Wellness is The Future of Pharmacy. Is The Profession Prepared?
Scott Kjelson
Manager of Integrated Health, Pharmacy | Concierge & Precision Medicine | Sports Nutrition Coach | Humanizing Health | Lifestyle - Performance - Prevention - Treat
Original Article on Pharmacy Times Wellness is the Future of Pharmacy But is the Profession Prepared? (pharmacytimes.com)
Scott Kjelson, Pharm.D.
Wellness is one of the hottest buzz words being thrown around today in many industries, especially as insurance and healthcare becomes more complex and expensive. It may seem obvious when reading the text but staying healthy and catering to your personal wellness is less taxing, both mentally and financially, than treating poor health. Still, we have many variables that keep our unhealthy population and the quick-fix market growing. Sixteen million Americans have at least one disease caused by smoking, which costs the health care system over $240 billion each year. Obesity costs the US health care system nearly $173 billion a year. Finally, physical inactivity costs the nation $117 billion a year for related health care just to name a few.1,2
Recently TikTok trends have popped up, highlighting quick-fix medications for weight loss.3 Without too much of a deep dive, it’s without a doubt that many users are not starting with eliminating the real cause of the unwanted weight they are targeting. Because of the over utilization of some medications for their off-label use, there are now shortages around the country. This leads to patients with diabetes and other chronic diseases scrambling to find much needed treatment. What happened to lifestyle changes as a first line approach? This is a controversial topic due the fact that there are so many variables such as genetics, affordability of a healthy lifestyle, education level and general health knowledge, and societal pressures. It’s something worth looking at from a fifty-thousand-foot view of how we as a culture push the “easy button.”
Wellness is exponentially growing. Are pharmacists ready to grow with it?
In 2019 the wellness industry was estimated at over 4.4 trillion dollars and said to increase to 6 trillion dollars by 2024.4 What is wellness? It depends on who you ask and what you are looking to purchase. That is one of the problems with a quick-fix society; someone is always looking to sell you a new flashy product. If you look at the National Wellness Institute’s definition of wellness, it states “Wellness is an active process through which people become aware of, and make choices toward, a more successful existence.”5 The Wellness Council of America’s definition of wellness states, “Wellness is the active pursuit to understand and fulfill your individual human needs—which allows you to reach a state where you are flourishing and able to realize your full potential in all aspects of life.”6
Currently no national pharmacy organization has defined wellness in the pharmacy profession. There is a need for a definition to be adopted so that others in the profession have some sense of guidance around wellness within the profession. The proposed definition to date is “Wellness in Pharmacy: An individual approach to the center of physical health and mental well-being, with an intentional focus on prevention, treatment, and applied learning from one’s history to present, to optimize the future state of care and quality of life through actions taken.” The portion of the definition “actions taken”, is important for a couple reasons. In a truly patient centered model patients are empowered to become active participants in their care.7 This should also be extended to clients as we focus on whole house health, which is discussed more later in this article. This is the only way real results will ever be seen. To get there, a lot must change.
Wellness is being sold in many forms and fads.8 One thing a lot of the industry has in common is customer service. The idea that someone is there to help you live better and healthier comes with a real belief in a product or service. It also comes with a great deal of enthusiasm and customer friendly engagement. This is not always the case for the pharmacy profession. Much of the profession identifies as introverts, are burnt out due to the unsafe working conditions, and were never taught the concept of selling. This is not to say all pharmacists need to become Gary Vee overnight, but to engage clientele pharmacists must understand what the consumer is used to seeing, hearing, and demanding in the market. Crucial conversations with patients and clients are a must, with the main intent of listening to what their goals are. Next, there’s a major need to consider the professional pharmacy brand. Pharmacy is not well known for prevention beyond immunizations and community health fairs. It should be noted that physicians are experts in diagnosis but can prevent a new diagnosis with the right action plan. Pharmacists are the medication experts that can help take preemptive wellness steps to prevent the need for long-term use of medications, deprescribe medications, or recommend effective nutraceuticals to hep combat nutrient depletion from selective medications.
