News
Medicine via Vending Machine; Patients can talk to pharmacist in Billings by video phone
Arville Lammers, a tall, craggy Shawmut rancher, needed to fill a prescription on a recent Monday afternoon.
The 60-year-old man, diagnosed with leukemia more than a year ago, started to feel congested. A physician at the Bair Clinic, housed at Wheatland Memorial Hospital in Harlowton, told Lammers he had pneumonia and that the infection was spreading quickly.
By SUSAN OLP
Of The Gazette Staff
The good news was that Lammers, who was feeling lousy, had only to visit the hospital’s second-floor pharmacy to pick up an antibiotic. Remarkably, the pharmacy – the only one in Harlowton – had just opened that day.
Equally remarkable, the pharmacist who dispensed the drug was 90 miles away in Billings at St. Vincent Healthcare. The remote pharmacy – the first of its kind in Montana – is a joint pilot project of the two hospitals.
Harlowton used to have a retail pharmacy, but the pharmacist closed shop more than a year ago and moved to Columbus. That left the 2,200 residents of Wheatland County with few options. They could drive to a pharmacy 45 miles away in Big Timber, or even further to Lewistown or nearly 100 miles to Billings.
Now, thanks to technology, a St. Vincent pharmacist can enter a prescription into a computer and electronically authorize it to be dispensed from a large tan-and-turquoise vending machine at the Harlowton hospital.
The vending machine – actually a secure cabinet – spits out the drug, which the certified pharmacy technician labels and hands to the patient. The patient then steps into a private booth to chat by video phone with the pharmacist about any questions they might have.
The rancher Lammers, feeling better a few days later, said he is "very glad that it was here and that they had the medication I needed. If I had to drive to Billings, it wouldn’t have been a good deal," he said.
Patients who didn’t have access to a pharmacy had been able to renew their prescriptions by phone and get them in the mail the next day. That system works for regular prescriptions, Lammers said, "but I was hurting Monday and what I needed wouldn’t have been here until Wednesday."
St. Vincent, which has a management contract with Wheatland Memorial, already had been providing some pharmacy services to the rural hospital. When nurses needed a prescription drug for a patient, they would sign a log sheet in the drug room, said Margie Naffs, director of pharmacy for the Billings hospital.
The nurse would then fax the log sheet, together with the physician’s order, to the St. Vincent pharmacy to ensure the drug was the one the physician wanted. St. Vincent also provided pre-labeled medications that physicians could dispense at the Bair Clinic.
But the supply was limited to antibiotics, cough syrup and eye and ear drops that patients could start on until they could get a prescription filled somewhere else or by mail, Naffs said. And patients couldn’t use insurance cards to purchase them at discounted prices.
The new pharmacy, Naffs said, "was kind of an extension of what we were doing, but this has more pharmacy involvement, which the State Board of Pharmacy likes a lot better."
Providing a more comprehensive pharmacy service to patients was top on the list of the Harlowton hospital’s management team, said CEO Scot Mitchell.
"The board had a strategic planning retreat in August, the second day I was on the job here," Mitchell said. "They decided the pharmacy was the number-one priority the hospital needed to deal with in the coming year."
Still, hiring a full-time pharmacist is an expensive proposition for a small hospital. So Wheatland Memorial went the more creative route.
After securing a $210,000 grant from the Charles M. Bair Memorial Trust and another $40,000 contribution from an anonymous donor, the hospital turned to technology for the solution. It purchased two of the secure drug-holding cabinets from Telepharmacy Solutions.
The larger of the two cabinets holds 60 different kinds of drugs, Mitchell said, and the smaller one holds 30 odd-sized medications, such as inhalers and creams.
"I think we have six or seven left open so if we see we didn’t pick the right medications, we can add on as we go," Mitchell said.
That also means that not all prescriptions patients bring to the pharmacy can be filled. Naffs said St. Vincent has nearly 2,000 different medications.
Mitchell said the hospital is looking into buying one or two more of the electronically operated cabinets to expand its inventory. The number of customers is already above expectations, he said.
A break room on the second floor of the hospital was remodeled to house the pharmacy and consulting room. Then a full-time pharmacy technician and two part-time technicians in training were hired to staff it.
Before the telepharmacy could become a reality, Naffs said, regulations had to be drawn up to govern the new venture.
"We are deeply indebted to the State Board of Pharmacy because they really played ball with us," she said. "They wanted this to work and they’ve helped us out a lot."
Becky Deschamps, executive director of the state board, said the idea of telepharmacy makes sense "for a rural state such as ours." Deschamps said she has been contacted by pharmacies in Helena and Great Falls who also have expressed an interest opening similar satellite pharmacies.
The regulations that would govern the new type of pharmacy are only preliminary, she said, and will go out soon for public comment.
To protect pharmacies already in business, Deschamps said "a site cannot be licensed as a remote site if it is located within a 10-mile radius of an existing pharmacy."
Mitchell said Wheatland Memorial isn’t looking to make a huge profit off its pharmacy. With the cost of medication and adding staff to run the telepharmacy, Mitchell said the hospital will be lucky to break even.
But he is glad for patients, such as Arville Lammers, that the pharmacy is now in place.
"Hopefully, we’ll be able to blaze a trail for other rural communities in Montana to be able to offer this service down the road," Mitchell said. "It allows us to provide better health-care services to the people of our community."
Copyright © The Billings Gazette, a division of Lee Enterprises.
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