Letters June 2011

Key Points

Split the difference

This is often a cost-saving activity when performed with the appropriate dosage forms. I would never say "never" to a patient's inquiry."

The other side of the story

As the "originator" of pill-cutting identified by Dr. Phillips, I can tell you that it is widely practiced today because, when it is used with the appropriate medications and appropriate patients, there are tremendous benefits that should not be overlooked by patients, healthcare systems, and society as a whole.

Of course I would never advocate pill-cutting of all drugs or with all patients, but when used prudently it is a cost-effective strategy both for patients on fixed incomes who must balance life and financial needs, and for health systems seeking to control costs in a manner that provides patients with expanded access to medications without compromising quality and outcomes.

Anthony Morreale, PharmD, MBA, BCPS
SAN DIEGO, CALIF.

[Readers seeking more information on the subject should watch for the August 2011 issue of Drug Topics, in which Dr. Morreale presents the data and reasoning behind his argument for the appropriate use of pill-splitting.]

Enough, already

I must disagree with pharmacist Jacquelyn S. Heisler's idea about depression screening in pharmacy ["Depression screening: A natural role for pharmacists," May 2011].

Today, most physicians, let alone pharmacists, do not understand the complexities of chemical imbalances in the brain. Furthermore, pharmacists barely have the time to do minimal counseling, much less an assessment of depression, which if done properly can take at least 30 to 45 minutes. After long stressful days, many pharmacists may feel as if they're the ones who need a psychiatrist.

Pharmacists are expected to be experts in all health conditions, and this is absurd. Do you go to the dermatologist with an eye problem or the cardiologist if you need a knee replacement?

It is a full-time job keeping up with all the available medications. So I would suggest that we let depression be treated by the therapist, not the pharmacist.

Robert S. Katz, RPh
STAMFORD, CONN.

She hires the virtually nonexistent

Regarding David Stanley's column about Walgreens' POWER program ["The 4-second Rx Review: Who benefits?" April 2011], I was very interested in Walgreens' statement that "staff turnover for our pharmacists is virtually nonexistent."

I am the assistant director of pharmacy at a large academic medical center in Richmond, Va. We fill about 2,300 scripts a day in all the ambulatory pharmacies (clinic, oncology, department of corrections, discharge, employee).

Since October 1, 2010, I have hired 4 pharmacists who used to work for Walgreens. They were tired of the long hours, tired of working every other weekend, tired of being underappreciated and overworked, tired of all the metrics pushing them to go faster and faster ... tired of always being worried about the bottom line, regardless of the working conditions of the pharmacists.

The newest request from Walgreens' administration was to have all pharmacists "spend more time on the floor with patients/customers," but at the same time, "Oh yeah, don't forget you have metrics you have to meet."

Laurel M. Marsden, BS Pharm, MSHA
RICHMOND, VA.