As many of you know, CVS has set up what they call Minute Clinics in many of their pharmacy locations across the country. These are meant to help triage patients with minor ailments, as well as refer them to the appropriate facilities for treatment of more serious conditions.

Well, my curiosity got the best of me; I did some research to find out if the other major chains had similar arrangements. Lo and behold, I discovered that both Walgreens and Rite Aid do provide patients with clinic opportunities in selected areas they serve.

While these endeavors sound like a good way to address medical access issues and take pressure off the ED-hospital stay-back home cycle while containing costs, as a pharmacist, I have some questions about this situation.

I reside in Fresno, which is the 5th largest city in California. Much of the population lives in smaller communities around Fresno as the hub. The general area has a great deal of poverty, a significant lack of insurance coverage and is a major underserved population. Therefore, access to care and payment for services are major issues within the community.

What better geographical location to place a group of minute clinics to ease the burden on both patients and the system?

Again, curiosity reared its head. I put my zip into the CVS locator……..strangely there were no pharmacy locations in the entire Fresno area with a minute clinic for patients to go to. As I performed similar searches on the other chain ‘clinic’ websites, I discovered to my dismay the same results. None of those chain pharmacies had clinics in my communities.

What could possibly be the motivation for this decision? As I pondered this question, the same answer that guides most business decisions kept repeating itself in my mind: PROFIT?

The system as constructed is pay as you go, so those patients who don’t want to spend long hours at their doctor’s office to get diagnosed and treated for minor ailments, or wonder if their insurance will cover, have a quick, less time-consuming solution. For them, the cost is no object. At the same time, patients in communities such as mine are driven to use the current emergency room care cycle or go without the care they need.

However, buyer beware. I checked service prices as well, and the menu items are not inexpensive. If labs are drawn or immunizations are given prices appear to me to be above costs incurred through the normal channels like office visits or pharmacist-provided immunizations. Thus, the clinics may be viewed by patients as nothing more than mini revenue generators for the pharmacy with no altruistic goal.

As a pharmacist, I have some other professional issues about the clinics. During my career, I practiced with many nursing personnel who are clinically savvy, energetic and caring individuals. However, why would the clinics only be staffed by nursing practitioners?

First, would the fact that pharmacists have not achieved provider status, cannot bill for cognitive services and not generate dollars contribute to this decision?

Why would the nurse want the responsibility of performing the initial assessment, doing the medical triage, AND deciding what medications to prescribe with provider oversight?

There could be a pharmacist in the clinic to address all issues about medications.

Second, assigning a pharmacist to the clinic, while possibly increasing staffing costs, would allow health professional collaboration for the benefit of the patient.

In my view collaboration would be a more cost-effective use of professionals time. Pharmacists would add their expertise through higher quality counseling and drug information. It would break the ‘adversarial barrier’ created between pharmacists and nurses over many generations. Finally, it would positively impact pharmacy workflow.

Patients could be counseled better in a quieter part of the pharmacy without HIPPA concerns of inadvertent eavesdropping.

With this relocation, the dispensing pharmacist could concentrate their efforts on addressing phone call issues, and appropriately filling/checking the multiple prescriptions moving across the back counter during the normal workflow.

I believe this change would lead to less filling errors, be a more cost-effective use of employee time and lead to a more positive patient experience. So, stepping off the soapbox for this month, I remain……

Neal S. Howard, Pharm. D


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