Innovative pharmacy program a hit with patients

By ELLEN GOLDBAUM
News Services Editor

An innovative program that operates community pharmacies jointly through the UB School of Pharmacy and Tops Markets, Inc., has resulted in better care for patients and better use of pharmacists' skills, and also is responsible for significantly increasing business in the pharmacies-in one case, more than doubling the number of prescriptions filled.

The program was featured as a national model at a conference held in Chicago on "The Role of Shared Faculty and Community Pharmacy" sponsored by the National Association of Chain Drug Stores and the University of Oklahoma. The UB/Tops program was described Tuesday during a session on "Pharmacy Innovation and Outcomes" by Linda Schultz Rothberg, coordinator of clinical pharmacy programs for Tops, and Melissa Metzger, Tops/UB pharmacy co-faculty member.

"This program is a 50-50 model of cooperation between a chain drugstore-in this case, in a supermarket-and the university," says Wayne K. Anderson, dean of the School of Pharmacy.

While other schools of pharmacy across the U.S. are exploring similar strategies, the UB/Tops program is considered by far to be the most advanced.

Anderson credits the UB pharmacy school's reputation as the reason its program with Tops has progressed so quickly. He also notes that UB is developing similar programs with other local supermarkets, chain drugstores and independent pharmacies.

To date, there are three clinical sites at Tops markets, staffed either by permanent Tops pharmacists or by UB pharmacy students. By the end of this summer, that number will jump to 10. Eventually, Tops aims to have clinical pharmacies in the majority of its stores in Western New York.

In the clinics, pharmacists go far beyond the usual dispensing and counseling functions, which now are required by New York State law.

They ask customers about adverse effects from their medication, but they also ask about symptoms and about other medications the customers are taking. When filling a prescription for an antibiotic, for example, pharmacists make follow-up calls to the customer a few days later, checking to see if they are still taking the medication and if they have had any side effects.

The pharmacists always ask permission to call patients at home; Rothberg says they have never been turned down.

Patients also can make appointments with pharmacists to discuss concerns about their condition and medications. Physicians are involved in the process, often providing the pharmacists with lab-test results if the patient has given permission.

A patient with asthma, for example, is taught how to use an inhaler and about ordinary substances that may trigger attacks, while diabetic patients are taught how to use a glucometer and how to manage their disease through proper diet and lifestyle.

"Patients can come and talk to us and not feel judged and get good information about their medications and health issues," says Rothberg. "At the same time, we can be physicians' eyes and ears, seeing whether or not a patient has been compliant and then communicating with the physician."

Physicians, as well as patients, must be educated about how pharmacists will augment, not replace, their role in patient care.

"At first, patients don't expect to have to sit down and make an appointment with a pharmacist," says Metzger, whose job is to develop clinical pharmacy sites at Tops where the pharmacists are heavily involved in patient care. "We've had to condition patients to expect that service."

But once patients have had an appointment, they are quick to realize the benefits. At one Tops, pharmacy staff expected business to decline because a competing supermarket had opened across the street. In fact, the number of prescriptions filled there continued to climb.

Driven partly by new professional pharmacy standards and by the tremendous growth and complexity of drugs on the market, the expansion of pharmacists' duties into aspects of patient care and away from traditional dispensing functions is an inevitable shift, according to Anderson.

But it is a shift that still depends on convincing physicians, insurers and the public that the specialized training of pharmacists has real value in the health-care system.

"It's a catch 22," says Anderson. "Pharmacists want to counsel patients and they have been trained to do it, but there still has to be some recognition that counseling patients has real value in managing drug therapy and that that, in and of itself, should be paid for."

Ultimately, the patient-outcome data gathered at clinical sites run by Tops and UB will be used to convince third-party payers of that.

"We want to see a change in how pharmacies are paid," explains Rothberg. "Like lawyers or accountants, we should be paid for our cognitive abilities. We've been giving out this information on a daily basis for free."