Drug Topics - February 2009 - (Page 24)

Issues & Trends PEDIATRIC AND GERIATRIC PHARMACISTS Tod Children’s Hospital, who couldn’t ﬁnd anyone to make specialized compounds. The trio almost had the hospital on board as a sponsor — but then management changed. That’s when they put together a business plan. Now, 10 years later, they still hold other jobs. Frank and Dom review prescriptions for the Cleveland Clinic from their home computers. “Children 6 and under are second only to senior citizens in medication use,” Frank Dundee said. “And the thing about kids’ prescriptions is most of them are of an acute nature; you can’t mail away for them.” Kids ’N Cures’ revenues have grown 5 percent to 10 percent year after year since the store opened, except for one year when the numbers remained stable, after an early ﬂu season gave them a big December. Another business advantage of concentrating on pediatrics, Dundee said, is a smaller up-front investment in drug inventories. When the store opened in 1999, he said, the cost of the average inventory needed to open a community pharmacy was $120,000 to $130,000. The three partners opened with $65,000 in inventory. They ﬁll about 150 prescriptions per day. Wolsoncroft, in Birmingham, Ala., ﬁlls only about 50 per day, but is set up completely differently from Kids ’N Cures. Her business, KidsMeds Pharmacy, doesn’t have a front-end store. Instead, it is inside a pediatric practice, although it does have a separate entrance where customers can bring prescriptions from other pediatricians. Small Fry’s, in Harlingen, Texas is also located in a pediatric practice. It ﬁlls 250 prescriptions each day and is a “one-stop shop” for mothers and children. One side of the building is fashioned to resemble a ship with portals for windows; the other side is styled as a train engine. Supporting the canopy over the front entrance are what look like two large Crayola crayons. Although the pediatricians have no ﬁnancial interest in the pharmacies, the collaboration has been great for Ohio State’s Nahata, who said that having the time to counsel parents is one of the biggest advantages of pediatric pharmacies. Bill Brownstein, RPh, who just opened his second pediatric pharmacy in the New York City area in November, introduces his stores to doctors through birth announcements and personal visits. Brownstein makes puddings, transdermal gels, freezer pops, gummies, and the ever-controversial lollipops. “People come in and they say, ‘You’re trying to make medicine taste like candy, and we ﬁnd that deplorable, and you should be put in jail. You’re going to overdose kids,’” he said. “My response to that is, ‘Making sure your child doesn’t take too much medicine is not my job.’” He said that’s been critical, especially for children receiving chemotherapy, who can’t keep foul-tasting medications down, and autistic children with sensitivity to texture and taste. Baby boomers fueling increase in geriatric pharmacists Just as with pediatric pharmacy, counseling is at the apex of community geriatric pharmacies, too. Busy pharmacists in chain drug stores might argue they, too, don’t have time to spend counseling patients. In fact, Culbertson of Kansas City’s 50-Plus Pharmacy said that when she worked at a nonspecialized pharmacy, she was often reprimanded for talking to customers too much. “I ﬁnally feel like all those years I counseled people and took the time to sit down and do their blood pressures and do their blood sugars have ﬁnally come to fruition,” Culbertson said. The pharmacists at 50-Plus Pharmacy sit down with every patient to review medications, talk about side effects, and answer questions. They also offer services, such as blood-pressure and blood-sugar checks. Such counseling is critical since many seniors take multiple medications, prescribed by numerous specialists, many of whom don’t know what else their patients are taking. In fact, the American Medical Association said that if adverse reactions to medications were classiﬁed as a distinct disease, it would rank as the ﬁfth leading cause of death in the United States. But Culbertson points out that many pharmacists forget to look at disease states as well. Kidney, heart, and liver function can worsen as a person ages or becomes ill, and that has an impact on how seniors metabolize drugs. Nicole Brandt, PharmD, CGP, associate professor of geriatric pharmacy at the University of Maryland, said it’s critical to educate pharmacy students on the processes of aging and disease progression, rather than simply isolating potential drug interactions. “I think it’s really the comprehensive care of the patient and the inﬂuence of the medication on that patient that’s important to evaluate,” she said According to Jerry Gurwitz, MD, at the University of Massachusetts Medical School, “All symptoms in a senior should be considered a drug side-effect, until proven otherwise.” That is the philosophy every pharmacist dealing with older adults should live by, said Phyllis Moret, RPh, associate executive director and chief operating ofﬁcer of the Commission for Certiﬁcation in Geriatric Pharmacy in Alexandria, Va. She uses the quote by Gurwitz, W W W.D R U GTO P I C S .C O M 24 DRUG TOPICS Februar y 2009 COURTESY GETTY IMAGES / PHOTODISC http://WWW.DRUGTOPICS.COM

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Drug Topics - February 2009 Contents Health-System Edition Group Attempts to Resurrect Pain Care Act HSE Business Management HSE Clinical Letters Up Front Up Front in Depth Community Practice Niche Pharmacies Serve Special Populations Special Report Oral Oncology Drugs New Drugs Update 2008 Approvals OTC New Products Viewpoint

Drug Topics - February 2009

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