Ross Valley Pharmacy, tucked away inside a larger building of clinics, is not a big place, but it's very very busy. Its owner, Paul Lofholm, PharmD, has a vision of the pharmacist's role that goes far beyond simply putting pills in bottles. He sees pharmacists as integral members of the healthcare team who can fill the gaps in patients' education about their conditions and their medications.

Dr. Lofholm initially saw the need for a diabetes education program after a friend's son was diagnosed with type 1 diabetes. After helping his friend deal with that crisis, says Dr. Lofholm, "I looked around and said, ‘Well, what do we have in this county, Marin County, to help diabetes patients?' I found out that we really didn't have anything." To fill that gap, he developed a Medicare-certified diabetes education program run by a certified diabetes educator. It took time to fulfill the ADA requirements necessary for Medicare certification, but the program is now in its third cycle of accreditation, and Ross Valley Pharmacy offers classes several times a year.

Dr. Lofholm notes that only eight percent of diabetics go to endocrinologists; all the rest are monitored by internists or, in some cases, pediatricians. He says, "They do not have the staff to do the education, so it doesn't really get done. That's why the specialized courses have been successful, frankly, teaching people about lifestyle. The advantage of the pharmacy is that we see the patients frequently because of medication refills. We've had a pretty good relationship with physicians being willing to refer, because they simply don't have the time to do the educational stuff, realistically, nor can they get paid for it."

In line with the new role of pharmacists as "physician extenders," Dr. Lofholm offers medication therapy management (MTM) services to his patients. According to the pharmacy website, "MTM is a meeting with the pharmacist to review ALL of your medications, allergies, and conditions." The service is covered by Medicare under certain conditions. Dr. Lofholm says, "MTM is talking about taking a drug history, analyzing the combination of drugs, asking the patients why they're taking them, with the idea to get people off drugs that they don't need, or on drugs that they should be on. We believe that pharmacists are over-trained for what they do, putting pills in bottles, and the question is, how could they more appropriately be used? One of those key issues is MTM."

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