ITT: I Talk about my experience at Costco

[Its Z]

---

Members do not see this ad.

Page 2

 

[rxlea]

Sparda, when that pharmacist told you not to suggest alternatives, too bad you couldn't post one of your images to his face.

 

[MountainPharmD]

Sparda, when that pharmacist told you not to suggest alternatives, too bad you couldn't post one of your images to his face.

I liked the girls kissing avatar better....

 

[rxlea]

I liked the girls kissing avatar better....

Yeah, I've had a few complaints. I will take it under advisement 🙂

 

[scoobygrl79]

Yeah, I've had a few complaints. I will take it under advisement 🙂

Okay, I really need to jump this bandwagon...I mean, when I was younger...it seemed all the folks that were a decade plus older than me were obsessed, so I never got into it...but NOW here I am, like a whole decade older than current Star Trek fanatics.......how did I get skipped?? 😕

 

[owlegrad]

Yeah, I've had a few complaints. I will take it under advisement 🙂

I like this one. O RLY? lol

 

[crazybob]

I like this one. O RLY? lol

I like the one in spanish better

 

[aboveliquidice]

Maybe I've been infected by academia. The pharmacists I've worked with at Costco basically have this mentality that your job as a pharmacist in the retail setting is simply to fill what the prescriber writes for, not suggesting alternatives, etc. Their reasons for this are:

#1 - You don't know what is happening with the patient just based on their medication profile.
#2 - It pisses off the physicians and they do not want to do that.

One instance of this was when a patient brought in a prescription for Crestor, it was too expensive for her so I told her to go back and have the physician switch it to Simvastatin or Pravastatin or Lovastatin. The pharmacist I was working with did not like hearing that at all and said I went beyond the boundaries of what a pharmacist is supposed to do. 😕

CVS has that whole generic switching program where they call MDs and try to switch the patients to generics, so I'm sure that's within our boundary, right? 😕😕

Besides, who makes a statin recommendation without knowing a patients LDL? Gotta get the facts before making a recommendation. Maybe try working at Kaiser or VA/PHS/Military. That way you can just pull up the labs.

 

[Sparda29]

Besides, who makes a statin recommendation without knowing a patients LDL? Gotta get the facts before making a recommendation. Maybe try working at Kaiser or VA/PHS/Military. That way you can just pull up the labs.

Why would I need the labs? The fact is they are already being prescribed a statin because the LDL is too high. Why would a physician in a statin-naive patient, start the patient off on Crestor? Doesn't make sense to me.

http://www.ncbi.nlm.nih.gov/pubmed/15531001

Clin Ther. 2004 Sep;26(9):1388-99.
Effects of rosuvastatin versus atorvastatin, simvastatin, and pravastatin on non-high-density lipoprotein cholesterol, apolipoproteins, and lipid ratios in patients with hypercholesterolemia: additional results from the STELLAR trial.
Jones PH, Hunninghake DB, Ferdinand KC, Stein EA, Gold A, Caplan RJ, Blasetto JW; Statin Therapies for Elevated Lipid Levels Compared Across Doses to Rosuvastatin Study Group.

Section of Atherosclerosis and Lipid Research, Baylor College of Medicine, Houston, Texas 77030, USA. [email protected]
Erratum in:

Clin Ther. 2005 Jan;27(1):142.
Abstract
BACKGROUND: Non-high-density lipoprotein cholesterol (HDL-C), apolipoprotein (apo) B, and lipid and apolipoprotein ratios that include both atherogenic and antiatherogenic lipid components have been found to be strong predictors of coronary heart disease risk. OBJECTIVE: The goal of this study was to examine prospectively the effects of rosuvastatin, atorvastatin, simvastatin, and pravastatin across dose ranges on non-HDL-C, apo B, apo A-I, and total cholesterol (TC):HDL-C, low-density lipoprotein cholesterol (LDL-C):HDL-C, non-HDL-C:HDL-C, and apo B:apo A-I ratios in patients with hypercholesterolemia (LDL-C > or =160 mg/dL and <250 mg/dL and triglycerides <400 mg/dL) in the Statin Therapies for Elevated Lipid Levels compared Across doses to Rosuvastatin (STELLAR) trial. METHODS: In this randomized, Multicenter, parallel-group, open-label trial (4522IL/0065), patients > or =18 years of age received rosuvastatin 10, 20, 40, or 80 mg; atorvastatin 10, 20, 40, or 80 mg; simvastatin 10, 20, 40, or 80 mg; or pravastatin 10, 20, or 40 mg for 6 weeks. Pairwise comparisons were prospectively planned and performed between rosuvastatin 10, 20, and 40 mg and milligram-equivalent or higher doses of comparators. RESULTS: A total of 2268 patients were randomized to the rosuvastatin 10- to 40-mg, atorvastatin, simvastatin, and pravastatin groups. Fifty-one percent of patients were women, the mean (SD) age was 57 (12) years, and 19% had a documented history of atherosclerotic disease. Over 6 weeks, rosuvastatin significantly reduced non-HDL-C, apo B, and all lipid and apolipoprotein ratios assessed, compared with milligram-equivalent doses of atorvastatin and milligram-equivalent or higher doses of simvastatin and pravastatin (all, P < 0.002). Rosuvastatin reduced non-HDL-C by 42.0% to 50.9% compared with 34.4% to 48.1% with atorvastatin, 26.0% to 41.8% with simvastatin, and 18.6% to 27.4% with pravastatin. Rosuvastatin reduced apo B by 36.7% to 45.3% compared with 29.4% to 42.9% with atorvastatin, 22.2% to 34.7% with simvastatin, and 14.7% to 23.0% with pravastatin. The highest increase in apo A-I (8.8%) was observed in the rosuvastatin 20-mg group, and this increase was significantly greater than in the atorvastatin 40-mg and 80-mg groups (both, P < 0.002). CONCLUSION: Rosuvastatin 10 to 40 mg was more efficacious in improving the lipid profile of patients with hypercholesterolemia than milligram-equivalent doses of atorvastatin and milligram-equivalent or higher doses of simvastatin and pravastatin.

