Kmart unveils patient-care center in alliance with pharmacy school

Drug Store News, June 22, 1998 by James Frederick

TALLAHASSEE, Fla. -- Kmart Corp. has teamed up I with Florida A&M University's School of Pharmacy to launch its first in-store, clinical care center devoted to managing patients with hypertension and other diseases. The chain's pharmacy executives are keeping close tabs on the results of the new pilot and are already exploring potential alliances with pharmacy schools in other parts of the country for additional pilot projects in disease management.

Dubbed the Kmart Kare Center, the new facility adjoins the pharmacy at the Kmart store at 1701 Apalachee Parkway in Tallahassee, not far from the Florida A&M campus. The center provides a private consultation area where patients can work closely and systematically with a clinical-care pharmacist to set and achieve health-improvement goals, periodically monitor their condition, learn more about their disease and improve their own therapeutic regimen.

"We know this can't be done while a pharmacist is busy dispensing prescriptions," said Catherine Polley, Kmart director of pharmacy health services and third party, in an interview at the Kare Center. "We've got to give our pharmacists the resources to do this ... and it needs to have a dedicated area of the store."

At this point, Kmart is not billing for the service, but plans are to begin charging after the impact on patient outcomes can be documented. "We are partnering with the university in a research effort to collect data. and the overall goal is to show the value of these types of services," said Polley. The next stage, she said, is to create a fee structure that will apply to both cash-paying customers and third party payers. "We hope to be billing by the end of 1998," she noted.

Utilizing Pharm.D. training

The clinical care center is staffed by a clinically trained pharmacist serving a two-year fellowship with the retailer, funded by a grant from Kmart. That pharmacist, Florida A&M Pharm.D. graduate Sara Stallworth, is not at the pharmacy to fill prescriptions. She works exclusively as a patient-care specialist, meeting with patients at the site--often by appointment-and contacting local physicians to alert them to the potential benefits of Kmart's pilot project and enlist their support in the monthly management of their hypertensive patients.

"This is an intensive, full-time program for hypertensive patients," Polley explained. "The training a Pharm.D. gets is absolutely perfect for this environment."

Stallworth's initial mandate: to develop individually tailored programs to help hypertensive patients improve their overall health through a comprehensive review of their lifestyle, diet and drug therapy regimen. That includes meeting with patients to answer questions about their drug therapy; teaching them about high blood pressure and its treatment; monitoring and recording their blood pressure, free of charge; teaching them about healthier lifestyles to help control hypertension and related conditions; and helping patients alleviate outside environmental influences that can adversely impact their condition. Stallworth also provides patients with refill reminders to ensure compliance with their drug regimen.

"My first interview with a patient may take 30 to 40 minutes because I have to gather so much information" Stallworth told Drug Store News. "During the initial interview, I'll also take their blood pressure in both arms and use the higher of the two readings as my baseline."

The Pharm.D. is on hand to develop with patients a more comprehensive plan for health in conjunction with their regular physician visits. "If I don't think their disease state is controlled, I'll talk with them about their complaints and make note of objective measures, such as increased weight, higher blood pressure, etc.," said Stallworth. During the initial interview and in follow-up sessions, she added, "I will review the patient's medication to find out if they're taking anything they really don't need to take, or therapeutic duplication. I'm also looking for inadequate dosing or overdosing, inappropriate medications and interactions.

"My job is to notify the doctor and educate the patient," she added. "I usually give the patient vocal praise to let them know when they're making an effort to comply [with drug regimens or lifestyle recommendations] because with hypertension, these patients usually don't have symptoms.

"That can be frustrating for patients because they're taking a medication to control their hypertension, and it's having adverse effects, and they felt just fine before," she said. "So, I try to encourage the patient. That's where we as pharmacists can say [to the medical community], 'Let us help this patient and be a part of this healthcare team."'

Focus on patient care

Stallworth was quick to point out that physician buy-in is important. "I don't want to overstep my bounds; I just want to let the doctor know I'm monitoring his or her patient between visits to the physician," she explained. "If I see problems between their scheduled appointments with the physician, I can mail [a report] to them to alert them."