2018 SEP in the U.S.
Week 1: Walgreens Specialty Pharmacy (Community)
Introduction
When it comes to community pharmacies, there is little difference among each other in Taiwan. However, there are various kinds of community pharmacies in the U.S.A, such as retail pharmacies, specialty pharmacies, compounding pharmacies, etc.
Retail pharmacy
The business scope of retail pharmacists is similar to that of community pharmacists in Taiwan. Retail pharmacists provide general healthcare advice to the public, which is often known as patient counseling. They are also responsible for processing prescriptions as well as dispensing medications, including prescription and non-prescription ones. Furthermore, retail pharmacists order and sell medicines as well as other stock, so marketing services are also parts of their work.
Specialty pharmacy
Specialty pharmacy, which has become a burgeoning industry in the U.S.A, focuses solely on treatment of complex, chronic or rare conditions. These medications are usually high-cost (above $10,000), so they are available only through exclusive, restricted or limited distribution. Additionally, special storage, handling and administration requirements are often seen here, as well as ongoing monitoring for safety and efficacy (once every 3 months).
Compounding pharmacy
The role of compounding pharmacies is to make medications for specific patients with needs that can’t be met by commercially available ones. For example, a child may need a small, liquid dose, while the medication is made only in adult-dosage tablets. Allergy is also an important issue when dealing with prescriptions, so compounding pharmacists have to communicate with the prescriber and the patient to prepare a personalized medication.
Business scope
Medical conditions: focus especially on transplantation, cancer, HIV and hepatitis C
Technicians
1. Dispensing: The work should be reviewed by a pharmacist afterwards
2. Shipping: This pharmacy receives prescription from 6 states, so they ship out medications for patients who live far from there or those who are too busy to get their medication in person
3. Financing: Since specialty medications are quite expensive, patients require insurance to pay for them. Otherwise, technicians who are in charge of financing will help them find out some resources to save some money. They also have to check out the final co-pay, and confirm that patients do pay the money.
Pharmacists
1. Reviewing: They review the medications dispensed by the technicians, especially names and appearances, and call the prescriber or the patient if there’s any problem. For instance, when patients are prescribed the same medication with two different doses, when patients want to extend the prescription period, or when the brand of the medication changes.
2. Counseling: New patients for Walgreens Specialty Pharmacy should be counseled thoroughly to document their profile like allergy, other medication, side effects and missed dose. Address, phone number and credit card number should be confirmed initially, so that the shipping process can move on smoothly. Subsequently, pharmacists will call every patient every month to follow up their situations.
Interns
Interns can actually do everything here. However, they have to be supervised by the pharmacists. Many students in UW (University of Washington) do their IPPE (introductory pharmacy practice experiences) and APPE (advanced pharmacy practice experiences) here.
Experiences
Filling in medications
Since I only have an assistant license here in the U.S.A, I don’t have the right to pull out drugs from the shelves. Technicians have to help me with that. The technician who takes responsibility for dispensing asked me to recognize every medication for a patient, and try to judge his/her medical conditions from them when filling in medications. It really helps me a lot to recall the things I learned in school. During the procedure, I found it common that patients were only diagnosed with one disease in the beginning, but ended up with several complications, so the medications became more and more. Pharmacists here lay emphasis on attitude and the importance of respecting patients, so they make every effort to do the best on everything. Labels, for example, are supposed to be ordered, neat and clean, without covering the name and the expiration date of the medication.
Case study
Medical conditions: hepatitis C, atopic dermatitis, HIV
1. Finding out the key points: As students, we are taught to think widely and take everything into consideration. Nevertheless, as pharmacists, you should narrow down the conditions and focus more on acute problems instead of chronic ones since you have limited time to deal with a patient.
2. Understanding the mechanisms: It’s always easier to explain the characteristics with mechanisms, so the pharmacists here pay much attention to it. However, it was so difficult for me that I could hardly answer any questions about this whenever they asked me.
3. Standing in patients’ shoes: Using simple words which are familiar to everyone helps patients understand what you’re trying to say. Make sure to tell patients why you need to counsel them in case that they lose their patience.
4. Finding reasons for weird prescriptions: Try to explain the reasons for all prescriptions and see if there’s something unreasonable. Do your best to make patients benefit most from the medications.
Patient counseling
To be honest, I was not allowed to do this. Only pharmacists and interns can counsel patients. However, there happened to be a special patient who spoke Mandarin, and since nobody in the pharmacy could speak Mandarin, they provided me with the rare opportunity to counsel her! I was assigned to do the initial assessment, which Mockenzie did on Monday. I prepared whole morning and practiced with a pharmacist before calling her. Much to my disappointment, she refused to fill on hearing the price! Consequently, I didn’t have a chance to counsel her about the medication. Though the things I looked up didn’t come in handy this time, I still learned a lesson that pharmacists should always be well prepared before counseling patients. The pharmacist in charge of this let me document her profile and reviewed it for me afterwards, and the task was finally finished! That was definitely the most impressive experience for me before logging out from Walgreens Specialty Pharmacy!
Thoughts
1. They have an elaborate division of labour. The advantage is that people are experts in their own fields, but it can cause a lot of trouble sometimes. Since there’s a chain of work from dispensing, reviewing to shipping out, people who work at the downstream have to wait until everyone at the upstream finishes his/her work, and I consider it a little bit inefficient.
2. They emphasize more on patient care. Not only do they counsel patients, but also set up refilling date for them. Patients receive calls from Walgreens Specialty Pharmacy a week before he/she needs to refill the medication. It’s really considerate for them to do this, and I think maybe we can also do this in Taiwan in the future.
3. Doing things well is much more important than finishing them quickly.
4. Case study helps a lot to bridge knowledge from books with the reality world.
5. People here are super nice! They are always willing to tell me what they’re doing and chat with me with patience. They also try their best to answer my questions as long as I dare to ask. It’s extremely fortunate for me to have a week here!
