Sep 10, 2016
New Mexico's state motto is “The Land of Enchantment,” but it might also be dubbed the The Land of Opportunity. Pharmacists here are increasingly breaking barriers to deliver frontline, provider care services in an environment that fosters innovations for the profession, students, and patients.
Stephanie Headrick and Mona GhattasOne of the most unusual pharmacies in the state (or perhaps anywhere), is the family-owned Duran Central Pharmacy of Albuquerque. Owner Mona Ghattas, who worked alongside her father who bought the establishment in the 1960’s, says that after she completed pharmacy school, she took over the reins determined to make the store a landmark in progressive services.
“We’ve worked hard to be better and not compete with retail chains; we want to be known in the community as a friendly, customer-service oriented, wellness destination—someplace that you want to go to for an experience, not just someplace to pick up medicine.”
And few could argue with the experience. Besides the full service pharmacy, Ghattas said her father renovated the retro soda fountain lunch counter and offers a “New Mexican” restaurant with a healthy menu of “made from scratch” recipes, including their nationally distributed, award winning chili. But if you’re pressed for time you can choose a last minute birthday gift from the artisan crafts and jewelry section, peruse the imported chocolates, or the luxury body and bath shelves for the perfect selection.
“We don't have cleaning and school supplies, cosmetics or car oil,” she says.
But, their innovative pharmacy (“We were the first pharmacy in the state to be computerized”) does have a high level of patient interaction and personal service. These assets were planned as central to their mission and to bring value to the practice.
Only one date to remember
“One thing we did was implement a large drug synchronization program, which has so many benefits to both patients and to our operations. We coordinate refills for patients. So, not only do we have our stock, costs, and inventory planned for . . .we know which people will be coming in when, and can plan an opportunity to engage with them, to see if they are taking their meds, ask if there any side effects, and explore other issues.”
She adds that patients who take more than two medicines are eligible to participate. Patients are asked if they would like to be in the program, but it is by no means compulsory. “Most people like the concept and more than 50% of our population is in the program.”
“When you know you are getting all your medicines at the same time, patients can be ready financially for out of pocket co-pays or other costs. Some patients require compounded medicine—which we do also—and we can plan to have those ready. Also, some people need to arrange transportation, so this timetable is very helpful.”
Pharmacy manager, Stephanie Headrick, RPh, says this strategy and other patient services such as diabetes and cholesterol clinics allow them to be truly “full service.”
The role of “full service”
“We have compression hosiery and we have certified fitters who measure people and get them set up with the right product. Plus, we are certified CLIA-waivered, so we also participate in drug studies, and we are certified to offer smoking cessation classes—we can write prescriptions for the patches. We were one of the first states to dispense emergency contraception to patients directly,” Headrick says.
As of January, 2016, legislation also expanded the vaccine role of pharmacists to include travel vaccines—a program already perfected for both children and adults at Duran Central. “We can now give travel vaccines, such as yellow fever, (one of our pharmacists is certified in travel vaccines) which makes it convenient for people since these are typically only available at public health facilities, and not all carry those products.”
Sitting down and taking the time to talk to patients is another priority, Headrick adds. Owner Ghattas built private counseling rooms in the pharmacy where staff can sit down and discuss health and medicines. “We can help encourage and motivate people to choose healthy lifestyles, discuss herbals and supplements, and also make recommendations to their physicians during these private encounters.”
Finally, they are helping combat the crisis of opioid prescription (and illegal opioid) drug-related deaths
with their Naloxone program. Headrick says that the State passed a blanket access protocol, and they no longer have to screen patients to dispense the drug. “The Department of Health now allows us to give this drug to anyone who comes in and asks for it. We’ve been doing this for over a year. I think preliminary results from DOH are starting to show a decrease in mortality rates.”
The services are innovative and are continuing to expand, and moreover Duran is reimbursed from payers—an issue that Ghattas says has typically “been a huge obstacle for all pharmacists.” She says, “Most of what we do falls under the MTM (medication therapy management) program and we are truly improving patient outcomes in a measurable fashion.”
Relationships, key to the evolving frontier
While all the pharmacist services are forward thinking, Dale Tinker, Executive Director of the New Mexico Pharmacist Association (NMPA) says networking and relationships are the key to their success. “I credit our good collaboration between our organization and the State Medical and Nurse Associations, and our ability to work with policymakers to advance the practice of pharmacy in New Mexico,” Tinker explains.”
A veteran administrator with nearly three decades of management with the NMPA gives him the perspective to see how changes have occurred, and how to plan and navigate the pathway to future collaborations.
“In 1993, a Pharmacist Prescriptive Authority Act was passed as part of an initiative for rural health care practice. This was a collaborative act with physicians that allowed pharmacists to order tests. But it was very cumbersome and complicated for pharmacists to qualify as it required extensive clinical experience, which at that time, was not part of their curriculum.”
Tinker said it was a good idea, but given the challenges, it didn’t really have a significant impact on public health. “What we needed was different legislation to allow pharmacists to do different things. So we passed a law in 2001 that had a new approach.
He explains that “protocol-based” services started first with immunizations.
“The way it works is our member teams write a protocol for what they envision is a service they can provide, and is needed. They write a protocol on that practice and we submit it to the State Medical Board, Board of Nursing and Board of Pharmacy for their approval. After consensus on the protocol it is submitted to policymakers who can approve the practice.”
The first programs were for immunizations, emergency contraception, and tobacco cessation: the next protocol was for TB testing. “This was a huge help since the state program was cut, and if you are in education or the health system you have to get a TB test and there was no place to go.”
The Naloxone protocol was also approved. And Headrick says one of the latest new service protocols is in genetic testing, which she believes is the future of prescribing.
“This is very exciting because we can see how patients are reacting to certain medications and we can find out what metabolic variances they may have that will inform prescribing and take the guesswork out of achieving good outcomes.”
New curriculum changes benefit all
Training students in the cutting edge of provider opportunities in New Mexico will have far reaching effects, says Tracy Hunter, RPh, MS, PhD, Assistant Dean for Experiential Education at the University of New Mexico College of Pharmacy.
Hunter, who places students in both retail chain and independent settings, as well as clinics and institutions says this hands-on experience throughout the curriculum allows students to learn in an environment “where their preceptors are providing care and are reimbursed for their services.”
“Under preceptor supervision, students practice as a team, and provide care to a diverse population. They take drug and medical histories, do a script monitor, identify medication-related problems, and design therapeutic solutions acceptable to provider, patient, and/or caregiver. In other words, they participate in the full continuum of health care provided in a variety of cultural settings.”
Hunter adds this is a very new approach to pharmacy education that also helps advance the practice of pharmacy. “Students explore how their unique interests and skills can best serve a community, and they graduate ready to enter practice.”
“Big kudos go to the pharmacy students,” says Headrick who cites the receptor role as important, and one she recommends for other professionals to consider.
“They’re [the students] here for free doing their last rotation year and they can participate in the MTM program in action, and they can see what we do that nobody else sees. They can take that out into the world wherever they go. At the same time, their role here allows us to address patient needs more fully and frees us up to do more of what we want to do to help patient care.”
And Tinker forecasts a bright future for the profession. “Physicians are starting to think of pharmacists as medication experts. We bring value to their patients and to community health. Doctors refer all their patients to experts when needed, so it only makes sense to refer patients to the experts when it comes to medicines.”