North Carolina pharmacist [serial]

154 Pages·2000·9.1 MB·English

by  North Carolina Association of Pharmacists

1
^ll'jjev."
'Asheville Project
Results Exceed Goals
NCCPC
• Hears Recommendations on Credentialing
•Workplace Issues Discussed at Leaders Forum
1*
C
^if»
FEW THINGS ARE BIGGER
THAN 1ST CHOICE MARGINS,
SELL MORE. KEEP MORE. 1st Choice forValue t I r ft
OTC/HBA/HHC products are good for you and your I*^l ag--
customers. They're priced to give you exceptional /'OF
profit margins. And with more than 650 SKUs,
they're broad enough to satisfy everybody's needs. ,
ENJOYALLTHE NETWORK BENEFITS. Join more
than 1,000 independent and small chain pharmacies across the U.S. who benefit from
membership in the 1st Choice forValue network. Receive discounts and savings on brand and
^=. generic pharmaceuticals, national brand OTC/HBAs, pharmaceutical repack, the
&. 1st Choice private label line, and many more products and services.
THETOOLS YOU NEEDTO COMPETE. As a 1st Choice forValue
pharmacy, you also receive store signage, p.o.p. displays, shelftalkers,
I OUGHCOLDl LAXATIVES and advertising and promotions. To learn about all the 1st Choice
ANTACIDS IaNALGESICSI advantages, contact your BindleyWestern representative today. At
VITAMINS I FIRST AID] Bindley, we're surpassing expectations...delivering results.
1-800-800-4169
Shelby,NC
www.bindley.com
Bindley
Western
=1599.Bindl*,lV«llt>nD.uaCompany
826
1
OfficialJournalofthe North Carolina
North CarolinaAssociationofPharmacists
109ChurchStreet P
Chapel Hill.NC 27516 harmacist
800.852.7343 or919.967.2237 g
fax [phone]
JOURNAL STAFF
Volume80,Number1 ...applyingdrugknowledgeto improvehealth January/February2000
EDITOR
SallyJ.Slusher Inside
ASSOCIATEEDITOR
Daniel G.Garrett •Asheville Project Update 6
EDITORIALASSISTANTS
LindaGoswick • DCPH ReplicatesAsheville Project
Amy Hershberger I I
TeressaHorner Reavis
BethS.Williams • Workplace Issues Discussed at Leaders Forum
1
FINANCIALDIRECTOR
CatherineC.McDonough • NC Center for Pharmaceutical Care
BOARD OF DIRECTORS Hears Recommendations on Credentialing 14
PRESIDENT
Kevin L. Almond • DiabetesAdvisory Council Releases
PRESIDENTELECT "Patterns ofCare" Guidelines 1
William LHarris,Jr.
NC
PASTPRESIDENT • Collaboration to Impact Health Care
1
MargaretA.Sgritta
BOARD MEMBERS • Remembering Hurricane Floyd: The Experience
RandyAngel ofFour Pharmacy Practice Residents 20
Randy Ball
Alan Boyd
VKaenitcheEClomlloirnes • NCPRNAnnual Report 2
Johnny Hogg
MikeJames
Mike List • A Look at Consultant Pharmacists 22
SteveNovak
DebraSmith
DavieWaggett • ASHP Supports Medical Error Reporting System 24
TimWhite
JaneYounts
• Historic Meeting Unites Medical
TheNorthCarolinaPharmacist(ISSN0528-1725)is and Pharmacy Boards 24
theofficialjournaloftheNorthCarolinaAssocia-
tion of Pharmacists, published bimonthly at 109
CprhouvricdhedSt.t,oChNaCpeAlPHimlle,mNbCers275thlr6o.uTghheajloluorcnaatlioins • FDA Commissioner Underscores
ofannual dues.Subscription ratetonon-pharma- Pharmacists' Role 25
cists is $60.00 (continental US). Overseas rates
upon request.Periodicals postage paid atChapel
PHihlalr.mNaCci.sOtpairneionnostenxecpersessasreidlyinoftfihceialNoprotshitCiaornoslionra • NCAP Membership Benefits Employees 25
policiesoftheAssociation.Publicationofanadver-
tisement does not represent an endorsement. EditorsNote:WelcometothefirstissueofNorthCarolinaPharmacist'. TheCarolina
Nothingisthispublication may be reproduced in JournalofPharmacyhasundergoneamajorchangeandwehopeyoulikeournew
anymanner,eitherwholeorin part,withoutspe- format.Ifyou,orsomeoneyouknowhasinformationtosharewithourreaderswe'd
cificwrittenpermissionofthepublisher.POSTMAS- liketohearfromyou.Guestwritersandstoryideasarealwayswelcome.Formore
TER:SendchangestoNCAP109ChurchSt.,Chapel informationonhowyoucancontributetoourjournalpleasecontacttheNCAPoffice.
