US Pharm. 2006;5(Student suppl):4.     

Ask the average person what they think of when they hear the word pharmacist, and chances are it conjures up an image of a white coat–clad individual standing behind a counter, holding an amber vial filled with the pills he or she just counted. Ask a member of our profession what they think of when they hear the phrase clinical pharmacist, and more likely than not, they will picture a pharmacist working closely with doctors in either a hospital or a clinic, but rarely in a community pharmacy. As a member of the new generation of clinical pharmacists, I hope to apply my knowledge in a community setting, to not only improve patient care but also to change the perception of community pharmacy.

I am currently in my fourth professional year at the University of Rhode Island College of Pharmacy. After receiving my degree in May, I will be heading to the University of Georgia College of Pharmacy, where I have accepted a position as a community resident. You may be curious as to why I would do a community residency for a year, when I could go straight to work in a pharmacy after graduation, with no need for further training. The answer, to me, is simple. I would like the clinical experience and challenges a community pharmacy residency will provide me. This is in no way a slight on my education thus far. In fact, I believe I have received a great clinical education, but as my knowledge has increased, I've realized how much there is still to learn. This is why I would like to continue to discover how to apply this knowledge in a community setting.

My main practice site during my residency will be Kroger Pharmacy, where I will immunize members of the Athens community once I become certified. Georgia is one of the many states that allow pharmacists to provide immunizations. I will also conduct blood pressure and cholesterol screenings, along with many other patient-centered education programs. My preceptor at Kroger Pharmacy is also involved in an indigent care clinic in Atlanta. While my weekly involvement there will primarily focus on diabetes education and management, my responsibilities won't end there. The University of Georgia College of Pharmacy has a collaborative practice agreement with Athens Primary Care. The Pharmacy Care Clinic is located in a doctor's office and is run entirely by pharmacists. At this site, I will participate in diabetes education and smoking cessation classes, weight counseling, asthma management, and anticoagulation monitoring.

Older adults with multiple chronic conditions who are enrolled in a Medicare Part D prescription drug plan, and who are likely to incur over $4,000 in medication costs per year, are entitled to medication reviews under the Medicare Modernization Act. Pharmacists are mentioned as one of the health care professionals who can provide medication therapy management (MTM) services and get reimbursed for it. Despite a lot of progress, there are still many unknowns in this particular area. How do we determine who is eligible and then encourage them to participate? How will we measure outcomes from pharmacist-directed MTM services? What should be included in each MTM session? And how do we work these sessions into the flow of a busy community pharmacy so that our patients get their prescriptions in a timely manner? During next year, I hope to work through many of these challenges facing MTM and then build upon what other pharmacists and pharmacy organizations have already done to successfully provide this service to the community.

As community pharmacists, we are in a unique position to greatly improve public health, especially of older Americans with common, chronic medical conditions. We remain the most accessible health care professionals, since many of our pharmacies are open 24 hours a day and no appointments are required for our services. People who may not get the opportunity to see a doctor on a regular basis will come in to see a pharmacist for health-related issues and education. Services provided by a pharmacist, such as immunizations, wellness screenings, and education classes, could provide basic health care to those who need it the most. By providing more clinical services in a community setting, we as pharmacists can have a positive influence on public health. This is how I plan to improve patient care and change the perception of community pharmacy.

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