Launch of New Pharmacist Run Clinic Inside a Community Pharmacy

IMG_1633Point Loma recently welcomed The Pharmacists Clinic and the addition of clinical health services in the local, family-owned pharmacy, Point Loma Shelter Island Drug. We are the first pharmacy in San Diego to provide consultations with clinical pharmacists, prescriptions issued by clinical pharmacists, and lab testing. Patients are able to conveniently schedule a same-day, evening, or weekend appointment online. This means no more taking the day off work or spending hours in a waiting room. All clinic visits take place in a private room in the pharmacy where nobody can hear or see the conversation.

The Pharmacists Clinic is now offering important preventative health services, including consultations and prescriptions for birth control, lab tests, naloxone opioid rescue, and nicotine replacement therapy. We can order and interpret over 2000 lab tests such as cholesterol, thyroid, and blood glucose for very affordable and transparent prices. Women can meet with our clinical pharmacist, Dr. Sally Rafie, for a personalized birth control consultation and leave with a prescription for birth control pills, patch, ring, or shot. We also offer prescriptions for nicotine replacement therapy to help our patients quit smoking and naloxone opioid rescue in case of an emergency opioid overdose situation. Services will soon be expanded to include all vaccines and travel meds.

Dr. Sally Rafie, a board-certified pharmacotherapy specialist and licensed pharmacist, founded the Pharmacists Clinic. Dr. Rafie specializes in women’s health and preventive health. She completed her Doctor of Pharmacy degree from UC San Francisco and residency training at UC San Diego. “People want to take care of their bodies and control their health. We’re here to help make that easier.” – Dr. Sally Rafie

Dr. Rafie is able to offer these services because of a recent law in California that expands the scope of pharmacist practice to increase access to vital public health services and medications. “We’re not here to replace your physicians, but rather offer an additional, convenient point of care and medication expertise. If you have a primary care physician, we will be sure to keep them in the loop.” – Dr. Sally Rafie

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The Pharmacists Clinic and Point Loma Shelter Island Drug have a unique collaboration to offer these clinical services to the Point Loma community! Point Loma Shelter Island Drug is a beloved, family-owned pharmacy established in 1924 and owned by Michael Saad, with a second location called Point Loma Cabrillo Drug.

5 Ways to Make the Most of Your Pharmacist

With tax season just behind us, it’s that time of year where we ask, “Did I get everything I could out of my return?” or “Did I maximize my investments?” These are important financial questions but the same questions can be asked about our own health. Each year we complete our taxes and reflect on the financial decisions we made over the past year. We should be doing the same for our health care decisions, “Am I getting the results I’m looking for from my lifestyle changes?” or “Am I taking my medications correctly?” We get so busy wrapped up in the day-to-day activities that it can be hard to take care of ourselves. And at the end of a long stressful day, a fast-paced doctor’s visit might be overwhelming. Most of us only address recent health problems, like infections, injuries, or emergencies and we often neglect our ongoing health issues.

We live in a society obsessed with quick fixes and convenience, yet many overlook one of the most accessible resources — our local pharmacists. According to Gallup polls from the past several decades, pharmacists are consistently rated as one of the most trusted professions. People turn to their local pharmacist for many different reasons — advice, health education, and help managing complicated diseases. But are we taking advantage of all the benefits our local pharmacists have to offer?

