From “retailers” to health care providers: Transforming the role of community pharmacists in chronic disease management

- As under-utilised providers, community pharmacists are not primarily rewarded for delivering health care.
- Community pharmacists are increasingly responsible for effective, safe, and efficient use of medicines.
- Progress in transforming the roles of community pharmacists in chronic disease management remains limited.
- Countries are gradually introducing limited payment reforms encouraging patient-centered services.
- Moving forward, challenges include integrating pharmacists into primary care; developing tiered pharmacist services; and adopting new remuneration mechanisms.

Community pharmacists are the third largest healthcare professional group in the world after physicians and nurses. Despite their considerable training, community pharmacists are the only health professionals who are not primarily rewarded for delivering health care and hence are under-utilized as public health professionals. An emerging consensus among academics, professional organizations, and policymakers is that community pharmacists, who work outside of hospital settings, should adopt an expanded role in order to contribute to the safe, effective, and efficient use of drugs-particularly when caring for people with multiple chronic conditions. Community pharmacists could help to improve health by reducing drug-related adverse events and promoting better medication adherence, which in turn may help in reducing unnecessary provider visits, hospitalizations, and readmissions while strengthening integrated primary care delivery across the health system. This paper reviews recent strategies to expand the role of community pharmacists in Australia, Canada, England, the Netherlands, Scotland, and the United States. The developments achieved or under way in these countries carry lessons for policymakers world-wide, where progress thus far in expanding the role of community pharmacists has been more limited. Future policies should focus on effectively integrating community pharmacists into primary care; developing a shared vision for different levels of pharmacist services; and devising new incentive mechanisms for improving quality and outcomes.