Hill,NC 27516.
&
Voice Vision
By doing things differently,
NCAP
Gets State and National Attention
DanielG. Garrett
Executive Director
Peoplegetattention whentheybehavedifferently. North • TheJanuaryissueofAPliA Todayfocusedonworkplaceand
Carolinapharmacy leaders madeadecisionseveralyears universalprescriptioncardsandhadcommentsfromfourNCAP
agotounifypharmacyinthestatetospeakwithonevoice members.
andshareacommonvision. Theinitial focusofbringing • TheFebruaryissueofJAPhA will haveupdatesonNorth
pharmacytogetherwasontheprofession itself. I amhappyto ^Carolinaactivitiesrelatedtocredentialingand moreresults
reportthatpharmacistsarerespondingpositivelytothesenseof fromtheAshevilleProject.
unityinourprofession. ThefirstNCAPmembershipdriveis • PharmacyTunesispreparinganotherfull supplementon
goingwellandweareontracktohaveover2000membersinour asthmacareinitiatives inourstate.
firstyear. WhathassurprisedmeistheattentionthatNCAPis Twopharmacytechniciansreceivedrecognitioninthe
gettingfromthoseoutsideofNorthCarolinaPharmacy. Ithas November/DecemberissueofCommunityPharmacist.
beensaidthat"attention"isthescarcestresource inthetwenty- • The DecemberissueofTheConsultantPharmacist(The
firstcentury. Peoplearebombarded withinformation and Journal ofASCP)publishedtwoarticlesby NCAPmembers.
communicationfromeveryangle imaginedandgettingpeopleto • Thecoverstoryinthe DecemberissueofAmerica'sPharmacist
payattentiontoyourmessageisthefirststeptowardspositive waswrittenbyanNCAPmember.
actiononyourideas. NCAPisdoingthingsdifferentlyfor • TheleadstoryintheNovemberASHPNewsletterhighlighted
pharmacy,andothersarepaying attention. workbyanNCAPmember.
InNCAP'sfirstmonthsofexistencewehavehadmeetingswith: ThoseoutsideofNorthCarolinawanttoknowhowtheycan
• The Governor'sTaskForceon Heart Diseaseand Stroke makepositivethingshappen intheirstatesandonanational
Prevention. level. Wemustbedoingsomethingrighttoattractall this
• TheNorthCarolinaDivisiononAgingPrescriptionAssistance attention.
ProposalWorkGroup. Prescription benefitplansarealsogettingattention. Wehave
• TheNorthCarolinaMedicalReview. beenbusycoordinating feedbackfrompharmacistsonthenew
• Medical DirectorsofNorthCarolinaHealthPlans. stateemployees'plan,theChildren'sHealth Initiative,and
• TheSubcommitteeoftheMedicalBoardandBoardofPharmacy monitoringdiscussionsonboththestateandnational level about
onClinicalPharmacistPractitionerRegulations. the proposalsforadrugbenefitforMedicarerecipients. Based
Whatisevenmoreimpressiveisthatwewereinvitedtomeet on recentinformationfromthepresident,congress.PhARMA.