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Your pharmacist can provide 5 key services for you:

  1. Preventative Care: Pharmacists are an access point for screening services for a variety of diseases. They also help you figure out if you would benefit from immunizations. With easy access in most communities, it makes your local pharmacy a one-stop shop for many of your healthcare needs.
  1. Medication Management: A lot of patients have chronic diseases and a pharmacist plays a vital role in helping with medication adherence. It can be as simple as helping to program cell phone medication alarms, pre-record talking medication vials for the visually impaired, or assisting patients in organizing their medications in a weekly pillbox organizer.
  1. Medication Review: Pharmacists play an integral role as the final check between the physician and the patient. Sometimes you might feel like you’re stuck playing a game of telephone and many of the details may get lost in translation. Pharmacists can take a comprehensive look at their your medications, evaluating new medications and how they interact with ongoing medications to help make managing all the recommendations from recent hospital stays, regular office visits, and specialty clinic visits easier for you.
  1. Counseling: Pharmacists work with you to help you understand your diseases, the role of your medications, and side effects to look out for. This increases your ability to consistently take your medications and helps optimize long-term health. Your local pharmacist is also an expert on over-the-counter products for health issues that can be taken care of with self-care, so they can help you answer questions like “How serious is it?” and “When should I see a physician if it doesn’t get better?”
  1. Collaborative Care: Pharmacists work in partnership with physicians and other healthcare providers to help manage medications for chronic conditions — think high blood pressure, high cholesterol, and diabetes — and reduce hospitalizations that can lead to unnecessary costs such as lost wages, caregiver fatigue, and expensive medical bills.

So the next time you visit your local pharmacy, make sure you are taking full advantage of all the things your pharmacist can do for you! After all you put time and effort investing in your health, make sure you’re maximizing your return.


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About the Author: Sarah Ross is a fourth-year pharmacy student at the University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences.  After graduation, she will be completing her PGY1 pharmacy practice residency at Scripps Mercy in San Diego.

 

(Article image credit: Mai Le)

Hormonal Birth Control Now Available Directly At Pharmacies in California

Like our neighboring state to the north, pharmacists in California can now prescribe and dispense birth control directly to women.  Now this warrants a happy dance!  Women now have another choice in how they get their birth control.  They can either go see their primary care provider, Ob/Gyn, family planning clinic, or go straight to the pharmacy.  At the pharmacy, women will have their choice of birth control pills, patch, ring, or injection.  All thanks to a state law passed back in 2013.  So why the delay?  It took 2 and 1/2 years to develop and approve the protocol because of the multiple rounds of revisions.

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Is this safe?  What about the pap smear?  A pelvic examination and a pap smear are not necessary to initiate hormonal birth control.  They are important for other health reasons.  Women will need to complete a health history questionnaire and have their blood pressure taken at the pharmacy.  This helps the pharmacist figure out which methods of birth control are safe.  If the pharmacist finds something concerning in your health history or if you want a long-acting birth control device like the implant or IUDs, then you’ll be referred to a provider who can help with that.  Ultimately, the goal is to improve access to medications where there is a public health benefit.  After the visit, the pharmacist will send a note to your primary care physician to fill them in — unless you don’t want the pharmacist to do that of course.

Interested in getting your birth control directly from your pharmacist?  Give them a call first to find out if they are providing this service.  Just because pharmacists CAN provide this service doesn’t mean they WILL.  California pharmacists want to participate but they are worried about time constraints at the pharmacy that prevent them from taking the time to do this.  Over time, more and more pharmacists will provide this service.  When you call the pharmacy, ask when would be a good time to come in for this service.  Pharmacies have “rush hours” and the pharmacist will be able to give you more time if you  come in when it’s slower.  Some pharmacies may even make appointments for this service.  In California, women of any age can access this service from a participating pharmacist.  No age minimums and no ID checks.  This service is completely confidential and no information can be shared with your parents or anyone else!

What’s this going to cost me?  If you go to the pharmacist for your birth control visit and fill your prescription, the prescription costs will be covered by your insurance the same as if it was written by a different provider.  Unfortunately, insurance companies aren’t paying pharmacists for the visit like they pay physicians and the long list of others who can provide birth control, including nurse practitioners, physician assistants, nurse midwives, and even nurses.  So you may have to pay out of pocket for the visit and submit the receipt to your insurance company and hope they reimburse you (if you try this, please let us know if this works or not!).

