The pharmacist is no longer at the back of the store.
UC San Francisco is changing the way you think about your neighborhood drugstore by putting the pharmacist front and center – not just in the store, but also on your health care team.
By Kristen Bole
March 05, 2014 – For Helen, every morning starts with the same ritual: nine pills, six specifically with food. The bright green ones and two others have to be taken three times a day. One of those prescriptions requires three pills for each dose. One set of pills is taken twice daily. Three are just once in the morning and two are once at night.
By the time she’s taken a calcium supplement and two other medications at bedtime, the day’s tally has reached 20 pills, to help control her diabetes, high blood pressure, back pain and other chronic conditions. And that’s not counting the nicotine lozenges throughout the day to help her quit smoking, and fish oil for heart health.
“Every time I go to the doctor, there’s another pill they add,” said Helen, who is in her 60s and asked that her last name not be used. “From the time I get up to the time I go to bed, I take pills. The bin is just overflowing with pill bottles.”
Helen is hardly alone in juggling a dizzying schedule of pills: About 29 percent of American adults take more than five prescription medications every day – mostly due to chronic illnesses – and 82 percent of Americans take at least one daily, according to the Institute of Medicine.
Yet three out of four patients admit that they don’t take their medications as prescribed, and studies show that roughly 40 percent don’t even fill their prescriptions.
A new initiative by UC San Francisco and Walgreens seeks to turn those numbers around, starting at the neighborhood pharmacy.
“Walgreens at UCSF” is a pilot store that offers the most advanced level of community pharmacy care available in the United States today.
It starts with the store’s unusual layout: Walk inside and the first thing you see isn’t racks of cosmetics or greeting cards; instead there’s a concierge desk where you can arrange a private consultation with a pharmacist or find out whether your prescription is ready. Pharmacists work with every customer to make sure they understand the medication they’re picking up, while also offering services such as the medication management that brought Helen to UCSF.
“This collaboration aims to transform the practice of community pharmacies to enable pharmacists to do what they’re trained to do, which is helping patients manage their health with the right medications and understand how to take them correctly,” said B. Joseph Guglielmo, PharmD, a leader in the field of clinical pharmacy and dean of the UCSF School of Pharmacy, which partnered with the UCSF Medical Center and Walgreens in creating this new facility.
A New Model of Pharmacy Care
For Walgreens, the new facility is an extension of their “Well Experience” stores, which offer expanded health services, are designed to foster increased patient-pharmacist interaction and make them more accessible to community members and patients.
For UCSF, it will serve as a teaching ground for student pharmacists completing their doctoral degree program, a clinical training site for pharmacy residents, and a research facility that explores new pharmacy patient-care models and programs.
The new pharmacy model also comes on the heels of a new California law that took effect on Jan. 1, 2014, expanding the role of pharmacists on the patient care team.
Under the new law, which was based on Senate Bill 493, pharmacists can perform additional health care responsibilities within the realm of their expertise, such as furnishing travel medications, oral contraceptives and smoking-cessation medications, monitoring patient health and adjusting prescriptions, as needed. With additional training and certification, they will be able to provide further care, such as adjusting a patient’s medication therapy.
“People already know that they can go to a pharmacist for vaccinations,” said Marilyn Stebbins, PharmD, a clinical pharmacy professor who was an advocate for the new law. “Now, they’ll also be able to go to pharmacists as part of their health care team.”
The new facility, located across the street from UCSF Medical Center on the University’s Parnassus campus, will provide Walgreens pharmacist consultations as a standard of care to every customer, along with other services offered by the School of Pharmacy and Walgreens, such as comprehensive medication reviews for customers who receive prescriptions.
Pharmacists also will work with patients to create and update an accurate, portable medication lists, known as a MedList, to take to their appointments with medical providers, to help decrease drug-to-drug interactions and encourage patient medication adherence.
For the store’s grand opening on Feb. 25, the School of Pharmacy held a special event, called a MedList Clinic, where the public was invited to walk in for free pharmacist consultations.
Helen was among several dozen patients who came to assess whether all of her medications were still necessary, which ones might be conflicting, and which could be simplified to make her medication burden a little lighter.
Working with two UCSF pharmacy students and a faculty member, with her pill bottles arranged neatly on the square card table, Helen discovered that the pain medication she’s taken thrice daily for years comes in a higher dose, which would eliminate six pills per day. The pharmacists also told her those medications could be spread out more, helping her manage her back pain better in the evening, and she could talk with her doctor about getting a full month’s supply, so she doesn’t need to refill them as frequently.