Part 1: Meet some outstanding R.Ph.s who are making a difference in community pharmacy

What better place to try something new than at the crossroads of a new millennium? In previous years, Drug Topics divided salutes to the best and the brightest into separate groups of independent pharmacies, hospital pharmacists, and chain pharmacists. Also, during those years, the nominations for outstanding pharmacists came from wholesalers or corporate executives.

But this year, for the first time ever, nominations were opened up to readers, who were asked to nominate pharmacists they consider to be the crème de la crème in their chosen fields. A full-page Nominating Ballot Form appeared in several recent issues of Drug Topics and on the home page of www.drugtopics.com. Nominations were suggested for the whole spectrum of pharmacy—independent, chain, hospital, long-term care, or managed care.

Suggested criteria for nominees included pharmacists who, through innovative practice, have made a difference in patients' lives during the past year. Nominees did not have to be limited to the nominator's pharmacy and could practice in a supervisory or staff position.

Proving that people really do appreciate those who give something extra to their profession, nominations flowed in via the U.S. mail, over the fax, and through the Internet from patients, technicians, fellow pharmacists, interns, supervisors, students, and others. And hardly a venue was left out—nominees represented the corner drugstore, the major chain, the hospital, the nursing home, the Internet, mail order, and public health service.

And the winners are…

Interestingly, the qualities co-workers and others praised mirrored those found laudable by wholesalers and chain executives in prior years. Caring about customers and patients was one quality that showed up repeatedly on nomination forms. Dedication to pharmacy was another.

Because of the large number of nominations, it is not possible to profile all of the nominees. But we did talk to many of them in order to spotlight a representative sampling of the honorees, who are listed at the end of the articles in this two-part series.

Featured in Part 1, appearing in this issue, are outstanding pharmacists from chain and independent settings. Part 2, which will appear in the next issue, will feature pharmacists from hospital, consultant, and other practices.

CHAIN PHARMACISTS

For many, chain stores equate with assembly lines. But that's not always true, if the nominations coming in from chain stores are any indication. Included in this category are chain, supermarket, and mass-merchandising pharmacists.

John J. Johnson, who is pharmacy manager at Kmart #3985 in Lakeland, Fla., recognizes the importance of extra attention to customers. His nominator described him as "caring and compassionate toward our patients; he is never too busy to explain a medication or give an OTC recommendation." Johnson places special emphasis on moving out of the pharmacy to help people with questions, even if it's about over-the-counter items. He explained, "If people are not getting their prescriptions here, then they see the pharmacist come out and help with their OTC, I think down the road they bring their prescriptions here."

Also, Johnson feels that if customers see the personal service, they're not as likely to change stores "just because we're busy one day and they have to wait a while longer." And even though the store has no formal delivery policy, Johnson has been known to drop off Rxs or meet people halfway when they can't get to the store before it closes, or when seniors, especially, have trouble getting out. The need for that extra service comes up only once or twice a month, he said, "but I think their knowing we're willing to do that keeps them coming back."

A personal relationship with customers is the mantra of Benji Post, pharmacy manager of Fred's Pharmacy in White Hall, Ark. "I love taking care of the people," he exclaimed. His nominators wrote, "His patients absolutely adore him." Post makes a special effort to learn more about his patients than just what their medicines are. "I want to know if they have a new grandchild, or if they have a dog that is sick." Getting to know people, showing you care, and treating them all the same builds trust, he said. "In pharmacy, I believe the only way you can build a business is by word of mouth. You can build a business or destroy a business that way."

It must work. When Post started at Fred's about 18 months ago, they were doing about 40 Rxs a day; now they handle more than 100 a day. "It's all about taking care of people," he said, and that means more than counting pills or even explaining their medications. "Taking care of them often means listening to their problems, even if it takes five minutes out of your day." Even when he worked at a pharmacy doing 500 Rxs a day, he still found that five minutes for a patient who needed someone to listen.

Mike Poch, the pharmacy manager at Shopko Pharmacy in Pullman, Wash., was nominated for his eagerness to share knowledge with his staff. Poch finds details interesting. For example, he explained, "Rather than having only general knowledge about a general class of drugs, sometimes there are interesting specifics about individual drugs. And that's what I try to share." His nominator called Poch "one of the best preceptors I've ever had."