Wellness is here to stay, and companies are already offering services.
National brands like Kroger, CVS, Walmart, Costco, and Walgreens have all launched wellness or digital health initiatives around their pharmacy services. It’s no coincidence that corporations are once again leading the conversation on another hot topic but in all honesty, most of what many call wellness are just normal pharmacy services packaged and marketed. Now that’s not to say one is not offering more than the other. Kroger for instance writes “Our expert pharmacy teams do more than just fill prescriptions – they provide advice and support to help patients live their healthiest tomorrow, today.”9 CVS writes “Pharmacists play a key role in care delivery, and more than ever before, today's retail pharmacies are known as destinations for convenient, accessible health care services and proactive wellness needs.”10 Those are statements that open room for prevention and the ability to work within the client space. Crystal Yu Pharm.D., Integrated Health Senior Manager at L'Oréal USA says “Patients are more than ever turning to wellness services. The pandemic-fueled interest in health and wellness have made retailers innovate ways to weave wellness into the shopper experience through services, goods, and design. When it comes to skin health, we look at wellness holistically. With skin being the largest organ, many conditions can manifest on the skin such as stress and sleep. In addition, 1 in 4 Americans are impacted by skin conditions and often experience its mental and emotional burdens especially with eczema and acne.” These companies understand that consumers are demanding wellness as part of their health and healthcare needs. They are meeting the patient or client where they are. However, this is where pharmacy organizations can be at the forefront and guide these conversations. Ilisa Bernstein Pharm.D., Interim CEO of the American Pharmacists Association says, “Wellness has a role in the future of the profession.” One institution, Baptist Health South Florida, recently hired the nation’s first two clinical wellness pharmacists. These pharmacists are working in the areas of sports medicine, executive health, pre/postnatal family wellness, employee wellness, and oncology wellness support services. Madeline Camejo Pharm.D., VP and Chief Pharmacy Officer at Baptist Health South Florida says “The only way to innovate is to lead the charge in change. Wellness must be a big part of our profession as we move forward.” This is a huge move and what many would call the chicken before the egg. These pharmacists had external training to become certified wellness coaches, among other certificates, to offer more to than just the “Why is my blue pill orange this month?” engagement. They can offer on-going coaching and consultation with the patient’s or client’s health and wellness goals in mind.
It's already known that pharmacists working with physicians will offer value to providers and their staff but bringing in the ability to do more and provide more for that patient or client outcome is really the bread and butter. Take into consideration the case of a patient being scheduled for an orthopedic procedure. Prehabilitation, or prehab, is a form of multidisciplinary healthcare interventions which aim to dampen side effects of medical or surgical intervention.11 Think about the opportunity for diet, supplements, current medications, lifestyle and environmental factors, labs, sleep, gut health, and even movement to be reviewed by your pharmacist, or what should be referred to as your clinical health liaison. Imagine if a pharmacist, utilizing their expertise, could help a patient improve vitals, lower the need for anti-inflammatories, reduce sugar levels and lessen the potential for infection, or even reduce the need for pain medications post-surgery.12 Now consider another case where every time an anti-inflammatory was prescribed or recommended, a probiotic and education on healthy gut bacteria was provided. Mix this all in with social determinants and you have yourself true wellness in pharmacy. These are just a few of the many examples readily available.
Has the profession missed an opportunity or just scratching the surface?
