50 Stories from 50 States - New England

About the Pharmacy

Stoll's Pharmacy 
Waterbury, CT
https://www.stollspharmacy.com/

Description of Pharmacy

Stoll’s Pharmacy, Inc is a family-owned independent community pharmacy located in downtown Waterbury, CT since 1956. As an inner-city pharmacy, our bilingual staff serves a large population of low-income and elderly households. We offer the following services in our community:

• Medication Synchronization and Adherence Program
• Patient-Customized Adherence Packaging
• Immunization Services
• Narcan Prescribing and Opioid Awareness Training
• Medication Reconciliation and Medication Therapy Management Services
• Institutional pharmacy services for Long Term Care Facilities, Assisted-Living, Residential Care Homes, and Correctional Half-way Houses
• Durable Medical Equipment and Mastectomy Forms/Apparel (BOC Accredited) 

Pharmacy Story

For almost 2 years, Stoll’s Pharmacy was partnering with the City of Waterbury Department of Public Health and the Waterbury Fire Department on a community outreach initiative focused on the “opioid overdose epidemic”. Stoll’s pharmacists participated in over forty-five public Opioid Awareness/Narcan Training Events at various locations throughout the Greater Waterbury area. The Events were conducted as follows:  

#1: A Stoll’s pharmacist would start the event by explaining what an opioid drug is and providing examples of common drugs that were opioids. Our pharmacist then explained what Narcan was and how it worked to stop an overdose.

#2: A Fire Department First Responder would review overdose recognition (signs/symptoms of an overdose) and what to do if a person encountered a suspected overdose victim. They would then review the process that occurred after a person called 911. This included a demonstration of the various Naloxone products that could be used, including the naloxone kits the first responders had in stock on their vehicles and Narcan nasal spray kits that the pharmacy would be dispensing later in the program.

#3 The Waterbury Dept of Health Prevention Outreach Coordinator, a trained addiction counselor, would then talk about opioid risk factors, how to reduce overdose risk, and addiction prevention resources and addiction treatment resources available to the public.

The Pharmacy Intervention:

During the Question & Answers Sessions, Stoll’s pharmacists would write prescriptions and dispense Narcan Kits with one-on-one training to anyone interested in obtaining their own Narcan kit. This was done under event permits granted by The Department of Consumer Protection Drug Control for off-site (outside of the pharmacy premises) dispensing under their established protocols.

Outcome of care provided:

As a result of our pharmacy’s partnership with our local Department of Public Health and Fire Department, Stoll’s pharmacists prescribed and dispensed well over 200 Narcan kits to residents of our local community.

State/Federal Connections/Advocacy/Impact:

We were able to get Narcan into the hands of hundreds of people via an innovative collaboration with unique pharmacy partners. This was only possible because the Connecticut Legislature enacted new state statutes allowing pharmacists to prescribe Narcan and by following protocols established by the Connecticut Department of Consumer Protection’s Drug Control Division for dispensing an Rx product at locations outside of the pharmacy premise. By combining pharmacy services with those of First Responders and trained Addiction Counselors, we were able to educate numerous community residents about the realities of Opioid addiction. The program offers solutions they could use with confidence to assist an individual experiencing an opioid overdose. 

About the Pharmacy

Bangor Drug Company
Bangor, ME
https://bangordrug.com/

About the Pharmacy

Olden’s Pharmacy 
South Weymouth, MA
https://www.oldens-pharmacy.com/ 

Meet the Team

Faculty Lead Contact:  

• Todd Brown

​Pharmacist Lead Contact:  

• Paul Hackett, RPh  

​Student Pharmacist(s):  

• Silky Kaur  

Description of Pharmacy

Olden's Pharmacy is owned and operated independently by pharmacists and has been serving the South Shore region of Massachusetts since 1952. As a high-volume community pharmacy site that also provides clinical services, Olden’s is a true pillar within the community it serves which primarily consists of a middle/working class and older adult population. With the motivated staff that includes clinical pharmacists and student pharmacists, the pharmacy is able to provide a multitude of services beyond the dispensing of medications. Services offered at this site include medication therapy management, medication synchronization, special adherence packaging, immunizations, non-sterile compounding, diabetes education and care, durable medical equipment and more. 

Pharmacy Story

Initial Presentation:
A 61-year-old male patient with type 2 diabetes [Francis] came to Olden’s Pharmacy to pick up his medication refills. Francis had just come from a diabetes follow up with his primary care provider (PCP) and asked to speak to the pharmacist about some concerns around his uncontrolled diabetes and medication regimen.  

