Tipping the Scales

For preceptor Dan Scales, “Pharmacy is more than putting pills in a bottle. We can shape patient care especially if we slow down, spend time with our patients and focus on educating them about their diseases and how to manage them.”

Specializing in HIV and hard to manage chronic illnesses at his Denver area pharmacy, Dan takes a case management approach to pharmacy. “I sit down and get patients to open up and tell us what is really going on in their lives.”

With a dedicated space that is like a cozy sitting room, Dan first makes customers comfortable, which sets their minds at ease. He then gets them talking about their illnesses and their lives, which in turn shapes how he cares for them. “We tackle issues that our patients are faced with. For instance, many are trying to navigate social and financial systems that can be overwhelming. But if a patient doesn’t have access to resources or know where to turn, they can get all the medication in the world, but their diseases will still be out of control.”

Building Trust

Listening, creating a connection, and helping patients navigate a complicated system builds trust. “Once we’ve laid that foundation, we explain why they should take a medication, how they should take it and why it’s important for their health. Then, we find they follow through and rely on us for our expertise and opinion.”

This ‘old school’ philosophy of getting to know their patients has been enhanced by the use of a closed-door consultation room, which allows patients privacy, anonymity and convenience -- all distinct advantages when providing care. “You’re not talking to a pharmacist behind a counter and everyone who is waiting hears your conversation. Instead, we take the customer to our consultation room and spend time with them.”

More of a mini clinic setting, this allows Dan and his team the ability to perform more in-depth testing like rapid HIV testing, and phlebotomy and lab draws (which are scheduled for the future), training, counseling and education.

Distinct Advantage of Corner Pharmacy

According to Dan, pharmacies have a unique advantage. “We’re convenient, comfortable and somewhat anonymous. There’s a lack of stigma associated with popping into the local pharmacy versus an HIV or STD clinic.” When a person walks into a Sexually Transmitted Disease (STD) or HIV clinic they are automatically labelled, making it challenging to get them to feel comfortable or even to come back after being diagnosed.

“When a person walks into a local pharmacy, they are a customer… period. So, there’s a certain level of anonymity and privacy. This is a distinct advantage when providing care.”

Dan says, “We can have a huge impact on patients and the practice of pharmacy. Students need to know that community pharmacists are in a unique situation to mobilize patients and establish connections.”

Why Precept?

For Dan who has been percepting CU students for five years, precepting is a unique opportunity to shape the way students think about retail pharmacy. “It’s about more than dispensing meds. You can create your own care model and in the process leave your mark and have a real impact.”

His excitement is contagious.

Leaving rotations relatively unstructured, Dan lets the students take charge. “They can learn about the business aspects of running a local pharmacy, everything from accounting to marketing and the day-to-day operations or they can get involved with public health and advocacy efforts. I let the students decide based upon what interests them.” Then they craft the six-week rotation together.

An example of advocacy efforts that Dan and students were involved with was Senate Bill 13-14, expanding access to the life-saving medication, naloxone, a prescription medication that blocks and reverses the effects of opioid drugs such as heroin and OxyContin.

Under standing orders from a physician, pharmacists, first responders, and harm-reduction organizations in Colorado are now able to dispense naloxone to any opioid users or third parties who request it. Scales Pharmacy was the first pharmacy in Colorado to participate in this program and provide naloxone without a prescription.

Dan understands that some pharmacists are hesitant to provide the medication for fear of encouraging drug abuse and facilitating dependence. That’s why Dan insists that customers interested in this medication receive comprehensive training and education about why to use the medication and how. “By providing education and training on [naloxone] safety in a stigma-free environment, [pharmacists] are actually promoting informed decision making…and providing an entrance point to care for those that want to seek it.”

For those who think that clinical pharmacy is practiced only in a clinic or hospital setting, Dan Scales and the Scales Pharmacy is turning that theory on its ear. Literally bringing care to the patient’s door, he is tipping the scales of pharmacy in the patient’s favor, making it easier to receive care by bringing access to all. “As pharmacists, we should be taking every opportunity to further our role in the communities we serve, and the new laws and state-created protocol allow us to do that,” he says.