Does the profession highlight the difference between a patient and a client? Many vision statements and initiatives tie us to the patient and a product.13,14 When we think of health vs healthcare, we must think about those opportunities to engage every member of that household. Maybe the client is a young healthy individual that heard about your wellness services. They are thrilled that you can look over their parent’s meds, diet, labs, sleep, gut health, potential drug induced nutrient deficiencies, drug-drug and drug-food interactions, and provide a consumer-friendly report. They, clientele in this case, see the value in paying $75 per person every six months for your services to have peace of mind. This is what a consultant pharmacist already does in a long-term care setting, but now is performed in the community setting. This is a big area many pharmacies, corporate and independents, have missed the curve on. People are willing to pay for wellness, especially if they trust and like what’s being offered. John Whyte M.D., Chief Medical Officer at WebMD says “When we consumerize health information, make it accessible, and deliver actionable insights we will see success in healthcare.” Another example is the couple looking to start a family. Fertility is a quickly growing area. Not only is a negative test month after month stressful and depressing, not knowing what else you can do to enhance your chances of conception makes you feel helpless. Discussions with both the male and female around weight management, smoking cessation, alcohol reduction, wearables and FDA approved apps15, movement and exercise, supplements and diet changes, medications that could potentially interfere, and better sleep habits can enhance the chances of success. Both individuals are potential clients or patients that would absolutely benefit from wellness services through their journey to parenthood and beyond. Having the best knowledge throughout the process, knowing all about fertility and infertility treatment, understanding nutrition and supplementation, and medication pre/post-partum and during breastfeeding are areas of great opportunity for a pharmacist to get involved.
Pharmacy schools need to expose their students to more wellness opportunities in their curriculum.
Colleges of pharmacy need to start thinking of ways to implement wellness into their curriculum. NEOMED is one school that is approaching student personal wellness and making it a part of the curriculum in a longitudinal fashion. Some schools are currently speaking about offering an elective in wellness to their students, but unless they are hiding it somewhere, one that’s already in motion could not be found. Some schools of pharmacy, like Auburn University, are teaching well-being, which is important but not wellness in its entirety, depending on what definition you look at. To add to this, colleges of pharmacy have opportunities to create and offer teaching kitchens, like Tulane University School of Medicine, where students learn to cook and eat healthy so they can educate their patients on these important topics.16 Interpreting labs is a major topic to teach from a wellness perspective. More motivational intervention training and a deeper dive into intrinsic and extrinsic factors would be another priority for wellness compentencies.17 Providing healthier options to students while in school plays a major part of practicing what we preach. We can’t be the smoking cardiologist in the room. Pharmacists need to also take a hard look at their own health and habits, and those start within the educational institutions. We can’t discuss schools without mentioning the fact that applications are trending downward, and something must change.18,19 Could that change be wellness? Could we see young healthy individuals wanting to be part of a profession that wants to keep others healthy and do more than just dispense a drug? Could we see these future candidates mixing their passion for wellness and fitness wanting to become a pharmacist to provide more to their communities? It should be noted that the current residency accreditation standards include “wellness services”, but still no definition of wellness exists.20 This causes confusion on how to clearly offer these services.
Who will lead the charge for Wellness?
Lastly, trust and likability are two completely different notions. Pharmacists consistently rank in the top 5 most trusted professions each year, which means they are deemed honest and ethical.21,22 It’s not common to hear many people talking about how enjoyable their experience was at the pharmacy. Well, it’s not because pharmacists are unpleasant. It’s also not because pharmacists are not knowledgeable; the exact opposite is the case. Most pharmacists are knowledgeable, empathetic, and are the most accessible professionals in healthcare. However, being overworked and dealing with a broken health care system, and long hours throughout a pandemic, it’s no wonder that the pharmacy doesn’t have the best of brands or enthusiastic experiences. Will wellness be another added service that burdens the profession even more, once again asking pharmacists to do more for less, or will we see institutions and community pharmacies paying pharmacists more for these high demanded offerings? Will we see a cash-based payment model, or will payers see services like wellness and deem prevention as a priority of their business models? I guess time and innovative minds in the profession will be the variables that tell all.
1. https://www.cdc.gov/chronicdisease/about/costs/index.htm
4. https://www.statista.com/topics/1336/wellness-and-spa/
5. https://nationalwellness.org/resources/six-dimensions-of-wellness/
6. https://www.welcoa.org/blog/what-is-wellness/
7. https://pubmed.ncbi.nlm.nih.gov/19901351/
8. https://consumer.ftc.gov/articles/truth-behind-weight-loss-ads
9. https://www.qfc.com/health
11. https://uoanj.com/what-is-prehabilitation/
12. https://pearlpoint.org/nutrition-and-surgery-guidelines/
16. https://goldringcenter.tulane.edu/