Abstract
The shift toward value-based care has placed emphasis on preventive care and chronic disease management services delivered by multidisciplinary health care teams. Community pharmacists are particularly well positioned to deliver these services due to their accessibility. To compare the number of patient visits to community pharmacies and the number of encounters with primary care physicians among Medicare beneficiaries who actively access health care services. This cross-sectional study analyzed a 5% random sample of 2016 Medicare beneficiaries from January 1, 2016, to December 31, 2016 (N = 2 794 078). Data were analyzed from October 23, 2019, to December 20, 2019. Medicare Part D beneficiaries who were continuously enrolled and had at least 1 pharmacy claim and 1 encounter with a primary care physician were included in the final analysis (n = 681 456). Those excluded from the study were patients who were not continuously enrolled in Part D until death, those with Part B skilled nursing claims, and those with Part D mail-order pharmacy claims. We conducted analyses for the overall sample and for subgroups defined by demographics, region of residence, and clinical characteristics. Outcomes included the number of visits to community pharmacies and encounters with primary care physicians. Unique visits to the community pharmacy were defined using a 13-day window between individual prescription drug claims. Kruskal-Wallis tests were used to compare the medians for the 2 outcomes. A total of 681 456 patients (mean [SD] age, 72.0 [12.5] years; 418 685 [61.4%] women and 262 771 [38.6%] men) were included in the analysis; 82.2% were white, 9.6% were black, 2.4% were Hispanic, and 5.7% were other races/ethnicities. Visits to the community pharmacy outnumbered encounters with primary care physicians (median [interquartile range (IQR)], 13 [9-17] vs 7 [4-14]; P < .001). The number of pharmacy visits was significantly larger than the number of primary care physician encounters for all subgroups evaluated except for those with acute myocardial infarction (median [IQR], 15 [12-19] vs 14 [7-26]; P = .60 using a 13-day window). The difference in the number of pharmacy and primary care physician encounters was larger in rural areas (median [IQR], 14 [10-17] vs 5 [2-11]; P < .001) than in metropolitan areas (median [IQR], 13 [8-17] vs 8 [4-14]; P < .001). In all 50 states and in all but 9 counties, the number of community pharmacy visits was larger than the number of encounters with primary care physicians. This cross-sectional study suggests that community pharmacists are accessible health care professionals with frequent opportunities to interact with community-dwelling patients. Primary care physicians should work collaboratively with community pharmacists, who can assist in the delivery of preventive care and chronic disease management.
Highlights
The shift toward value-based care has placed emphasis on preventive care and chronic disease management services delivered by multidisciplinary health care teams
Among the 681 456 active Medicare beneficiaries included in this nationwide cross-sectional study, the median number of visits to community pharmacies was significantly higher than encounters with primary care physicians (13 vs 7). Meaning These findings suggest that community pharmacists are accessible health care professionals with frequent opportunities to deliver preventive care and chronic disease management services in collaboration with primary care physicians
Encounters With Primary Care Physicians vs Pharmacies Among Medicare Beneficiaries. This cross-sectional study suggests that community pharmacists are accessible health care professionals with frequent opportunities to interact with communitydwelling patients
Summary
The shift toward value-based care has placed emphasis on preventive care and chronic disease management services delivered by multidisciplinary health care teams. Some patients continue to have difficulty accessing affordable quality care. Pharmacists are accessible and trusted members of the health care team and routinely encounter patients at their community pharmacies. Patient-pharmacist encounters have traditionally focused on the provision of medications. Community pharmacists have transformed and optimized their roles from product-centered services (ie, medication dispensing and sale of over-the-counter medications) to patient-centered services (ie, medication therapy management). The goal of medication therapy management is to optimize medication use, reduce the risk of adverse events, and improve medication adherence.
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