50 Stories from 50 States - West

Description of Pharmacy

Hendricks Pharmacy is an independently owned community pharmacy, located in Claremont, CA, a city in the county of Los Angeles, CA. Hendricks Pharmacy has served Claremont residents since 1954, and under current ownership, Dr. Brian Garner since 2003.  Claremont’s population is 36,000 and the median age is 40 years old. The median household income is approximately $101,000 and 56% of the population has a bachelor’s degree or higher. Hendricks Pharmacy is near multiple elderly independent living communities, nursing homes, and universities. Hendricks Pharmacy primarily caters to senior citizens and college students.  Hendricks Pharmacy is a CPESN participating pharmacy that offers the core services as well as, home delivery, naloxone dispensing, and birth control furnishing.

PHARMACY STORY

Hendricks Pharmacy served as one of my Chapman University-CPESN residency sites. During my time at Hendricks pharmacy, I was tasked with implementing clinical services and, given the state of the COVID-19 pandemic, our goal was to become the ultimate source of information and site for COVID-19 vaccines. When we started administering COVID-19 vaccines, we weren’t strangers to the appointment-based model, as we’ve used it for other services, including we offered, birth control furnishing, routine vaccinations, and formerly our travel clinic. We knew that we would serve as a major vaccine resource center for the community, especially as the major vaccine hubs were closing and other age groups would shortly be eligible/approved for inoculation. It was shortly after we got our supply of the Pfizer vaccine, that it was approved for individuals aged 12+. We opened our appointment calendar for a special weekend event for individuals 12+ (with the aim of catering to individuals 12-15 of age) with tentative appointments, pending FDA and CDC approval. This was possible because we monitored and tuned into scheduled FDA and CDC meetings. We would go on to administer roughly 300 doses via a clinic set up on Friday and Saturday of that weekend.

It was our preparation leading up to this that allowed us to have such a successful event,. The preparation includes the hiring of 6 additional staff (pharmacists and pharmacy interns) for the vaccination efforts (pharmacists and pharmacy interns). In addition, with the waiving of the Business and Professions code in California regarding provisions prohibiting pharmacy technicians from administering COVID-19 vaccines, two of our established pharmacy technicians completed training in vaccine administration.  Furthermore, a thorough training with administrators (pharmacists, pharmacy interns, technicians) was completed, including COVID-19 vaccine specific information. Hendricks pharmacy’s continued relationship with local schools of pharmacy, including Chapman University, allowed us to train/educate/utilize student pharmacists during this event. This training included a workflow briefing, as well as specific vaccine facts. It was important to Dr. Brian Garner (PIC/Pharmacy Owner) and I that we vaccinated the community in a safe manner in an environment that allowed for mass vaccination, without the feeling of the rush of mass vaccination. We utilized dividers to provide privacy for everyone and highlighted the importance of cleaning measures during this time. Our workflow included a check-in station, where individuals who signed up via our website were greeted and identified, they took their paperwork to the next station(s) where an administrator also verified their identity and confirmed the vaccine they were to receive, followed by a final station where they would be observed for 15-30 minutes and provided with a vaccine card and a complimentary bag of snacks.  In addition, pharmacy interns learned the importance of educating the public about the COVID-19 vaccines. Student pharmacists were encouraged to review the clinical studies and counsel patients on common side effects, and how to alleviate them. Furthermore, student pharmacists learned how to dispel vaccine misinformation and combat vaccine hesitancy.  This event kicked off a trusting relationship between the community, specifically with the parents and the teenagers being inoculated. The process didn’t feel rushed, and they were grateful the local pharmacy was offering the vaccines immediately after FDA/CDC approval. Another part of this successful event was our streamlining of the process from signing up via our website, checking in at the pharmacy, getting vaccinated and being discharged with a bag of goodies.

This event paved the way for us to provide COVID-19 vaccinations to the masses while still maintaining a smooth and clinically sound experience for our community. What we learned from vaccinating the teenagers we applied to future groups, the boosters, and children 5-11 years of age. As we received the different vaccines we streamlined the process further, by utilizing stamps, labels, color coordination, and a verification system when drawing up vaccines, to ensure the correct products are administered to the intended individual.  We can proudly say, to date, we’ve vaccinated a total of 10,793 and counting of the Claremont children, teenagers, and adults.

