Jeffrey A. Singer
The American Society of Hospital Pharmacists (ASHP) launched its Practice Advancement Initiative (PAI) in 2010 and updated it in 2020 with PAI2030.
PAI 2030 is the ASHP’s initiative to improve how people access and use medications by expanding pharmacists’ roles in patient care, promoting the use of data and technology, and strengthening pharmacists’ leadership in safe medication use. The ASHP provides hospitals, clinics, and pharmacy training programs with clear goals, practical tools, and strategies to expand pharmacists’ responsibilities, integrate pharmacy teams into broader care, and track progress.
Today, the American Journal of Health-System Pharmacy published the results of the ASHP National Survey of Pharmacy Practice in Hospital Settings—Clinical Services and Workforce 2024. It surveyed pharmacy directors at 1,497 general and children’s hospitals across the country. The results:
Pharmacists routinely provide clinical pharmacy services to a majority of inpatients in over 75% of hospitals and are most commonly assigned to general medical-surgical (73.3%), critical care (68.5%), oncology (56.9%), cardiology (48.5%), infectious disease/antimicrobial stewardship (48.1%) units and the emergency department (46.5%). Pharmacists independently prescribe in 18.5% of hospitals. Progress towards the ASHP Practice Advancement Initiative (PAI) 2030 goals has been mixed; except for technicians performing more advanced roles, measures have remained relatively stable over the past 5 years.
The authors of the paper concluded, “…inpatient and ambulatory care clinical pharmacy services continue to expand across the country, with most hospitals routinely providing care to a majority of patients in over three-quarters of hospitals.”
Pharmacists’ growing role in patient care extends beyond hospitals. When prescribing medication, physicians often consult pharmacists about potential drug interactions with the patient’s current medications. Pharmacists are well qualified to handle these inquiries because they frequently interact with many patients and receive as much classroom training as physicians.
The Doctor of Pharmacy (PharmD) degree has become the standard entry-to-practice degree for pharmacists in the US, replacing the Bachelor of Science in Pharmacy degree. Most state pharmacy boards require license applicants to hold a PharmD degree. It takes students four to six years to earn a PharmD degree. Their coursework includes biology, chemistry, physics, mathematics, pharmacology, and medical ethics.
In our 2024 briefing paper, Let Pharmacists Prescribe, Marc Joffe and I explain how policymakers in the UK, Australia, and Canada have expanded patients’ access to routine outpatient care through pharmacists. Instead of waiting for appointments in doctors’ offices, clinics, or urgent care centers, people can go to the many pharmacies where pharmacists test and treat common medical issues like urinary tract infections, strep throat, and allergic reactions; provide preventative measures such as HIV pre- and post-exposure prophylaxis, Lyme disease prophylaxis, and routine immunizations; and dispense hormonal contraceptives.
In 2018, Idaho became the first US state to adopt Alberta’s policy on pharmacist prescribing. Montana and Colorado have since followed suit. Pharmacy chains have started advertising test-and-treat services directly to consumers.
Pharmacists are highly trained health care professionals who could provide many more services to patients than licensing laws in many states permit. As I wrote in my book, Your Body, Your Health Care:
The various health professions regularly battle before state lawmakers over concerns about their scope of practice. Some entrenched incumbents jealously guard the scope of practice their licenses permit, resisting efforts by other professions to encroach on their domain. Each tries to persuade lawmakers about what services they believe it is safe for the government to allow patients to seek from competing professions.… Patients didn’t ask lawmakers to license health professionals. Patients have no say in the matter.
Expanding pharmacists’ scope of practice is a straightforward way to enhance access and decrease unnecessary bottlenecks in care. Ideally, states should eliminate all licensing laws. Third-party accrediting organizations can perform the functions of licensing boards. However, if that is not politically feasible, states don’t need to wait—Idaho and Alberta have already shown the way.