Filling a Prescription for the Community
When Tracy Reed, DPM ’97, DABPM, sent her patients away with prescriptions, she couldn’t be sure they took the next step to fill them. Being in an under-resourced part of St. Louis didn’t help, since that meant many of Dr. Reed’s patients couldn’t always easily access pharmacies — or health care.
“There’s not much around here but some houses and some cemeteries,” said Dr. Reed, who has been in private practice for 20 years in northwest St. Louis, right at the edge of the city. “Down the street from us, a Walgreens closed. There’s another Walgreens that’s somewhat close to us. There’s a federally qualified healthcare center not too far away. Other than that, there’s no large medical centers in the immediate vicinity.”
Wanting to streamline ongoing, long-term medical care for her patients, Dr. Reed and a pharmacist partner launched TPD Pharmacy in the same building as her practice in June 2017. Jensine Chacko, PharmD, now serves as the pharmacist in charge, offering quick-fill prescriptions, free delivery, pickups after appointments or during office hours, and counseling.
Dr. Reed said having that in-house service is not only convenient, but also is a critical way to make health care less daunting and more personal for patients.
“I can consult with the pharmacist and then know that my patients pick up their medication,” Dr. Reed said. “Now, they may not take it, but at least they picked it up — that’s half the battle right there to get them to be more compliant with the treatment.”
Dr. Reed now is readying to open TPD to the community at large, hoping it can be an important step toward health equity in the area. As of March 2022, TPD Pharmacy was on hiatus for a few weeks while Dr. Reed explored a potential merger with another local pharmacy to open the service to the broader public. The goal is to merge under the same umbrella organization but open multiple sites to serve the area outside of her practice and her patients, Dr. Reed said.
Growing up in Florissant, northwest of St. Louis and south of the Missouri River, Dr. Reed initially wanted to be an engineer. She attended Lindenwood University in St. Charles, Missouri, graduating with a degree in chemistry in 1992.
Not wanting a discipline that involved too many bodily fluids — “I can’t do dentistry; I don’t know how people do it,” Dr. Reed said, chuckling — podiatry piqued her interest because it was something “where I can make people feel better on their first visit. There were a lot of things that attracted me about being able to make people feel better, quicker.”
Her parents were skeptical about it when she first approached them, Dr. Reed said. But when her father asked around, he learned the brother-in-law of one of his golf buddies was a podiatrist. Her father arranged for her to shadow Robert Moore, DPM, at his practice in St. Louis.
From there, she did a summer pre-med program at Fisk University in Nashville, then was accepted into the Dr. William M. Scholl College of Podiatric Medicine. She received her degree in 1997 and completed her residency at Saint Barnabas Hospital in New York, before going into private practice in St. Louis in 2001.
Proper health care is a continuum, necessitating preventive and routine care to avert the need for critical medical intervention. Over her two decades in the field, Dr. Reed said she has seen how patients in the Walnut Park West neighborhood where she practices have systematically been denied that kind of care.
It breaks my heart that they have to go through a whole lot of stuff and then they end up coming to me so I can fix something somebody else didn’t take care of.
As in many underserved areas, health problems lie at the intersection of multiple social equity issues, like nutrition. The area near Dr. Reed’s office is peppered by fast-food restaurants, including national and international chains like McDonald’s, Wendy’s, White Castle, Popeyes Louisiana Chicken, and numerous pizza, burger and barbeque spots.
“You can get all the fried chicken you want around here … but that’s about it,” Dr. Reed said.
Transportation is a factor as well. “If you want an apple or banana, you have to go kind of far. We’re right on a bus line, but you would definitely have to take a bus or drive further down several miles before we get to a grocery store,” Dr. Reed said. “It’s really hard to get a decent grocery store in the area.”
The area is predominantly African American. Dr. Reed said she often has patients with inadequate insurance coverage, plans that involve extremely high copays or as high as 90% coinsurance costs.
Combine the lack of quality-of-life amenities with paucity of comprehensive medical care, and “it just makes it harder for them to access the things that they need,” Dr. Reed said.
“Then when they do need something drastic — like they do need some medication because they got (diabetes) but also because they weren’t able to take care of themselves — it just makes it harder for them to try to get medication. It’s hard for them to have (proper) nutrition to try to heal a diabetic foot ulcer and just harder for them to even get somewhere to be seen to get it treated.”
Historic mistreatment of people of color in medicine continues to play a role, Dr. Reed said.
“I just want to make sure that my patients are taken care of, because sometimes I’m seeing them go to other places, and they kind of get subpar treatment because they are people of color … or they might think that they’re going to get decent treatment, and I see different things that have been done to them.
“It breaks my heart that they have to go through a whole lot of stuff and then they end up coming to me so I can fix something somebody else didn’t take care of. Or they’ll come to me when their foot is almost hanging by a thread, and I’m like, ‘I wish you could get here earlier.’ I try my hardest to make sure that my amputation rate is low, (because) a lot of it is really treatable and even preventable.”
All of that informs Dr. Reed’s approach to TPD Pharmacy. Along with making medication easier for patients to get, she said they can provide personalized service, answer questions and guide people through the treatment. It’s a throwback to the type of relationship neighborhood pharmacists commonly had with patients, who sought them out for advice in addition to — or even instead of — physicians.
It’s “definitely a more personal touch, because I think people respond better to that,” Dr. Reed said. “Sometimes, people are trying to get medication pre-approved from the insurance company — that is some paperwork sometimes just to get your patient what you need to get them. The pharmacist is willing to go the extra mile and make sure they get that or help me get it for the patient, and that helps. … She’s also good at making sure they take (medication) correctly, following up to see if they’re using it, things like that.”
Once TPD Pharmacy is open to the wider area, Dr. Reed said she has no intention of stopping there. She wants to compete with, or even surpass, major chain pharmacies. “But I’ll start in the community and work our way up,” Dr. Reed said.
Dawn Rhodes is a Chicago-based writer and editor. She’s worked in journalism for more than a decade.
Pharmacy deserts — defined as neighborhoods where the average distance to the nearest pharmacy is 1 mile, or a half-mile in neighborhoods where at least 100 households have no vehicle — can be found in 1 out of 3 neighborhoods in U.S. cities with 500,000 or more residents.
- 15 million of U.S. residents live in a pharmacy desert.
- An estimated 8.3 million are Black or Latinx.
Pharmacy disparities between Black and Latinx neighborhoods and white or diverse neighborhoods were most pronounced in Albuquerque, Baltimore, Boston, Chicago, Dallas, Los Angeles, Memphis, Milwaukee and Philadelphia. In Chicago, 1% of white neighborhoods were defined as pharmacy deserts compared to 33% of Black neighborhoods.
Source: Health Affairs, “Fewer Pharmacies In Black And Hispanic/Latino Neighborhoods Compared With White Or Diverse Neighborhoods, 2007–15,” May 2021