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The average pharmacist goes to school for approximately six years, spending most of his or her study time on drug chemistry, compounding, interactions, and patient counseling. Unfortunately, when these new pharmacists reach real-world pharmacies, they'll have few opportunities to put such knowledge to good use.

Instead, pharmacists spend more than two-thirds of their time on activities that do not directly relate to patient care, reports a recent study by Arthur Andersen LLP. The study, funded by the National Association of Chain Drug Stores' education foundation, shows that pharmacists spend 22% of their time counting, pouring, labeling, and packaging prescriptions. They also spend more than two-thirds of their time on activities that are nonclinical and nonjudgmental, like dispensing orders and managing inventory. Only 1.6% is spent on disease management, which includes performing patient assessment, formulating and documenting treatment plans, and developing health education programming.

"The biggest educational waste in the world is the pharmacist who counts from 1 to 30," says Pat Cropper, national director of specialty services at Bergen Brunswig Corp. (Orange, CA).

Pharmacy directors could remedy the problem themselves by automating their operations, either by using automated counting and dispensing systems or by using robotics. For instance, many hospital pharmacies employ the MedStation System 2000, an advanced point-of-use system made by Pyxis Corp. (San Diego), a subsidiary of Cardinal Health, that streamlines and automates the routine tasks of distribution, management, and control of medications. Paul Seelinger, RPh, manager—pharmacy logistics products for Pyxis, says that this system is primarily designed for hospital and alternate-site care facilities. However, "there clearly is a need to automate similar repetitive dispensing tasks in the outpatient pharmacy," he says. "In the future, pharmacists will probably see more automated product offerings for outpatient pharmacies."

On a smaller scale is the SureCount by NovoTec Systems Inc. (Mountain View, CA), a digital scale intended to count capsules and tablets, read bar codes, and interface with a computer. The system can even be integrated with existing pharmacy dispensing counters.

Robots could even be employed to dispense prescriptions. Robotics expert Shimon Nof of Purdue University (West Lafayette, IN) describes a number of such systems in his book, Handbook of Industrial Robotics. One system is the RxBOT, a robot that scans bar codes for instructions and locates coded packages and transports them via a robotic arm. Another, Autoscript II, fills more than 2000 orders per 8-hour shift.

While these systems promise to eliminate manual counting and sorting and therefore give pharmacists more time to spend on patient counseling, their impact on the entire pharmacy industry may only be minimal. Thousands of pharmacies would need to be reequipped and redesigned to utilize the systems. Pharmacists and support personnel would need to be retrained. And pharmacy chains, which are competing aggressively among themselves as well as with the emerging on-line entities, would show little interest in paying for technologies that do not provide an immediate, tangible return. Of course, the patient service at these individual pharmacies would markedly improve, but few patients would be willing to pay more for their prescriptions just for better service.

Instead, the solution lies further up the supply chain. If drug manufacturers were to prepackage their products into standard unit-dose amounts, pharmacists would simply have to pull a package off the shelf, place a prescription label onto it, and then deliver it. Pharmacies would not need to purchase new equipment or to retrain employees. And the time spent on sorting, counting, and packaging would shrink, thus enabling pharmacists to spend more time with the patient. Such an interaction would foster a better pharmacist-patient relationship, which could lead to better drug compliance, better pharmacy patronage, and increased pharmacy and manufacturer profits.

Daphne Allen, Editor

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