China trip offers alternative ideas Area pharmacists use visit to boost options for new consulting business

Posted: Monday, November 12, 2001

When Jacksonville pharmacists Anne Cordes and Suzanne Meadows went to a nursing home in China, they were impressed.

Impressed they had found one since it was the only one in town. Most families keep their elders at home to care for them.

Impressed with the patients. Most patients, even the oldest at 97, were healthy, mobile and vibrant. Patients moved around the elevatorless two-story center to visit with others or play mahjong.

Impressed with the effectiveness of the pharmaceutical treatments. The manager of the center had to be asked twice what maintenance medications the patients were on. It wasn't the language as much as the idea of medicating patients daily to maintain their health that the manager didn't understand. A commonplace treatment in American long-term care centers, maintenance medications weren't used on any patients at this center.

For Cordes and Meadows, it was an affirming experience. Both are pharmacists and specialists in senior care. As they prepare to launch their senior care consulting pharmacy practice next year, they know that their visit to China strengthened their arsenal.

"The more we studied and the more we talked to people, the more we got excited," Cordes said.

In an effort to continually enhance their education, the duo spent two weeks in October studying the pharmaceutical practices and cultural treatment of the elderly in China as part of the People to People Ambassadors Programs, which was created by President Eisenhower but is now privately run. The trip leader, Dianne Tobias, also is president of the American Society of Consultant Pharmacists and invited Cordes and Meadows to participate.

Given their professional interests, Cordes and Meadows jumped at the opportunity. They plan to start MedMinders Pharmacy Care Services Inc. after the first of the year.

Meadows is working full time on the launch, and Cordes will remain working part time at Consolidated Pharmacy Inc., where she and Meadows used to work together as consultant pharmacists, until the company takes off. They will work with seniors one-on-one to evaluate the effectiveness, appropriateness and maintenance of their medications.

While pharmacists in consulting practices are not as common as pharmacists who work in a traditional pharmacy, many pharmacists do reach out to specialized groups, such as physicians, organizations or patients, said Michael W. McKenzie, the associate dean for professional affairs at the University of Florida School of Pharmacy.

A large part of their jobs as pharmacists is to be aware of and implement options for patients who are having difficulty with their medication therapy. While they are not planning on becoming an Eastern medicine-focused team, they plan to use the knowledge they gained during their trip to expand the array of options they give to an increasingly medication-dependent population.

Medical therapies

Long-term care centers in Florida are required by law to have a consultant pharmacist regularly come in to review the medication therapies given to the patients. As a result, Cordes and Meadows are familiar with the increasing use of medications in the treatment of elders.

Cordes said it is not uncommon to see patients on as many as six to 10 medications at once.

"Most pharmacists are trying to get patients off medication," Cordes said.

Their job is to evaluate the drug therapy and provide consultation and education to people about medication. They said there is little room in American health care to work with patients on this sort of level.

However, in China, where long periods of time are spent with patients discussing all elements of their health, there seems to be a more effective outcome.

Pharmacists ask about mood, temperature and other well-being questions to evaluate a patient, not just about the pain or temperature of specific conditions that occur because of an illness. Some practices, such as taking six different pulses in one spot to evaluate the flow of energy may not be rapidly accepted here. But the idea of thinking about more than just a disease or organ set could possibly take root.

"One of the biggest concepts we picked up from Chinese medicine that needs to be imported is looking at the whole person," Cordes said.

During their visit, they found Chinese practitioners appreciated the medications of the United States for short-term use, such as antibiotics or painkillers. But for long-term conditions, such as diabetes, they prefer Eastern treatments, such as acupuncture, herbs or other alternative treatments.

For patients who have tried other options and are looking for something else that may help, these local pharmacists have seen what impact these alternative treatments can have.

"I was already pretty open-minded about alternative therapies, and after being there and seeing firsthand the effects and well-being of the elderly, I'm more convinced," Cordes said.

The acceptance level of these alternative therapies over medication continues to grow in America. Particularly so as the baby boomer population, which is more comfortable with these options, ages.

"If the opportunity presents itself, I might suggest it to the physician," Cordes said.

McKenzie said pharmacists are drug therapy experts and that requires knowing all available dosages, treatments and options that area available.

Cultural acceptance

The pharmacists also wanted to glean hints from societal treatment of elders.

The people of China "hold their elderly and ancestors in such high esteem -- we wanted to see how they treated them as they grow older and ill," Cordes said.

What they found was that there is a regular pattern of caring for parents and other family members in the home that seems to have a positive effect. While this is not usually seen here, Meadows said they found that people's needs are still very much the same regardless of where you are.

"Everybody treasures their independence. Nobody wants to go into a nursing home, and no one wants to put their family in a nursing home," Cordes said.

The difficulties of facing these challenges are becoming increasingly important to the sandwich population -- those still raising children at home and also caring for their parents.

"We heard from many, many people that it's not good enough... a short interaction with someone doesn't equal the same as a lengthy conversation where they are comfortable to bring up all their concerns," Cordes said of their idea for their consulting business.

After watching the time health professionals spent with each patient and the thoroughness of each interaction -- they were reaffirmed of their decision.

"Even with the Internet, people still want to talk to someone who is knowledgeable," Cordes said.

Because of this need, Cordes and Meadows want to make it possible for people to live as long as possible outside of a nursing home or improve their quality of life inside a facility.

For Meadows, it was more personal. Her mother struggles with Alzheimer's, and it has been an "emotionally draining experience" for her to deal with.

She wanted to observe the treatment of elders in China to get tips to help others handle the challenges she has faced.

The acceptance of alternative medicine is pervasive in China -- large herb markets are in the city, people don't balk at the idea of drinking a tea with boiled lizard.

And professionally, the world is very different -- Chinese pharmacists do not have to be licensed or certified, and the contents of prescriptions are only loosely monitored.

But the needs are the same: to be cared for and to be healthy.

The ambassador program, which aims to promote peace and understanding, encourages this type of sharing of professional knowledge.

While MedMinders will largely focus on Western medication, traces of the ambassador program's influence will be seen.

For individuals who are interested in alternative therapies, the pharmacists are ready. And when they get an office, they'd like to add an instructor to offer yoga or tai chi for overall well-being.

"It gives us more inspiration -- especially seeing how healthy these people are," Cordes said

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