Is this a good idea?  This is an enormous step forward in increasing access to birth control.  Hopefully women will appreciate having more choices in where to get birth control.  Next steps?  Ideally more states will pass similar laws expanding access with pharmacist prescribing — Tennessee is already moving forward with legislation and many other states are considering it.  There is also growing support for over-the-counter birth control pills.  

Want to consult with Dr. Sally Rafie, PharmD, BCPS about your birth control and get a prescription?  Fill out the contact form and let her know how to reach you.

Will Pharmacists Give You Birth Control Without a Prescription? The Survey Says…

For those who may have been following this blog since its inception, you may recall that I was conducting a research project with Dr. Rafie last year. We conducted a survey study to gauge pharmacists’ attitudes towards a recent California law that will allow pharmacists to provide hormonal birth control directly to women without a prescription.

Kevin Vu ACCP MeetingI recently had the opportunity to present my findings at the American College of Clinical Pharmacy (ACCP) Global Conference on Clinical Pharmacy. Held in San Francisco, this conference was a gathering of pharmacists from around the world and provided a platform for those in the field to network, share and exchange ideas, as well as learn the latest developments in the pharmacy world.

So what were some of the findings I presented from our survey of community pharmacists in California?

  1. Only half of the pharmacists were familiar with the new law that allows direct pharmacy access to birth control.
  2. Most pharmacists (about 70%) said they were very likely or somewhat likely to participate in this new service. It’s promising to see all the excitement and interest within the pharmacy community around this new authority! We are hopeful that this will manifest as lots of pharmacists actually providing the service when it becomes available. We don’t want women to have to call or visit multiple pharmacies before they find a pharmacist who can help them.
  3. The main reasons for why pharmacists said they wanted to participate in this service was that patients would benefit from improved access and that this service would foster increased use of birth control. This increased use and consistent use could eventually translate to fewer unplanned pregnancies, which currently stands at half (51%) of all pregnancies that occur in the U.S. every year.
  4. Nearly all (98%) of pharmacists feel comfortable intervening if they notice a patient had a drug interaction with their birth control. This is encouraging given that pharmacists are often seen as the final safety check when it comes to medications, ensuring that patients are getting medications that are safe and effective.

As the service is on the brink of being rolled out, I’m glad to say that some California pharmacists have already begun participating in training programs specifically aimed to help prepare them for participation in this service. With time, the hope is that patients and pharmacists across the country will recognize the value of direct access to birth control, and that other states will follow and adopt a similar authority.


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About the Author: Kevin Vu is a fourth-year pharmacy student at the University of California San Diego Skaggs School of Pharmacy & Pharmaceutical Sciences.

What California Teens Need to Know About Pharmacy Access to Birth Control

ProviderGuess what California! Having safe sex is about to get a whole lot easier for you in the next few months! We think that increasing access to highly effective forms of birth control is the best way to help prevent unplanned pregnancies and the lawmakers in California agree! A law was passed that is getting ready to rock how you get your birth control in a big way. Starting towards the end of 2015, your local pharmacist can start providing you with more effective forms of birth control in the pharmacy (the pill, the patch, the ring, and the shot)!

This means that you would be able to get your birth control without worrying about making a doctor’s appointment or clinic visit. (Side note: Getting checked out by a doctor regularly is really important! ESPECIALLY, if you are sexually active. It just shouldn’t prevent you from getting effective birth control!) Now if you need birth control you are going to have choices – the doctor’s office, your local family planning clinic, or your local pharmacy!

Who can get birth control at the pharmacy?

First of all, all you ladies out there can use it! Women of all ages — including teens — will be able to use this service. You also don’t need to have insurance or an ID card to get birth control. In California, minors can consent to medical care for the prevention or treatment of pregnancy without parental permission. In fact, legally the pharmacist cannot disclose any information to your parents without your written permission. Of course we know that your parents had sex at least once (hey, you’re here right?) so they probably know a thing or two about sex and birth control. So if you feel comfortable you can always chat with them about any questions you might have and they are welcome to come along to the pharmacy. We know teens like their privacy too; so just know if you don’t want to tell them, we won’t either!

