Caring Team Builds Lifelong Relationships With Patients

After graduating from pharmacy school at Albany College of Pharmacy and Health Sciences in 1984, John Croce, RPh, began working for an independent pharmacy and then for a regional chain, followed by a stint as a district manager for 15 years, before going back to work as a staff pharmacist at Target.

While working at Target, he became good friends with Paul Pagnotta, RPh. They decided to open a pharmacy together.

“It takes a special kind of person to own an independent, and we looked forward to that challenge,” Croce said. “We wanted to help people, more than just filling prescriptions.”

They found a vacant spot and “a coat of paint, a head full of dreams,” Croce said. “We opened with nothing but that.”

Four Corners Pharmacy in Delmar, New York, quickly became successful. Several years later, the duo acquired a stand-alone bank location on a main street, and the pharmacy has grown even more since then, filling about 1100 prescriptions weekly. Croce and Pagnotta converted the bank’s vault into a compounding center and a drive-through for patient convenience.

Croce is the Community Pharmacy Enhanced Services Network lead luminary for New York State. He said that payers are looking at pharmacies to be part of the solution to better patient outcomes on disease states, such as offering asthma, behavioral health, and diabetes management through enhanced services.

Croce is part of an innovative $6 million, 5-year New York Medicaid project. Ten stores in the area received funding to provide behavioral health care management for Medicaid patients. The goals are to address social determinants of health, drive adherence, have healthier patients, and reduce hospital readmissions.

Because many patients were homebound, pharmacists received Health Insurance Portability and Accountability Act (HIPAA)—compliant tablets for video conferencing.

Croce spoke of a patient who would not come in for a medication review and compliance packaging, and he realized that she was agoraphobic. Using the tablets helped her understand her medications and packaging.

“We are providing so much better care for her now,” Croce said. The pharmacy is so far seeing very strong numbers and is reaching many of its goals, he said.

“Patients are very appreciative, they are feeling better, and they are taking their medications correctly,” Croce said.

The New York Medicaid project offers opportunities for collaboration as the pharmacists are now updating physicians on patient status, not just calling for refills.

Meanwhile, the pharmacy does quite a bit of compounding, and this is a passion of Pagnotta’s.

“[Neonatal intensive care unit] compounding is so rewarding, working with parents, hearing about their journeys and how they overcome struggles. We form lasting relationships,” Croce said.

“You build a close relationship with the parents; we are always talking to them,” he said. “We care; we really want to make a difference.”

In addition to neonatal intensive care unit compounding, which includes heart medications and liquid formulations of spironolactone and other diuretics, Four Corners Pharmacy does a lot of veterinary compounding. Cats often receive compounded methimazole or fluoxetine. One specialty of Four Corners Pharmacy is a compounded transdermal gel for inside the ears of cats that cannot handle liquid medications or pills. Dogs often receive potassium bromide or seizure medications.

The pharmacists stock up on large quantities of flavors. “Cats prefer tuna fish by far, and dogs love the smell of bacon,” Croce said.

Croce’s attention to detail and willingness to go the extra mile has boosted patient’s appreciation of the pharmacy profession. He recalls a situation when he helped a family. The mother was worried because her daughter needed an EpiPen, and there were errors in the prescription. Croce helped to quickly rectify the situation. The little girl drew a picture of herself at the pharmacy counter with him, simply captioned “Thanks, Dr. John,” he said.

“I know that family will always see a pharmacist as a resource. This is what we strive to do,” Croce said.

Knowing that it is important to give back to the community, the Four Corners Pharmacy team visits a local senior apartment complex to conduct a flu clinic every fall. The pharmacy students talk to local library and senior groups about health-related matters. The pharmacy also sponsors the local high school swim team and Little League baseball team.

The pharmacy uses a unique technology, Backline from DrFirst. “Now we control the chaos instead of having the chaos come to us,” Croce said.

The pharmacy has a fast-paced and hectic environment, so this HIPAA—secure technology has been a lifesaver for the staff. With this system, electronic messages from health care providers or patients are routed directly to a computer and can be answered immediately. The Backline program also allows for direct integration into electronic health records, refill reminders, and text alerts.

Croce credits Backline for significantly improving customer service and satisfaction. “Now we have less phone call interruptions. Those little moments add up to better time management,” he said.“These days, [patients’] phones don’t get answered, but texts always do,” Croce said.

Karen Berger, PharmD, is a pharmacist at an independent pharmacy in northern New Jersey.