Sorry to be contributing to this discussion so belatedly. 
 
First, I just wanted to note that under the Medicare Modernization Act, Medicare now reimburses for Medication Management Therapy. While the reimbursement for a brown bag review is not much, pharmacies can get some compensation for providing this service for the elderly.
 
Second, I wanted to mention that there are two recently published AHRQ tools that address some of the issues around privacy and training pharmacists on health literacy-friendly counseling. The first is Is Our Pharmacy Meeting Patients' Needs? A Pharmacy Health Literacy Assessment Tool User's Guide <https://webmail.hhs.gov/qual/pharmlit/index.html> . It is a self-assessment tool and reviews, among other things, the physical space of the pharmacy and asks patients if there is a private space at the pharmacy where they would feel comfortable talking to staff person. The second is a training program for pharmacists called Strategies To Improve Communication Between Pharmacy Staff and Patients <https://webmail.hhs.gov/qual/pharmlit/pharmtrain.htm> . Both can be accessed from AHRQ Health Literacy and Cultural Competence Browse page (http://www.ahrq.gov/browse/hlitix.htm) under Pharmacy Tools.
 
Cindy Brach
Center Delivery, Organization, and Markets
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850
301-427-1444
fax: 301-427-1430
Cindy.Brach at ahrq.hhs.gov

________________________________

From: healthliteracy-bounces at nifl.gov on behalf of Laurie Sheridan
Sent: Fri 1/18/2008 1:00 PM
To: The Health and Literacy Discussion List
Subject: [HealthLiteracy 1686] Re: Wednesday Question: Health LiteracyandMarketing


 

I go to a pharmacy in Boston where there are quite a few LEP and low-literacy customers and there is very little privacy for them or for anyone.  In fact, the pharmacists often shout pretty loudly, especially to people they are serving who are having difficulty understanding or being understood.  The only "privacy" is a sign near the pharmacy counter that says "Please wait here, to protect customers' privacy."  People do respect that, but they are only waiting a few feet behind the person being waited on at the counter, and you can still hear everything.  You can't always hear the customer, but you can always hear the pharmacist, who is facing you.   I have often felt embarrassed myself, with a captive audience of strangers, and no effort  to protect privacy.   I'm sure it's even worse for customers with literacy barriers, though at least some of the pharmacy staff are bilingual.  

But there are not many pharmacies these days to choose from--in our area there's usually only the choice between CVS and RiteAid, and they are everywhere.  So there's probably little incentive to draw more customers by improving service.

By the way, most of the people who serve customers typically are not pharmacist--they are pharmacy technicians who receive just a little training.    They are usually people form the community who have a few customer service skills and a little technical knowledge, but they are not actually pharmacists, who have six years of post-secondary education.    A lot of pharmacy techs are trained on-line, and the quality varies considerably.  The big chain stores also provide in-house training.    But their training is typically only a few weeks, and it's really a retail job, not a technical job, despite the presence of the white coats.  This is a big change I have observed in recent years.  It's great that the chain drugstores hire from the community, and it's evident that they reflect the diversity of customers much better--but not so great that they apparently provide or require so little training.

Still, it might be useful for someone to look into who provides the training and how/whether they could be convinced to incorporate some of these areas around literacy, language and privacy.

Laurie

Laurie Sheridan, Workforce Development Coordinator
World Education/SABES Central Resource Center
44 Farnsworth St.
Boston, MA 02210
(617) 385-3737
lsheridan at worlded.org

SABES:  Training Leaders in Adult Basic Education



>>> "Janet Sorensen" <Jsorensen at afmc.org> 1/18/2008 11:51 AM >>>

Interesting topic. In Arkansas, the pharmacies don't even have privacy
panels. People standing behind you in line can hear every word, as can
all of the pharmacy employees. My pharmacist is always in a hurry but
still knows all his regular customers' names and is very good about
catching possible interactions or other kinds of inappropriate
prescribing. He also manages to be discreet and spends a lot of time
talking to patients on the phone. But he may be the exception. He works
in an independent pharmacy catering to professionals downtown. If I have
to go to Walgreens or Wal-mart after hours or something, it's almost
always a bad experience.
Janet Sorensen
Arkansas Foundation for Medical Care

-----Original Message-----
From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Davies, Nicola
Sent: Friday, January 18, 2008 9:33 AM
To: The Health and Literacy Discussion List
Subject: [HealthLiteracy 1678] Re: Wednesday Question: Health
LiteracyandMarketing

I think a more inviting or private consult area would encourage more
communication between patient and pharmacist. I don't know how many
times I have overheard some poor soul asking their pharmacist to keep
their voice down when talking about how to take certain medications, or
shifting uncomfortably. Embarassment doesn't only exist at the doctor's
office. Personally, I don't think I should have to overhear someone
being asked "Have you taken the morning after pill before?" while
shopping. People would be more willing to ask questions in the first
place, if there was a more private place for them to ask.

