The Pharmacy as Adjunct Care Center


Hello, all.

I’ve been out of the loop for a while, unplugged so I could help my niece with her master’s thesis.  When I agreed to check grammar and spelling (English is not her first language, but man, is she good at it) I figured I was getting myself into reading hundreds of pages about the finer points of con trails or worm hearts or some esoteric stuff like that.  Well, it wasn’t a yawn-fest at all.  Her thesis deals with the pharmacy as an adjunct care center and the software that goes into tracking the proper indicators to recognize effectiveness and efficiency in patient care.

Right up my alley!

I hadn’t thought much about my pharmacy experience here in good ol’ NL, but comparatively speaking, I see a huge, positive difference in the pharmacy ‘care’ I receive here in contrast to my experiences in the US. In America, I was given my pills and a hefty leaflet, asked if I had any questions for the pharmacist and sent on my way.  Well, I always wondered, if it’s a new med how the heck am I supposed to ask intelligent questions when I haven’t even swallowed a pill yet?  Oh, yeah.  And about that leaflet?  I would read them (sometimes) but of course, especially with psychiatric med, the general information was kinda useless in most cases.  My pharmacy experiences in the US seemed largely reactionary, the pharmacist inserting themselves only when some question or problem is brought to them.

Except when a three-month supply of med arrived in the mail.  Then, I was pretty much on my own.

In The Netherlands, the model (although still evolving) is quite different.  To say the pharmacists here are proactive instead of reactive is an understatement.  Pharmacists are given more latitude to actively participate in a patient’s care.  One example is the expectation by the medical establishment that pharmacists will be knowledgeable enough to recommend an adjunct, over the counter med in conjunction with the medication the patient is receiving, if that additional OTC med will reduce the amount of side effects the patient may experience.  The example my niece used was the suggestion of a laxative to those patients prescribed a narcotic (constipation is a pretty common side effect).  Pretty much common sense, right?  Doctors often don’t discuss this particular gem of a side effect and it’s the pharmacist who, in cases like this, winds up filling the void left in between most patient’s being prescribed the med, popping that first pill of the treatment and then having pretty common issues somewhere down the line.

The set of indicators used to evaluate the quality of adjunct care is still evolving but there is a good start.  Of course, targeted software is beginning to make its way on to every computer in Dutch pharmacies.  Which is a very good thing, since not only lists of drugs that a patient takes and drug interactions can be generated, but the patient record can now include more robust details, including the condition for which the medication was prescribed, whether the patient was offered an OTC to help with side effects, whether or not they declined the OTC and the reasons why, etc.  With a bit of imagination, I’m sure everyone can come up with other ways this capability can be used.  Also of importance to the pharmacy, these systems afford the ability to rate a pharmacist’s performance and gives the pharmacy itself a rating that is used when funding allocation is at stake.

This all sounds well and good.  Does it really work?  Well, yeah.  When I went to fill a prescription for a particularly nasty Class Three med when my insomnia was out of control, I joined my pharmacist at the consultation station – which is expected and not an option – for a full fifteen minutes.  It was beyond enlightening.  The way this medication works is a bit, well, ‘interesting’ and it could cause side effects my doc never even remotely discussed.  Not just the garden variety stuff, either.  Try and fit that on a pamphlet I’m not going to read anyway.  We talked about my condition, interactions, what I should do in the event a nasty side effect did arise, how it could affect other health problems I have and whether there were any alternatives out there (yeah, this med scared me that much).  After I left the pharmacy, I got a call from my pharmacist.  She wanted to be absolutely certain I heard and understood I could not, under any circumstances, drive the car.  At all.  During the course of treatment. If I were in an accident it would be an extremely bad deal.  (The Dutch justice system is a lot more unforgiving than the American one about people having Class Three substances in their system.)  That tidbit would certainly not have been included on any pamphlet from Rite Aid.  And certainly wouldn’t reach my ears if a three-month supply of med arrived in the mail.

As I read this back there is something missing from my description of this Dutch model of care. The difference really lies in attitude.  Pharmacists (it seems to me, anyway) are more respected and interact with physicians a lot more than in the US.  The superiority complex that most docs bring into interactions with nurses and pharmacists doesn’t seem to exist as much here.  Which gives the pharmacist confidence to act as a partner instead as an underling pill counter.  This isn’t something my niece touched upon in her thesis, but it screams to me loud and clear every time I need to get or refill my stupid med.  I have a lot more confidence in the medication choices my docs make and the pills I choose to swallow because of my pharmacist.  I’m better informed.  About the medications, how they work, what their interactions are and what else I could be doing to make the cocktail boat sail a bit smoother.

Bottom line:  here in NL as far as meds go, I’m being double-teamed.  And, I kinda like it.  Thanks to my niece, I now realize it and fully appreciate it.

My pediatric dialysis unit has the same philosophy, but you are so right that it is a very unusual occurance. We have a PharmD who works on our team and our physicians rely on her to review and look for problems with meds and make recommendations when necessary. I am so proud to work on a (rare) team like that in the US! I think pediatrics is the only place where that might be seen since they react so differently to meds that aren’t studied in their age group.

Warms my heart to hear there is a pediatric unit with the same Care Center philosophy! Kids pose so many more interesting challenges, don’t they? I was hoping I got my point across in that post, but my Nurse Friend understands 🙂

Sounds fascinating – and much nicer than the US system. Heck, it’s a miracle if you can get your prescribing doctor to fill you in on side effects…

Oh, and I do try to read those pamphlets, but they’re not really that useful. These days I spend a few hours doing web searches on pharmacokinetics and CYP 450 isoenzymes before I even consider picking up an OTC drug. Even the most competent doctors (much less a pharmacist – ha!) are nearly at a loss to make a recommendation for a decongestant, and no one can suggest a painkiller that’s not a controlled substance (which they won’t prescribe anyway.) It doesn’t do much for my respect for the medical professions, let me tell ya…

Yeah, I hear you loud and clear. It’s a disgrace patients have to do their own drug research. Some of these docs are just downright clueless, too. I used to go to an American ex-pat doc here in NL. I was getting migraines from reinjuring and old neck thing. He told me to take alprazolam. Alprazolam! Who cares if I would become addicted after 4 days continued use? HOW DID HE NOT KNOW/MENTION THAT?? Who prescribes alprazolam for an injury induced migraine?

I’m also with you on the uselessness of the pamphlets. I used to ball them up and give them to my then-puppy as a toy. 🙂

I hope you’ve been able to find OTC meds that work. Trial and error just isn’t acceptable!

I did find an adequately acceptable allergy medicine for now, but I’m out of luck for painkillers.

The worst part about the pamphlets is that they’re incomplete. The second worst part is that they’re unreadable for a lot of people – talk about bad information design! Not everyone goes and looks up meds on the Internet before taking them, and those who do are the ones who are least likely to take them anyway.


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