Building MTM services and immunization programs from the ground up

Alabama pharmacist Chris Barwick, BSPharm, at the forefront of patient care

 

Chris Barwick, BSPharm, is a pharmacist with a vision for the future. As Director of Pharmacy at Jim Myers Drug, Inc., a local drug store chain with several independent pharmacies in the Tuscaloosa, AL, area, Barwick was a pioneer in providing individualized counseling to each patient. He offered medication therapy management (MTM) services to his patients before the term was even coined.

Nearly a decade ago, Barwick became the first pharmacist in the area to be certified to administer vaccines. Armed with clinical foresight and a belief in offering patients the best possible care, Barwick commandeered a section of one of the Jim Myers Drug pharmacies and built two soundproof patient rooms and two offices solely dedicated to MTM services and immunizations, creating what is known today as the Jim Myers Health & Wellness Center.

In the 4 years since launching the Health & Wellness Center, Barwick, along with Kellie Cooper, LPN, have administered thousands of vaccinations, performed hundreds of health screenings, and counseled countless patients about medication safety.

“There is no other place like the Health & Wellness Center around here, and it makes a huge difference for the patients. They know that we’re here for them,” said Barwick. “The best part is knowing that you changed peoples’ lives by helping them with their medications or immunizations. I’ve even had physicians tell me what a great thing we’re doing and how we’re saving lives.”

MTM services

The Jim Myers pharmacy chain began in 1975 as a single independent drug store staffed by three employees. The local chain expanded over the years, and it now comprises six pharmacies that provide community pharmacy medication sales, industrial and institutional pharmaceutical sales, medical delivery services, and MTM services.

The Health & Wellness Center is inside the chain’s southern location. All of the Jim Myers pharmacies send patients who need MTM services or immunizations to the Health & Wellness Center. “The MTM area is set up kind of like a doctor’s office. I designed it so we have patient rooms where my nurse and I counsel patients or administer immunizations,” said Barwick, whose services range from a complete medication review to providing cost-saving opportunities for patients by looking at preferred drug lists for OTC and prescription medications.

“We also look to see if [a patient] is taking duplicate therapy and see if changing [a medication] can help their financials,” said Barwick, who joined Jim Myers Drug in 1999. “A lot of patients we see are not in great financial shape, and anything we can do to help save them money [in terms of] their health care is really appreciated.”

Barwick talks to patients about adverse medication effects, lifestyle changes, and OTC medications. He offers cholesterol screening to patients 1 day per week, which includes an evaluation of a patient’s total cholesterol, HDL and LDL cholesterol, and triglycerides. He also provides diabetes education and tuberculosis skin testing.

Providing MTM services gives Barwick an opportunity to build relationships with his patients. “They know they can call me and ask me about a medication or things that change their lives like weight loss,” Barwick told Today. “I’ve had a number of patients who have called or kept in touch and wanted me to check something else out for them because I made them feel better or made the [adverse] effects go away. I have patients who always check with me first before they start something new.”

Immunizations

Barwick has expanded the Health & Wellness Center’s immunization program in a big way. He began administering immunizations about 10 years ago—mainly influenza and pneumonia vaccines. Over time, he added herpes zoster, travel, and immigration vaccines. Today, Barwick estimates that he and Cooper administer about 5,000 flu shots every year. “We do an open clinic at least once or twice a week at the Health & Wellness Center during flu season,” said Barwick.

On the other days, Barwick and Cooper drive out to companies in the area, including large manufacturing plants, banks, car manufacturers, and pharmaceutical distributors, to provide onsite influenza and pneumonia immunization clinics. “Often, these companies are open 24 hours a day, so we’ll go 2 days in a row at different times to accommodate people on the day and night shifts. We do whatever is most convenient for the employer,” said Barwick. “We can do sometimes 200 to 300 flu shots in a day.” The companies usually pay for their employees to get the vaccine as a preventive measure.

