Pharmacy Counseling – Mail vs. Retail Privacy

One of the other things that caught my eye in the USA Today article about the changing role of pharmacists were the comments about counseling.  I’m not sure if I see that as any change.  Isn’t that what most pharmacists go to school for?  They want to help patients.  They don’t go to school to count pills. 

A few years ago when I worked on my idea of a kiosk to dispense medications that was the big discussion I had with several pharmacy leaders.  I wanted to free up the counter time for counseling and let the kiosk hold the refills and acute medications which didn’t require as much pharmacist time. 

Today, when you go to most pharmacies, you talk with the pharmacy technicians which in some states don’t even have to be certified and can essentially be someone with only a high school education.  Not that there is anything wrong with not going to college, but I bet that most of us have high expectations for the person standing on the other side of the counter.

So, I think everyone would love the pharmacist role to evolve.  BUT, I think the other question this begs is whether this is a private setting to have that discussion.  Now, there are a few pharmacies that have created a quiet area for counseling, but let’s face it, the majority of the time, you’re standing at the counter with another patient right over your shoulder (or back at the yellow line 24″ behind you).  How many of us really want to talk about the rash that developed as a side effect or the new diagnosis that we got from our physician or the fact that we can’t afford the medication in front of our neighbor or some miscellaneous person that might be judging us?

So, I’m always amazed when people talk about mail order as this anonymous 800# for counseling.  Isn’t it more convenient to be able to call your pharmacy from your own home (or another private setting) at anytime of day or night and ask questions?  Isn’t it more private?

Since less than 20% of people can even tell you the name of their pharmacist (and probably an equally low percentage of patients are known by name by the pharmacist), does this face-to-face relationship really matter?

I won’t deny that the Ashville Project worked and that the cases where the pharmacist is engaged with the patient in a long-term, trusted care relationship that it makes a difference.  I only question whether that model exists, is scalable, is cost-effective, and can be staffed.  (Don’t forget that just a few years ago they were forecasting massive staffing shortages around pharmacists…I don’t think that’s been solved.)

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