By: Victoria Chirico, PharmD Candidate c/o 2018
From I-STOP surveillance to vaccine administration, many changes have been made in the world of pharmacy, with more to come. Whether these changes are for the better or worse, they define the roles of a pharmacist in our world today. As the role of a pharmacist is shifting toward a more patient-interactive one, laws such as the Omnibus Budget Reconciliation Act of 1993 and the Medicare Modernization Act of 2003 have enabled to make these changes possible and contribute in preventing medication errors.
Jeneane Chirico, RPh, owner of Annadale Family Pharmacy in Staten Island and Gerard Chirico, RPh, a pharmacist at Rite Aid in Brooklyn were interviewed about the recent changes made to the pharmacy profession. Prior to establishing her own pharmacy, Jeneane Chirico graduated from St. John’s University in 1988 and has owned her independent pharmacy for 15 years. Gerard Chirico, who also graduated from St. John’s University in 1988, owned his own independent pharmacy, Carroll Court Pharmacy in downtown Brooklyn, for 15 years before working at Rite Aid.
Pharmacists now have the ability to administer certain vaccines. What is the significance of this change to the pharmacy profession?
Gerard: “I feel that pharmacists are often on the first line in the medication process. We are often contacted for advice and consultation before a doctor is even called. Also, we are the most trusted profession, and our patients rely on us for information. I think it’s a no brainer that pharmacists can immunize. In the past, doctors were not informing patients on the benefits of immunization, and therefore the U.S. has been under-immunized. Pharmacists have changed this trend, which is why we are allowed to immunize. Patients no longer have to go to the doctor to get their annual flu shot, which makes it more convenient for the patient. Since pharmacists can administer vaccines now, we have more duties that promote patient care, which is what our profession is all about.”
Jeneane: “I feel it is great that pharmacists can immunize. No more waiting 3 weeks to see a doctor for a flu shot and possibly getting sick while waiting in the packed waiting room. On the other hand, I chose the pharmacy profession because I wanted to be in healthcare and help people but not actually touch patients. As long as immunization is not a mandatory for pharmacists and it’s still optional, I think on the whole it’s a great idea. The significance of this change to the pharmacy profession is that pharmacists have more patient centered care jobs to perform. Our profession is patient care based, and I think it’s great that we are being trusted to perform more works such as this. ”
New York prescriptions are going to be electronic next year. What are the consequences of this legislation for the pharmacy profession?
Gerard: “I think that it will cut down on medication errors and lessen prescription fraud via forgeries and prescription stealing. If the doctor has to pick the medication from a drop down menu in order to send it electronically, he will be able to pick the correct dosage for the medication that he or she prescribed. This will definitely prevent a lot of dosing errors. Without paper prescriptions, patients won’t be able to steal prescriptions and prescribe themselves medications by forging the doctor’s signature. Only doctors and their employees will have access to the computers where they can e-prescribe prescriptions. Patients won’t have access to these computers, nor will know how to use them.”
Jeneane: “I feel extremely happy that all prescriptions will be electronic next year. There are a few kinks that need to be worked out, but on the whole, I feel there will be less handwriting-guess errors made.”
Pharmacists are seen as healthcare providers, but not under federal law. Should pharmacists be compensated for the time they take to counsel patients like doctors do when they see patients?
Gerard: “I think that pharmacists are increasingly seen as healthcare providers. This goes along with allowing pharmacists to immunize. Since pharmacists are allowed to immunize and are doing other jobs that they were once not allowed to do, they should be seen as healthcare providers and should be compensated for it.”
Jeneane: “Pharmacists are healthcare providers. We are the first people that patients seek for advice. We aren’t paid for each individual. As pharmacists get more responsibilities, like counseling and immunizing flu shots, they should be compensated for them like healthcare providers like doctors are.”
Counseling patients is a big part of the pharmacist profession. Do you believe counseling should be extended to situations such as refills?
Gerard: “It is our job to counsel patients, that is the major part of our profession. I counsel patients a lot, especially when they have questions regarding their medication. It is important to let inform the patients what they are taking, why and for how long. It makes the patient feel more comfortable and gain more trust with their healthcare professionals.”
Jeneane: “Counseling patients was always part of our job. To tell us who needs it and for how long is a different story. I counsel patients when I am required to or when patients have questions for me. Some patients even ask me questions when they are getting a refill. They have taken the medication before, but want to make sure they are taking it the correct way and want me to remind them of the side effects. Counseling is a great way to communicate with the patients and form a trustful relationship with them.”
