Pharmacists dispense pills, counsel, screen for illness, give vaccines

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Pharmacists dispense pills, counsel patients, screen for illness, give vaccines

By G. Boodman, Special to The Washington Post

Tuesday, January 12, 2010

When Charley tells people he's a pharmacist, he knows what many of them

think: that he spends his workdays sequestered behind a counter doling out

pills, dropping them into little plastic vials and handing them to customers.

That may have been an accurate job description for a retail druggist circa 1978

-- the year was born -- but it bears little resemblance to the

multi-tasking the job requires these days. Pharmacists, particularly those who,

like , work for large national chains, are moving into areas that have long

been the exclusive province of doctors and nurses: providing immunizations for

diseases including H1N1 influenza, screening for chronic health conditions such

as diabetes, counseling patients about the increasing panoply of medications

they are prescribed and, in a sour economy with dwindling access to health

insurance and primary care, offering basic medical advice. Health-care reform

legislation would probably increase pharmacists' involvement in patient care by

expanding reimbursement for certain kinds of medication counseling.

" We are the face of neighborhood health care, " said Edith to, a senior vice

president of the andria-based National Association of Chain Drug Stores. " We

see the role of pharmacists as helping the patient improve health outcomes, " not

merely dispensing drugs. Pharmacists' training and duties, to said, have

undergone a metamorphosis in the past two decades, as health care has become

more complicated and the use of medications has exploded. Between 1997 and 2007,

the number of prescriptions purchased by Americans increased by 72 percent, from

2.2 billion to 3.8 billion, according to a 2008 report by the Kaiser Family

Foundation.

Pharmacists have become " physician extenders " in hospital and community

settings, said Lynnae Mahaney, president of the American Society of

Health-System Pharmacists. Drug therapy, a cornerstone of treatment for

everything from attention-deficit disorder to whooping cough, is " much more

complicated, both the number of medications we have and the number of patients "

taking medicines, she said. The nation's 100 colleges of pharmacy have

overhauled their programs, extending training from a four-year bachelor's degree

to a doctorate that requires six years of schooling.

, who began working for Walgreens while a student at the University of

Florida, says he regards talking to patients about their medicines and their

health as the best part of his job. " I was always interested in medicine, and I

really wanted to be an expert on what is safe [and] on the impact of drugs on

the body, " said , who manages to be unflappable, efficient and empathic.

He is the pharmacy manager of Store 10616, open round the clock and located

along andria's busy Route 1 corridor, a diverse slice of urbanized suburbia

that includes raw-looking new townhouses, high-rise condos, garden apartment

complexes and a handful of inexpensive motels.

oversees a staff of 10, half of them pharmacists, and contends with a

steady and occasionally frenzied work flow; his store fills between 100 and 200

prescriptions per day, well below the 500 a really busy pharmacy dispenses. The

job requires physical stamina -- pharmacists stand for hours on end -- as well

as the ability to deal with frequent interruptions, little downtime, the arcane

rules of dozens of health plans, and customers who can be harried, confused or

needy. Recently a reporter spent several days with as he brewed liquid

Tamiflu for sick children; screened people at a walk-in diabetes clinic; filled

dozens of prescriptions, many for painkillers and antibiotics; and provided

basic medical advice to a steady stream of customers, some uninsured or visibly

ill.

Free Screening

The free, six-hour diabetes screening clinic had been advertised for weeks and

, hoping for a big turnout, arrives early to set up tables in the cosmetics

aisle at the front of the store. Two drug saleswomen lugging large sample cases

arrive to lay out their wares, which include a stack of glossy pamphlets

entitled " Diabetes and You " and tiny square pillows that can be used for

practice injections. Before leaving, they promise to buy lunch for the pharmacy

staff soon.

In addition to a blood test to measure glucose levels, which costs between $15

and $60 in a doctor's office, those who already know they have diabetes will be

checked for hemoglobin A1C, which reveals how well blood sugar levels have been

controlled during the previous few months. A day earlier at a clinic held at a

Walgreens in rural Warrenton, had found a patient whose blood sugar was so

high it was potentially lethal. He advised the man to immediately seek treatment

at a nearby emergency room.

A little after noon, a 52-year-old woman rushes in, thrilled to be the first in

line. She looks crestfallen when the visiting nurse who will be drawing blood

tells her the event doesn't start until 1, when the woman's lunch hour ends.