​Background:
Francis’ primary care doctor had prescribed the following for his diabetes regimen:  

1. Metformin ER 500mg – 4 tablets (2000 mg) once daily
2. Glipizide 10mg – 1 tablet (10mg) twice daily, 30 minutes before meals  

​Patient Report:
The patient reported:

• Often missing his second dose of glipizide as he forgets to take it sometimes  
• Not always taking glipizide before meals, more so whenever he remembered to take it  
• Expressed concern around self-monitored blood glucose values (SMBG) and most recent A1c, which had been >10%  
• SMBGs generally reported were above the recommended goals per the American Diabetes Association (ADA) guidelines – patient was using a traditional blood glucose meter:  
• Typically, >150 mg/dL fasting and >200 mg/dL two hours post prandial  
• Patient also reported difficulty around testing daily as it was painful to prick his fingers and had been hard to get a useable droplet size of blood  
• After the diabetes visit/follow up with his PCP, the patient reported that the focus of the visit was more diet-focused and minimal discussion around medication
• Patient also stated that he was hoping to lose weight to help with his diabetes and overall health  

​Physical Observation:

1. Patient appeared to be overweight and clearly upset about the uncontrolled diabetes to a point where it was starting to affect his motivation and mood  
2. Patient seemed overwhelmed with how much goes into diabetes care and did not know where to begin to help better control his condition  
3. He reported being more fatigued throughout the day for the last few months and wanted to learn how he could feel better and begin to control his diabetes  

​Intervention:
Education:  

• The pharmacist/student interviewed and educated the patient about the importance of caring for himself holistically which included working on diet, physical activity, and getting on an appropriate medication regimen that works for him, while remaining adherent to the current regimen.  
• Motivational interviewing techniques were used and included ensuring the patient understood that they were not alone but rather well-supported through this process as his wife was present. The pharmacist also let him know that the pharmacy is committed to helping him with his goals.  
• Guideline-directed treatment for type 2 diabetes was discussed, and patient was educated on why certain therapies were used over others which then led to conduction of a diabetes-focused medication review.

Comprehensive Medication Review:

• Conducted a diabetes-focused comprehensive medication review in which medication adherence issues were identified (missing second daily dose of glipizide often due to forgetfulness).  
• The pharmacist stressed the importance of taking glipizide twice daily and before meals to get the most benefit. Additionally, the pharmacist discussed more effective diabetes medications based on the current evidence and guidelines. Patient was amenable to trying a different type of medication after being educated on additional benefits for cardiovascular health and weight loss potential.  
• Educated patient about risk of hypoglycemia with current medication and went over recognition/signs/symptoms and how to properly manage it if it does occur.  
• Educated on the importance of continuing to taking metformin 2000mg per day due to its many benefits and also ensured patient was taking correctly.  
• Reviewed patient’s SMBG/testing technique and found that patient was uncomfortable pricking his own fingers and has trouble getting an appropriately sized blood droplet for test strip.  
• Suggested and educated patient about continuous glucose monitors (CGMs) such as the Freestlye Libre® which can prevent some of the pain experienced with traditional blood glucose meters, and also allow for a larger snapshot of blood glucose levels.  
• Educated patient on importance of testing at appropriate times of day to ensure accurate blood glucose readings.  

Action Plan For Patient:  

• Continue taking metformin 4 tablets (2000mg) per day  
• Continue taking glipizide 10mg as prescribed (twice daily). Set a reminder on your phone when it is time to take your second dose of glipizide and try your best to take it BEFORE meals to get the most benefit from this medication.  
• Talk to your PCP about potentially trying alternative diabetes therapies that are favored more by current guidelines and have a lower risk of hypoglycemia and weight gain.  
• Talk to your primary care provider about potentially trying a continuous glucose monitor (CGM) to allow for better monitoring of blood glucose at home. In the meantime, wife will assist with blood glucose measuring twice daily and write the numbers down.  

Action Plan For Pharmacist/student:  

• With patient’s permission, reach out to their PCP to inform them that the pharmacy conducted a medication review with Francis in which the following was brought up:  
• Patient is concerned about medication regimen and is not compliant with current therapy.  
• Suggest a plan to decrease dose or discontinue glipizide due to the minimal benefit for patient, alongside issue of non-adherence.  
• Recommend the possible addition of a more preferred therapy as Francis was receptive to try a new medication that helps both diabetes and potential weight loss. Request prescription if appropriate.  
• Recommend the potential for Francis to try a CGM such as the Freestyle Libre® and request prescription if appropriate.  
• Set up a follow-up visit in 2 weeks to review any medication changes and educate patient accordingly.  

Outcomes of Care Provided:
Outcome 1: Patient was transitioned to a more guideline-directed and effective diabetes therapy of once weekly Trulicity and discontinuation of glipizide.