Barwick has also administered influenza vaccines under unconventional circumstances. During the influenza vaccine shortage in 2004–05 influenza season, Barwick had only 400 doses. He decided to hand out tickets for the influenza clinic so patients would know in advance whether they would get the vaccine or not. “Once that final ticket was gone, that was it,” said Barwick. “Patients would know that we didn’t have any vaccine left and they wouldn’t have to wait around needlessly.” The influenza clinic was held on a particularly warm October day, and Barwick rented chairs and set up a canopy to help keep patients cool. The local police were called to direct traffic. Barwick and a nurse administered the 400 doses in about 4 hours.

Uptick in immunizations

In addition to providing an increasing number of influenza immunizations over the years, Barwick has also seen a spike in herpes zoster immunizations. Together, Barwick and Cooper have administered more than 6,000 herpes zoster immunizations since the Health & Wellness Center opened its doors.

After receiving the vaccine, “patients sometimes call us to let us know they got shingles but didn’t have the pain, just the rash,” said Barwick. “They were very happy about that, because one of the worst things about shingles is the pain. It makes you feel like you’re making a difference because you’re giving them the vaccine, and even if they get shingles, it keeps them from getting the pain.”

Barwick has also observed an increase in the number of immigration vaccinations that he provides. “We think that the rate has increased due to the new immigration laws in Alabama that our governor has put into effect,” said Barwick. “The new law makes it a lot more difficult for illegal immigrants to work and live in Alabama. Since the new law has taken effect, we have seen an increase in the number of illegal immigrants trying to gain legal status. Part of this process is obtaining the required vaccinations. We were doing one set of immigration vaccines about every other week before the new laws were passed. Now we average about one set of immigration vaccines every other day.” The top three vaccines that Barwick and Cooper administer for immigration are tetanus–diphtheria–acellular pertussis, measles–mumps–rubella, and varicella.

Patient education

In addition to MTM services and immunizations, Barwick provides educational presentations to businesses or groups on topics such as cholesterol management, diabetes, or medication safety.

“I’ve done PowerPoint presentations, or sometimes I just answer questions at a brown bag type [event] where patients bring me their medications and I answer their questions,” said Barwick, who is also a certified diabetes educator. “It is MTM, but not on a one-to-one basis. It’s more of a group MTM where we’re going out into the community and trying to make the community aware of certain things.” For example, noted Barwick, it is important to make sure that seniors are aware that certain medications can make it easier for them to fall and break a hip.

Disaster recovery

Barwick is involved with helping his community recover from a rash of violent and deadly tornadoes that ripped through the South last spring. Jim Myers’s main pharmacy was severely damaged and was located in an area that was cordoned off by the National Guard. The pharmacy was completely repaired and was open for business about 3 weeks after the tornado.

“Everyone in the city and from outside areas really pulled together. The rebuilding process [continues],” Barwick said. He noted that the city is still recovering from the damage and many businesses have not reopened yet or have no plans to open their doors.

On the horizon

Always with an eye toward the future, Barwick is focused on adding new and innovative programs for his patients. He is in the process of obtaining funding for a mobile pharmacy unit that can travel into Alabama’s rural areas. “We want to be able to get closer to these patients to offer them MTM services. We want to go out there on regular basis so we can get to know them,” he said. “It would be great to have a place to counsel patients and administer the vaccines.”

Barwick envisions using the mobile unit for onsite vaccination clinics, which are typically held in a company’s break room. In addition to routine pharmacy services, the mobile unit could be used in emergency situations such as tornadoes.

Under Barwick’s leadership, the Health & Wellness Center is in the process of becoming certified as an alternative injection clinic for patients who need someone to give them their injectable medication, or for those patients who do not want to wait at the physician’s office. “We’re more accessible, and [the pharmacy] is easier to get in and out of,” said Barwick, who also provides vitamin B12 injection administration to patients.

The best part of Barwick’s job is helping his patients. “There are a number of patients who come back to me and they really appreciate the MTM counseling. They really get something out of it,” said Barwick. “It makes me feel good to know I helped change a patient’s life by talking to them about their medications.”