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Retail Rx has key role to play in preventive care.

KIRKLAND, Wash. -- Pharmacists are generalists, with a broad understanding of drugs and the conditions they target. But Dennis Hayes finds gratification in being a specialist.

A 19-year veteran of Bartell Drugs, he has developed an expertise in preventive health care, namely immunizations and drugs for travelers. He provides the service through the travel clinic at Bartell's outlet in the Bridle Trails section of Kirkland, where he is pharmacy manager.

"It was kind of carving out my own little niche," says Hayes.

His store also is a very busy flu shot provider, having given the vaccines since 2000. Hayes has given some patients their shots for each of those years.

"It's a business that we've built up," he says. His store is one of 61 Bartell outlets offering flu shots. The chain also has an off-site flu clinic program serving area businesses and retirement communities.

Hayes and his team of pharmacists also provide immunizations for hepatitis A and B, human papillomavirus (HPV), meningitis, shingles, tetanus, diphtheria and pertussis.

Hayes says that Washington is a good state in which to practice pharmacy, having been ahead of other states in allowing pharmacists to provide vaccinations and the Plan B morning after pill (before it was available over the counter).

Washington also permits collaborative practice agreements with physicians, which enables pharmacists to perform a wide variety of nontraditional services. They can, for example, prescribe drugs to prevent travelers from contracting malaria.

"The physician delegates certain functions to the pharmacist," says Hayes. "We operate on a physician's model where we have you come in for a sit-down consultation. If you're going to Machu Picchu in Peru I'll write a prescription for medication to prevent altitude sickness. We're not taking the doctor's role because we're not diagnosing illness. It's preventive care."

He says that Bartell has expedited his professional advance by being ahead of the curve with both travel medicine offerings and immunizations. "Bartell is pretty nimble and when it wants to do something it can turn the ship around pretty fast," Hayes says.

Hayes sees his pharmacy's scope of services as a response to accelerating change for the profession.

"A lot of what I've been hearing about over my whole career in pharmacy--MTM and disease state management to cite two examples--is finally on the verge of happening, with the Affordable Care Act as a catalyst," Hayes says. "The challenge is making it pay, because it's so labor intensive. Finding a way to make it work as a business is challenging."

Among the benefits of the ACA, he notes, are health plans that cover immunizations with no co-pay.

"That's a huge positive for retail pharmacies in general and mine in particular," he says. "We're looking at removing the barriers to vaccination. A lot of people can't afford to pay for a flu or shingles shot. Retail pharmacy needs to own immunizations and the ACA's going to help that."

In the meantime, Bartell offers screenings for hypertension, and elevated levels of cholesterol and blood glucose, as well as for low bone density. This past year the drug chain conducted a clinical study of a nutritional supplement designed to reduce cholesterol. The study entailed regular blood tests.

Recruiting patients for the study was facilitated by Hayes' long-standing relations with customers.

"I knew what kind of customers would be interested in a program like that," he says. "It made it easier to have this little file of patients in my head. With all the technology, health care still works better when it's personal--when you know who you're dealing with."

However pharmacy changes, interaction with patients will remain at its core, says Hayes.

"Staying in the same store has enabled me to have really good relationships with my customers," he notes. "It's been relatively easy for me to go into areas like immunization and travel medicine, because the customers know me real well and they trust me."

Hayes enjoys being a health care provider and an advocate for his patients.

"It might be a long, tiring day, but if I can go home knowing that I solved a problem for a patient I can feel pretty good," he says. "That's going to happen a lot more often if I have good relations with my customers and they trust me. And that takes some continuity. You don't get that the first week of work."
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Title Annotation:Excellence in Pharmacy Practice
Publication:Chain Drug Review
Date:Oct 28, 2013
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