Breakdown of Vaccines Administered to Date

Pfizer- 8,535

Moderna- 1,569

J&J- 689

State/Federal Connections/Advocacy/Impact:

In the state of California, pharmacists are healthcare providers (Bill 493) with authority ; provide the administration of medications and biologics when ordered by a prescriber, independent immunization of individuals 3 years of age and older, ordering and interpreting appropriate tests for drug therapy in conjunction with a primary care provider, the dispensing of prescription nicotine replacement products, dispensing of travel medications not requiring a diagnosis, dispensing of self-administered hormonal contraceptives, training and educating about drug therapy , disease management, and disease presentation. In addition, this law established the advanced practice pharmacist, an expansion of these services and greater autonomy as a pharmacist.

The California board of pharmacy has issued various law waivers throughout the COVID-19 pandemic that has allowed pharmacists to serve their patients and communities. Such waivers have allowed for pharmacy technicians to administer COVID-19 vaccines after undergoing the appropriate training. In addition, changes to the ratios of pharmacists to technicians and interns have allowed pharmacies to utilize more individuals during times of greater demand. 

Description of Pharmacy

Geographic description

• We are in Newport Beach, CA,Ca. We are located across the street from Hoag Hospital, which is the highest ranked hospital in Orange County, five years in a row. Overall, we are based in a medically underserved population in a non-rural health area.  Our highest population for patients is in women’s health and neurosciences.

Patient population description

• Based on maps provided above, we are based in a medically underserved population in a non-rural health area. Could expand services offered by the practice site(s)

Medications Services

• Here at Newport Lido Pharmacy, we offer many medication services that include prescription compounding, flu shots and immunizations, durable medical equipment, adherence packaging, medication synchronization, medication therapy management services, and private consultation room.

Over the Counter Services

• Pain Medication, Cold and Allergy medications, Oral Health products, Feminine hygiene products, and first aid items.

Type of practice

• The type of practice is an independent multiple location chain pharmacy. Newport Lido is a pharmacy that is a part of a group of 6 other pharmacies all located in Orange County and up to Upper Los Angeles County.

Pharmacy Story

Having Hoag hospital right next to our independent pharmacy allowed us to broaden our community reach, while also being able to provide patients with excellent care from our staff. We work one on one with providers to create, gather, and supply patients with their medications right before discharge instead of having the patient travel to another pharmacy that could be a stretch for the patient to get to. A patient may not have the ability to go to a pharmacy after discharge depending on the reason for the hospital stay. Once we have all the information we need from providers, the pharmacy staff will get everything ready for the patient and will walk to the patient’s bedside at Hoag Hospital. This is where the patient can ask any direct questions to a trained clinical pharmacist.

Outcomes of care provided:

• Quick Bedside Delivery: Newport Lido Pharmacy is located right across from Hoag Hospital, allowing the team to provide medications in a timely manner to patients.
• Patient Consultation: This face-to-face consultation allows the patient to ask any questions about their new medications to a clinical pharmacist. Having a pharmacist go over this information with the patient is critical in getting the patient on the right path after discharge from the hospital.
• Lowest Out of Pocket: We partner with many different manufacturers and insurance plans to help us get the overall lowest out of pocket for the patient.
• Avoid Re-hospitalization: This is our overall mission for creating our meds to beds program. We want to ensure that we avoid re-hospitalizations for these patients and overall keep them on the right path to recovering from whatever they faced before.
• Personal/public health impact of care provided: With our meds to beds program, we look bring lower out of pocket prices and avoid re-hospitalization.
• Care providers involved: Pharmacists, Pharmacy Techs, Doctors, Nurses

State/Federal Connections/Advocacy/Impact

• Currently the Center for Medicare Advocacy promotes discharge planning and Meds to beds programs, with the idea that good discharge planning for patients, their families, and their healthcare providers, paves the way to successful transitions from one care setting to another.
• Another advocate, Disability Rights California, has an overall debrief of hospital discharge rights. “Section B describes state laws that apply to an individual if he/she (hereinafter “they”) is admitted to a hospital regardless of whether they have insurance. Section C describes additional protections available to those in hospitals that accept Medicare payments regardless of whether they are insured, have Medicare1, or have Medi-Cal.2 Section D describes the additional protections an individual will receive if they have Medicare. Section E describes notice and appeal rights.  Section F provides additional resources”.
• Lastly, Senate Bill 1152, states a specific hospital discharge process for homeless patients.
• This is just a small amount of state/federal legislation and advocacy efforts in California to help those either in a discharge program or meds to beds program. 

Description of Pharmacy

Clearspring Pharmacy is an 3-location independent pharmacy in the Denver and metro Denver area.  The interaction described above took place at the pharmacy in the neighborhood of Cherry Creek in Denver. Cherry Creek is an affluent residential district with a vibrant shopping scene, boutiques, restaurants, and galleries. Services offered include, compounded medications, medication synchronization, diabetes self-management education classes, point-of-care testing, immunizations, as well as a wide selection of pharmaceutical-grade supplements.

