When people first meet Armon Neel, Jr., CGP, FASCP, they usually have no inkling that he's among the most respected, most honored movers and shakers in consultant pharmacy. Neel presides over one of the leading senior care companies in the Southeast, Griffin, Georgia-based Institutional Pharmacy Consultants.  Now, at the pinnacle of his nearly 40-year career, Neel talks about the early innovations that made him a trailblazer in patient-focused pharmaceutical care, what sparked his excitement for consultant pharmacy so many years ago—and why he's even more excited about the future.

A Pioneer in Senior Care

Neel recalls his entrée into the long-term care pharmacy arena. "It was about 1968 when my partner, Bill Pittman, and I got involved in long-term care. We saw a real need for a clinical pharmacists' input in that arena," he says. "Here was this new health care field, started in 1965, that was looking to take hospital protocols and procedures and make them fit with chronic care. But they didn't fit. It was a different population—a more demanding population of old people with different diseases and chronic diseases that did not heal. The medications didn't work the same way they did in younger patients. Here was a brand new field to pursue, and the prospect of getting involved was very exciting."

Sensing the emergence of a new arena of enormous challenge and opportunity, Neel and his colleagues began coming up with new ideas and new protocols on how to better meet the complex drug therapy needs of geriatric populations. "We were the first in Georgia to computerize medical records in the nursing station, and the first to use unit doses in nursing facilities," he says. "We were the first to initiate a number of different protocols, everything from a liberalized geriatric diet to glucose monitoring for diabetics. We were really the early pioneers of disease state management."

Putting It All Together

Neel eventually decided to retool his company's focus away from dispensing activities and build his practice completely on clinical consulting. At first his consulting activities were narrowly focused on medication use and directly related issues, but as time went on he saw the need to develop a whole new platform for integrated delivery of long-term care in partnership with other health care professionals.

How has the role of consultant pharmacist changed since Neel first started out? "I'll never forget how we opened our practice in 1963 just when Medicare and Medicaid were getting under way," Neel recalls. "It was written into the regulations that long-term care facilities had to employ the services of a consultant pharmacist. Every facility was required to have one. But at the time the physician had control of all aspects of patient care. So what did the pharmacist do? Make sure the prescription labels were correct, and that's about all," Neel recalls.

NOW, Neel says, "IPC pharmacists make 28,000 to 30,000 suggestions a year to the different physicians at the facilities we serve, and about 84% of those recommendations are accepted, so we're pretty much in control of drug therapy management." In IPC-served facilities, he says, patients use drugs at a rate 41 times lower than the national average—one of the lowest medication usage rates in the nation—and hospitalization rates are also substantially lower than the national average. Overall prescribing rates are about 50% lower than the national average.

Not the Retiring Kind

Neel is a big believer in ongoing skills enhancement through continuing education and other avenues. He views this process of continual learning not as a chore, but a pleasure, and he strives to instill the same philosophy in IPC's three dozen employees. Neel added yet another feather to his professional cap in 1997, when he became one of the first in the nation to earn the designation "Certified Geriatric Pharmacist" (CCGP) from the Commission for Certification in Geriatric Pharmacy.

Neel readily admits that, like his father, he's turned out to be a workaholic: "This is not only my profession; it's also my hobby and my pastime," he says.   

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