Leaving a Mark on Community Pharmacy

Nada Rezkallah
April 3, 2012
Filed under Opinions&Reviews

Community pharmacy, much like any other profession, faces several challenges. One of the toughest obstacles is the pressure of running a business while continuing to make informed clinical decisions that will yield positive health outcomes. The problem arises as big corporations encourage pharmacists to have a higher prescription volume, while not considering direct patient care as a necessity. In my previous experience working in retail pharmacy, I have worked with different pharmacists who shared many opposing views and philosophies. In some cases the pharmacist wouldn’t council patients often, follow up, or provide any real pharmaceutical care.

I chose to become a pharmacist because I wanted to provide direct, individualized patient care in the pharmacy and felt the retail setting is where the most patient-pharmacist interaction exists. Thus, more of an opportunity exists to make an intervention and improve quality of life. There are many ways in which a pharmacist can make a difference in their patient’s pharmaceutical care.

In the community pharmacy setting, there are many standard practices which can have an impact on patients’ clinical outcomes. First, initiation of new prescription medications should always be followed by a consult from the pharmacist to the patient.  This should include common side effects, any significant drug interactions, and how this might affect the course of the disease or condition.  I have seen several times where the technician only asks if the patient has any questions. The patient, in most cases, doesn’t have the knowledge to know the appropriate questions to ask, or they are in a rush to leave. In the few cases where the patient does know about the medication, a lot of the times they do need to be reminded about key points.

Another practice that I would do in the pharmacy are monthly medication check-ups, which are counseling sessions for patients that have chronic conditions who are on maintenance medications.  This allows the pharmacist to explain the disease state to the patient, as well as management through non-pharmacological and pharmacological methods. I have witnessed many medication-related problems, including duplicate therapies, treatment without indication, or indication without treatment, and much more.

Moreover, I would like to set up information sessions at the pharmacy, where I can educate patients about specific health topics or disease states. While on my school community rotation, I had a project in which I raised patient awareness of the effects of NSAIDs on the kidneys in patients who are at high risk for cardiovascular events (i.e diabetics who are also on ACE inhibitors or ARBs).  At first I didn’t anticipate that patients wanted to take the time to listen to what I had to say. But I slowly found that with time I had people calling me after they left the pharmacy for more information. I even had people tell their family members at home what they have learned.

Taking a few minutes to educate patients can go a long way in the community, and can reduce morbidity and mortality.  This in turn improves the overall quality of life of patients, and reduces the overall health care costs. The issue is that pharmacists sacrifice direct patient care for business purposes, while I truly believe that they come hand in hand. Good service is what brings a patient back to your store, and they can differentiate if the pharmacist has their own self-interest in mind or not.

For example, I once had a patient who had a dry cough but did not have asthma or COPD. I looked at the patient profile and saw that he had been taking an ACE inhibitor for the past 4 years. I educated the patient regarding this common side effect of ACE’s, and he told me that no one had ever told him this information before. This is a prime example of what community pharmacists are doing wrong in current practice; there is limited patient- pharmacist interaction. A change must occur in order to better educate our patients, improve health outcomes, and reduce morbidity, mortality and health care costs.

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