How does pharmacy access to birth control work?

So here’s how it works. It is kind of like when you go get a flu shot from the pharmacist (if you don’t do that you totally should!). You fill out a health screening questionnaire and get your blood pressure taken to make sure that it is safe for the pharmacist to give you birth control and that’s it! The pharmacist will review your questionnaire and talk you about which methods of birth control would be safe for you to use. Then you can discuss how each method works and pick which you like best. The pharmacist will then provide you with birth control supplies just like you would get with a doctor’s prescription and you are good to go.

Keep in mind that not all pharmacies will be providing this service right away. It’s always a good idea to give the pharmacy a quick call to find out if they do before you go in.

How much will this cost me?

There will probably be a small service fee for the screening. This is different than the cost of the medication. If you do have insurance, you will most likely be able to get your prescription filled with no copay. (Thanks Obama!) If you are under your parents insurance, the insurance company might send your parents documents about what you got from the pharmacy. If this is something that you want to keep private, consider filling out a “confidential communication request” for your insurance company. See www.myhealthmyinfo.org for more information and a copy of the form.

What if I don’t live in California?

Basically, this new law is very exciting in the word of birth control. Hopefully once the other states see how much it has helped in California they will follow suit! So if you don’t live in California keep your eyes out changes to come!

What are some trusted sources for more info about birth control methods?

If this gets you excited about birth control, check out these helpful links to help you learn about different methods! These are really cool resources for teens and they break down all the pros and cons of each method. Bedsider includes videos from guys and girls talking about the experiences they’ve had with each method. On their website you can also sign up for text reminders for clinic appointments or to remind you to take your birth control pills, patch, ring, or shot. Planned Parenthood has an interactive quiz to let you know which methods might work best for you. They’ve even got info just for teens.

How can I get my questions answered?

Check out our new resource page just for teens!  If you have any other questions about your sexual health or anything pharmacy related you can submit your question anonymously. Your question will be answered by Dr. Sally Rafie, PharmD, who is a pharmacist and is very passionate about sexual health and how pharmacists can help!


Courtney HeadshotAbout the Author: Courtney Miller just finished her first year of pharmacy school at the University of California San Diego Skaggs School of Pharmacy & Pharmaceutical Sciences. She is from the central valley which has the highest rates of teen pregnancy in California so this topic is very close to her heart!

My Personal Journey from “Choose Life” to “Choose Control”

I am a pharmacy student at UCSD and if you would have told me one year ago that I would be spending my summer advocating for adolescent reproductive health I probably would have laughed.

My Conservative Background

You see, I was born and raised in the central valley in California, in a conservative community, in a conservative Christian home. I was raised to value human life, including the unborn. You could (and should) call me pro-life. However, during the winter quarter of my first year in pharmacy school, Dr. Sally Rafie, PharmD gave us a lecture about emergency contraception that really impacted me. She shared some staggering statistics. You see, in the United States over 50% of pregnancies are unplanned. Of those unplanned pregnancies, 40% are going to end in abortion. That’s about 20% of all pregnancies in the U.S. But it was her next comment that really struck me and got me interested in this topic, “if we are ever going to decrease the number of abortions, we have to decrease the number of unplanned pregnancies.” That was a lightbulb moment for me.

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Why I Care About Teens and Family Planning

This summer I have the privilege of doing a project with Dr. Rafie on pharmacists’ growing role in reproductive health services for adolescents. Teen pregnancy in the U.S. is at an all-time low of roughly 26 births per 1000 teens. Now this sounds like a pretty good statistic right?  Less than 3% of teens are actually having babies every year (of course even more are getting pregnant)!  Until you consider the fact that is one of the highest teen birth rates among developed countries and places like the Netherlands have only 5 births per 1000 teens. That means 5 times as many teens are having babies here in the United States. In the central valley where I grew up, our rates are well above the national average and some counties (like Tulare) nearly double it. Obviously what and how we are teaching our teens about and the access that they have to birth control services is not working.

