尽管如此，特别是在社区环境中，人们普遍认为，以病人为中心的护理实践并不像可以实践的那样最佳和一致。此外，从历史上看，以病人为中心的护理存在许多障碍，包括社区一级的时间限制。10 .也许最重要的障碍是，药店在提供病人保健服务方面没有得到有利可图的补偿。【译文】造成这些令人失望的变化的一个主要原因与这样一个事实有关:在最近的一段时间里，由于药剂师的严重短缺导致了有意义的工资增长，因此没有一种紧迫感来持续地、从根本上改变药店的做法。由于至少两个主要因素，今天的情况可能有所不同。首先，根据总需求指数(ADI)，美国大部分地区与少数需求温和的州处于“平衡状态”。这与2007年对药剂师的高需求形成了鲜明的对比。造成这种供应变化的因素包括新药学院和新学院的空前增长，以及现有药学项目的显著扩张。此外，一些人认为，由于2008年的经济大衰退，许多药剂师的工作时间比他们预期的要长。今天的情况可能有所不同的第二个原因与自动化和技术的进步有关。虽然之前有关于自动化和技术及其对专业的影响的讨论，但有一些证据表明，药房的分配功能(即)将在近期和长期内受到负面影响。科尔文最近对技术进步所做的总结强调了这些进步可能对工作世界产生的影响。科尔文认为，关键问题是:“还有什么能比电脑做得更好?”例如，谷歌的自动驾驶汽车将对未来的卡车运输产生什么影响?律师身上发生的事情是一个有用的例子，说明了技术如何影响专业工作。在诉讼的发现阶段，计算机比人更善于筛选与相关法律案件相关的文件。他们也比人类更善于预测最高法院的判决。这对法律界的高薪和充分就业来说可不是个好兆头。IBM的认知计算系统沃森(Watson)不仅比我们更聪明，而且在过去的两年里速度提高了240% !在药房方面，位于旧金山医院的加州大学的机器人已经取代了所有的配药，35万张处方中没有出现错误。虽然医院没有减少药剂师的人数，但是将来他们有可能减少。此外，该技术还可以用于其他制药组织，从而潜在地减少对药剂师的需求。
Despite this, especially in the community setting, there is wide-spread agreement that patient-focused care is not practiced as optimally and consistently as it could be practiced.8,9 In addition, historically there have been many barriers to patient-focused care, including time constraints at the community level.10 Perhaps the most significant barrier is the fact that pharmacies have not been reimbursed at a profitable level for providing patient care services. 10,11 One major reason for the underwhelming changes relates to the fact that, with significant shortages of pharmacists during the recent past resulting in meaningful salary increases, there was not a sense of urgency to consistently and fundamentally change pharmacy practice. The situation may be different today due to at least two major factors. First, according to the Aggregate Demand Index (ADI) most of the United States is “in balance” with a minority of states in moderate demand.12 This contrasts to a high demand for pharmacists as recently as 2007.12 Contributing factors to this supply change include an unprecedented growth in both new schools and colleges of pharmacy, as well as significant expansion of current programs.13,14 Also, some will argue that many pharmacists are working longer than they expected due in part to the Great Recession of 2008. A second reason for why the situation may be different today has to do with the advances in automation and technology. Although there have been previous discussions regarding automation and technology and their impact on the profession, there is some evidence to suggest that the distributive function of pharmacy (i.e., dispensing) will be negatively impacted in the near and long term. A recent summary by Colvin regarding the advances made in technology spotlights the impact these advances may have on the world of work. 15 According to Colvin, the key question to ask is: “What can people do better than computers?” For example, what impact will Google’s autonomous car have on the future of trucking? What is happening to lawyers is a useful example of how technology can impact professional jobs. In the discovery phase of litigation, computers are much better than people for screening documents for relevance related to germane law cases. They are also better at predicting Supreme Court decisions than humans. That does not bode well for high salaries and full employment in the law profession. Watson, IBM’s cognitive computing system, is not only smarter than we are, but has become 240% faster in the past 2 years! In pharmacy, the robot at University of California at San Francisco’s hospital has replaced all dispensing and has not had an error in 350,000 prescriptions.16 Although the hospital has not reduced its pharmacist staff it is possible that they could in the future. In addition, the technology can be used in other pharmacy organizations to potentially reduce the need for pharmacists.