I don't know how pharmacies are set up in the US, but here in Canada the
most I have seen is a similar layout to a bank teller's desk, with
privacy panels, but people queue behind the person being served, and so
it only gives the illusion of privacy. I have seen a few 'consultation
rooms' but I have never seen one used.

Any other thoughts on how the layout of pharmacies can contribute to HL?

Nicola
-----Original Message-----
From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov]On Behalf Of Julie McKinney
Sent: Friday, January 18, 2008 7:35 AM
To: healthliteracy at nifl.gov
Subject: [HealthLiteracy 1676] Re: Wednesday Question: Health Literacy
andMarketing


You all have brought up good points. I agree that we have to look at the
motivation and process with a critical eye. But mostly the process.
Here's why: Even if the motivation is increasing sales and stock value,
if a pharmacy recruits customers by truly providing better service to
those with literacy and language challenges, then it's still a good
thing. If I have an option to go to a pharmacy that consistently ensures
that I understand my medicines, then we all win. They get another
customer and I get better service.

If pharmacies start competing by addressing health literacy issues in
real and effective ways, it could push up the quality of services across
the board. This is good!

Of course it all depends on a sound process.  The pharmacy must aim to
be truly effective, consistent, and long-term in providing better
service, and they must do it well. So, what is doing it well?

I suggest collaborating with a health agency, getting input from health
literacy experts, testing the process with adult learners, making sure
that there is some plain language and picture-based material to let
people take home, and evaluating the program carefully. It's also
important that it be a long-term program rather than a quick tease to
pull people in.

What else can we suggest for a sound process?

Julie

Julie McKinney
Discussion List Moderator
World Education/NCSALL
jmckinney at worlded.org


>>> "Ann Rathbun, Ph.D." <a.rathbun at morehead-st.edu> 01/18/08 8:36 AM

>>> >>>

As pharmacies move more toward the 'big box' model, I am constantly
amazed at the paradoxes that are present in the stores.  Stores are
selling health promoting medications, disease preventing medications,
and other life saving drugs.  At the same time, big box stores sell 
cigarettes and alcoholic beverages, etc....things that may kill us.  
Why are cigarettes sold under the same roof where the pills, patches and
gums that help us quit are also sold?  Mark is right...profit driven,
not health promoting/prevention driven.  Really confusing to consumers,
too, I think.

Ann



Quoting MarkH38514 at aol.com:


> In late 1998, Rite Aid stock was about $50 per share; now it's  at

less than

> $2. I have family members who owned stock in the company. Rite  Aid  

> has really

> struggled, in large part because of some financial  malfeasance by

> previous executives; a  former CEO got  10 years in prison.

>

> It's fair to assume that having patients bring in all their 

> prescriptions is a way for Rite Aid to try to get them to shift their

prescriptions from

> their current pharmacy to Rite Aid. In one way that may not  be a  

> bad idea, since

> pharmacists who are aware of all the drugs a patient is  taking may be

more

> likely to pick up on potentially serious drug interactions.  For  

> those patients

> who get their prescriptions filled at different  pharmacies, keeping

> track of drug  interactions is almost  impossible.

>

> But that's probably not as important as increasing their  prescription

drug

> sales, or even getting consumers into the store in hopes  they'll  

> buy something

> on their way to or from the pharmacy in the back of the  store. That's



> the reason pharmacies are in the back of the store to begin with.

>

> It's all about marketing and money and getting the stock price  up.

>

> Mark Hochhauser

>

>

> Mark Hochhauser, Ph.D.

> Readability Consultant

> 3344 Scott  Avenue North

> Golden Valley, MN  55422-2748

> Phone:  763-521-4672

> Cell: 612-281-1517

> Fax: 763-521-5069

> email: _MarkH38514 at aol.com_ (mailto:MarkH38514 at aol.com)

>

>

>

>

> **************Start the year off right.  Easy ways to stay in shape.

> http://body.aol.com/fitness/winter-exercise?NCID=aolcmp00300000002489

>




Ann Rathbun, Ph.D.
Department of HPES
200C Laughlin Health Bld.
Morehead State University
606-783-2464


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