCPS, has written about the “Flip the Pharmacy” program as one example of the impact pharmacists can make on those populations. The program has helped more than 1,000 community pharmacies transition into direct patient care from the traditional dispensing-only model.

Expanded access is just one factor of health equity, however. While decentralizing primary care could shift healthcare services to more accessible and convenient locations, it could also reduce costs by way of improved access to preventive care, testing, and enhanced medication management.

Health equity risks of a decentralizing care environment

Benefits notwithstanding, there are some risks and implications to consider with pharmacists’ expanding role. In the efforts to improve access and affordability, some groups may get left behind with this new model — especially if silos between providers and pharmacists develop.

After all, maintaining close collaboration with the patient’s existing care team is pivotal to the success of decentralized care. If pharmacists take on a more prominent role independently, they may not be able to contextualize the patient’s case with their care plan, which can disproportionally affect patients who may be less familiar with their own medical histories.

The challenge is compounded given that more than half (52%) of patients believe their pharmacists checked their medical records or case information before filling a script. These may be false assumptions: electronic health record (EHR) exchange and interoperability are not (yet) a standard part of practice.

Lastly, financial impacts have hit some drugstores considerably hard because of both the current economic moment and policies such as the expiration of the pandemic public health emergency. With many pharmacies cash-strapped and hard-pressed for talent, some experts have called for reimbursement parity so that pharmacists can get paid commensurate to the health services they now offer and can continue driving health equity by serving underserved communities. A recently introduced bill known as the Equitable Community Access to Pharmacist Services Act could accommodate those needs by covering services explicitly for the purpose of health equity.

Preparing for the future of decentralized care

As pharmacy and healthcare leaders examine these decentralized care insights, they should consider a few key takeaways. First, the trends might be sticky: Younger generations are more likely to embrace nontraditional care delivery now, so it’s likely they will continue those patterns as they get older, even as their healthcare needs become more complex.

Second, pharmacists can improve health equity — but not without some effort. For nontraditional care delivery to be effective, providers must maintain collaboration with care teams as appropriate and modernize their systems to the extent possible for improved data exchange. Increased patient education will also be essential as they take on more of a provider role.

Healthcare delivery, including where care takes place, is changing. With consumers more amenable than ever to digital and decentralized care, pharmacy leaders should assess what’s ahead so that they can optimize the shifting market and better serve everyone.

For more support on preparing for the future of pharmacy, visit Pharmacy Next to explore additional resources including survey reports, executive briefs, and expert perspectives. Explore Best Care Everywhere to learn more about our perspective on improving health equity.

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