If the AAFP approved the FDA’s proposal to allow pharmacists to prescribe some medications, which medications do you think pharmacists should prescribe and how would this impact our profession?
Gerard: “I think some classes of medications we should be allowed to prescribe like NSAID’s, first line antibiotics and some asthma inhalers. I think pharmacists should be able to do this because it would lower healthcare costs. Also, doctors are prescribing anti-inflammatory medications for 30 days, but pharmacists know that patients shouldn’t be taking these medications for longer than 2 weeks. Since pharmacists know more about the safety of medicine, they should be able to prescribe at least some of the more common medications that patients take.”
Jeneane: “We kind of do that now. If someone has an ache from doing a little too much gardening, I recommend them to take Advil (NSAID) if they are able to. I also tell them the prescription dose is the same medication but just a higher milligram. I let them be the judge on how much to take. I just provide them with the limits.”
With the recent implementation of the I-STOP, do you think the program has been beneficial in pharmacy? Notably, in the prevention of medication errors with controlled substances?
Gerard: “I think it was a long time coming. I-STOP can and will save lives, if only we can convince doctors to actually access and use the system. I think it will prevent medication errors with controlled substances. Since we are counting how many control pills we have and are dispensing everyday, we can keep track of control medications. Also, I-STOP prevents patients from getting prescriptions written from different doctors for the same control medications. Since it is documented that a patient has received a script for a control substance, the patient is limited from getting that control substance prescribed to them from a different doctor. This helps prevent pharmacists from different stores from dispensing the same medication and causing the patient to overdose on the control substance.”
Jeneane: “It is about time…that’s all I have to say! I was involved with the groundwork helping make this program work. I have seen doctors and ER physicians writing for less medicine. I never see Percocet 10/325 #360 tabs anymore! Unfortunately heroin use has gone up and also there has been and increase in Adderall and Xanax scripts. I think I-STOP has been beneficial in pharmacy. We have more control over abused substances and are preventing abusers from getting their hands on these substances. Since doctors know what the patients are prescribed, there are less medication errors, such as overdosing patients.”
The idea that New York prescriptions should only be allowed to be filled in New York has been brought up quite often. Do you agree or disagree with this proposal?
Gerard: “I don’t agree that NY prescriptions should only be filled in NY. Patients travel and most drugs are federally controlled. However, I think control drugs given by an NY physician should only be filled in NY. I also think that out of state controlled drugs should not be allowed to be filled in NY, until all states adopt the I-STOP policy.”
Jeneane: “My pharmacy is in Staten Island near New Jersey, and I do get a lot of New Jersey scripts. So I would not like that too much. What would be ideal is if New Jersey and all the states adopt the I-STOP policy. I do notice that some pain doctors on Staten Island stamp their prescriptions with Fill in NY only.”
We thank Gerard and Jeneane Chirico for sharing their outlook on the pharmacy profession. They both hope that if changes are made, these changes will prevent medication errors, benefit patients, and prevent the abuse of controlled substances.
- More Pharmacists Positioned to Protect Public Health by Expanding Immunization Services During Flu Season. National Association of Boards of Pharmacy. Available at: https://www.nabp.net/news/more-pharmacists-positioned-to-protect-public-health-by-expanding-immunization-services-during-flu-season–2. Published on 09/02/2010. Accessed on 06/28/2015.
- Pennic J. NY Gov Cuomo Approves EPCS Delay to March 2016. Hit Consultant. Available at: http://hitconsultant.net/2015/03/16/ny-gov-cuomo-approves-epcs-delay-to-march-2016/. Published on 03/06/2015. Accessed on 06/28/2015.
- NYS Pharmacy: FAQ: Q&A. New York State Education Department. Available at: http://www.op.nysed.gov/prof/pharm/pharmqa703.htm. Accessed June 28, 2015.
- FDA Proposal to Allow Pharmacists to Prescribe Some Drugs Sparks Swift Rebuke From AAFP. American Family of Family Physicians. Available at: http://www.aafp.org/news/government-medicine/20120502pharmprescribing.html. Published on 07/2003. Accessed on 06/28/2015.
- I-STOP/PMP – Internet System for Tracking Over-Prescribing – Prescription Monitoring Program. New York State Department of Health. Available at: http://I-STOP/PMP – Internet System for Tracking Over-Prescribing – Prescription Monitoring Program. Published on 11/2013. Last Accessed on 06/28/2015.