, who overhears the conversation, agrees to begin early.

" I don't have health insurance, " says the woman, who declines to give her name,

citing embarrassment over her lack of coverage. She works full time at an IT job

and cobbles together free or low-cost health care by searching out free

screenings. When she needs prescription drugs, she hopes they are generics

available for $4 at Wal-Mart.

To her obvious relief, tells her her blood sugar is normal, then launches

into the practiced spiel about the importance of a healthful diet and exercise

that he will repeat 74 more times before the clinic ends at 7 p.m. By then

will have seen a 28-year-old man with bipolar disorder who takes a medication

known to increase the risk of diabetes (his blood sugar is fine), a gaunt woman

in her 40s complaining of frequent urination, numbness and blurred vision whose

blood sugar is normal ( recommends she make an appointment with a physician)

and a 63-year-old diabetic with alarmingly high blood sugar readings. urges

him to see his doctor in the next day or two.

Flu and Tamiflu

The large name tag pinned to his short white lab coat proclaims a

" certified immunizer. " Like virtually all of the 17,000 Walgreens employees

authorized to administer shots, on this day he has neither seasonal nor swine

flu vaccine, to his -- and his customers' -- frustration.

Walgreens exhausted its supply of seasonal flu vaccine in mid-October, giving 5

million flu shots in a seven-week period in 2009, compared with 1.2 million in

2008. The swine flu vaccine that was quickly supposed to follow arrived months

late. 's store didn't get its first batch until Dec. 16, when it received

100 doses of nasal vaccine. As of Monday, Walgreens had administered a million

H1N1 immunizations at stores around the country.

The concept of enlisting pharmacists took off during the bird flu scare several

years ago, when states adopted regulations allowing them to provide

immunizations to cope with a possible pandemic. said local physicians and

urgent-care clinics do not seem to resent the competition and have referred many

patients to his store for various shots.

Vaccine isn't the only thing in short supply. To cope with a shortage of liquid

Tamiflu, which is taken by children to blunt the severity of H1N1 illness,

and his staff began making their own. The simple compound, made from grains of

Tamiflu capsules pulverized using a glass mortar and pestle and mixed with

cherry syrup, is stored in the pharmacy's large white refrigerator.

Triage

A phone is pressed to his ear, its long white cord swaying, as pivots with

balletic grace to reach a bottle on the bottom shelf in a far corner of the

900-square-foot pharmacy. He returns to the counter, pours small round pills

onto a plastic turquoise tray and, using a spatula to count by fives, flicks 30

pills into an amber plastic vial bound for a waiting customer.

Nearby, one technician is ringing up a sale at the drive-through window, while

another is stuck on the phone in an unsuccessful 20-minute attempt to decipher a

doctor's name on a prescription. Several customers whom the pharmacy staff

refers to as " waiters " are wandering the aisles or lurking near the counter when

a woman rushes up clutching a prescription. , who as the lone pharmacist on

duty must check and verify all prescriptions before they are dispensed, stops

what he is doing and heads to a bay to confer with her.

" CVS is out of it and they sent me here, " she said, referring to the morphine

prescribed for her mother by a Northern Virginia oncologist. " Do you have it? "

Relief floods her face when tells her he does. " I'm between conference

calls, but I'll be back, " she says, racing off to pick up her mother's insurance

card.

spends the next 10 minutes conferring with a 70-year-old regular customer

whom he greets by name; the man is having trouble getting his diabetes meter to

work, and tests it. He then fields a call from a woman asking what she

should take for gas pains; another caller, who is breast-feeding, wants to know

the best time to take a sleeping pill. A young mother, her sick-looking

9-year-old daughter in tow, approaches the counter to ask what she should

give the little girl, who has had a fever for a week. After talking with the

woman for five minutes, he recommends an over-the-counter medicine, then urges

her to insist on an appointment with the child's pediatrician. " A week is too

long, " he tells her.

An elderly man who speaks little English hands a ripped piece of notebook

paper with a long list of medications written in purple ink; he wants help

tracking down a medicine. " We'll figure something out, " says, putting the

sheet on a growing stack of prescriptions to be filled as he heads back to the

drive-through window, where a woman in an idling minivan waits.

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