withthesegroups. Itisoftensaidthatyoushouldbecareful what andnational pharmacy leaders,thereisapossibilitythatsome-
youwishfor. PharmacyLeadershopedthataunifiedvoiceand thingcouldhappenthisyearinWashington DCtoestablishthe
visionforpharmacywouldleadtoaplaceatthetableforpublic frameworkforaMedicaredrugbenefit. NCAP'spositionisthat
policyformationonissuesaffectingpharmacy. Well, it's reimbursementfordispensingmustbereasonable andthebenefit
working,andIhavebeenverybusytryingtokeepupthepaceof shouldincludecompensationforpharmacists" clinicalservices.
meetingwithallthegroupsthatwanttoknowhowNorth Wewouldpreferaplanthatisoperatedatthestate levelwith
CarolinaPharmacycan helpmeethealth needsinourstate. reimbursementatleastatthestateemployeeplanrate. This
NCAPhasbeen involvedinhostingtwomajormeetings,one positionisbasedonthepremisethatwepromotepatientchoice
oncredentialing andoneonworkplaceissues. Wethoughtit ofaccessformedicationsandthatpharmacistsplayanessential
wouldbeagoodideatoletthe leadersofthe nationalpharmacy roleinappropriateuseofmedicationsandpreventionofadverse
organizationsknowabouttheseforumsandinvitethemtoattend. drugevents. TheNCAPLegal andPublicAffairsCouncil is
Theresponsefromthenationalorganizationshasbeen signifi- stayingontopofthesedevelopmentsandwewill needthehelp
cant. I amgettingphonecallsfromheadquartersinWashington ofeverymembertogetourvoiceheardbythelegislators.
DC.Chicago,and KansasCity. Peopleareflying inandbeing AttentionisthekeyforPharmacy intherapidlychanging
connectedbyconferencecallstoparticipate inwhatishappening landscapeofhealthcaremanagementandreimbursement. NCAP
inNorthCarolina. hasnowgivenpharmacythe attentionwedesiredandit'supto
NCAPactivitiesandworkbyourmembersarereceiving allofustospeakwithonevoiceandonevision. Thanksfor
recognitioninnationalpublications. helpingusgetofftoagreatstart.
• TheDecemberissueofJAPhA featuredfourarticles
byNCAPmembers.
[email protected].
4 NorthCarolinaPharmacist,January/February2000
<Q.
ChapelHill.NC27516
*ph*ont C(9I|9,H|6986-79.2<23307
DearColleagues,
forZlZZfZV"6 a"dadVa"Ce*"*«-
' ofpharmacy
«
.™
*Pshysatremmasc,yspenrioofrecsarse^a^ndf° "! acydegree-es. T~he tno*pfaonudrhoftfice^ S?°?'"""^the^Va~st^<y^of
chafmoelxlecouwti^ver,ep1reisnednuts!tryneo,dr'tid™***^»*' a*caoduermf'ocu.r' Ccon^sulEtanSt T""*°UrSW6ebsite"h*av*ce
'PC»haParrroomlfaiencsays.iPohnTaahlZicseidwusict„a)t.hioenWleLlal'™"aU°^"n"^^T^C«°^n*t*inw*Uii*tn">St*«hea*fnadc«uflotryZt2mZdw2, "^'"^T**"*e°XbUtertitSsecsrhuo"eoo,PfsNpoofmrJ^
T
Members. Pharmacy .gq ^ti ? f 6™'P'easefeel free toe-mSlTr „ P'°beC°mmitted«
Sincerely, t0know-v°urconcerns.
KevinL.Almond
NCAPPre
Sldent
°PP'y<"!*r
Ugknowledgetoimprmeheakh
NorthCarolinaPharmacist,January/February2000 5
Asheville Project Update:
ADA
Results Continue to Exceed Goals
TheAsheville Projectcontinuesto thecostofaformaldiabeteseducation withapproximately 10,000coveredlives,
growandmakeadifferenceinthe programofferedbythe EducationCenter agreedtoofferthepharmacy sponsored
livesofpatients. ofMissionSt.Joseph's HealthSystem wellnessprograms indiabetesand
MostreadersoftheNorth Carolina (MSJ). asthma.
