Bremo Pharmacy's Tana Kaefer (right) consults with a patient, as VCU School of Pharmacy students on rotation Mackenzie Page VonCanon (left) and Alyssa Stucke look on. Photo by Ash Daniel
The lunch counter went first, soon followed by the soda fountain and the shelves where the previous owners of the Berryville pharmacy had sold chocolate and candies.
In 1969, Dr. Eugene White, a 1950 graduate of the Medical College of Virginia (now Virginia Commonwealth University) School of Pharmacy, returned home to the small Shenandoah Valley town to open his own practice — one that would revolutionize the role of the neighborhood pharmacist.
In place of candy-stacked shelves, White installed cabinets where he kept medical records detailing patients' weight, allergies and prescription histories. At the back of the drugstore, he built a consultation room where he could meet privately with his patients.
"[White] challenged the status quo and ended up developing his own way of providing care to his patients," says David Holdford, professor and vice-chair of graduate education at the VCU School of Pharmacy.
At VCU and the nearby Shenandoah University, pharmacy classes would visit the Berryville drugstore until White's retirement in 1998. Holdford continues to include the story of the pioneering pharmacist's innovative patient-centered approach in lesson plans to first-year students.
In the past half-century, the role of the pharmacist has evolved from friendly neighborhood pill dispenser to an integral member of today's health care team. The VCU Medical Center and its graduates have been at the forefront of that evolution.
"[The] practice has changed such that the product is just one step of the job," Holdford says. "The other steps are to make certain that the products achieve the health outcomes they are designed to have." Those other steps include managing medication schedules, administering immunizations, checking blood pressure, counseling on smoking cessation and much more.
The trend extends beyond the neighborhood pharmacy. On Feb. 5, CVS announced that it would stop selling cigarettes and other tobacco products at its 7,600 locations nationwide, and start evolving its pharmacies into "full-fledged health care providers." One of the nation's largest drugstore chains, CVS already has the country's largest chain of pharmacy-based health clinics.
"We believe cigarettes have no place in a setting where health care is delivered," company spokeswoman Christine Cramer says. "This decision underscores our role in the evolving health care system."
In December, the Journal of the American Pharmacists Association published a VCU study that investigated a model known as "appointment-based medication synchronization." The study, which was led by Holdford, found that patients are more likely to take chronic medications when they meet monthly with pharmacists to coordinate their prescription regimens and treatment plans.
"The [pharmacist's role] is to promote health and wellness as well as help with the proper use of medications and work together with physicians and nurses," says Victor Yanchick, dean of the VCU School of Pharmacy. A 1962 graduate of the University of Iowa College of Pharmacy, he remembers being taught not to discuss medication with patients.
"We were not even supposed to tell the person who was getting the prescription filled the name of the drug if they asked," he says. "Today, our students are given four years of intensive training on the intricacies of the medications that are available for use, and how they interact with each other."
Ten years ago, Yanchick experienced the importance of the pharmacist's role first-hand. His mother-in-law, who lived alone in Chicago, fell and broke her hip. At the hospital, she was put on 14 medications. After returning home, "she wouldn't eat, she was confused, and she had bruises on her arms," Yanchick says, adding that she was taking some medications incorrectly and double-dosing on others. "My wife thought her mom was going to die."
After bringing his mother-in-law to Richmond, Yanchick worked with her physicians to narrow the 14 drugs to a single pill, which she continues to take for swelling ankles. "She needed a pharmacist," he says of his mother-in-law, who is now 102 years old.
This month, 135 students will graduate from the VCU School of Pharmacy. More than 30 percent of that graduating class will continue on to residencies or fellowships where they will work directly with physicians and nurses as part of an integrated health care team. "These are individuals who have a much more well-defined professional role for a clinical practice," Yanchick says. "We're communicating with our students their moral, ethical and legal responsibility to be patient-care advocates."