Small Community Pharmacy Makes a World of Difference

By Peggy Kaplin

According to Joel Zive, RPh, PharmD, there are two different types of pharmacists. Some work directly with the public in a somewhat limited capacity taking orders and filling prescriptions, while others work in small community pharmacies and take a more personal approach to patient care. In recent years, the role of the community pharmacist, and pharmacists in general, has expanded. It has become vital to stay educated in order to help each patient as much as possible.

Zive co-owns Zive Pharmacy; a small community pharmacy in Bronx, New York. He works there with his father, who started the business in 1962. He works mainly with HIV/AIDS, Heptatitis C, and asthma patients in a community with a lot of diversity and a real need for quality, affordable care.

Zive received an ABJ from the University of Georgia in 1994. After graduation, he chose to take a detour from a career as a pharmacist. During an eight-year time span, he worked as a magazine editor, a long-distance phone plan salesman, and eventually wound up working for a drug company before deciding that it was time to go back to earn his BS pharmacy degree from St. John's University. And five years later he went back to earn his PharmD. He says, "When I went back to school, I was almost 10 years older and had a different mindset than the first time around, and I completed the three-year program in two and a half years. I went from being a drug rep with a car and all the perks, to being a student in a hot and stuffy chemistry classroom. That was quite a culture shock for sme."

"I have to give my wife credit, since she encouraged me to go back to school sooner than I wanted to. I told my dad, who eventually offered to fund my return to pharmacy school, that I wanted to leave my job at the drug company and open up a stall in a flea market. I know it sounds funny, but if you are able to find a good supplier of anything, like socks, for example, you can do really well selling them at a flea market. Let's say you spend a quarter for a pair of socks, and you sell them for a dollar, you don't have to sell that many socks to do well. I was seriously considering leaving this drug company with all of the benefits because I didn't like it anymore, and go and sell socks at a flea market!"

Ultimately, after graduating, Zive joined his father at their family pharmacy as the new manager, which enabled him to channel his creativity into the business. "My dad was in business for over 30 years when I joined him. All of a sudden we have print reporter writing articles on us and television crews in the store to cover our efforts in the community—suffice to say this was quite a culture shock for him," Zive says. There are plenty of challenges that face a small community pharmacy, and Zive has approached them with a sense of determination and enthusiasm that has enabled him to help people in his Bronx neighborhood, as well as in communities worldwide.

He says, "I have about 15 employees, and we have a great deal of competition. On our street alone there are competitors five blocks away, across the street, and there are two chains on the main avenue. We all stay in business, however, because each pharmacy caters to it's own niche demographic. One of them caters mostly to the Russian population, and our niche is working with HIV and Hepatitis C patients. We really do play a major role in the patient's lives. We do more than just fill the prescriptions. Case and point: I'm on the committee of the Bronx HIV Care Network, and we meet on a monthly basis to discuss issues that affect HIV patients; whether it's trying to find the means for increased funding, or aiding people who just got out of prison. We meet with legislators to advocate their needs. With an increased need for medications and less help from the government, someone has to step up and help the underserved populations."

Another way that Zive tries to help his patients is by ensuring that they feel comfortable in his pharmacy. Communicating in a healthcare environment includes more than understanding and speaking a patient's native language—there are cultural nuances that also must be comprehended in order to achieve maximum adherence to medications. Aside from hiring people who speak various languages, Zive has adopted a new technology called Language Line, which is a 24-hour verbal translator and interpreter.

Zive explains, "The New York Academy of Medicine approached me because they wanted to see if we could improve immigrant access to pharmacy services. It's a little scary if you're a person who has just come to this country and you are in need of medical help. Language Line is a telephone system that has two handsets on it; you walk over to the handset, pick it up, and it says, ‘For Spanish press one, for all other languages press two,' and so on. Then you put in your ID number. Someone who speaks Spanish will come on the line, and you say, ‘Hi, my name is Susan, I have John here who is a patient of mine, and he has an asthma medication. I want to talk to him about how his medication works, and see if he has any questions.' Now you have framed the situation for the interpreter. You then look at the patient directly, like you're having a conversation, and speak English as you would in any situation. The translator will then relay the information to the patient. We have had huge success with this method. The over 170 languages the service translates and interpets represent approximately 98.6% of customer requests from the 6,809 languages spoken worldwide. This service is not cheap; it can be very expensive to do this, however."

Aside from having an impressive impact on people in his Bronx community, which has earned him substantial recognition—including the NCPA Prescription Drug Safety Award from New York's Mayor Guiliani—Zive has spent a great deal of time and money funding and overseeing the operation of a pharmacy in Rwanda, Africa. He says, "I was talking to a case manager who I was very friendly with one day in 2004. I told her that I had always been curious about international healthcare, and I had seen an advertisement for an international AIDS conference in Bangkok. She suggested that I write an abstract for it, so I did, and sure enough it was accepted to the International AIDS conference in July 2004."