Pharmacistare probablyfamiliarwiththe Employeeswhoenrolledinthe
Asheville Project,butalittlebackground program agreedtogothroughthisformal Current Status
may behelpful. diabeteseducationprogramiftheyhad
Astrategicplanning meetingofstate notpreviously had formal education,orif AsofJanuary 1, 2000thereare 165
pharmacy leadersin 1995 resulted in a ithadbeen morethan twoyearsprior. patientsbeing followedbyprogram
decisiontosponsorpharmaceuticalcare Theyalsoagreedtomeetonaregular pharmacists. 121 withdiabetesand44
demonstrationprojectsin NorthCarolina. basis,usuallyevery month, withoneof withasthma. Twenty-twopharmacy
Atthetime a the speciallytrainedpharmacists,who locationsinthegreaterAshevillearea
byBarryBunting
lotwasbeing theyselectedfrom alistofthosewhohad currently providetheseservicesand65
saidabout"Pharmaceutical Care" in gonethroughthetraining. individual pharmacistshavebeentrained.
pharmacycirclesbutpractical models, Pharmacistswhowereinterested in Many pharmacistshaveparticipatedin
especially incommunity settings, were participating intheprojectagreedto bothdiabetes andasthmatraining,anda
lacking. The purposesoftheseprojects receivetraining in the managementand numberoftraineeshavebeenfrom
weretobeat leasttwofold. First,to monitoringofdiabetes. They alsoagreed outsideoftheAshevilleareaandeven
developpractical working pharmaceutical tothearrangementofprovidingpharma- fromotherstates.
caremodels. Andsecondly,todemon- ceuticalcareservicesatnochargeforsix
stratethevalueofutilizingcommunity months. Initiallyall pharmacistsinthe Outcome Highlights
pharmaciststoprovidepharmaceutical greaterAshevilleareaweresentaletter
careservices inimproving patientcare. informingthemofthe program and Forpharmacistsasignificantearly
Iftheseprojectscould successfully availabilityoftraining. Theoriginal outcomecamewithinafewmonthsof
developpractice modelsthat measurably trainingprogramattractedtwenty-four beginningtheprojectwhenthecity,
improvedpatientoutcomes,themodel pharmacistparticipantswhowent havingreceivedagreatdealofpositive
couldthen beexpandedandthedataused throughatwoweekend,thirty-twohour, feedbackfromtheiremployees,voluntar-
tolobby forpaymentfromavarietyof program indiabetes. Thiswasarranged ily beganpayingthepharmacists,even
payers. by NCCPCwiththeassistanceofThe beforeobjectivepatientdatawasavail-
Thefirstprojectwasbegun in UniversityofNorthCarolina,Campbell able.
Ashevilleearly in 1997. TheCityof University,sixareaphysiciansandThe Wewere understandably anxiousfor
Ashevilleagreedtopartnerwiththe DiabetesCenterofMSJ. comprehensiveoutcomesdatawhich
North CarolinaCenterforPharmaceutical In Mayof 1997, 2! pharmacists cameafterafullyearoftheprogram.
Care (NCCPC), which hadbeen formed participatedinacertificateprogramin Fortunately thisdataconfirmedthe
toplanand implementtheseprojects. asthma,andin November,enrollment subjectiveobservations. Average
NCCPCofferedtotraincommunity beganforcityemployeeswithasthma. hemoglobinAleresultsforthe40Cityof
pharmacists indiabetesmanagementand In October 1998. Pharmacy Times Ashevilleemployeesdecreasedfrom
toofferpharmaceuticalcare servicesfor publishedasupplement on "The 7.6%to6.2%. Total cholesterolaverages
cityemployeeswithdiabetes. They AshevilleProject"whichreported droppedfrom 210mg/dlto 198mg/dl.
