THE NUTRITION CONNECTION

CHRISTINA VEIDERS

There's an obvious connection between good nutrition and good health. In the supermarket, the connection between food and pharmacy departments is now becoming obvious, too.

Indeed, some executives view integrating these departments as key to developing the potential of supermarket pharmacies -- and an important way to distinguish them from the competition.

"The niche supermarket pharmacy has over the traditional drug chain is that chain drug will never have the food component, and we need to capitalize on it," says John Beckner, director of pharmacy at Ukrop's Super Markets, Richmond, Va.

Here's one scenario.

After picking up a prescription for Diabinese, an oral blood glucose-lowering drug for diabetes mellitus from the local supermarket pharmacy, a patient is directed by the pharmacist to the Nutritional Counselor. This computerized interactive kiosk prints out information on drug/nutrient interactions for those using medications.

The kiosk also lists foods that people with diabetes should avoid. It gives the diabetes patient food and menu suggestions with appropriate serving quantities, and lists recommended foods sold specifically in the store.

Sound a long way off? Perhaps, but the technology is available today.

First DataBank, San Bruno, Calif., a health care information company, has nutritional software packages that are being used by 20,000 dietitians in various health care settings.

The company's Nutritionist IV program, which analyzes foods and breaks out percentages of carbohydrates, fat and protein, contains a data base of 13,000 foods and ingredients and more than 70 nutrients. Another program, Auto-Nutritionist IV, creates menus based on individual nutritional needs as well as personal food preferences.

Jim Wilson, First DataBank's vice president of marketing and sales, has been exploring the use of such software within supermarket pharmacy. He's been looking into ways to configure the software to meet the needs of a food-drug combo store, such as developing an interactive kiosk as described above.

"It makes a lot of sense for supermarkets to get into it [nutritional counseling] because they've got the drugs and the foods together. If they can find out the patient's diagnosis and start counseling on food, it would be an added service," Wilson says.

Supermarket pharmacy directors are now beginning to experiment with disease-state programs and lifestyle-related health issues that integrate pharmacy with nutrition and eating the right foods.

Early pioneers mainly focused on diabetes in their nutritional counseling efforts.

Janet Tenney, manager of nutrition programs at Giant Food, Landover, Md., says diabetes is a good disease to tie into because the level of concern and motivation among patients is high.

"The biggest problem we have in this country with the type II [noninsulin-dependent] diabetic is that it's not a crisis type of disease. It's a chronic disease, and as such it is not often well handled by our medical system," she explains.

"I don't think you'll find the same level of motivation and concern on the part of patients in other types of diseases," she says.

H.E. Butt Grocery Co., San Antonio, launched a diabetes care program for 200 patients last spring in which meal planning is an essential part of the program, since patients' disease states are carefully monitored.

When contacted by SN, Robert Coopman, the chain's vice president of pharmacy, declined to comment on the program's progress.

Giant Food has conducted diabetes store tours for some 2,000 patients. Giant hired 40 dietitians who were trained in diabetes education to conduct the tours, which included a 10- to 15-minute presentation by store pharmacists who reviewed glucose monitoring equipment, diabetes medications and over-the-counter products sold in the store for this targeted group.

"Our intent was not only to get diabetics to use the food store properly but to make use of the professionals who are always there in the pharmacy as well," Tenney explains. Giant plans to conduct more tours in the spring next year.

Coburn's Inc., St. Cloud, Minn., plans to host two Diabetes Days this month at two of its locations. On those days the store will serve low-fat and low-sugar foods to participants.

"Besides drug therapy, we're going to be dealing more with preventive medicine, and nutrition is an important part of that," says Marvin Moen, the chain's director of pharmacy operations.

At Hannaford Bros., Scarborough, Maine, Dennis Beauchene, co-director of pharmacy, is an active proponent of combining nutritional education with prescribing medicines.

Last October the 128-store chain developed a weeklong program in conjunction with the American Heart Association's Healthy Heart month, when dietitians were available at all of Hannaford's 60 pharmacies to ask customers questions about medications they were taking and their diseases. Dietitians analyzed customers' shopping carts and recommended food substitutes to reduce fat and sodium.

"It's just a no-brainer that if pharmacists in supermarkets become more educated on the nutritional aspects of the store, they can help build the pharmacy practice and customer loyalty in the store," says Beauchene.

On-staff dietitians or nutritionists can be enablers in the integration process between food and pharmacy. They can not only educate their customers on nutritional issues, but can teach the pharmacists as well. In some cases such nutritional education programs given by a chain's dietitian or nutritionist can earn pharmacists continuing education credits. The nutrition professional also develops programs and information to help shoppers make healthy food choices.

Last year at Tidyman's Inc., Greenacres, Wash., Karen Ferguson, health educator, created the See the Light labeling program, which helps shoppers quickly identify the fat content of foods. The signs will be rolled out to all store departments in the chain by next year.

Ferguson says the next phase of the program will include the development of information on diets, menu planning and recipes related to specific diseases like diabetes, heart disease and cancer. This information will be supplied to shoppers and distributed at the pharmacy counters. The health information also will be given to customers of third-party providers that contract with the chain.

Barry Moravec, director of pharmacy at Abco Foods, Phoenix, says he hopes to initiate an informational program by the end of the year that will involve informal instruction on a health-related issue, such as high blood pressure, geriatrics and diabetes. The program will be presented by an expert on the disease state and will include nutritional counseling.

"I've personally worked with geriatrics and know when they lose a loved one, they neglect their nutrition. It's important to have a dietitian on staff to get the person back on track," says Moravec.

By providing such benefits as nutritional counseling to their patients, supermarkets hope they can eventually get reimbursed for such services.

"I see reimbursement coming eventually because proper nutrition will impact the long-term health of people," says Beckner of Ukrop's.

Alisa Martinez, manager of pharmacy supermarket services at Giant Foods, who was involved in Giant's diabetes program, says, "We have to start documenting our interventions and quantifying them in order for reimbursement to take place."

Wendy Munroe, president of MedOutcomes, Richmond, Va., provides disease management consulting services to community pharmacy.

"Nutrition is absolutely important in disease-state management, especially with the disease states we are initially dealing with -- namely diabetes, hypertension and hypercholesterolemia [elevated low-density lipoproteins]. Diet plays an essential role in the diseases, and part of our program is not just focusing on drug therapy, but nondrug therapy as well," she says.

As far as getting reimbursed for such services, Munroe says since there is no real precedent out there yet, it has become a chicken-egg situation.

"If you aren't out there providing the services, then who is going to pay you for it? So if pharmacists sit back and say, 'I am not going to do it until I get paid for it,' then third parties are going to say, 'I am not going to pay for it until it exists,' " Munroe says.