Primary health care is defined as a patient’s first point of contact with the health care system. As such, pharmacists are an integral part of primary health care. Indeed, for many years, we have said that pharmacists see their patients more frequently than they see any other health care practitioner, including physicians. Let’s review the evidence for that.
To address this topic, we searched PubMed/MEDLINE, Scopus, EMBASE, Cochrane Library, Web of Science and CINAHL Plus from their inception to October 2017. The searches combined relevant keywords and subject headings relating to the concept of pharmacist visit frequency. The search terms used included pharmacist, pharmacy, visit, visit frequency, follow up frequency, physician, doctor and general practitioner. An additional search was conducted in Google for the phrase “pharmacists see patients more than physicians.” The results of these searches are shown in Table 1.
Table 1.
Literature review
| Study author | Date | Setting/country | Disease | Frequency of pharmacist contact with patient per year (median, IQR) | Comparison group (median, IQR) | ||
|---|---|---|---|---|---|---|---|
| McNamara et al.1 | 2012 | Wimmera/Australia N = 694 patients |
CVD (or risk factors for) | Overall: | (2, 0-10) | Overall: (GPs) | (3, 1-6) |
| Age <65 years | Age 25-44 years (1, 0-3) n = 94Age 45-54 years (2, 0-6) n = 161Age 55-64 years (2, 0-10) n = 162 |
Age <65 years (GPs) |
Age 25-44 years (2, 1-4) n = 94Age 45-54 years (2, 1-5) n = 161Age 55-64 years (3, 1-5) n = 162 |
||||
| Age >65 years | Age 65-74 years (6, 0-10) n = 161Age 75-84 years (10, 1-12) n = 116 |
Age >65 years (GPs) |
Age 65-74 years (4, 2-6) n = 161Age 75-84 years (5, 3-8) n = 116 |
||||
| Shiu et al.2 | 2006 | Saskatchewan/Canada N = 36,493 patients |
Diabetes | (15, 9-24) | GPs (7, 4-13) | ||
| Jose et al.3 | 2015 | Oman N = 390 patients |
General | 56.9% of the participants visited the pharmacy at least 6 times a year | No comparator | ||
| 2008 Pharmacy Satisfaction Digest4 | 2008 | United States N = 34,454 patients |
General | 30 (mean) | GPs, 2.9 (mean) | ||
| Unverified* Reports | |||||||
| Campbell5 | 1993 | Unknown | Unknown | States that pharmacists see patients at least 5 times more than any other health professional | |||
| Kroon et al.6 | 1997 | Unknown | Diabetes | States that people with diabetes see their pharmacist 7 times more than their family physician | |||
| Moose et al.7 | 2014 | Unknown | Unknown | 35 (mean) | GP, 4 (mean) | ||
CVD, cardiovascular disease; GP, general practitioner; IQR, interquartile range.
No data or citation provided.
Using Saskatchewan population data, Shiu et al.2 demonstrated that pharmacists see patients with diabetes at least twice as frequently as general practitioners and 36% more than any physician.2 These results did not change when stratified by the size of the urban centres.2 McNamara et al.1 reported that patients in rural Australia visit their general practitioners more frequently than they visit their pharmacists. However, when broken down by age groups, this finding appears to be driven by patients who are younger than 65 years of age (25-64 years, with over half of those being under 55 years). It is very plausible that younger patients might not have as many chronic conditions as older patients, and so they might visit their general practitioner more frequently (presumably for acute conditions). When looking at patients aged 65 years and older (65-84 years; 40% of patients), the visits to community pharmacists were more frequent. Jose et al.3 did not include a comparator group but interestingly reported visit frequency numbers similar to those reported by Shiu et al.2 and the older cohort of McNamara et al.1 A 2008 Pharmacy Satisfaction Digest4 article reported that patients visit their pharmacists 30 times vs 2.9 for their family physicians. The average age of patients for this study was 59.2 years. This is consistent with the mean age that was reported by Shiu et al.2 and the older cohort of McNamara et al.,1 which reinforces the prevalence of chronic conditions in this patient population. We found other studies for which the data could not be verified. They reported that primary care pharmacists see patients 5 to 8 times more frequently than primary care physicians.5-7
Based upon our review, the best available evidence suggests that primary care pharmacists see their patients somewhere between 1.5 and 10 times more frequently than they see primary care physicians. In addition, emerging evidence from Alberta suggests that about 30% of patients with chronic conditions cannot, do not or will not see a family physician (personal communication, Dr. Richard Lewanczuk, November 8, 2017). Taken together, these have important implications for patient access to primary care. With a broader scope of practice that includes prescribing and appropriate remuneration incentives, pharmacists could assume an even more important role in primary care.
We have identified that more research is needed in this important area. Areas for future research should look at various age groups and by specific disease states (e.g., hypertension, asthma, mental health, etc.). Such data will be important for health care policy makers.
In conclusion, the evidence suggests that pharmacists play a major primary care role that is enhanced by their accessibility. Such role could be further enhanced with a broader scope of practice and remuneration that reflects this role. It has been said that the strength of a country’s health care system is fundamentally driven by the strength of its primary care system.8 Here is an opportunity that we cannot ignore. ■
References
- 1. McNamara KP, Dunbar JA, Philpot B, Marriott JL, Reddy P, Janus ED. Potential of pharmacists to help reduce the burden of poorly managed cardiovascular risk. Aust J Rural Health 2012;20(2):67-73. [DOI] [PubMed] [Google Scholar]
- 2. Shiu JR, Simpson SH, Johnson JA, Tsuyuki RT. Quantifying opportunities to affect diabetes management in the community. Can Pharm J (Ott) 2006;139:37-8. [Google Scholar]
- 3. Jose J, Al Shukili MN, Jimmy B. Public’s perception and satisfaction on the roles and services provided by pharmacists—cross sectional survey in Sultanate of Oman. Saudi Pharm J 2015;23(6):635-41. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.2008. Pharmacy Satisfaction Digest. Boehringer Ingelheim Pharmaceuticals. Available: www.rx-edge.com/research%20pdfs/PharmacySatisfactionDigest_2008.pdf (accessed Nov. 9, 2017).
- 5. Campbell K. DCCT opens new opportunities for pharmacists. California Pharmacist 1993;December:26-7. [Google Scholar]
- 6. Kroon LA, Coleman LT, Koda-Kimble MA. The management of type 2 diabetes mellitus: a call to action for pharmacists. US Pharmacist 1997;May(suppl 1):1-18. [Google Scholar]
- 7. Moose J, Branham A. Pharmacists as influencers of patient adherence. Pharmacy Times 2014;August Available: www.pharmacytimes.com/print.php?url=/publications/directions-in-pharmacy/2014/august2014/pharmacists-as-influencers-of-patient-adherence- (accessed Nov. 9, 2017).
- 8. uOttawa. Society, the individual, and medicine. Primary care: definitions and historical developments. Available: www.med.uottawa.ca/sim/data/Primary_Care.htm (accessed Nov. 9, 2017).