offeredtoarrangethatthisbedone for significant improvementinclinical, The LDLaveragedecreasedfrom 118
thefirst six months atnochargetothe financial,andhumanisticoutcomesfor mg/dl to98 mg/dl. Alloftheseaverages
city. Then ifmeasurableclinicaland thediabetesproject patients. exceededtheAmericanDiabetesAssocia-
financial improvementscouldbedemon- InNovemberof 1998. 19pharmacists tiongoalsof<7%forhemoglobinAle,
strated. NCCPCwould negotiatewiththe participatedinanotherasthmacertificate <200mg/dlfortotalcholesterol,and
cityforpaymentforthe services. programandinJanuaryof 1999. 20 <100mg/dlforLDL. Healthstatusand
Thecityagreedtoofferincentivesfor j pharmacistsparticipated inadiabetes satisfaction withpharmacy alsoimproved
employeeswithdiabetestoparticipatein certificateprogram. significantly. In addition, thecity spent
this"wellnessprogram." Theseincluded Early in 1999asecondemployerwas nearly $20,000lessontotalhealthcare
waivingemployeeco-paymentson all added totheprogram. MissionSt. costsforthese40employeesduringthe
diabetes-related medicationsandsup- Joseph'sHealth System,the largest firstyearoftheprogramcomparedtothe
plies. Theyalsoagreedtopay 100% of employerinWestern NorthCarolina, previousbaselineyear. Equally impres-
6 NorthCarolinaPharmacist.January/February2000
sivewasthe findingthattheaverage "atlesscostandeffort." Andattwo baseline the MSJ patientsreported that
participant worked6.5 moredaysduring yearstheAsheville Project results asthma limitedtheirdaily activityan
theprojectyearcomparedtotheprior continue toexceededADAgoalsby using averageof4.5daysintheprevious
year. Thecityquantifiedthe monetary "widely availableresources" with month. Afterbeing in the programthis
valueofthisatapproximately$18,000. relatively little "time,effort, andcost." numberdecreased significantlyto 1.5
Secondyeardataforthisoriginal dayspermonth. Additionally,at
groupof40diabetespatients isjustnow More Outcomes baseline,only 10%ofenrolleeshada
becomingavailable.Althoughanalysisis NationalAsthma Education Program
stillbeingconductedweare pleased to Also, forthe firsttime,wehave (NAEP) recommended"asthmaaction
publish, forthefirsttime,someofthese asthmaoutcomestoreport. Ofthe44 plan." Asaresultoftheprogram 100%
results. Aftertwofullyearsinthe asthmapatientscurrentlyenrolledinthe ofenrollees now have individualized
programADAgoalscontinuetobe CityofAshevilleand MSJ programs 25 asthmaaction plans.
surpassed. Thegroup'shemoglobinAle have been inthe programatleastsix Furtheranalysisisbeingconducted
averagecontinuestobebelow7%,at months. The mostsignificant improve- onboththediabetesandasthmagroups.
6.8%. Thetotalcholesterol and LDL ment hasbeen in the MSJ group, which AsupplementtoPharmacyTimesin
averageshavedecreasedeven belowone interestingly hadsignificantly poorer March, 2000will includedataon not
yearlevels. Thetotalcholes- only theAsheville Project,but
terol averageis 190mg/dl and on otherpharmacyasthma
theLDLis94mg/dl. initiatives inthestate. And
Thesignificanceof nowthattwo-yeardataare
sustainedtwo-yearimprove- i availableon thediabetesgroup,
mentcannotbeoverempha- ourplan istopublishcompre-
sized. Itisextremely important hensiveresultsinapeer
forpharmaciststonotjust reviewedjournal thisyear.
demonstratetheirabilityto
improveclinical parameters, In The Works
educationalonecandothat,but
todemonstratethatapharma- TheCityofAsheville has
cist-patientrelationshipcan beensopleasedwiththe
sustain this improvement. We program'sresults,they are
are,afterall, attempting to askingus toprovideasimilar
provethatpharmaceutical care servicefortheiremployeeswho
isacost-effective intervention havehypertensionand/or
thatwill reduce long-term hyperlipidemia. They would
complicationsofdiabetes. like forpharmaciststostart
Risk reduction issomething seeingpatients inApril and
thatisnotattainable without haveidentifiedover200
prolongedimprovement in employees whomthey believe
bloodglucosecontrol. Unfor- AshevilleProjectCoordinatorBarryBunting, PharmD,explainsthe will qualifyfortheprogram.
tunately thislevelofcontrol is importanceofmanagingdiabetestoapatient. Wecurrently are verybusywith
often associatedwithhigh programplanningand are
resource, highexpenseprograms. baselinerespiratoryfunction thanthecity preparingtrainingprograms forpharma-
Notably,the 1,400patient, 10year, employees. Thisisanespecially cists.