In Amherst, N.H., Skip Folsom proves that one doesn't have to know people well, work in a corner drugstore, or be a veteran pharmacist to build a rapport with customers. Folsom graduated from pharmacy school in 1998 and only recently moved to New Hampshire to work for Wal-Mart Pharmacy. He makes an extra effort to be sure his patients are utilizing all discount programs available, plus he pushed for an intern program this summer. "That frees up the pharmacists so we're able to go out into the OTC area to talk to people and help them out," he explained.

One day, a patient came up and gave Folsom a big hug. "She'd tried several different medications to control her blood pressure, and of course had many questions during the process, before finally getting the right one. So she was thanking me for being patient with that." Other patients have sent him thank-you cards. And it's not unusual for patients to drop by even when they don't need an Rx filled to let him know how a family member is doing or why they haven't been by lately. But Folsom insists it's a two-way street. "It would be impossible for me to find quality time to spend with patients without the excellent staff we have here."

Marylee S. Reynolds, Pharm.D. and pharmacy manager at ABCO Desert Market's Tucson store, is trying to make her practice as unique as she can. For starters, she set up a patient medication monitoring program for extremely noncompliant patients. Usually they are elderly patients, "because that's my population here. But sometimes they are cancer patients or simply difficult-to-handle patients."

In the beginning, patients bring Reynolds all their medication bottles, including all OTCs or vitamins they're taking. "Then I go over all their medications with them and give them a med box, divided into four times a day for one week. Then I send them on their way." She will monitor blood sugars for diabetes patients, adjusting medications as necessary. "Then I'll let the physician know, and he or she goes ahead and adjusts the prescription for me." Once a patient is compliant, Reynolds will lay out pills for two weeks, then for a month. "It's working great," she said. "Right now, I'm getting a cancer patient, and we're trying to get her pain under control. It's clinical pharmacy on a retail level."

Reynolds also makes it a point to visit her patients when they're in the hospital. "I'll go in and go over their chart and let them know what's going on with them. Then I leave a note on the chart on what medications I know they're taking or on any nuances for that particular patient." This special service began when one of her patients became upset because her husband was in the hospital and she couldn't figure out what was going on and didn't understand what the doctors were telling her. So she turned to Reynolds for help. Now Reynolds visits them all, "as long as they let me know they're in there." She says the hospital staff love it. "I haven't gotten any negative feedback yet. And the patients feel better seeing their pharmacist checking on them."

Donald J. Stewart is a longtime chain pharmacist who counsels his customers on various pharmacy-related questions and is active in the community. Currently pharmacist in charge for Winn-Dixie Pharmacy #2462 in Killeen, Texas, Stewart has worked for most of the big drug chains during his 35-year career, plus he has run his own relief company and worked as a drug rep for Eli Lilly & Co. His subspecialty is herbal pharmacy, which he became interested in while trying to help cancer patients who "were at the end of their rope and had no choice but to turn to some alternative therapy." While exploring alternative treatments for them, Stewart determined that herbal therapy was the best way to go and continued his study in the field. "I've actually seen patients do a 100% turnaround, so that has been very rewarding for me."

In addition to fielding questions, suggesting herbs for people to try, and cautioning against mixing some herbs with some medicines, Stewart gives talks on antiaging, skin care, herbal cleansing, back to natural health, and other herbal topics about once a month at the Georgetown Library. At the pharmacy, he is also involved in care for the elderly and diabetes patients. "I do a lot of counseling for people who are on as many as 12 different drugs, getting them to spread them out over the day so they're not taking a handful at once." People come into the store all the time with all the pills they take. "Either we take care of them then and there, or, if we're busy, we set a time and have them come back." It can be difficult, he said, because his pharmacy is busy, doing 200 prescriptions a day—and there's only Stewart and some techs.

Stewart also has been a volunteer for the Killeen Free Clinic, plus he's been a Shriner for 33 years. In his spare time, he collects pharmacy antiques, many of which he inherited from his grandfather, who owned his own drugstore in Blacksburg, Va.

