We wouldn't pick on a sophomore, would you?

We would not pick on a sophomore would you?

That is more or less what I told an executive from a mid-tier pharmaceutical manufacturer at a business conference I attended several weeks ago, one of several conversations I had over course of event regarding current state and the future of retail clinics in America. I could not help but recall that conversation as I read a recent Wall Street Journal report about relatively small number of clinics that had been forced to shut down.

You see, most people these days want to talk about growth, which, at time of that conference, was up about 800 percent over prior year, and was on pace, as it still is, to more or less double year over year for next three to five years.

But a few others want to know what we think about small number of clinic closings, a cruel and somewhat predictable result of early evolution of retail clinic model. Predictable not because these were bad companies that did not know how to run clinics; predictable, because we had to believe, with as much venture capital that was coming at this whole thing in the very early days, that there was going to be some kind of shakeout -- and some degree of consolidation to be sure -- before this industry even began to sense its own maturation.

At one point, The Drug Store News Group had tracked more than 40 companies that had emerged as clinic providers. We never imagined it would stay that way for long. If the typical retail pharmacy takes two to three years before it begins to reach profitability, why would expectation for a new clinic be much different? The truth is models are quite similar from that standpoint. While these companies aren't openly reporting these numbers, Drug Store News has learned that where their clinics have been up and running for about two years, convenient care industry's leading operators have reached profitability in these more mature markets. Many more of these markets are going to be hitting this maturation point over the next six months to a year.

Still, some people -- it would seem even fewer than actual number of clinics that have closed in recent months -- aren't quite convinced of viability of model.

" What about the doctors? " they ask.

We tell them that all top operators actively build their referral networks with local physicians, urgent cares and hospitals in communities where they operate their clinics, and that in general, AMA is on board; that it was only ever a handful of splinter groups within the AMA that ever really challenged the clinics at all.

" What about nursing shortage? " they ask.

As much as I hate to answer a question with a question, what about dwindling ranks of America's family physicians? The number of third-year medical students who opt to pursue a career in general internal medicine has plummeted over past 10 years while the number of nurse practitioners continues to grow.

Moreover, if we take a look at job satisfaction among nurse practitioners working in a retail clinic setting like we do -- The Drug Store News Group polls Retail Clinician magazine readers, which now include several thousand nurse practitioners, twice a year -- we would know that getting NPs to migrate over from other practice settings to work in the clinics isn't really a very tough sell. Almost 99 percent of our readers describe themselves as very or extremely satisfied in their current positions, and as almost 90 percent came either from a physician's office or an urgent care or a hospital setting, they have a frame of reference to compare it to. Our readers use words like " empowered " and " energized " to describe practicing in a retail clinic environment.

And then there are other signs out there; sure signs that retail clinics are still in their relative infancy in terms of impact they can make on health care and how it's delivered in this country. Indeed, 1, 000 retail clinics is only tip of the iceberg. Drug Store News online recently reported on the nation's first retail-based dental clinic, All Smiles Dental, which last month opened in a Carnival Food Store in Plano, Texas. Then there's Hear At Last, which earlier this year opened its first retail " hearing solutions " retail outlet in south Florida, its first U. S. location. While that store is a freestanding location, company also operates 18 of its hearing aid clinics, which use high-tech equipment to assess cause of hearing loss and match customers up with appropriate system in Wal-Mart stores in Canada.

Or, we could just concentrate on leaders: CVS, recently celebrated opening of MinuteClinic No. 500, and although it recently trimmed back its projected clinic openings for year from 200 to about 100, company has earned a solid reputation for setting conservative goals and then blowing the doors off those goals. Meanwhile, in addition to about 160 retail-based clinics currently in operation and plans for as many as 250 more by end of year, Walgreens will now look to transition more than 350 corporate-based clinics it acquired from I-Trax/Whole Health Management over to Take Care brand. And, to help build national awareness for Take Care brand, Walgreens is sending 10 RVs on the road to 300 U. S. cities this year to provide free health screenings and counseling to customers across country, as part of its Take Care Health Tour.