landmark DiabetesControl &Complica- interestingfinding in lightofthe fact that
tionTrial (DCCT)statedintheirconclud- healthsystememployeeswould be Lessons Learned
ingparagraph. "Intensivetherapy was expectedtobe moreknowledgeable
successfullycarriedout inthepresent abouttheirasthma,andperhapseven Eachdisease isdifferent. People with
trial byanexpertteamofdiabetologists, havebetteraccesstocare. The MSJ diabetesseemtobe highly motivatedto
nurses,dietitians,andbehavioral special- group'sbaseline FEV1 (ForcedExpira- participate in wellnessprograms. Wehad
ists,andthetime,effort,andcost tory Volume in 1 second)averagewas almost 100% enrollmentofpatientswho
requiredwereconsiderable. Becausethe 64%,comparedtoabaselineof84% for wereofferedthediabetesprogram.
resources neededarenotwidely avail- thecitygroup. Bothgroups improved However, with asthmatheenrollment
able, new strategiesare neededtoadapt significantly, the MSJ average improving wascloserto25%. Approximately 75%
methodsofintensivetreatment forusein from64% to88%,andthecityaverage ofasthmaticshave infrequentsymptoms
thegeneral community atlesscost and from 84% to98%. There were also andpresumably itishardertointerest
effort." Ifsomeoneweresearchingfora significantimprovements inthe "Role theminwellnessprogramsthan someone
simpledescriptionofcommunity based Physical"healthstatusindicator,which is withdiabetes whohasconstantdaily
pharmaceuticalcare itcouldeasilybe ameasureoftheimpactoftheirdisease remindersoftheirdisease. And we
referredtoasa"newstrategy,""widely on theirphysical ability tofunction suspectthatenrollmentforprograms in
available," "in thegeneral community," normally onadaytodaybasis. At hypertension and hyperlipdemia,which
NorthCarolinaPharmacist.January/February2000
"
arevirtuallyasymptomatic,maybeeven disease. Physiciansreceiveacopyofall andprescribegoodtreatmentplans.
lower. Ourcurrentthought isthatwe programrelated laboratory information, Professionaleducatorsneedtocontinue
mayneedtomodifyourenrollment and spirometryresults,aswellas toassistpatientsin learningself-manage-
approachtoincluderiskawareness summary lettersandindividual patient mentskills. Pharmacistsneedtomonitor
educationpriortoenrollment. And recommendationsfromthe pharmacists. adherence,efficacy,sideeffects,and
perhapsthe incentiveswill needtobe There hasbeen amazingly littlenegative assess/supplementpatient knowledge.
different. feedbacktothisapproachand whatdid Andweall needtocommunicatewith
Followthemoney. Thissoundsa occurwashandledbythecity'smedical eachother. Duetopharmacy'stremen-
littlemercenary butthegeniusofthe directororthecoordinatoroftheproject. dousedgeinaccessibilityandmedication
AshevilleProject wasthe foresightof The primary fearofphysicianshasbeen knowledge,pharmacistshaveanopportu-
NorthCarolinapharmacy leadersto thatthiswasjustanothergroup"tryingto nitytopositionthemselvesasuniqueand
realizetheneedtobeginby partnering tell them how topracticemedicine,"and valuablehealthcare providers.