Donald Maloy, pharmacy manager at CVS Pharmacy in Rutland, Vt., is recognized for his availability to customers. Not only does he find patient consultation quite possible in a chain setting, he said it's the most interesting and most challenging part of his job. "You never know what people are going to ask." He has always been open to questions and assures his patients they are not asking "dumb" questions. "Too many times people are in and out of the doctor's office before they get a chance to ask their questions," he said. Because pharmacists are among the most accessible health-care professionals, he feels that it's important to take the extra time to answer patients' questions.

INDEPENDENT PHARMACISTS

Those independent pharmacies that not only survive, but thrive, rely on two important ingredients for their success formula to continue working: super service and superstar pharmacists to translate that service into customer care.

One independent nominated for his genuine patient concern is Richard Jaime, chief pharmacist at Glen Ridge Pharmacy, Glen Ridge, N.J. Perhaps because he is "very approachable" (said his nominator), a patient on Coumadin recently called him when she was not feeling well. "I had her read the labels of every one of the medications she had taken recently, whether it was from our store or not." One of them was warfarin she had obtained at a chain store. "So we made sure she got to the hospital, and everything turned out OK."

Donald L. Englerth, owner of Gilbert Drug Store in Gilbert, La., also goes an extra step for his patients, many of whom are poor and uneducated. Even though he's busy, he will always take the time to be sure they understand. "Sometimes I have to repeat everything." He doesn't always have the time because the pharmacy is growing busier. "But you have to make the time. Sometimes I'll mark the bottles a certain way to indicate how patients are to take it, so they won't be confused if they take multi-ple medicines." He counsels his customers on everything, but he specializes in diabetes care and asthma and respiratory disease care. And if there's an emergency need, he will stop what he's doing and get the medicine to the patients.

In York, Neb., Medi-Save head pharmacist Charlie Moore's knack for remembering names and his "caring for everyone from doctors to patients" has been noteworthy. Getting to know the doctors on a first-name basis makes it much easier when questioning something they've done, he said. "We know them well enough that they don't take offense." But he noted that it takes time to develop that kind of relationship, whether it be with doctors or patients.

John Parisi discovered early on that he enjoyed the teaching side of pharmacy. "I think that as pharmacists, that's what we do now—dispense information as much as dispensing drugs," he said. It's certainly what he does. Ivery & Dudley Pharmacy, Winsted, Conn., which he bought in 1972, has been redesigned to accommodate his various programs. Working from physician referrals only, his first program, diabetes education and disease management, has been very successful. And his Xhale smoking-cessation program has helped more than 100 smokers kick the habit. Working with his on-staff registered dietitian, he also developed a successful STEPS weight-loss program.

Except for several diabetes education payments from insurers, most of Parisi's patients pay for the programs. "That's usually not an issue," he said. "They could go to a local hospital 10 miles away and maybe get it covered by their insurance, but they've preferred to come to me. I always do a one-on-one, and they seem to like that." Next up on his schedule: a cholesterol program. "I do it because I thinks it's our place as pharmacists to do it. And you don't have to be the brightest pharmacist in the world to do it. What you're teaching is basic information, and one on one. They simply love to have your 100% attention." You do need a counseling room, he cautioned. "There's no way to do this without a counseling room." He added that if any pharmacist can come up with an excuse for not doing it, he has an answer for it. And he's been sharing his ideas and methods through talks at pharmacy association meetings.

"Today's innovative practitioner sees a gap in the delivery of pharmaceutical care services and fills it with his or her own brand of specialized competency," wrote David Kazarian, past president of the American Society of Consultant Pharmacists, in his nomination of Charles Calvano, manager of Weber's Pharmacy and president of Hybrid Technologies Inc., Sedona, Ariz. "Chuck has developed methodology for educating patients and professionals through CD and Internet technology. His VideoPharmacist.com provides ethical content in multimedia format for greater retention of information than the written word. A growing client list is testimony to his positive contributions to the industry."

