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Kmart Stores Go Clinical
Expansion of a new freestanding, clinical site is off and running in Helena, Montana. New operations started with their immunization program last year and recently their newest endeavor has been the initiation of a Coumadin Clinic. This is to monitor INR levels. See this website for the model of Montana’s anticoagulation protocol.
Last year during the peak flu season of 2005, Josh Morris and Kate McGree got State Board Approval to have their staff administer flu vaccines. Other certified pharmacists came and helped the new process and then it was expanded into to other K-Mart stores.
This year, as of a few weeks ago, the same pharmacists with the addition of Travis Fryenlund, have begun a new clinical work in monitoring a patient’s blood in the event of a DVT.
This new process allows for a collaborative practice between the doctor and a pharmacist. The medical doctor is diagnosing and prescribing while the pharmacist is now able to adjust doses and monitor the patients, which will allow for a more optimal treatment of the patient’s condition.
As a hospital pharmacist, I was able to have a hand in helping out with their immunization clinic as I have plans to implement the same process in southwest Montana this fall. Many retail stores are incorporating this into their programs and are looking for pharmacists who are certified to help out, especially in rural areas such I live in.
Also, I have been attempting to follow the new anticoagulation process with the hope of starting a collaborative process that would follow Josh’s leading. It was really brought home to me how important this process is and how it can benefit a patient. Late spring of this year, I got a call from my daughter who was attending law school in another state. She was frantic and upset as she related to me that she had been having some pain in one of her legs. It had worsened and as a result, she made a detour to her University Health Clinic instead of going to class. She had incurred a very serious DVT located in her left upper leg. Four other students (all female) suffered her same fate that semester. She was put on Innohep ® and later was switched to Coumadin.
When summer approached, she took an internship with a law firm in Helena. Being in contact with me, she was afraid of the transition from Oregon to Montana and what would happen to her care. This would be from the doctor and monitoring program she had through the clinic compared to what she would have here.
I called Josh and asked how far they were along in the program and he said that my daughter could be his first customer.
My daughter was willing to try this and related her pleasure from the onset of her first encounter with K-Mart and the pharmacists there. These were her thoughts as she related them to me.
She said that her Student Health Service was extremely busy, and she was often ill at ease because of the open areas and conversations she overheard that she had while spending the many hours there before her diagnosis. She was often embarrassed because of the lack of privacy in their treating many students at a time. So, her first observation was related to her appreciation in being able to talk to the pharmacist in a private room without distractions. She mentioned that they reflected a more serious attitude toward her condition and that she was treated with the utmost professionalism.
She was surprised at the price. She had insurance through the university and her copay of $20.00 was the same here as it was from her hometown. She really appreciated this.
While in Oregon, she had a collapsed vein in one of her arms. She had only one arm that they were able to obtain blood from. She related and complained many times to me about painful blood draws, bruising and a couple of untrained nurses who were unable to get a sufficient enough amount of blood to do her testing. She was really surprised of the simple finger stick, the lack of pain and the ease of the process.
In the past, she would have to be at the clinic at 8 am and the results would be faxed to her later that day at around 4 pm. As you might surmise, she had had a fax machine but if she hadn’t, she would have had to call and ask what her level was. Again she was surprised that the results were available immediately after the finger stick.
She also commented on the ease of “just going in” and the extended hours that one can go to the K-Mart Clinic. She said that it would also benefit anyone that worked and could choose to go at his or her convenience.
Other comments she made were that the pharmacists were helpful and gave her well-informed information.
Her medical information was faxed to her doctor and she was able to keep in contact with her physician through email.
Josh related that often a doctor would have them also adjust the medication and have the pharmacists there take over the monitoring and be able to make therapeutic decisions. They would then fax any changes to the physician. It is basically up to the doctor and the patient as to how they would like it to be done.
The K-Mart stores will be expanding their anticoagulation clinics this fall. Other pharmacists will now have this opportunity to practice this at their respective locations or be able to begin their own clinical practice site.
I’d like to mention one last item that I was really impressed with. Every time my daughter went in for her medication, she said every pharmacist, every time, asked her if she was having her blood tested. In both Oregon and here in Helena, they all related its importance. If she had said no, every one of them would have encouraged her to sign up and be immediately tested. This ease of testing can be done right now if this same question is posed to the pharmacists K-Mart store in Helena.
If you would like to see a sample of the protocol, remember to check out the MPA web site at www.rxmt.org. The Pharmacy Association encourages and promotes clinical work among the State’s pharmacists. Don’t hesitate to call the organization to see where these new collaborations can be incorporated into your practice. Contact Jim Smith, Montana Pharmacy Association Executive Director, at 406-449-3843.