Just three years ago, community pharmacy was anticipating, perhaps with some trepidation, the arrival of fully automated dispensing robots behind the counter. Now, the profession is scrambling for ways to throw even more automation into the breach, trying to stem the flood of prescriptions threatening to drown America's drug delivery system.
There's no question that automation's march is benefiting from the convergence of many powerful forces sweeping pharmacy into the 21st cenfury. Managed care's reliance on medications as a cost-effective alternative to expensive inpatient care is driving prescription volume to dizzying heights. The baby boomers' slide toward retirement, the arrival of powerful new drugs on the market, and direct-to-consumer advertising are also making prescription drugs the therapy of choice for more Americans.
While Rx volume is rising and drugstore chains are expanding into new markets at a frenetic pace, the supply of pharmacists to manage all those scripts has dwindled to a trickle in some areas. The actual growth in the number of pharmacists has been slowed by the shift to the entry level Pharm.D. The mandated six year program has left some pharmacy schools with reduced class sizes and even without a graduating class for a year as the degree switchover continues.
In addition, pharmaceutical care is pushing the profession toward a new patient-entered, drug therapy management model. It's no wonder that community pharmacy is ready to em brace robots and electronics as saviors that can take over much of the RPh.'s traditional drug-dispensing function.
Automation has been feared by some pharmacists as a Darth Vader bent on eliminating their jobs. Others see technology as a way out of the workplace nightmare of 12-hour shifts dispensing 350 Rxs with little support personnel and no breaks.
Quality of life
Pharmacists should "embrace technology" because it can vastly improve their work environment, said Joe Porfeli, chairman-CEO of TechRx, a Pittsburgh high-volume pharmacy software firm. "Hell, given the growth in prescriptions, pharmacists need automation just to keep from drowning," he said. "If they just keep from drowning, that means life goes on as it is today. If they can get more automation, that means they can get a life improvement in terms of doing more patient counseling. Automation is kind of George Orwellian. Until people can see it and touch it, there afraid of it. Right now, pharmacists are spending too much time on mundane things. The fewer mundane tasks pharmacists do, the more they can be involved in the patient care side of the business."
Technology and automation are really the pharmacist's friends, agreed pharmacy technology guru Bill Felkey, associate professor, pharmacy care systems, Auburn University School of Pharmacy. "Technology replaces only things that technology does better," he said. "Technicians ought to take notice. In this case, the technology frees pharmacists to do the only thing where new money is available: identifying, solving, and preventing drug-related problems; assuring outcomes are reached; and improving the continuity of care."
Whether pharmacists actually move into clinically oriented roles depends, to some extent, on whether such services are going to be valued enough to make payers reach for their checkbooks. Some groups are sort of hedging their bets when it comes to abandoning dispensing in favor of reimbursement for cognitive services. For example, pharmacists have to be involved in both dispensing and patient care, according to a recent white paper issued by the American Pharmaceutical Association, the National Association of Chain Drug Stores, and the National Community Pharmacists Association. "This challenge of pharmacy wearing two hats, managing both dispensing and patient care, is welcome and appropriate," the authors contended. "If the profession is to wear them successfully, over time, additional changes in clinical and administrative practices in health care are needed. …