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Community Access Pharmacy: Challenges and Rewards

Written by Dr. Sally Haack PharmD

I have had the chance to work at CAP for the past year. I was hired by Drake University to develop a rotation site for pharmacy students and to pursue projects at CAP which would expand its current services. Coming from a community pharmacy background, I was prepared to deal with the ambulatory care issues, but I soon realized that I had much to learn in other areas.

One of the best aspects of working at CAP has been serving this diverse patient population. I have gained a greater appreciation of the differences that lie right here in Des Moines. Our Hispanic patients seem to be the most grateful for the services we offer and the time we spend with them to explain their disease states and their medications. Many of them feel that others in the community might not give them a chance to be heard. I have grown in my understanding of the interpretation process and the impact that it can have on effective communication. One of the opportunities that I have is to teach pharmacy students about cultural competency in this unique setting. I am working on activities to incorporate into the rotation to help meet this objective.

I have an interest in health literacy and the ways that we can address it as pharmacists. Patients fall in a continuum on the scale of literacy. By individualizing our communication style to the patient’s level, we can be more effective. In our disease state management classes, I have encountered a few patients who told me that they couldn’t read, so they didn’t want to take the packet of materials home with them. There were probably others who couldn’t read, but didn’t want to admit it. The materials that we use focus on keeping the language at a low reading grade level, adding graphics where possible, and using large font to create more empty space on the page.

The disease state management classes that take place at the pharmacy are individual appointments that are scheduled ahead of time. Despite efforts at reminder phone calls and postcards, a number of our patients do not show up for their appointments. This has been frustrating for me, especially when we have scheduled an interpreter to assist with the appointment. Transportation to and from the pharmacy seemed to be a barrier that many of the patients expressed. We were able to purchase bus passes and cab vouchers for patients to use, if needed. I have also learned to become more flexible with the appointments. If a patient only has 5 minutes to talk, I accept that and use the time we have.

Balance is a quality that makes a pharmacy run smoothly. At Community Access Pharmacy, we have been tested, at times, in our ability to balance certain aspects. While one of my primary responsibilities is to coordinate patient care services, I also have to stay in tune to what is happening on the dispensing side of the pharmacy so that I can answer patient questions. The students that complete a rotation at CAP have to balance working on patient interviews and projects with processing orders and patient counseling. The other pharmacists have to balance time with administrative tasks along with daily dispensing functions. It has been a struggle to find a balance, especially on the days when the pharmacy is busy and there are many patient education appointments. We have grown, though, as a group and have a better understanding of what each of us expects from the others.

There have been other challenges along with way, such as understanding the 340B drug pricing, implementing a prescription program through Pfizer, and working around staffing issues. It is very rewarding, though, to hear from patients that they are grateful for our pharmacy. Before it was open, many of them could not afford the medications that they needed. According to one CAP patient, “I appreciate the opportunity to participate in this [diabetes] program. I think that it is very good for not only me but the entire community. Keep up the good work!!” Helping the people at CAP is one of the best benefits from my work.