Pharmacy robot
Photo by Kerry Dahlen

This "robot" holds and dispenses medication, freeing pharmacists to help patients.

The Changing Face of Pharmacy
Using entrepreneurial ideas and new technology, the UW School of Pharmacy is taking an old-fashioned health-care system into the future

Step into Kusler's Pharmacy in Snohomish (pop. 9,145), and you'll see photos of the champion 2009 Snohomish High School girls' basketball team for sale. Don Kusler, '51, age 80, who opened the pharmacy in 1967 and still works there as a part-time pharmacist, likes to point out that his daughter Janet played on the first Snohomish girls team in 1975 and set a record for rebounding that still stands today. While her dad boasts about her athletic exploits, Janet, who owns the pharmacy today, is out making "house calls," immunizing teachers in the local public schools.

Kusler's is a kind of crucible where the best of old-fashioned pharmacy care, based on relationships and patient needs, meets the newest trends in innovative pharmacy practice.

The practice of pharmacy is changing these days, thanks in large part to the innovations developed by the University of Washington School of Pharmacy, a national leader in health-care research and in meeting the needs of the community.

Pharmacy also seems to lead the nation in being overlooked as a component in health care.

"People think all pharmacists do is take pills from a big bottle and pour them into a smaller bottle and slap on a label," says Don Downing, '75, UW clinical professor of pharmacy. As late as 2004, Downing points out, pharmacists in the state of Washington were not even considered health-care providers. What people don't realize is how much pharmacists do—and could do—to improve public health in the newly reformed health-care landscape.

Most people also don't realize what a huge impact the UW School of Pharmacy has made. Several years ago, for example, Downing and Jackie Gardner, '80, UW professor of pharmacy practice, studied the low levels of immunization across the state of Washington. "Most counties weren't anywhere near their goals for percentage of people immunized," Downing recalls, "especially geriatric patients." So Gardner and Downing enrolled a group of pharmacists in immunization training offered by the Centers for Disease Control. As a result, Washington became the first state in the nation to grant pharmacists the ability to administer flu shots and other vaccines. Today, pharmacists in all 50 states routinely administer vaccines.

In 2006, the School of Pharmacy created the Institute for Innovative Pharmacy Practice. Under Gardner's leadership, the institute is tackling daunting realities: an aging population that is taking more prescription drugs; a shortage of skilled pharmacists; and lack of affordable access to basic health care.

Jeff Rochon
Photo by Kerry Dahlen

Jeff Rochon says medication-therapy management improves patients' health and saves money.

Chronic diseases make up about 75 percent of health-care spending nationally," says Jeff Rochon, '99, CEO of the Washington State Pharmacy Association and a member of the UW Alumni Association Board of Trustees. "Pharmacists see these patients on a monthly basis. The access and appropriate medications necessary to keep people healthy is where the future of pharmacy is mostly impacted."

To deal with these challenges, the Institute for Innovative Pharmacy Practice is focusing on educating well-rounded pharmacists who promote entrepreneurial solutions for better health—and better business.

Pharmacists are more involved in health care than most people realize, precisely because they have the most extensive knowledge and training about medications. They operate clinics that address special medication issues, such as how to safely use anticoagulation drugs, and offer advice on how to manage chronic medical conditions, such as congestive heart failure and diabetes.

Peggy Odegard, '85, '90, is a UW associate professor of pharmacy practice who directs the school's Geriatrics Program. She also oversees UW Pharmacy Cares, an innovative medication-therapy management service that is designed to help ameliorate the effects of a fragmented health-care system. Medication therapy management deals with an increasingly common situation: patients who see multiple specialists who prescribe multiple medications filled at multiple pharmacies—with no one clinician seeing the big picture.

Odegard says it isn't uncommon for a patient to take 10, 15 or even 20 prescription drugs. This can create what's called a "prescribing cascade." It occurs when one drug causes a side effect, and another drug is prescribed to relieve those side effects. Faculty pharmacists in the UW's medication-therapy management program review patients' medication regimens, teach individuals how to use their medicines safely and effectively, and collaborate with the patients' other health-care providers to prevent harmful drug interactions.

"Efforts to focus on quality care through medication-therapy management is huge," Rochon explains. But it isn't just the patients who are benefitting; Rochon points out how King County saved nearly $1 million last year by implementing a program where pharmacists could get involved earlier in patients' care to protect them from harmful drug interactions. That prevented drug-related complications and costly hospitalizations.

And everyone knows what a huge issue money is. The American College of Clinical Pharmacy estimates that more than $177 billion is spent every year in the U.S. on medication-related health problems that could have been prevented. Medication-therapy management programs have become so valuable that Medicare and some insurance carriers now reimburse pharmacists to evaluate the medication regimens of patients who meet their criteria.

Ryan Oftebro, '95, '03, president and principal owner of the five Seattle-area Kelley-Ross pharmacies, said pharmacists from Kelley-Ross deliver their medication-therapy management via house calls through an arrangement with Seattle's Aging and Disability Services.

"When a nurse goes into a patient's home and sees that they are having trouble managing their medications, he or she will contact us," Oftebro says. The pharmacist will then step in and educate the patients, and give them pre-filled pill boxes called Medisets, which are delivered to the home every two to four weeks.

"We have become the manager or coordinator on behalf of the patient in looking for optimal use of medications, cost savings and preventing drug interactions," Oftebro explains. "A lot of people are on unnecessary medications or taking a brand name when a generic would do the job. We coordinate with providers to adjust the medications."

In Snohomish, Kusler's Pharmacy also provides medication-therapy management. Dorothy and Joe Clayton, retired Snohomish teachers in their 80s, say pharmacists at Kusler's have done everything from question Joe's Coumadin dose to confer with Dorothy about medication for osteoporosis. "[Janet Kusler has] saved us money by giving us counseling on generic drugs versus brands," Dorothy says. "She also impressed on us the importance of taking medications at the right time."

Independently owned pharmacies such as Kelley-Ross and Kusler's have had to carve out niches for themselves—implementing medication-therapy management programs and immunization "house calls"—in order to remain profitable. These pharmacies both have what are called "compounding pharmacies," in which prescription products are custom-prepared from individual ingredients that are not available commercially. For example, if a patient is allergic to a nonactive ingredient in a medication, a compounding pharmacist can make the prescription to order without the offending component. Compounding pharmacies also prepare medications for animals that a veterinarian prescribes but which aren't otherwise available.

Kelley-Ross also has a travel clinic, the result of a collaborative practice agreement with some Seattle-area physicians. Kusler's offers wound treatments for hospice patients. Both pharmacies provide tailor-made bioequivalent hormone-replacement medications based on the needs of individual patients.

Ironically, despite the critical role pharmacists play in our lives, the word "pharmacist" didn't seem to be on anyone's lips as the national health-care debate unfolded this fall. Yet they are important as ever. Ninety-two percent of Americans live within 5 miles of a community pharmacy. Rural areas such as Central Washington are facing the possibility of losing local pharmacies because their business practices are threatened by diminished financial reimbursement. It has even happened in some areas of Washington, but UW-trained pharmacists have come to the rescue with innovative programs (see sidebar).

"The state of Washington has had a tradition of leading the profession forward," says Rochon. "For years, pharmacists in our state have provided increased access in emergency contraception, tobacco cessation, anticoagulation clinics, diabetes-care clinics, hyperlipidemia clinics, all of which show the impact pharmacists can have on patient care.

"The UW School of Pharmacy has been recognized as one of the leaders in the country," he goes on, "not only for the faculty but for the leaders that push the profession when they're in school and when they come into practice."

—Julie Garner is a Seattle-area freelance writer.


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