"I was given the opportunity to travel to Rwanda in January 2005, and my goal was to learn everything I could about the Rwanda pharmacy system, in addition to designing a pharmacy for a clinic that a colleague of mine was building," he says. "It was really interesting to see such abject poverty. Worldwide 20,000 people die every day because they are too poor to take care of themselves."

"After the first three weeks, I came back and I was able to raise the money to go to South Africa for two weeks to take a course on HIV medication management, then I went back to Rwanda to design the pharmacy. Then, my colleague (a physician) sat down with an architect and did the final drawings, and they started building. When I went back in February 2006, I had raised even more money, and I came back with roughly $25,000 worth of equipment.

Zive's non-profit organization, Prescription For Hope (www.rxforhope.org), shipped 900 pounds of pharmacy equipment to Rwanda in February 2006, and he installed one of the only computerized community pharmacies in Rwanda. As of today, the pharmacy has filled over 28,000 prescriptions, treated over 600 HIV patients, and dispensed a large quantity of trimethoprim/sulfamethoxazole tablets. "I've been back to Rwanda four times, in order to oversee the program and to raise additional funds. The project is now fully sustainable—it went from 42 HIV patients to over 600; it services HIV positive women and their families, and deals with malaria, diabetes, pain, colds, and allergies. Patient education is also being implemented now. From that particular clinic's standpoint, my work is done. That is the optimal way to do non-profit in my opinion; you have a beginning, middle, and an end. Right now I'm trying to raise funds to continue to do this; I'd really love to establish three or four pharmacies in Rwanda."

While his international efforts continue to thrive, Zive has not been neglecting his New York patient base, and he continues to seek out ways to improve healthcare at Zive Pharmacy. His most recent mission has been to try to implement in-store HIV testing. Zive says, "It is one thing to tell someone to get tested, but it's another to be sure that they will actually do it. It is a very simple thing to do. Even though you're handling human plasma, an antibody can't infect you, so it's perfectly safe."

"The issue here is there are a lot of legislative obstacles. If we are really going to do this and help people, we have to get reimbursed for the service. At this point there are two main obstacles: I can't seem to figure out a mechanism to get reimbursed by the state to do this and I am trying to work out legal liability issues—which means that this project is kind of stalled for me at the moment. It's rare. I don't know of any other pharmacy that is trying to do this, but I will continue to look into it."

As with any business, Zive's pharmacy always has to keep its eye on the bottom line. In order to help as many people as possible, he is on a constant search for the most cost-effective ways to offer superior service. He says, however, that the troublesome economy has played a key role in highlighting the pharmacist's place as a healthcare provider. There is more counseling involved, and a much more hands-on approach than there would have been years ago.

He says, "The biggest issues now have to do with the way that we are reimbursed by third party providers. There are three things that pharmacists can be sure about: death, taxes, and that every year our reimbursements will get lower. It's kind of a tragedy; it has gotten to a point where pharmacists are having problems paying the bills, their credit lines are strung out very tightly, and their cash flow is severely curtailed."

He admits that, while things are tougher for the little guy in the present economic environment, there are still some wholesalers who are out there to help. Bellco, an AmerisourceBergen Company—one of Zive's main suppliers has been especially helpful. Some pharmacies deal with the economic crisis by opening a card section, photo section, or a gift section, in order to tap into additional sources of income. Zive has not done any of these things, but instead focuses on improved patient communication.

He says, "There used to be this saying, ‘Pick it and stick it'—that is what pharmacist's roles were defined as. Our role has slowly evolved into something much more intimate, which I really love. I also enjoy collaborating with other healthcare providers in order to open a window to a myriad of new opportunities. I think most pharmacists go into this field because they want to help people, but you also have to consider the bottom line. One way I share this philosophy is through my blog The Joys of Pharmacy (http://3rdpharm.wordpress.com/). If you can keep your priorities somewhere in the middle of the humanitarian and money-making spectrum, you are more likely to help a lot of people and will be in business for a long time."

Joel Zive, RPh, PharmD, is a third generation community pharmacist who received a BS in Pharmacy and his PharmD from St. John's University. He lectures nationwide, and has won many awards and honors including the NCPA Prescription Drug Safety Award from former New York City Mayor Rudolph Guiliani. He lives in New York with his wife and two children, and co-owns and operates Zive Pharmacy, a small community pharmacy, with his father in the Bronx.

Peggy Kaplin is a writer based out of New York City. She is on the editorial staff of NEWS-Line for Pharmacists.

Feature story, News-Line for Pharmacists, 1 Feb 2009. Link here.