To be sure, while Take Care and MinuteClinic and a few other clinic operators have been at it longer than that, this is really just year two for organized retail clinic industry. It may be a slightly awkward time, to be sure, as evidenced by the recent fallout in industry. Still, in span of just two years, more than 1, 000 of these retail-based clinics opened in this country, and only 69 of them have closed; that is not too shabby -- not even for a sophomore.

The bottom line is that if you're a pharmaceutical manufacturer, branded or generic, or an OTC drug maker and we are not trying to make a meaningful connection with this key group of influencers, that is, the nurse practitioners, physicians assistants and in some cases, physicians, that are staffing these clinics and pioneering this brave new frontier of health care -- and most important prescribing and recommending your products, or NOT -- you're missing a major opportunity.

Drug Store News knows that this model of care is a major part of the future of health care in America, and how it will be delivered. We know this because we've watched and reported as growing numbers of payers and patients have embraced the model. And why not? In terms of closing the gap on access and affordability to health care in this country it's probably single most progressive idea to come along since Lyndon Johnson's Great Society created Medicare.

It also is the best piece of evidence that the free market can come up with a solution to America's healthcare crisis. And in this election year -- particularly as Clinton campaign, running purely on fumes, chokes to a halt -- Drug Store News believes this nod to the age of healthcare consumerism that's rise of retail clinic industry will not go unnoticed.

ROB EDER

EDITOR IN CHIEF

Health advice that you can't refuse

Diazepam - how with it.

uses of Diazepam Diazepam is used to treat episodes of increased seizures ( e. g. , acute repetitive seizures, breakthrough seizures ) in people who are already taking medications to control their seizures. Diazepam is only recommended for short-term treatment of seizure attacks. It isn't for ongoing daily use to prevent seizures. Uncontrolled seizures can turn into serious ( possibly fatal ) seizures that do not stop ( status epilepticus ) .

Diazepam belongs to a class of medications called benzodiazepines which produce a calming effect on brain and nerves ( central nervous system ) . It's thought to work by increasing effect of a certain natural chemical ( GABA ) in brain.

how to use of Diazepam Read Patient/Caregiver Information Leaflet provided by your pharmacist before you use Diazepam and each time we get a refill. If you have questions, consult your doctor or pharmacist.

Diazepam is given rectally by a caregiver trained to recognize symptoms of your seizures and to correctly give product. You and your caregivers must follow all instructions from your doctor and pharmacist exactly. Review all instructions on how to give Diazepam in the product package. If you have any questions or feel unsure about using Diazepam, call doctor or pharmacist before using Diazepam. Get emergency help if the person is having a seizure and we don't feel comfortable using Diazepam.

Before using, check syringe for correct dose. Your pharmacist should set correct dose and lock the syringe in " ready " position before giving we product. Before leaving the pharmacy, look at each syringe. The dose should be in display window on side. We should see a green band with the word " ready " at bottom of syringe barrel. Look to make sure we have correct syringe tip ( e. g. , smaller tip for a child ) and that there are no cracks around syringe tip. Return product to pharmacist if there's a problem or if we have any questions

Cracks can cause the medication to leak out and not provide the correct amount of medication. If we see a crack, use a different syringe. Cracks can appear over time, so keep checking your syringes to make sure we have good ones ready to use. Also check expiration date on package, and refill your prescription before medication expires.

The dosage is based on age, weight, medical condition, and response to therapy. Be sure we understand when Diazepam should be used, how to use it, and how to check for side effects/seizure control. In some cases, a second dose may be prescribed and given 4 to 12 hours after the first dose. Usually, Diazepam shouldn't be used to treat more than 5 episodes per month and no more than one episode every 5 days. If seizures continue after using Diazepam as prescribed ( e. g. , no change 15 minutes after dose is given ) , or if there is a change in person's breathing, behavior, or condition that alarms you, get emergency help right away.

Diazepam shouldn't be used regularly. This medication may cause dependence when it has been used regularly for a long time ( more than a few weeks ) or if it has been used in high doses. In such cases, if we suddenly stop Diazepam, withdrawal reactions may occur while use Diazepam. Such reactions can include increased seizures. Report any such reactions to your doctor immediately. When stopping extended, regular treatment with Diazepam, gradually reducing the dosage as directed will help prevent withdrawal reactions. Consult your doctor or pharmacist for more details.