Pharmacy Story

Initial Presentation:
A 73-year old woman called Clearspring Pharmacy to let them know that her caretaker who was helping her organize her medications would no longer be able to serve her.  Patient was currently on 8 maintenance medications. She would also often call confused on when she needed to refill her medications claiming she was already running low despite a recent fill.

Intervention:
It was recommended that her medications become synched via the PrescribeWellness platform and then put into Dispill packaging monthly. The patient is called 7 days prior to her monthly fill to go over her medications and make sure no changes have occurred.  After her medications have been packaged into the Dispill packaging, the patient is called to come in to pick up her medications.  At that pick-up appointment, the patient’s blood pressure is taken, immunizations are done (if needed), and the pharmacist discusses the medications with the patient asking about side effects, new over-the-counter medications, and adherence.

Outcomes of Care Provided:

Outcome 1: Patient Impact

The patient is able to know what medications she needs to take and when she needs to take her medications without a caretaker since they are packaged neatly into the Dispill packs.  She can also look back and see if she forgot to take her medications based on the bubbles still full in the packs. Since the pharmacist is monitoring her blood pressure monthly, the patient is aware of her blood pressure goal and will have a better chance of getting to her goal of <120/80. The patient is kept up to date on her immunizations.  At 1 visit she received her influenza vaccine as well as her Covid-19 booster.

Outcome to the Pharmacy

• The pharmacist documents each of the pick-up encounters via an eCare Plan and shares those plans with her provider.
• Synching the patients medications and meeting with her monthly helps the pharmacies STAR ratings (quality ratings for Medicare) due to adherence.
• The pharmacy also has more time since the patient is no longer calling the store multiple times per month to refill her medications.
• The patient is also on 1 very expensive medication and by having her medications filled at the same time every month, the pharmacy does not have to keep that medication sitting on their shelf but they are able to order right before it is needed.
• Care Providers Involved:
  • Pharmacist - calls patient to inform of upcoming fill, meets with patient at monthly appointment, takes blood pressure, gives immunizations, documents ecare plan.
  • Pharmacy Technician - packages the medication into Dispill Packaging
  • Physician - eCare plans are sent to them to inform them of recent blood pressure, immunizations completed, or issues addressed with patient.

State/Federal Connections/Advocacy/Impact:

Clearspring Pharmacy is part of CPESN as well as their Flip The Pharmacy program. This has helped the pharmacy transform to a more clinical patient-level care mindset and away from the point-in-time, prescription-level care process.

Clearspring Pharmacy participates in a grant through the Colorado Department of Public Health and Education which encourages the appointment-based-model and numerous clinical initiatives such as Diabetes Self-Management Education and Support. 

Description of Pharmacy

KTA Pharmacies include four family-owned, community pharmacies located within grocery stores on Hawaii Island. We serve patients island-wide with our four pharmacy locations and seven grocery stores. Hawaii Island, otherwise known as, “The Big Island,” lives true to its name and is the largest island in area in Hawaii. Filled with a diverse community, the entire island is designated as rural. Our pharmacies are located on the north, east, and west side of the island. Our pharmacies provide clinical services such as: medication synchronization, immunizations, point-of-care testing, medication therapy management, chronic care management, Diabetes Self-Management Education, Diabetes Prevention Program, and more. 

Pharmacy Story

Being in the midst of a global pandemic required pharmacies to pivot their operations and focus on services that were needed most. In our community, that pivot was towards vaccinations and point-of-care testing (POCT). While POCT was always something on the back of our minds, it became apparent very quickly that there was a need for access to quick and reliable testing. While waiting for our CLIA Certificate of Waiver (certification needed for any laboratory testing) and State Laboratory Permits, our pharmacies partnered with a lab and our local Department of Health to provide POCT for COVID-19. With this partnership, our community had access to another source of free testing at a time that it needed it most. Starting with a pilot project in local schools, we quickly grew to mass testing at county facilities, and collectively, our pharmacies and dedicated staff were able to provide over 17,000 tests island-wide in a span of 6 months. Along with collection of samples and performing the tests, we provided education to those who were being tested. The education piece was critical for our community. It included flyers, phone calls, and verbal consultations about “What to do after you test.” As we move forward, this service will remain available to our community and potentially expand to other types of point-of-care tests that are needed. KTA’s Director of Pharmacy Operations, Kerri Okamura, states, “POCT increases access to testing when needed… especially in communities with limited healthcare capacity.” Establishing a successful new clinical service would not be possible without teamwork. Our staff of pharmacists, technicians, volunteers and independent contractors all worked together to provide the, “Compassionate, Kind-Hearted Care You Can Trust!” which remains the principle that we stand by.

