Addressing pharmacist shortage through innovation

Anne Polta
West Central Tribune - 04/15/2006

MONTEVIDEO — For Jill Reinhardt and her husband, the decision to open a pharmacy in Gaylord has been a good thing.

They lease space in the Sibley Medical Center — a location that’s affordable for them and convenient for patients, physicians and the public. Their presence in Gaylord also means access to pharmacy services for the local nursing home.

Three months ago, the Reinhardts’ First Choice Pharmacy also established a telepharmacy to bring prescription-drug dispensing to the neighboring town of Henderson.

A new regional initiative is under way to help develop and foster innovative approaches such as these to southwestern Minnesota’s growing shortage of pharmacists.

“We know that we can do things better together than we can individually,” said Tom Richter, administrator of the Madison Lutheran Home and project director of the newly formed Southwest Minnesota Rural Pharmacy Network.

Organizers described the initiative and led a town meeting-style discussion with about 20 people Thursday night in Montevideo. The meeting was the final one in a series of four forums designed to launch a dialogue on the need for rural pharmacists.

It’s a critical issue across the state but especially so in southwestern Minnesota, said Todd Sorensen, project coordinator and associate professor in the University of Minnesota College of Pharmacy.

This region of the state has a disproportionate share of the elderly — a population that tends to have a greater reliance on prescription drugs, Sorensen said. It also has the highest number of single-pharmacy towns, leaving these communities at risk of losing local pharmacy services if a pharmacy shuts down or if pharmacists can’t be recruited and retained.

People who are elderly and low-income are especially vulnerable, Richter said. “If they can’t go to the local drugstore to get their prescription filled, they aren’t going to be able to go somewhere else.”

The pharmacist shortage not only affects customers but also hits small-town hospitals and nursing homes who often must rely on community pharmacies for services.

The challenges are many. The growth of prescription benefit plans and mail-order drugs is undercutting the ability of small pharmacies to remain financially viable.

Rural pharmacists themselves often are spread thin, commuting long distances to provide coverage. It can be an uphill battle to attract young pharmacists to rural practice. Those who are approaching retirement can have a tough time finding someone to replace them.

Organizers of the regional pharmacy network hope to find ways of maintaining the vital services that rural pharmacists provide.

The network’s board of directors will meet for a planning session next month to begin identifying specific projects to tackle.

“Each community may have to look at creative ways to try to keep their pharmacy operating. It may be with the local health care providers. It may be with the community,” Richter said.

A handful of independent initiatives are already being tried.

For instance, the Lac qui Parle Health Network, which consists of the hospitals in Appleton, Dawson and Madison, is working together to plan for the future of pharmacy services. The group has applied for a grant to establish a pharmacy residency program.

In Tyler, population 1,250, the presence of full-time pharmacist April Hanson has helped the hospital pharmacy make the leap from pencil and paper to computer-based inventory and ordering — all in the space of one year.

Hanson has implemented central dispensing of drugs and helped the hospital staff update its medication policies and procedures.

Pharmacists play an important role in patient safety and can be one of the leaders in helping rural providers improve their overall level of care, she said. “A full-time pharmacist is justifiable.”

From the town meetings, organizers also have gained several ideas.

One is to create a resource network of all the region’s pharmacists. Another is to develop an on-call system that allows pharmacists to better share coverage on nights, weekends, holidays and during illnesses or time off.

There have been suggestions to develop internships that bring pharmacy students to rural Minnesota in hopes they will decide to return when they complete their training.

“We’d like to get as many ideas as possible,” Sorensen said. “A lot of ideas have been already brought up — some really good ones that we wouldn’t have thought of on our own.”

Organizers also said it’ll be critical to educate communities about the role of rural pharmacies and enlist their involvement.

In most cases, once a pharmacy closes in a rural town, it’s very difficult to gain it back, Richter said.

“That’s when people finally wake up and say, ‘We have to do something.’ If they don’t all come together, they will lose their pharmacy,” he said.

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