Niche pharmacies serve children and the elderly

February 1, 2009

Specialty pharmacies are developing to meet the growing needs of children and senior citizens.

Key Points

Amy Hannig, RPh, doesn't always get to meet the people whose prescriptions she fills. They run right past her. After all, the wooden train and the stuffed animals are at the back of Kids 'N Cures Pharmacy in Boardman, Ohio. Hannig is one of a handful of pharmacists providing specialized services in pediatric community pharmacies throughout the country.

Serving the other end of the demographic market are pharmacists like Becky Culbertson, RPh, of 50-Plus Pharmacy in Kansas City, Mo., which is one of the few pharmacies dedicated to serving seniors.

Specialty, or niche community pharmacies, though still few in number, are reaching out to meet the growing needs of two populations with special needs - children and senior citizens.

With a wave of aging baby boomers advancing on the horizon, the American Society of Consultant Pharmacists started the Commission for Certification in Geriatric Pharmacy in 1997. Since then, 1,800 pharmacists have taken the exam and been certified.

Many work for nursing homes, which according to legal mandates, must have a pharmacist review patients' prescriptions every 30 days.

To serve pediatric pharmacists, the Memphis-based Pediatric Pharmacy Advocacy Group (PPAG) started in 1978 to serve pharmacists at children's hospitals, according to its executive director Matthew Helms. Today the group has about 700 members. Helms estimates all but "five or six" work for hospitals.

Helms explains that while there are few community-based pediatric pharmacies nationwide - the group currently doesn't track the exact number - he notes that there is a growing need for two key reasons: to provide continuity of care when a patient returns home after a hospital stay and because of the increase in diabetes and obesity.

'Diabesity' driving the need for pediatric pharmacies

In the age of "diabesity" - a word referring to two epidemics confronting children today: diabetes and obesity – PPAG works to educate pharmacists about the medication needs of children with those diseases.

"When you have a kid that looks more like an adult (in terms of the disease process) but still has the physiology of a child, what do you do with that? How do you deal with it?" Helms asks. "One of the things the association tries to do is to gather best practices around case studies."

Overall changes in children's health are bringing the pediatric pharmacist to the forefront, said Milap Nahata, PharmD, professor at Ohio State University with joint appointments in the colleges of Pharmacy and Medicine, where he teaches pediatric pharmacy.

"For example, obesity is creating problems with diseases that we never treated in children before, such as Type 2 diabetes or hypertension."

There isn't a simple formula to make medication acceptable for use in children. After all, children don't always respond to medication as adults do. Lea Wolsoncroft, RPh, a pediatric pharmacist and owner of KidsMeds Pharmacy in Birmingham, Ala., said since she opened her store six years ago, she has seen a big increase in asthma cases, as well as in babies being treated for reflux.

In fact, according to the Centers for Disease Control and Prevention (CDC) more than 6.8 million children have asthma - a rate that has more than doubled since the early 1980s. In addition, Wolsoncroft said premature babies and those with fragile conditions, such as recent heart surgery, benefit most from the special knowledge of community pediatric pharmacists.

"One of the things we do is we check all of our doses based on the weight of the child," she said. "If you don't know that and you're not comfortable with morphine for a baby, you could make a big mistake on a 4-pound baby."

Ben Fry, RPh, owner of Small Fry's Pharmacy in Harlingen, Texas, agrees that pediatric pharmacists can play a critical role in the treatment of infants and children.

"You need to go be able to avail yourself of a pharmacy with experienced pharmacists who can recognize when there might be an overdose or [a potential] drug interaction," Fry said.