State/Federal Connections/Advocacy/Impact:

The ability of our pharmacies to be able to start point-of-care testing as a new clinical service would not have been possible without the support of Community Pharmacy Enhanced Services Network (CPESN) and the National Association of Community Pharmacists. Their expertise in regulations and workflow were imperative in getting our program off of the ground. Pharmacies are one of the most accessible hubs for healthcare and are able to provide clinical services, like point-of-care testing, to patients who need them the most. To continue this access to care, it is crucial that beyond the public health emergency, pharmacists can continue ordering vaccinations and point-of-care tests. 

Description of Pharmacy

Smiths’ Food and Drug, Inc. is a division of The Kroger Co., the largest traditional supermarket chain in the United States. Smith’s operates 137 pharmacy locations in seven states in the Intermountain West. The interaction described above took place at the Smith’s Marketplace store #495 location in West Jordan, Utah, which serves low-income and moderate-income households. This pharmacy itself is not located in a designated Primary Care Health Professional Shortage Area (HPSA), but many patients live in HPSA neighborhoods in the two -mile radius surrounding our pharmacy. Services offered at this site include medication synchronization, COVID vaccines, COVID antibody testing, adult and child seasonal and scheduled vaccines, hormonal contraceptive assessment and prescribing, diabetes prevention screening and group classes, chronic disease health coaching, biometric health screenings, A1c point of care testing, and more.

Pharmacy Story

Initial Presentation:
A 68-year old male patient (Mike) came to Smith’s Marketplace Pharmacy to pick up medication refills. The pharmacy team was actively recruiting for our National Diabetes Prevention Program (NDPP) classes. While filling the medications, the pharmacist offered a Pre-diabetes Risk Assessment Form to the patient while he was waiting. The patient filled out the assessment with a score of 5, indicating high risk of developing diabetes.  

Patient Report:
The patient reported:  

• Concern for developing diabetes.
• Slight, gradual weight gain over the past 5 to 7 years, especially since retiring.
• Shared that he wanted to focus more on his physical and mental health, especially his energy level and mobility.

Physical Observation:
Mike appeared to be in good health, in no apparent distress, limitation, or pain. Mike had a pleasant demeanor and seemed aware of his health and medications.

Intervention:

1. Assessment: Mike’s score of 5 on the Diabetes Risk Assessment and his desire for improved health made him a great candidate for the NDPP class.
2. Enrollment: Our pharmacy team enrolled Mike in the NDPP class and provided him with the participant handbook.
3. Education: The pharmacist lifestyle coach educated Mike and the other group members on the NDPP class and what the schedule and classes would be like. Each class included a private weigh-in and self-report of minutes of activity, recap of the prior session–including goals achieved and success stories, a new topic, a case patient, active participation, and specific goals setting within action plans.

Planned follow-up for each week: A new weekly topic related to diabetes and risk reduction: activity, nutrition, shopping, menu planning, disease characteristics and progression, triggers, planning and more. Each week Mike reported on his minutes of activity, his weight and his progress toward his action plan goals.

Outcomes of Care Provided:
Outcome 1:  

Mike made significant improvement in his minutes of activity each week, often far exceeding the program goal of 150 minutes of moderate intensity activity. Mike also reported an increase in endurance and physical strength.

Outcome 2:

Mike reported moderate weight loss through the 18-month course. Mike discussed a healthy, mindful relationship with food and meal planning.

Outcome 3: Mental Health Support and Engagement during COVID stay home restrictions  

The NDPP class was disrupted along with all in-person gatherings in March 2020. In late 2020 the pharmacy offered NDPP participants the opportunity to join together through Zoom technology to continue to learn together and support each other in their lifestyle goals. Mike chose to rejoin the cohort. His physical and social health were supported through Zoom engagement with coaches and cohort members.

Outcome 4: Family Support and Engagement

Due to Mike's example, his wife Chris decided to join a NDPP cohort a few months after Mike. Mike and Chris worked independently and together to incorporate principles they learned regarding reducing the risk of developing diabetes.

Outcome 5: Additional Medication/Service – Biometric Health Screening  

Due to the trust built between Mike and Chris and the pharmacist lifestyle coaches, Mike and Chris also decided to get pharmacy-provided, point-of-care biometric screening that included fasting blood glucose, blood pressure, BMI, total cholesterol, LDL and HDL.