Though it's very unlikely to occur, Diazepam can also result in abnormal drug-seeking behavior ( addiction/habit forming ) . Don't increase your dose, take it more frequently, or use it for a longer time than prescribed.

Dispose of Diazepam properly. Follow directions in the Patient Information Leaflet. Don't reuse syringe.

Don't stop taking your regular seizure control medications when you're given Diazepam.

side effects of Diazepam Drowsiness, dizziness, diarrhea, and unsteadiness may occur. If these persist or worsen, notify your doctor promptly.

Remember that your doctor has prescribed Diazepam because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using Diazepam don't have serious side effects. Diazepam stays in the body for a long time. Be sure to watch for reactions for at least 4 hours after giving medication.

Seek immediate medical attention if any of these unlikely but very serious side effects occur:

A serious allergic reaction to Diazepam is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include:

This isn't a complete list of possible side effects. If we notice other effects not listed above, contact your doctor or pharmacist.

precautions of Diazepam Before using Diazepam, tell your doctor or pharmacist if you're allergic to it; or to other benzodiazepines ( e. g. , oxazepam, temazepam ) ; or if you have any other allergies.

Diazepam shouldn't be used if we have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if we have:

Before using Diazepam, tell your doctor or pharmacist your medical history, especially of:

Diazepam may make we dizzy or drowsy; use caution while engaging in activities requiring alertness such as driving, riding a bicycle, or using machinery. Avoid alcoholic beverages.

To minimize dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.

Caution is advised when using Diazepam in elderly because they may be more sensitive to the effects of Diazepam, especially drowsiness effect.

Diazepam is not recommended for use during pregnancy. If we become pregnant or think we may be pregnant, inform your doctor immediately. Consult your doctor for more details.

Diazepam may pass into breast milk. Because of possible harm to infant, breast-feeding while using Diazepam is not recommended. Consult your doctor before breast-feeding.

interactions of Diazepam Your healthcare professionals ( e. g. , doctor or pharmacist ) may already be aware of any possible drug interactions and may be monitoring we for them. Do not start, stop or change the dosage of any medicine before checking with them first.

Diazepam should not be used with the following medications because a very serious interaction may occur while use Diazepam:

If we are currently using either of these medications, tell your doctor or pharmacist before using Diazepam.

Before using Diazepam, tell your doctor or pharmacist of all prescription and nonprescription/herbal products we may use, especially of:

Tell your doctor or pharmacist if we also take drugs that cause drowsiness such as: antidepressants ( e. g. , amitriptyline, nefazodone ) , certain antihistamines ( e. g. , diphenhydramine ) , anti-seizure drugs ( e. g. , carbamazepine, phenobarbital, valproate ) , medicine for sleep or anxiety ( e. g. , alprazolam, kava, zolpidem ) , muscle relaxants, narcotic pain relievers ( e. g. , codeine ) , psychiatric medicines ( e. g. , chlorpromazine, risperidone ) .

Diazepam contains a small amount of alcohol. Tell your doctor if you are taking drugs such as disulfiram or metronidazole that can can cause an unpleasant reaction when combined with alcohol.

Avoid alcohol when using Diazepam because it may increase side effects such as difficulty breathing and drowsiness.

Check the labels on all your medicines ( e. g. , cough-and-cold products ) because they may contain drowsiness-causing ingredients. Ask your pharmacist about the safe use of those products.

This document doesn't contain all possible interactions. Therefore, before using Diazepam, tell your doctor or pharmacist of all the products we use. Keep a list of all your medications with you, and share list with your doctor and pharmacist.

overdose of Diazepam If overdose of Diazepam is suspected, contact your local poison control center or emergency room immediately. US residents can call US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include confusion, slow reflexes, clumsiness, deep sleep, and loss of consciousness.

notes of Diazepam Don't share Diazepam with others. It is against law.

missed dose of Diazepam Not applicable.

storage of Diazepam Store Diazepam at room temperature at 77 degrees F ( 25 degrees C ) away from light and moisture. Brief storage between 59-86 degrees F ( 15-30 degrees C ) is permitted. Keep all medicines away from children and pets.

Properly discard Diazepam when it's expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

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