Asides from the comparison of Rosuvastatin to Pravastatin, the results aren't significantly different enough for me to believe that Crestor is worth the extra cost.

 

[MountainPharmD]

Why would I need the labs? The fact is they are already being prescribed a statin because the LDL is too high. Why would a physician in a statin-naive patient start the patient off on Crestor? Doesn't make sense to me.

http://www.ncbi.nlm.nih.gov/pubmed/15531001




Asides from the comparison of Rosuvastatin to Pravastatin, the results aren't significantly different enough for me to believe that Crestor is worth the extra cost.

You don't know much about how physicians prescribe do you? I see it all the time. The Crestor reps are out in full force with Lipitor going off patent any time now.

 

[Sparda29]

You don't know much about how physicians prescribe do you? I see it all the time. The Crestor reps are out in full force with Lipitor going off patent any time now.

That's exactly how they prescribe. But personally if I were the physician, I would take the free stuff from the Crestor reps and then turn around and not prescribe Crestor at all. What can they do?

 

[Kentastic]

hi i know this thread is a bit old, but at costco are there any tuition reimbursement or scholarships available for pharmacy students? please let me know when you get the chance, thank you!

 

[Sparda29]

hi i know this thread is a bit old, but at costco are there any tuition reimbursement or scholarships available for pharmacy students? please let me know when you get the chance, thank you!

Doubt it.

 

[PharmDHawkeye]

From what I've seen, SOAP is something that physicians use.

Subjective Findings
Objective Findings
Assessment
Plan

The school prefers to teach use with FARM.
Findings
Assessment
Recommendations
Monitoring

The only annoying thing at the hospital is that this particular hospital where I did my rotations at, has handwritten charts. (MDs suck ass at writing. It's not just their Rxs, everything is chicken scratched.) Thank god this hospital is planning on upgrading their system to be completely electronic charts.

SOAP notes, FARM notes, it doesn't matter.

It is an inefficient way of organizing information. It isn't easily searchable or simple to add to a database, information has to be manually extracted.

A better alternative is information inputted through dropboxes. While the storytelling part is important, hospital notes should be mostly information inputted in an easily-compiled way (dropboxes) with notes as a supplement (hopefully with a character limit). I love reading some of the docs notes because its a fun story and all, but it doesn't make sense to compile patient info this way.

 

[rph3664]

From what I've seen, SOAP is something that physicians use.

Subjective Findings
Objective Findings
Assessment
Plan

The school prefers to teach use with FARM.
Findings
Assessment
Recommendations
Monitoring

The only annoying thing at the hospital is that this particular hospital where I did my rotations at, has handwritten charts. (MDs suck ass at writing. It's not just their Rxs, everything is chicken scratched.) Thank god this hospital is planning on upgrading their system to be completely electronic charts.

There's really not much a pharmacist can do with SOAP, because we can't diagnose. FARM is a better idea.

And I found that nurses had worse handwriting than doctors.

 

[UES Girl]

There's really not much a pharmacist can do with SOAP, because we can't diagnose. FARM is a better idea.

And I found that nurses had worse handwriting than doctors.

Pharmacists it seems write soap notes daily in am care clinic. Warfarin clinic, lipid clinic, you name it.

Warfarin clinic example, super simplified but physicians do essentially same thing, it's am care after all, not MICU:

S: Patient reports blah blah, adherent ? Non-adherent and missing doses ? Bruising, bleeding ? Diet ? Alcohol/smoking ?

O: Vitals: I take vitals, considered "brief physical exam" for billing purposes.
Labs: PT/INR

A: therapeutic ?

P: dose adjustment/boosting/no change in therapy. Refills, new Rx - we write Rx under prescribing protocol and hand it to patient.

 

[UES Girl]

in any case, I'm surprised by the comments.

Maybe it's because majority of pharmacists and services for acute care ( I only had one ambulatory care rotation in my life and all the rest were inpatient) have prescribing protocol at UC, but we "soap" patients for every presentation for "preceptor rounds - these are when you rounded with your team independently and then meet with the preceptor to present your patients and let them know what you want to do". That's how you present to your preceptors and for change in therapy regarding what you want to do, you can actually do it. Like I wrote orders myself on the last service, oncology, ( I was able to put them in CPOE) and preceptor just signed it.

Is this how things are not done elsewhere ?

 

[Sparda29]

in any case, I'm surprised by the comments.

Maybe it's because majority of pharmacists and services for acute care ( I only had one ambulatory care rotation in my life and all the rest were inpatient) have prescribing protocol at UC, but we "soap" patients for every presentation for "preceptor rounds - these are when you rounded with your team independently and then meet with the preceptor to present your patients and let them know what you want to do". That's how you present to your preceptors and for change in therapy regarding what you want to do, you can actually do it. Like I wrote orders myself on the last service, oncology, ( I was able to put them in CPOE) and preceptor just signed it.

Is this how things are not done elsewhere ?

That's how it was done at my amb care site.

I don't know why this Costco thread was resurrected though...