Friday, August 10, 2007

Compounding Pharmacists - Who knew?

In a lot of my research on medication non-adherence (that is the new accepted term for noncompliance), I come across what researchers deem as the "important role of the pharmacists". Especially in all of the pharmacists surveys and reports! For me (I have taken two or three medications on and off for 8 years) I just pick up my drugs and leave. I recall once, maybe five years ago, the pharmacist gave me the option of getting a generic as opposed to the branded drug - and I think I took it.

BUT after thinking about their role a couple of weeks ago, I started engaging the pharmacist. I had a phlegmy cough in Nantucket over the 4th of July weekend and wondered what I should take - musanex (sp), robitussin, etc... She was very helpful and outlined the pros and cons of each. Helpful, but not exactly prescription help.

So in the last two days I was surprised to find two articles about compounding pharmacists - a job I never knew existed. I have always just gotten my pills as they come from the pharma company. I guess other people are pickier than I am. At least both articles state that it helps with Medication Non-Adherence.

Here are the two articles:

The first from the website Hometownlife by Nathan Mueller:

Kenny Walkup has hands that can turn a solid into a liquid; change the taste of medicine to anything from bubble gum to beef; and change certain aspects of a prescription to remove parts that people or animals are allergic too.
OK, Walkup does not do it all with his hands — some high-tech equipment and technicians also play a role — but they are a key reason Specialty Medicine Compounding Pharmacy has been successful.

"I always liked working with my hands. I should have been a mechanic but I can't fix a car," he joked. "Plus it gives me a chance to be creative." But he can fix medicine.

Walkup's job as a compounding pharmacist is solely based on the individual he is working for. He works with the patient and physician to create a medication that will work for the customer.

The most common situation he comes across is "patient non-compliance." Many people or animals are allergic to certain parts of a prescription or sensitive to strengths, and a compounding pharmacist can — with physician consent — change the strength, change the form from solid to liquid, etc. and change the flavor. Flavors range from chocolate to pineapple to bubble gum for humans and from apple to catnip to chicken for pets.

"All prescriptions are made from scratch, specific to each patient," he said. Walkup owned both the compound pharmacy and the South Lyon Pharmacy before splitting them in February 2003. He has been in South Lyon since 1998.

A graduate of the School of Pharmacy at Ohio Northern University in Ada, Ohio, Walkup joined the Professional Compounding Centers of America and began training there before opening the pharmacy in South Lyon. His pharmacy is a clinical site for Ohio Northern and the University of Michigan, and he gives lectures and does work for both universities.

"I enjoy (talking to students) but I like being in the lab too," he said. "Most of the new stuff I make myself the first time."
The pharmacy has been so successful that it was recently featured on the Heath Watch on the Channel 4 News. Reporter Rhonda Walker said the pharmacy was the "ultimate when it comes to personalized medicine."

It also touched on a story about a patient, Noel Gelfund, who was undergoing treatments to remove a birthmark and the pain killing cream he needed was discontinued. Walkup got to work and formed a new cream that worked better and cost half as much.

Gelfund was killed in a car accident in 2004 and the cream was named "Noel's Numbing Cream" in his honor.
Walkup donates 20 percent of the proceeds of the sale of the product to the Sturge-Weber Foundation which researches Port Wine Stain conditions.

"I have the best job in the world," Walkup said. "I get to help people and do something I truly enjoy."

Here's the second article from the Salt Lake Tribune by Fitzgerald Petersen

Tad Jolley may have the pharmacy business coursing through his veins, but innovation runs in them, too. Jolley was recently awarded "Innovative Pharmacy Practice" by the Utah Pharmacy Association at their yearly convention. Jolley won for his creation of an in-house program to train pharmacy technicians, who are a critical component to Jolley's pharmacy business.

Prior to the creation of the program, aspiring pharmacy technicians would need nine months of schooling before becoming certified. Jolley's program allows technicians in training to receive a paid education while gaining valuable work experience. Jolley benefits by gaining technicians who know their way around his unique store.

Jolley's pharmacies specialize in compounding, which Jolley calls "a lost art." Compounding is highly specialized and involves mixing ingredients specifically for each patient. Of the hundreds of pharmacies competing to fill prescriptions in the Salt Lake Valley, only a handful offer this special service. Most simply rely on pre-made formulations from big drug companies.

Tad Jolley is the third generation of compounding pharmacists to sit behind the counter of the family business. Joel Jolley opened the first Jolley's Pharmacy in 1954. Fifty-three years and four stores later, the family business is still going strong.

Jolley's Pharmacy employs 30 pharmacy technicians in all, so the in-house program makes a significant impact - and not just for Jolley's. The program has caught on with other pharmacies as well. Jolly has received numerous calls from colleagues asking for his advice on implementing their own in-house training. Jolley acknowledges that his program "does something outside the norm" but, he says, "It's helped a lot of other pharmacists as well."

Though Jolley has been working as a pharmacist since 1980, he still loves picking up his mortar and pestle to serve the community. While his award from the association hangs modestly on a wall in his store, he hopes the positive impact of his training program will be felt for years.

Compounding the cure

Pharmacy compounding is the long-established tradition in which medicines that are specially prepared by pharmacists to meet patients' individual needs. Physicians often prescribe compounded medications when:
* Medications are discontinued by or generally unavailable from pharmaceutical companies.
* The patient is allergic to certain preservatives, dyes or binders in available off-the shelf medications.
* Treatment requires tailored dosage strengths for patients with unique needs.
* A pharmacist can combine several medications the patient is taking to increase compliance.
* The patient cannot ingest the medication in its commercially available form.
* Medications require flavor additives to make them more palatable for some patients, most often children.

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