Although practicing as a community and natural pharmacist (Nutri-farmacy/Med-Pharm, Wildwood, Pa.), Dan Wagner has done extensive work as a health-system pharmacist in Cuba, Belize, and Nigeria. In November 1999, he returned to Nigeria to further implement diabetes training by working with the Bayer Corp. to set up a diabetes screening clinic with other members of the World Health Mission. The Allegheny County Pharmacists Association nominated Wagner as an Outstanding Pharmacist in recognition of his voluntary contribution to health-care quality in society on behalf of the profession of pharmacy, both here and abroad.

When Greg Segner bought his own pharmacy in 1992, he was determined to follow his golden rule: Treat customers the way you want to be treated. And it was a customer who nominated him, one for whom Segner had done some compounding even though he had moved out of state. As a matter of fact, Segner's Rann Pharmacy in Harleysville, Pa., has customers from all over the country. When they move out of the area, they ask to stay with Rann because of the service. "We do billing for them. We contact their doctors for refills. We really try to take care of them," he said.

Actually, Segner believes his golden rule and friendliness to customers reap two benefits. "We like the return business, of course, but if they feel more comfortable, we can help them out more." He is openly critical of pharmacies that simply give the patient a package insert. "We try to go over the medication and make sure they understand why they're taking it. If they have a better understanding of their disease state, they're more likely to continue the medication."

Segner won't have a drive-through because they take staff away from the floor and aren't conducive to counseling. And he doesn't accept long waiting times for his patients. "Here again, it's treating people the way we want to be treated." The pharmacy is busy, doing around 1,800 Rxs a day. How does he do it? "I staff heavier to handle it." He has a nurse as a tech and at the register. "She was a hospice nurse, so she's very good with people." He has other techs, plus two pharmacists working at all times. "So one can be filling and talking to doctors, and the other can actually be out in the store talking to patients."

One of Segner's patients' favorite extra touches: He flavors and colors medications for kids. The kids get to pick their favorite flavors (out of 30), and often they get to put the flavoring or coloring drops in themselves. "It gets them more involved," he said. He says the flavoring changes the medicine to something "I did" and "I helped make." "We had two little kids on the same medication but two different strengths, and you couldn't tell the difference by looking at them. So we had the little boy color his blue, and the little girl color hers pink. Now we know the parents aren't confused." The pharmacy also provides OTC flavoring. "One child is taking mineral oil, so we flavor that peach."

Especially close to Segner's heart is veterinary compounding. He had wanted to become either a veterinarian or a pharmacist and ended up going to pharmacy school. "So I guess I'm trying to touch on the veterinary through my pharmacy." He said the pharmacy does a lot of veterinary Rxs. "We'll grind up tablets, make a suspension, and then we can flavor it different ways for the animal." Their patients have included iguanas, cockatoos, horses, cats, dogs, and rabbits. "It's fun looking on the prescription file and seeing the last name and saying, 'All right, they have two dogs, a cat, and three children.'"

Linda Garrelts started out teaching English and math to seventh and eighth graders for a year. Then she went on to study pharmacy and, along with a partner, bought Jones Pharmacy in Spokane 20 years ago. But she's never really been away from the teaching. If she hasn't been instructing patients—on immunization, lipid monitoring and management, or diabetes education—she's been mentoring students at Washington State University or showing R.Ph.s around the country how to implement smoking-cessation or other programs.

Garrelts especially likes to talk to pharmacists about how they can change the practice of pharmacy and feel good about what they do. "Patients want a little time spent with them. With eight minutes average for a doctor's office visit, and with many of our diabetes patients seeing family practice physicians, they can't get all their questions answered in those eight minutes. And thanks to the insurance industry, we have an opportunity to interact with our patients generally on a monthly basis." Because of the consulting and health programs pharmacists can become involved in, she said, "this is the best time to be a pharmacist."

Garrelts and her partner recently sold their two Jones Pharmacy stores to Horizon Pharmacies, but the stores will continue to be called Jones Pharmacy and will operate under their original "independent" philosophy. While she has continued to maintain a presence in both stores, Garrelts will officially direct national pharmacy care services for the Horizon chain. One of her initial projects was writing a grant in order to bring lipid management and monitoring to all 52 Horizon stores. "That's been one of my passions, because I know it's one of the things pharmacists can do well and make a difference for patients."

 

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