withaself-insuredpayer. Whetherit thatitwouldfurther"fragmentcare." It Noveltyvs.practice. Wearerapidly
wasconsciously spoken,orintuitive,the hasbeen helpful tobeable toemphasize approachingacriticalphaseinpharma-
questiontheyaskedwas,"Whostandsto that thesewere local pharmacists, who ceuticalcareinAshevilleandperhapsin
benefitthe mostfinanciallyifemployees hadreceived special trainingby local thestate. Wehavedemonstratedthat
live healthierlives'?" Theanswerwas physicianexperts,andwtiowere simply payersarewillingtobuywhatwehaveto
"employers." Sothisiswherethey actingasanextrasetofeyesandearsfor sell. It istime,asthesayinggoes,to
started. Underthetraditional U.S. model the physician. Alsowepointoutthat "fishorcutbait." Wehaveproventhe
employersbasicallypay 80% ofan patientsalreadyseepharmacistsfive boatwill floatbutwestillhaveonefoot
employee's healthcarecostsand, timesmoreoften thananyotherhealth intheboatandoneondry land. Itisnot
therefore,haveahugestakein clearatthispointhowmany
reducingoverall healthcare i"(...the genius oftheAsheville Project pharmacistsareinapositionto
costs. Soapproachingaself- stepintothe boatorevenknow
insuredemployerratherthan, was theforesight ofNorth Carolina howtodoit. Butacoupleof
forexample,an insurance modelsappeartobeevolving
company,avoidedamiddle pharmacy leaders to realize the need thatofferhopethatthisstep
manwhowouldhavevery canactuallybetakenbya
likely said"no." to begin bypartnering with a critical massofpharmacists.
Informandconnect. "Hiredgunchainmodel."
Although thereareprosand "Dual-hat independent
self-insuredpayer.
constothis method,our model." The ideal modelwe
general approach withphysi- envisionedseveralyearsago
cianshasbeentoinformthemofthe care providerandthatinthisprogram the nowseemsabitnaive. Someofushad
program,but notnecessarilyaskthemto participatingpharmacistswerecommit- hopedthatalargeenough numberof
givetheirblessingtoeverystepofthe tingtotaketimetomakethatinteraction pharmacistscouldbetrainedinaregion
process. Ifindividuals, and theirem- more useful toboththe patientand thatvirtuallyevery pharmacywouldhave
ployer,choosetoparticipateinawellness physician. apharmaceuticalcareproviderwith
programitistheirchoice. Afterall it is Nolonerangers. Wecandomany expertisein avarietyofdiseasestates.
theirmoney. Andeventhe20% share thingswellbutwe should notattemptto However, withtheshortageofpharma-
thatU.S.employeespayoutoftheir doeverything. Agoodexampleofthisis cists,the needformultipleexpensive
pocketseveryyearforhealthcare ourpartnershipwith theCertified certificateprograms,andafinitenumber
amountstoapproximately $265 billion. Diabetes Educators intheAshevillearea ofhighly motivatedpharmacists,this
Sotheyalsohave avestedinterestin toofferacomprehensiveeducation "ideal" modelhassomeproblems. Asthe
loweringhealthcarecosts. Thefirststep programforpatients. Pharmacists inthe realityofthishasset inwehavehadto
in informingphysiciansaboutthe projectdonotdoextensivedietinstruc- lookatdifferentwaysofmakingthis
programwasalettersentbythecity's tion. Pharmacistsareinanexcellent work. Wemayachievetheideal model
medical director, whowas involved inthe position toassesswhetherpatientshave someday but inthe interim weneed
planningoftheprogram,toallthe comprehendedandare applyingdiet differentmodels. Twooftheseseemto
physiciansinthecommunity whocared instruction thattheyreceivefromCDEs. beevolvinginourarea.
forpatientswithdiabetes. This letter However,wehavenotattemptedtotrain The"hired-gunchainmodel"maybe
informed themofthe intentionofthecity pharmaciststobeexperts indiabetic diet an answerforbusychain storeswhoare
tooffertheiremployeesawellness instruction. Thatis nottosaythatsome havingdifficulty staffingtheirstores,let
programthatincludedincentivesfor pharmacistsmayhavetheinterestto aloneprovidingpharmaceuticalcare. We
patientstocomply withthephysician's becomeexpertsorofnecessity needtobe currently haveapharmacistexperiment-
treatmentplan. Theletteralsoexplained thistypeofresource in areasthatlack ing withanapproachthatprovides
thattheprogramwould includetheuseof CDEs. Butourphilosophyhasbeento pharmaceuticalcareatseverallocations
speciallytrainedcommunity pharmacists connect-the-dots, notduplicatethem. We forachain. They havecontractedwith
tomonitorthesepatientsandassistthem each needtodowhatwedobest.
with self-managementaspectsoftheir Physicians need tocontinuetodiagnose Continuedonpage10
8 NorthCarolinaPharmacist.January/February2000