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Pharmacist: Scott V. Monte, PharmD

Pharmacy: Mobile Pharmacy Solutions

City, State: Buffalo, NY

What led you to a career in independent community pharmacy? My first job application was to Eckerd for a sales associate position. Evidently, the need at the time that I applied was for a clerk in the pharmacy department. Having worked in the pharmacy for an extended period of time pharmacy school was appealing because it was a blend of community interactions and patient care. Once I received my intern permit I became very active in patient counseling. One major limitation I noticed during my intern years was a lack of time to help address major patient care issues. I can distinctly remember being chastised by a pharmacist for spending too much time counseling a parent of a sick child. It was in this moment that I decided one of my career goals would be designing a pharmacy model that could accommodate the time to dispense accurately and provide the necessary time and setting to provide a meaningful patient care interaction. In 2009, a good friend decided to start a pharmacy with a core component of home delivery. A novel idea for the time. From my vantage point this was an incredible opportunity to introduce clinical pharmacy components that would augment the core delivery service. It was a natural match.

What makes your pharmacy standout from the competition?
Every community pharmacy will promote the value or quality of their pharmacy service. It is our philosophy to go beyond the subjective promotions and innovate alongside the medical and caregiver community to identify and develop solutions that work in the real world. To that end, we have developed numerous interventions and services including:

(1) Inbound phone call triage to a clinical pharmacist managed hub
(2) Outbound adherence phone calls linked to home delivery scheduling
(3) Medication refill synchronization and customized adherence packaging
(4) Impromptu medication compounding
(5) Certified public accountant managed patient accounts receivable
(6) Free home delivery with an option for mailing or personal courier
(7) Pharmacist home visit
(8) Community pharmacist liaison to medical or community organizations
(9) Electronic database interface (Health-e-Link)
(10) 24/7 on-call pharmacist availability

The integration of all these services in conjunction with careful planning alongside the referring medical or community-based organization creates a patient care and service environment that merits recognition as a high quality pharmacy service.

What are your biggest challenges?
The pharmacy model is a disruption. The services we have built into the pharmacy model are meaningful to the patient, provider, and caregivers referring to the pharmacy. The payment system has not evolved quickly enough to support providing these services. Many of the services are time intensive and require a professional component. Therein, these services are costly to the pharmacy and growth has to be carefully managed. Too much growth too quickly can create stress on the pharmacy staff. This is magnified when you are developing and subsequently implementing a new service. The greatest challenge that we face is demonstrating value of these services and obtaining reimbursement beyond dispensing revenues.

Describe a recent, rewarding experience with a patient:
In my opinion, the most rewarding patient care experiences are through home visits. Each year I ask our resident to share a personal experience. Below is that description from our soon graduating resident Alexandra Pullano:

"We have a patient—a 40-year old female—who I visited for a referred in-home in December. The patient has a traumatic brain injury and has had a variety of assistance in the past ranging from 24 hour nursing to solely family care. She is mentally very involved in her care despite her impairments and she takes great pride in knowing which medications she takes, when she takes them, and what they are for. Despite that, her medications had become too much to manage. The caregivers that were legally qualified to handle her medications changed frequently and her family, although very involved in her care, weren't able to give enough attention to her medications as they knew she needed. A caregiver suggested Mobile Pharmacy Solutions and the family jumped at the suggestion.

I visited the patient in December and spent about an hour going over our services, how we would set up her medications, and reassuring her that we were up to the task. It was obvious that the hardest part of the transition for the patient would be giving up some control over her medications. I spent most of the visit explaining that we would never make a change in her medications without communicating with her and her providers and explaining in different ways exactly how everything would work. When I left the visit it was clear that many of her concerns with the new system for her medications were addressed and resolved.

It took about a month to get the first packages out since she just had prescriptions filled at her previous pharmacy. I spoke to the patient at least weekly. She would call and ask for me and I would answer her questions or assure her we were still on top of her medication management. She constantly thanked me for talking to her and I reminded her that it was our job and we were happy to help care for her. When her first package was ready to be delivered I decided it was in the best interest of the patient to deliver it myself. I set up another visit and reviewed the packages with the patient for a second time to make the transition as seamless as possible.

She is still successfully using Pop-Paks and I get to speak to her every now and then when she has a question. She remembers me and trusts that I'll put every effort into her care. These visits and patient interactions were especially rewarding to me because of how involved the patient continued to be in her care. Many Pop-Pak patients are just so overwhelmed with their medications that they happily hand over the reins to someone else. This patient was so involved in her care that convincing her to give up some control—even when she knew it was in her best interest—was the biggest obstacle in the program enrollment. It's incredibly rewarding to know that the time I spent with her eased her mind and led to a maintained pharmacy-patient relationship that is truly in her best interest."

How has NCPA helped your business?
NCPA has been instrumental in helping our business establish operational and financial benchmarks. Having a core group of pharmacists that are experienced in dispensing or clinical practice and not business can be challenging when growth is aggressive. It can also be challenging to appropriately develop organizational structure and job descriptions that optimize all parts of the business. Having taken advantage of NCPA sponsored educational opportunities and conference proceedings, we have expanded ourselves professionally and enhanced our ability to recruit innovative people that can fill voids in our knowledge. This is an important evolution from which our ownership, company leaders, post-doctoral residents, and students will greatly benefit.