An overview of community pharmacist interventions: Assessing cost-effectiveness and patients' willingness to pay

Abstract

This article evaluates the cost effectiveness of and patients' willingness to pay for interventions by community pharmacists in the overall context of pharmaceutical care. The rationale for interventions by pharmacists in patient care is examined from the viewpoint of clinical and economic needs of the healthcare system. The philosophy of the practice of pharmaceutical care is compared with that of disease management. The analysis shows that both clinical and economic deficiencies exist in the current healthcare system that the practice of pharmaceutical care could help to rectify. More importantly, there is congruence in the practice philosophies between pharmaceutical care and disease management, with both being patient centered and outcome focused. Therefore, the practice of pharmaceutical care can be facilitated within the context of disease management. There are many examples showing that interventions by community pharmacists can result in cost savings. However, there are few studies on consumers' willingness to pay for such services provided; those to date suggest that consumers are willing to pay a modest amount for pharmaceutical care provided by community pharmacists. Barriers for implementing pharmaceutical care by community pharmacists are discussed, and some suggestions of strategies to be adopted for the successful implementation of pharmaceutical care are made. The author is of the view that before full reimbursement for pharmaceutical care is achieved, the successful implementation of pharmaceutical care by community pharmacists will hinge on better utilization of available resources and improvement in communications between pharmacists, patients and other healthcare professionals. Coordinated and systematic efforts would be required to collect information regarding consumers' willingness to pay in order to assist in negotiating an acceptable level of reimbursement. Finally, in this age of accountability in healthcare, it is necessary for community pharmacists to demonstrate the benefits of their interventions in terms of better outcomes whether they be clinical, economic and humanistic, and that the improvement is achieved at a cost acceptable to the healthcare system. Without the evidence of acceptable cost effectiveness and perceived benefits, any attempt to promote the implementation of pharmaceutical care by community pharmacists, especially in countries where the concept is relatively new, would only be perceived as lobbying for the interest of a particular professional group, and could not be justifiable.