盡管如此，特別是在社區環境中，人們普遍認為，以病人為中心的護理實踐并不像可以實踐的那樣最佳和一致。此外，從歷史上看，以病人為中心的護理存在許多障礙，包括社區一級的時間限制。10 .也許最重要的障礙是，藥店在提供病人保健服務方面沒有得到有利可圖的補償。【譯文】造成這些令人失望的變化的一個主要原因與這樣一個事實有關:在最近的一段時間里，由于藥劑師的嚴重短缺導致了有意義的工資增長，因此沒有一種緊迫感來持續地、從根本上改變藥店的做法。由于至少兩個主要因素，今天的情況可能有所不同。首先，根據總需求指數(ADI)，美國大部分地區與少數需求溫和的州處于“平衡狀態”。這與2007年對藥劑師的高需求形成了鮮明的對比。造成這種供應變化的因素包括新藥學院和新學院的空前增長，以及現有藥學項目的顯著擴張。此外，一些人認為，由于2008年的經濟大衰退，許多藥劑師的工作時間比他們預期的要長。今天的情況可能有所不同的第二個原因與自動化和技術的進步有關。雖然之前有關于自動化和技術及其對專業的影響的討論，但有一些證據表明，藥房的分配功能(即)將在近期和長期內受到負面影響。科爾文最近對技術進步所做的總結強調了這些進步可能對工作世界產生的影響。科爾文認為，關鍵問題是:“還有什么能比電腦做得更好?”例如，谷歌的自動駕駛汽車將對未來的卡車運輸產生什么影響?律師身上發生的事情是一個有用的例子，說明了技術如何影響專業工作。在訴訟的發現階段，計算機比人更善于篩選與相關法律案件相關的文件。他們也比人類更善于預測最高法院的判決。這對法律界的高薪和充分就業來說可不是個好兆頭。IBM的認知計算系統沃森(Watson)不僅比我們更聰明，而且在過去的兩年里速度提高了240% !在藥房方面，位于舊金山醫院的加州大學的機器人已經取代了所有的配藥，35萬張處方中沒有出現錯誤。雖然醫院沒有減少藥劑師的人數，但是將來他們有可能減少。此外，該技術還可以用于其他制藥組織，從而潛在地減少對藥劑師的需求。
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.