HARDWICK – For many, medications are a necessary component for managing chronic illness. As someone who cares for people as an EMS provider and a nurse, I see that chronic conditions often hang in the delicate balance of having access to one’s prescriptions, among other factors. As time goes on, it seems like the extent and number of chronic conditions locals are facing only seems to increase, often precipitating the need for emergency medical services when these situations become acute again.
Studies from the CDC show that the burden of chronic illness is higher in rural areas, which include the Northeast Kingdom. This is especially true when it comes to conditions like cardiovascular disease, respiratory disease and diabetes. Part of that boils down to health care access.
That is why I was surprised that, as if it was meant to only be subtly noticed, I discovered the only pharmacy in our area was closing with just over 30 days of notice. The sign posted in the pharmacy trailer at Walgreens caught my attention. I reached out to a colleague at the Hardwick Health Center who was hearing the news from me for the first time. Now the challenge: a community whose resilience, while strengthened due to flooding, will now be tested again. How do we find sustainable solutions for community members who will struggle to access this vital piece of the health care system?
On the surface there are several simple solutions. These solutions do stop short of being ideal for some community members, though. Pharmacy users have a diverse array of transportation availability, technology literacy, and immediate vs. delayed need regarding access to medication. Considering those potential limitations, it exposes how people could potentially fall through the cracks without adequate support systems seeing the process through. It appears the burden of figuring this piece out may fall on family members, friends, community organizations and health care providers.
Consider this scenario: a patient with a history of chronic respiratory disease arrives at the emergency department with worsening shortness of breath, fatigue, low oxygen and a fever. He is diagnosed with pneumonia. Feeling a little better after some treatment, the patient is discharged from the ED at 10 p.m. with a prescription for azithromycin, an antibiotic commonly used to treat pneumonia. He returns home to rest.
The mail order pharmacy he uses is unable to fill a prescription that quickly, so he must make a trip to Morrisville a second time to get the azithromycin filled. He is too fatigued to drive after his ED visit and decides to put off picking the prescription up for a couple of days because it’s too far. Subsequently, he calls 9-1-1 with a severe drop in his oxygen saturation and is unable to get out of bed. He is returned to the emergency department where he requires admission to an intensive care unit and respiratory support via a ventilator; a scenario easily avoided had the patient been able to pick up his antibiotics locally and maintain his regimen.
Another factor to consider is when a medication regimen changes, insurance companies sometimes get involved and it is difficult for prescriptions to get filled. The nightmarish tangle of administrative roadblocks often leaves either the patient or a health care provider stuck in a dizzying labyrinth of automated phone trees that would be surprising to see resolved by entrusting prescriptions to a larger-scale mail-order system.
These gaps unaddressed through the lack of having a local pharmacy have the potential to require more care coordination with primary care offices, increase the number of EMS calls and ER visits, and, most importantly, impact the quality of life for patients affected by the closure.
The quality of service in the Walgreens Pharmacy has certainly changed over time, with immense pressure of trying to fill prescriptions and administer seasonal vaccines consuming all the bandwidth of the pharmacists. When pharmacists were in short supply, services that customers relied on were cut as were the hours, which for months on end were sporadic in nature. Flooding then caused the pharmacy to move to a trailer two years in a row and it appears the decision-making executives who concluded Hardwick’s pharmacy was on the chopping block didn’t have any intention of communicating with key stakeholders that the town had been selected for such an abrupt discontinuation of service. Community members are now wondering, as time runs out, how the gap will be bridged.
With many vacant commercial buildings sitting outside of the vulnerable flood plain of the Lamoille River, another reputable company or mom-and-pop shop would do well restoring some trust and hope in a small community that values customer service, stability and transparency. In the meantime, Walgreens should be held accountable to its loyal customers by proactively reaching out to assist in solving the problem created by this vacancy.
Tyler is our weather reporter and a community journalist. He works as a nurse and EMT, volunteers with Hardwick Rescue and helps to train new EMTs.
