Are community-based pharmacists underused in the care of persons living with HIV? A need for structural and policy changes

Objective: To describe community pharmacists' perceptions on their current role in direct patient care services, an expanded role for pharmacists in providing patient care services, and changes needed to optimally use pharmacists' expertise to provide high-quality direct patient care services to people living with human immunodeficiency virus (HIV) infections. Design: Cross-sectional study. Setting: Four Midwestern cities in the United States in August through October 2009. Participants: 28 community-based pharmacists practicing in 17 pharmacies. Interventions: Interviews. Main Outcome Measures: Opinions of participants about roles of specialty and nonspecialty pharmacists in caring for patients living with HIV infections. Results: Pharmacists noted that although challenges in our health care system characterized by inaccessible health professionals presented opportunities for a greater pharmacist role, there were missed opportunities for greater level of patient care services in many community-based nonspecialty settings. Many pharmacists in semispecialty and nonspecialty pharmacies expressed a desire for an expanded role in patient care congruent with their pharmacy education and training. Conclusion: Structural-level policy changes needed to transform community-based pharmacy settings to patient-centered medical homes include recognizing pharmacists as important players in the multidisciplinary health care team, extending the health information exchange highway to include pharmacist-generated electronic therapeutic records, and realigning financial incentives. Comprehensive policy initiatives are needed to optimize the use of highly trained pharmacists in enhancing the quality of health care to an ever-growing number of Americans with chronic conditions who access care in community-based pharmacy settings.