Consultations at big box pharmacies usually involve the pharmacist quickly reading off the directions and maybe some possible side-effects. Independent pharmacies typically set aside more time for patient interactions; this is especially true for compounding pharmacies, which dispense medications in unique dosage forms that require greater explanation and instruction. Compounding pharmacists who judge new topical applicators based off their patients will liking them know that it all comes down to the consultation: if the topical applicator can be easily explained in the consultation and used without any incidents in the first month, then the applicator can be a useful tool for the pharmacy.
A few common themes you'll find in this blog are new patients that need to titrate or adjust their dose and mail orders (especially since in the age of Amazon and mail-order pharmacies patients expect to receive things by mail).
A dosing concept that won’t vary too much
Sometimes when I tell doctors that syringes can be hard for patients to use, they laugh. They’ve been working with syringes for so long that they have a hard time remembering that most patients rarely have, if ever. Changing the dose on a syringe means using different syringe lines or a different size syringe, which may not be challenging for patients that work in the healthcare industry, but for novices and new patients, you want a topical applicator that anyone can use, and that requires little skill.
Apply directly to skin site, less risk of spilling
Direct application to the skin-site has many advantages. Patients don’t rub it into their hands, wasting the medication and increasing the risk of transferring to another person.
It’s also cleaner, with less risk of spilling. Pumps can spray if there’s an air pocket or clump. Syringes can be hard to hold in a position where the measuring lines are visible and where the medication won’t get wasted (I've heard stories of trying to hold a cat while measuring the cream, and it can get pretty messy).
Multiple ways to confirm dosage
Most HRT patients use it for many years; some patients may be in their 70's or even 80's. While the benefits can be fantastic for them, are they using an applicator that's easy to use if their eyesight or dexterity isn't what it used to be? If they don’t have perfect control of their hands- and who does? – they still need to be able to apply their medication. That’s why applicators should ideally have multiple ways to tell how much they’ve dosed. If they have poor eyesight, then they can hear their dosage, or if they have poor hearing, they can feel the dosing, and so on.
Don’t make it too easy to over-dose or under-dose
How much can patients mess up without messing up their dose too much? If they accidentally add just one extra actuation, how much will it change their dosage? Or do they have the ability to go “backwards” in dose? We all know that applicators can't actually take a dosage back in, but the backwards-click can cause dosing inaccuracies because the piston can only displace air with the next click. (Similarly, think about half-clicks. Because half-clicks aren't calibrated, you don't know how much patients are actually getting with half a click).
What if they want to adjust their dose mid-prescription?
New HRT patients usually have their prescriptions changed within the first few months as their doctor fine-tunes the dose. However, if their topical dispenser has large actuations, they have fewer options. Will they end up doubling their dose? Cutting it in half? Can they practically make any adjustments? Even though topical pumps can technically be used with half-pumps, there’ If they use a topical dispenser with too large of a single mechanism, their stuck with sub-optimal dosing until they pick up and pay for another prescription.
Even if your patients don't usually modify their doses between prescriptions, you can let your doctors know that their patients can easily fine-tune their dosage. It's another way to show your doctors that you're anticipating their needs.
Have extra instructions that your patients can use at home
Do you ship out? As more and more patients get used to home shipping options with big companies, they expect it from small companies, too. Choose an applicator that is easy to do phone consultations with. If patients live far away in rural areas, or simply don’t have a compatible schedule, you’ll need to consult over the phone. Before calling in for another consultation, or driving all the way in during work hours, you can provide a way for patients to answer their own questions. Download TICKER® Patient Instructions.
Compounding pharmacies have a history of shipping prescriptions, especially in rural areas with few pharmacies to serve large areas, but as we continue to deal with a global pandemic and economies opening just to shut down again, pharmacies still need to adjust to new patient and prescribing needs.
Did they receive instructions with their shipment beyond what’s on the label? The truncated instructions on a label may not always be sufficient. Are there extended instruction forms? Can they watch a video their applicator in use? Sending patients a link to a video is an easy way to prepare them for their phone consultation, but recording videos and maintaining an online library may not be practical for every compounding pharmacy. Watch Instructional Videos
Look for a company that’s going to work for you, not just sell you applicators. Ask for resources and ask questions on the best way to consult, and see if the answers will work for you.
BONUS PRO-TIP: Keep an applicator filled just with cream base by your consultation area. Show patients how they should use the applicator themself to answer any unanticipated questions that would normally arise only when they've gotten home.
How easy a patient's therapy is ultimately comes down to your consultation. Patients come to your pharmacy because they trust your professional judgement and have a relationship with you. If you chose an applicator that you truly trust and prefer, then your patients will feel confident with their prescription.