Outcome to the Pharmacy:  

• The pharmacist documented each of these encounters with Mike in the Impact Diabetes portal so that each pharmacist lifestyle coach on the team could view the patient's progress and continue his care.  
• This documentation also allowed for the pharmacy team to be reimbursed through the Kroger and APhA grant for the meaningful care provided to help improve this patient’s life and reduce his risk of developing Type 2 diabetes.
• The aggregate of CDC National Diabetes Prevention Program (NDPP) data gathered across The Kroger Co. enterprise added to the national body of knowledge regarding the impact of the NDPP program and curriculum. 

State/Federal Connections/Advocacy/Impact:

The care provided to Mike was made possible through The Kroger Co.’s participation in APhA’s grant for implementing the CDC’s National Diabetes Prevention Program.  Smith’s has also been involved with the Community Pharmacy Enhanced Services Network Utah. CPESN Utah is a network of pharmacies across the state that provide extra services such as medication optimization activities or medication delivery to help improve the health of their patients.  Negotiation of payment for patient care services through CPESN allows Smith’s to not only dispense necessary medication to patients, but also to provide chronic care management, as evidenced by Mike’s and Chris’s story. Pharmacies are key health care access points for many patients like Mike and Chris, but to make providing this level of care financially feasible at pharmacies, we need to be recognized as health care providers to be able to ensure this level of care is available to people in all communities through their local pharmacy.

Description of Pharmacy

Amy and Scot Schmit are the owners of North Star Pharmacy and Infusion opened an infusion company in 2007 and in 2011 they opened their retail pharmacy. Amy is  a social worker at CPESN and works on the social side of the pharmacy’s goal of providing patient care. and Scot is a pharmacist.

Pharmacy Story

Interview conducted with Amy Schmit on March 17th, 2022.  

Who does your pharmacy serve?  

Residents of Cheyenne Wyoming which has a population of 60,000 and 100,000 in the county. It is one of the largest cities in Wyoming. There are a lot of elderly patient but the pharmacy serves a mix of people  

What services does your pharmacy offer?  

Traditional prescriptions, retail of other health needs and over-the-counter products, infusion, compounding (sterile and non-sterile), drug adherence packing, and unit dosing.

What would you say is one of the most impactful patient stories from your pharmacy?  

In 2021 we did COVID clinic, the pharmacy was specifically contacted by the CDC to get more Pfizer in Wyoming. We had only 10 days to do it. Population is up to 500000 people who are eligible to come to the clinic for the vaccine. In less than a week they put a clinic together with  assistance from Cheyanne hospital, EMT, fire department, nursing and pharmacy students and volunteers in their community. The clinic administered 1211 doses and put on a large event like that in a whole week. The first clinic was in Feb 2021, and ran smoothly. When it was time for patients to come back for the 2nd dose, the week of the second clinic got 44 inches of snow so had to deal with additional stress of clearing the parking lot so all 1200 people could get their vaccines. This was not a typical snowstorm for Wyoming, as the power was out at most places and children were out of school due to inclement weather. Scot was taken to work on a snowmobile to check on the fridge storing the vaccine. An intern picked them up on a snowmobile for the second clinic. Volunteers cleaned up the parking lot to successfully complete the second clinic that had a 99% return rate. The pharmacy was able to absorb all missing patients needing their second vaccine to the pharmacy store on a different day.

We had a 12 year old patient with cancer who wanted to die at home, so we coordinated with the family for a pump and a pain medication to die at home. We were able to do this with the sterile compounding lab. Everyone's health care is so individualized, having a surface for any need that may arise is a goal of the pharmacy. We always go above and beyond if we are able to contract and put into place a service. My (Amy’s) social work background and trying to incorporate that in the community to make sure patients’ needs are being met. Need to have the same resources and communicate where resources are to patients.  

How has providing these services impacted the patients you serve and your community?

We realized that healthcare is not a 9-5 profession, that patients' health needs address at different times. Scot is willing to meet their patients whenever they are needed and if something happens off hours all patients have Scot cell phone for emergencies he will meet them and take care of them. Taking care of hospice patients as it is near and dear to their heart, anything to make their patients lives easier. Lots of services and diversity but taking care of people is the most important thing.

How impactful would it be to be recognized as a provider nationally affording patients access to services like yours nationwide?  

We would like a health information exchange for community pharmacists to help be a part of an interdisciplinary team and engage in a health team. Patients should be rotating around the providers to treat patients in a more comprehensive way if they are stable in the center. Providers can’t be experts at everything but really good at what we know. Utilizing each other's strengths and having access to each other's notes for the patient would put them at the center of care and provide them the best quality care.