Clinical pharmacy practice in community pharmacies: A frontier with promise?

Pioneers in the early days of clinical pharmacy practice overcame substantial barriers (eg, “Exactly why are you up here on the wards instead of in the basement?”) but have blossomed in a relative sense in the hospital setting, where the shared mission of all employees is to care for patients with significant illnesses, practitioners share a common geography, there is access to the critical patient data necessary to make decisions on care, and pharmacists are paid as employees in inpatient settings not dependent on drug revenues. Clinical pharmacy practice in the community setting has lagged behind, frankly because it is much harder to implement due to barriers not present in the hospital setting. Like the evolution of clinical pharmacy in hospitals, the community pharmacy setting will need pioneers with passion, grit and persistence. We applaud those new pioneers willing to challenge the status quo such as Dr. McGivney, our Guest Editor, and those publishing in this issue of Journal of the American College of Clinical Pharmacy (JACCP). We wrote this editorial not with pessimism toward the future but with criticism of the past. We hope it provides a forum for debate, a call for action and a challenge to the profession. Nonetheless, the barriers to transforming pharmacy practice in community pharmacies are substantial, and in our opinion, the traditional practice model in most community pharmacies requires a complete reboot. New thinking and solutions to barriers are required. Here are some of the most substantial challenges facing the provision of optimal patient care in community pharmacies.