Studies have repeatedly shown that increasing knowledge of and access to birth control methods and services does not increase the number of teens having sex or even how often or with how many people they have sex with. The only statistic that it affects is the number of teens having safe sex and the number of teen pregnancies and teen births. Studies have also revealed that abstinence-only education is ineffective in decreasing the number of teen pregnancies. When we as conservative Christians fight to implement abstinence-only educational programs in schools and limit teens’ access to information and birth control methods, we are contributing to the number of teen pregnancies, the number of abortions, and the number of teen parents and children in the foster system. That is not a statistic that I want to be a part of. Additionally, unless parents know for 100% sure that their child will be living a life of celibacy, family planning education will be valuable to them at some age even if they remain abstinent until marriage. It can also be helpful for teens to share information with their friends who could benefit from accurate knowledge about birth control.

What I’m Doing About It

A new law was passed in California that will allow pharmacists to provide hormonal birth control directly to patients in pharmacies regardless of age. My project this summer is focused on teen girls to see if this is a service that they are interested in and how pharmacies can serve them best. This project will be very important in helping pharmacists prepare to meet the needs of adolescents in their communities as this new program is rolled out.

If you have questions about any of the statistics I discussed or you just want to know more about my research please feel free to contact me. As you might have guessed, this is something that I feel very passionate about and I would love to discuss it with you more.


About the Author:  Courtney Miller just finished her first year of pharmacy school at the University of California San Diego Skaggs School of Pharmacy & Pharmaceutical Sciences. She is from the central valley which has the highest rates of teen pregnancy in California so this topic is very close to her heart!

Look For These 5 Features When Choosing A Pharmacy For Your Birth Control

When it comes to picking a pharmacy for your birth control — whether you are buying something over-the-counter or filling a prescription — we are inundated with choices.  There are probably as many pharmacies in your neighborhood as there are coffee shops.  Everything from your corporate chain pharmacies (think CVS or Walgreens) to grocery store pharmacies (Vons, Ralphs) to big box pharmacies (Costco, Walmart, Target) to independent pharmacies (YourStreet Pharmacy, Sally’s Drugs).  There are a couple of other options too.  We can’t forget about mail order pharmacies and online pharmacies.  So how do we pick one?

There are a couple of features to look for.  These can be applied to other medications beyond birth control too.

#1 – Privacy  

Is there a private area where you can discuss your confidential medication and other health issues with the pharmacist?  We have all overheard awkward conversations between the pharmacy staff and the person in front of us in line.  The dividers on the counter don’t cut it.  It doesn’t have to be this way.  Some pharmacies are making the effort to have a private room or at least a private cubicle to meet with you.  

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(Photo credit: Random Retail via Flickr)

Does the pharmacy guarantee your personal health information will not be shared with family members or others without your permission?  There are laws protecting your personal health information but that doesn’t always mean you’re safe.  A lot of people send their loved ones to the pharmacy to pick up their medications or ask a question, so the pharmacy is used to sharing information.  But if you want your records to stay private, ask about their privacy practices.  

#2 – Knowledge

The pharmacy exists for two reasons.  One is to get you the medication supplies you need.  The other is to make sure your medication will be safe and effective for you — essentially serving as a second set of eyes on your doctor’s prescription.  Birth control is not one-size-fits-all.  Pharmacists add an important layer of safety to the risky business of using medications.  You want to be sure your pharmacist is knowledgeable about birth control and everything that goes with it, like the menstrual cycle and sexual health.  

