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In Illinois, the Jewel-Osco grocery-pharmacy chain has taken on pharmacy consulting and dispensing services for Passages Hospice.
Jewell-Osco is moving outside the traditional chain-pharmacy world with a new hospice partnership in Illinois. The grocery-pharmacy chain has taken on pharmacy consulting and dispensing services for Passages Hospice, which provides institutional and home hospice care in Northern and Central Illinois. The initial version of the program involves 15 of Jewel-Osco’s 170 stores, but company officials are already talking growth.
“The big chains are focused on the prescription business,” said Matt Cross, RPh, regional manager of managed care for Jewel-Osco Pharmacy. “There’s a whole other clinical aspect, diabetes education, immunizations, consulting, that pharmacists ... don’t get to do in the typical chain setting. This is an opportunity to expand.”
Cross is a pharmacist with experience in pain management, a key component of hospice care. Hospice care is largely palliative, he said, usually focusing on pain relief, constipation, and comfort care. “There are a lot of pharmacies that don’t carry these pain meds.”
He continued, “About 75 percent of hospice meds are stocked by a typical pharmacy. The other 25 percent, medications to make hospice patients more comfortable, aren’t carried by the typical store. A chain or independent can take days to source, order, and receive them. We aim to take away the guesswork and the worry for patients and their families.”
It was a drug-sourcing problem that brought Jewel-Osco and Passages together in the first place. A home hospice patient was having problems getting pain prescriptions filled from the family’s standard pharmacy, said Passages director of business development Cory Tague. A family member who worked for Supervalu, Jewel-Osco’s parent corporation, asked whether the company could help through one of its 24-hour pharmacy outlets.
“This relationship is really about taking care of patients,” Tague said. “We found that regular pharmacies couldn’t always help our patients and their families, especially when it comes to special needs like pain medications in the middle of the night. Jewel-Osco allows us to fill those difficult prescriptions immediately and gives our patients access to pharmacists who understand hospice.”
Understanding hospice takes a special mindset, said consultant pharmacist Travis Sonnett, clinical assistant professor at Washington State University College of Pharmacy in Pullman, Wash.
“We aren’t looking at prolonging life per se,” he said. “We still treat acute episodes, like a urinary tract infection or pneumonia, but we typically don’t provide chemo. We work on quality of life, not quantity.”
Although there are no hospice-only medications, Sonnett said, hospice care frequently makes use of familiar drugs in unfamiliar ways.
One of the common problems for hospice patients is the death rattle, a breathing complication caused by accumulation of fluid in the lungs. Typical treatments include Levsin (hyoscamine, Alaven), usually prescribed for irritable bowel syndrome, or atropine eye drops, given sublingually or taken orally. Also common is the substitution of methadone for more expensive opioids.
“Most pharmacies don’t stock methadone,” said independent pharmacist Paul Lofholm, who contracts with several hospice providers in Marin County (Calif). ”You need to consider these products and administration issues. You not only need methadone, you need it in injectable, solid, and liquid formulations.”
Pharmacy chains usually steer clear of high-maintenance clients such as those who need hospice and long-term care, Lofholm said. Jewel-Osco is effectively creating a core group of hospice pharmacies within the larger company. Sites were selected on the basis of the needs of Passages patients and the stores’ ability to provide these pharmacy services, Cross said.
Stocking products that hospice patients consistently use in stores that serve the hospice population provides a reasonable return on the additional inventory investment, Cross said. Cross said Supervalu hopes to expand the hospice program.