Pharmacies roll with the changes

January 16, 2012|By MARIE GILBERT |
  • Modern technology has afforded today's pharmacists a better way to serve a larger and more diverse patient population.
By Joe Crocetta/Staff Photographer

Behind the pharmacy counter, the familiar bags of medications are tagged and labeled alphabetically in plastic containers.

Customers come and go —but not everyone is there to drop off or pick up a prescription.

Some have come for an influenza or shingles vaccine.

Others are there to have their blood pressure checked.

And many arrive with questions. Will a certain over-the-counter medicine interact with their hypertension pills? What can they do to improve their cholesterol count? What health care supplies are recommended for someone newly diagnosed with diabetes?

This isn't your grandparents' old-fashioned neighborhood drugstore.

Today's pharmacy reflects its expanding role of better serving the customer.

There are drive-through lanes and automated refills.

The sound of a telephone ringing has been replaced by the computer and mobile devices.

And some pharmacies are open 24 hours a day.

Joseph J. Scalese III has seen the changes firsthand.

Scalese said he wanted to become a pharmacist by the time he was in the eighth grade.

"I have many family members who are in health care, so it was a profession that was familiar to me," he said. "My father also had some friends and colleagues who were pharmacists."

Scalese said he received his education at the University of Maryland at Baltimore's School of Pharmacy and while in college, worked as a pharmacy technician at Johns Hopkins and on several FDA projects.

Since graduating, Scalese said he has worked community/retail pharmacy, which he has found to be most rewarding.

He also taught pharmacology at one of the local colleges and is an instructor for both the University of Maryland School of Pharmacy, and the Notre Dame of Maryland University School of Pharmacy, "which is also extremely rewarding."

A pharmacist with Home Care Pharmacy in Washington County, Scalese said he was a high school student when, in the mid-1980s, he landed a job as a clerk at a community drug store.

"Most pharmacies were either independent pharmacies or part of a small, regional chain," he said. "Many had soda fountains and cosmetic departments  Delivery, while still available but now rare, was common place."

And technology, appropriate for that era, was antiquated by today's standards.

"I can remember the excitement generated when my boss, ‘Doc,' purchased his first fax machine," Scalese said.

Even though the technology might seem archaic by today's standards, "we were able to serve our patient population without major issues," he noted. "Back then, every pharmacy seemed to have an old typewriter, which was used for emergencies. I remember having to use that old beast on several occasions. Unlike today, we could still fill prescriptions if the power went out or the computer and/or printer died. We weren't tied to a server or an IT department. If something broke, we made a phone call, pulled out the typewriter, the whiteout and kept going."

But while some might be nostalgic for the good old days, modern technology has today's pharmacists a better way to serve a larger and more diverse patient population, Scalese said.

"It has allowed us the ability to check for drug-to-drug interactions, drug-to-disease interactions and even drug-to-age interactions.  Old-fashioned pharmacies would have required the use of encyclopedia-sized reference books rather than just a few clicks of the mouse," he noted.

Years ago, the pharmacist's main job was filling prescriptions. Today, that role has been reinvented. Pharmacists — male and female — have become an integral part of a health team, partnering with both the patient and the doctor.

And pharmacists, Scalese said, are probably the most accessible members of that health care team.

"We are, by far, the most visible," he noted. "Pharmacists' centralized placement in the community and clinical expertise make them invaluable partners in helping consumers improve their health. They dispense medications, counsel patients on the use of prescription and over-the-counter medications and advise physicians about medication therapy."

Many pharmacists, including Scalese, are certified and registered to administer the influenza vaccine. Some pharmacists, he said, also administer the shingles and pneumonia vaccines.

In addition, today's pharmacies often offer blood pressure screenings, medication therapy management programs and generalized prescription drug counseling.

"Pharmacists also advise patients about general health topics, such as diet, exercise and stress management and provide information on products such as durable medical equipment or home healthcare supplies," Scalese noted. "Some pharmacists also specialize in various disease counseling, including diabetes and hypertension."

There even are pharmacies that focus on specialty compounding, veterinary medicine, IV therapy and homeopathic medicine, he added.

While many people are aware of the many responsibilities that fall on today's pharmacists, many others aren't, Scalese said.

In particular is the fact that pharmacists are at the front line in detecting prescription overlaps and dangerous interactions.

"As prescription drugs become more complex and as the number of people taking multiple medications increases, the potential for dangerous drug interactions will grow," Scalese said. "Patients may provide both the pharmacist and the prescriber with their complete medication profile every time a prescription is filled. But, often, patients do not remember every medication that they are taking."

The problem is compounded by the fact that many patients use more than one pharmacy and a profile is not easily accessible.

"If the patient has prescription drug coverage, the plan's safety protocols will check for interactions no matter what pharmacy is being used," he noted. "But if the patient does not have a prescription drug plan or chooses not to provide the information to the pharmacy, the pharmacist is unable to detect potentially dangerous interactions."

Over-the-counter medication interactions also are potential areas of concern, he said. "Even the most seemingly benign medication, such as ibuprofen (Advil) or acetaminophen (Tylenol) can cause issues with prescription medications."

Scalese said the overdosing of medication is another concern to the pharmacy profession.

"We have to monitor overuse of everything from narcotic analgesics to high cholesterol medications," he said. "Sometimes, depending upon the type of medication, taking just a few extra doses can cause serious consequences."

Today's pharmacist, Scalese said, is often a buffer between the patient and his or her doctor.

"Patients often do contact the pharmacist first before contacting their primary care practitioner," he said. "Sometimes, it seems as if patients want us to diagnose them so they don't have to go to the doctor. This is OK for issues such as poison ivy. But, usually, we do need to refer the patients back to primary care."

Then there are the cases of individuals who don't have a primary care provider or no health insurance.

"If the patient doesn't have health insurance, we may be able to refer them to an urgent care provider," Scalese said. "It becomes more complicated when the patient does not have health insurance. Treating a chronic cough and shortness of breath with over-the-counter medication won't provide adequate relief for someone with asthma. When situations such as this happens, we refer them to places such as a free clinic or other avenues that might be available."

Being a licensed profession, Scalese said pharmacists must comply with all local and federal laws. This even includes how long a written prescription is valid or which drug orders can be faxed or sent to the pharmacy electronically.

"It is hard to tell a patient that I cannot fill a prescription because the order is too old to be filled or sent incorrectly. But we are obligated to obey all applicable laws," he explained. "Many times, it just requires a phone call to address the issue. Other times, there is no simple fix."

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