Birth control is amazing.  It prevents unwanted/unplanned pregnancies and does wonders for some mood disorders, making periods lighter and less painful, getting rid of acne, and so much more.  It’s not without its side effects.  As with all other medications, it’s a balancing act of the risks and benefits.  In most cases, the benefits outweigh the risks.  But you want to be sure your pharmacist warns you about the risks –there are some rare yet serious complications.  Many women give up on birth control because of more benign side effects like spotting, hair growth, decreased sex drive, weight gain, etc.  A pharmacist who knows birth control can use this information to recommend a different birth control formulation that will give you less grief and helps you plan if/when you want a baby.

#3 – Service

What services does the pharmacy provide that might add value to you as the patient or client?  Check if they can auto-refill your prescription.  Some pharmacies may be able to call/text/email you when your prescription is ready for pick up or when you’re due for a refill to see if you want them to process it.  Ask if the pharmacy can reach out to you when you are due for vaccines or other preventive health check-ins like STD testing.  

Perhaps you’d like to make an appointment to discuss your birth control or other health/medication issues with your pharmacist.  If this is an available service, does the pharmacy have an online scheduling option?

Is your pharmacy willing to go to bat for you?  This may mean playing phone tag with your doctor to get your prescription just right.  Or spending time convincing your health insurance company that you need this method of birth control or whatever medication and that the insurance company should pay for it (so you don’t have to).  See if your pharmacist has collaborations with other nearby health care providers and refer you as needed for related services like a pap test, pelvic exam, or breast exam (note: these are not needed for birth control, but help screen for cancer).

#4 – Convenience

Is the pharmacy convenient for you?  And I included you because we are each looking for something different.  Would it more convenient if the pharmacy was near school, near work, or near home?  Would you prefer they are open on weekdays or weekends?  Mornings or evenings?  Don’t forget to consider the parking situation.  

In this century, it’s not just about getting to the physical location anymore.  Does your pharmacy send you through an automated phone maze or is it easy to get through to someone who can help?  Can you email or text your pharmacy?  Do they accept refill requests online?

Now think about what the pharmacy can offer you to make it even easier.  Do they offer delivery or shipping services?  A small fee could well be worth the added convenience.  Your time and effort is money…and there’s the cost of gas too.

Does the pharmacy have other items that you can conveniently grab or have delivered/shipped?  Maybe you want to pick up a Mother’s Day card (hint hint, it’s just around the corner).  Or you’d like to pick up a thoughtful gift for your roommate.  Or you just need to stock up on the basics — we all need to brush our teeth  and use deodorant right?

#5 – Trustworthiness

This is somewhat of a catch-all for for the remaining things you should be looking for.  First, is the pharmacy legitimate and licensed?  Your neighborhood pharmacy will be but what about the anonymous people operating the online pharmacies.  Are the pharmacists licensed with their state board of pharmacy?  Does the pharmacy have a license/permit?  Are they getting the medications from a trusted wholesaler or could they be off-market?  The integrity of a medication cannot be trusted if it touches an off-market wholesaler.  You do not want to be fooled by counterfeit medications.  There’s a fantastic book on this topic.

Why isn’t cost on the list?

Medication prices are controlled much higher upstream and the pharmacies may not have much input on the matter.  The drug wholesalers set prices and insurance companies dictate how much the pharmacy gets reimbursed for dispensing prescription medications.  Oftentimes, pharmacies are actually losing money on some of the prescriptions they fill.  When the pharmacy’s costs and reimbursements are controlled by these outside factors, so is the cost to you — the patient.  Your copay will be the same regardless of which pharmacy fills your medication.*  So you can let the other features listed above help you pick the pharmacy that meets your needs.

*Some health insurance plans have lower copays when using their mail order pharmacy.  So a 3-month supply may be given for the price of 2-monthly copays.  Some health insurance plans may have “preferred” pharmacies so using a non-preferred pharmacy could cost a bit extra.

We would love to hear about your experiences with different pharmacies.  Please add comments below!