• Patient’s PCP was amenable to pharmacist recommendation and sent a new prescription in for Trulicity® to be used once a week by subcutaneous injection.  
• Patient was educated by pharmacist once again on benefits, proper use, administration, possible side effects, and proper disposal.  

Outcome 2: Improvement in self-monitoring of blood glucose through initiation of Freestlye Libre® CGM for less painful and more effective blood glucose monitoring  

• Patient’s PCP was agreeable to pharmacist recommendation about trying a CGM.
• Pharmacist educated patient on proper use and informed him that PCP can also monitor his blood glucose levels through online, shared provider platform.  

Outcome 3: Greater trust built between patient and pharmacist  

• With the time the pharmacist spent on helping Francis, he was very appreciative of the efforts taken by the pharmacy to help improve his diabetes care.  
• With the action items, Francis reported he was more motivated to take care of his diabetes and get it under control.  
• After about 3 months, Francis reported that his A1c dropped to ~8% (a 2 % decrease since the initial assessment) and was feeling much better health wise and less fatigued. He also lost some weight which he attributed to the Trulicity®.  

State/Federal Connections/Advocacy/Impact:

Oldens Pharmacy is part of the Massachusetts Community Pharmacy Enhanced Services Network (CPESN) Network. This network of pharmacies has re-engineered their operations to assist patients with chronic disease management and provide services such as education, adherence, and medication therapy management. Because pharmacists are one of the most accessible health care providers, patients like Francis are increasingly turning to pharmacies like Oldens Pharmacy to get assistance with their conditions. This allows Oldens to provide these services and refer them to other health care providers when needed.

About the Pharmacy

Rite Aid Pharmacy
New Hampshire

About the Pharmacy

Walgreens Pharmacy
Rhode Island
https://www.walgreens.com/

Meet the Team

Faculty and Pharmacist Lead Contact:  

• Ginger Lemay, PharmD

Faculty co-author:

• Tom Kalista, PharmD

Resident Pharmacist:

• Joe Honig, PharmD 

Description of Pharmacy

Multiple-location, community pharmacy chain in a suburban area.

Pharmacy Story

Initial Presentation:
A 13-year-old patient came to the community pharmacy accompanied by mother and father for the first dose of the Pfizer COVID vaccine. The family was traveling out of state to visit grandparents next month and wanted the child to complete the vaccine series before the trip.

​Background:
The patient’s mother approached the pharmacy counter requesting to speak with the pharmacist. The mother informed the pharmacist the patient was extremely nervous. The pharmacist asked if there was anything she could do to make the patient feel more comfortable and the mother replied, “Please use his preferred pronoun.”

​Patient Report:
After speaking with the mother, the pharmacist gathered the necessary supplies to administer the vaccine and proceeded to the waiting area. Before leaving the pharmacy, she removed her white coat to reduce any anxiety. The pharmacist approached the teen and introduced herself, making sure to ask the patient their name and preferred pronouns. After establishing a rapport with the teen, the pharmacist escorted the patient and his father into the private consultation room.

​Physical Observation:
Once inside, the patient was very curious about the vaccine and agitated in his responses. He reported being uncooperative with vaccines in the past, including “kicking a nurse.”

​Intervention:
Education: The pharmacist approached the teen in an age-appropriate, patient-centered manner and successfully administered the vaccine:

• Spoke TO him and not about him to his parents
• Used a normal tone of voice
• Remained calm
• Kept full attention focused on him and his needs
  Allowed him to express concerns and ask questions
• Actively listened
• Ensured he was safely seated in the chair
• Provided an age-appropriate distraction (YouTube on his phone)
• Had a reward ready and available - lollipops!

Follow-up: Made an appointment for the 2nd Pfizer COVID vaccine in 21 days to complete the primary series

​Outcomes of Care Provided:
Outcome 1: Clinical Outcome

• The pharmacist administered 0.3mL Pfizer COVID-19 Vaccine (ages 12and older) intramuscularly in the left deltoid.

Outcome 2: Patient Satisfaction

• The patient successfully received the vaccine and overcame significant needle phobia. He felt more relaxed and capable of receiving future vaccines.

Outcome to the Pharmacy

• The pharmacist processed the vaccine using her NPI number as the healthcare provider ordering the vaccine for the patient. The claim was adjudicated to the private insurer for reimbursement.
• The pharmacist documented the vaccine administration using the Vaccine Screening Form, scanned the image into the pharmacy dispensing system, and filed the hard copy in a secured location in the pharmacy. A copy of the vaccine documentation was electronically sent to the teen’s pediatrician. 

About the Pharmacy

Rutland's Pharmacy
Rutland, VT
https://smilinsteve.com/