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Barbara G. Wells, PharmD, FASHP, FCCP
CPNP Foundation President

One of the ways the CPNP Foundation furthers evidence-based treatment for patients with neuropsychiatric disorders is to focus on the needs of these individuals, their families, and health professionals in general practice settings, including community pharmacies. 1st Avenue Pharmacy is an exemplary community pharmacy specializing in serving the mental health community in Spokane, Washington.

Several of the initiatives in the Foundation’s strategic plan address the needs of patients, caregivers, and community-based pharmacists to advance best treatments. Examples are initiatives to elevate patient expectations of their pharmacist/pharmacy, helping patients to access community pharmacies focusing on their special needs, promoting best practice guidelines, and providing educational opportunities, tools, and resources for pharmacists in general practice settings. Because of the Foundation’s focus on improving the care of neuropsychiatric patients in the community, we will from time to time provide a description of a pharmacy in the community which is leading the way in advancing evidence-based treatment for patients with psychiatric and neurologic disorders. 

In this issue, we feature 1st Avenue Pharmacy, established in 2005 as an independent, community pharmacy specializing in serving the mental health community in Spokane, Washington. The pharmacy is located close to a community mental health center and to public transportation. The owner, Rob Leland, Pharm.D., BCPP, is a pharmacist who saw an opportunity to provide much needed services for individuals he had long enjoyed serving. The pharmacy offers traditional services, as well as specialty packaging, mailing and delivery services, and prescription support for patients in assisted living facilities. The pharmacy accommodates walk-in customers for administration of long-acting antipsychotic injections administered by a pharmacist. Clients are able to come to the pharmacy on their appointment day (not necessarily a specific time) where there is a dedicated pharmacist to provide the injection service. The pharmacy’s small-volume hematology analyzer enables measurement of a complete blood count (CBC) with differential in less than 2 minutes using a small volume blood sample from a finger-stick, rather than venipuncture. For clients taking clozapine, this is a much more acceptable method for routine monitoring of CBCs. For these clients, it is convenient to have their other prescriptions synchronized for pick-up on a weekly, bi-weekly, or monthly basis.

Recently a nurse has joined the staff to assist with management of clinical services for residents in assisted living facilities. Soon a remodel of the pharmacy will expand the waiting room and allow further restructure of work flow, allowing pharmacists to be more frontline and proactive in reaching out to patients to address their medication-related needs. 

The pharmacy and pharmacy staff have developed a reputation within the mental health community for providing compassionate care to neuropsychiatric patients. They have established a collaborative relationship with mental health professionals including providers and case managers at a local community mental health center. They also work with Washington State University College of Pharmacy and other pharmacy schools and pharmacy technician training programs as a practice site for clinical skills development. Clinical pharmacist, Brandy Singer, PharmD, BCPP, routinely participates in training pharmacy, physician-assistant, occupational therapy, and social work students, and local police department crisis response teams.  

Dr. Singer notes that both job satisfaction and profitability have improved as a result of the enhanced services provided. Enhanced profitability took longer, but over time, the clientele has grown, and programs are now available to compensate pharmacies for administration of long-acting antipsychotic injections.

For the pharmacy staff, job satisfaction derives from regular encounters with the clients. Pharmacy staff show respect for clients and seek to engage them in a way that develops rapport, building client confidence and trust in the information and services provided. “The greatest rewards come from being able to meet clients’ specific needs through clinical interactions,” says Dr. Singer. 

Dr. Singer states, “Probably the biggest challenge is that pharmacists need to be recognized as healthcare providers under Medicare part B and by third party payers in general. When this occurs, compensation can be structured in a way that these clinical services will be available to many more patients.” 

Dr. Leland recommends that other pharmacists interested in expanding their services to neuropsychiatric patients should aggressively market their specialty services early on. He states, “It is important to like what you do, and the rewards will follow. Prior reputation of the pharmacists, a willingness to go the extra mile to meet individualized needs, and location of the pharmacy are all very important to early success.”

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