PORTLAND, Ore. – For a lot of people in Central and Southern Oregon, the nearest pharmacy is 40 miles away - and their provider can be that far, or farther still.
Tyler Dearing is a multi-store owner operating independent pharmacies across small communities in the region. Every week, he watches patients make the same long drive, sometimes several times, just to pick up medication. "We have patients driving 40 miles one direction just to reach us, multiple times a week, and for a lot of them their doctor is that same drive or even farther," Dearing said. "That's not sustainable for anybody … not for their gas tank, not for their time off work, not for their health."
So, his staff started enrolling patients in MedSync, which consolidates a patient's refills onto a single schedule so they only need to make the trip once a month instead of several times a week. It's a small operational change with an outsized effect on people who don't have the luxury of a pharmacy on every corner.
The Pharmacist as the Most Consistent Face in Healthcare
"In a lot of these towns, we're the most consistent, most accessible healthcare provider a patient has," Dearing said. "We know their full medication list, their health history, their family. We're checking for interactions every single time they come in - and honestly, we're often the ones who catch something before anyone else does."
That relationship showed up recently when a longtime patient came in with an infected wound and asked Dearing what to do. "I told him straight up - you need to get in and see the doctor," Dearing recalled. "But he couldn't get an appointment for weeks. So, we got him set up with a recommended OTC triple antibiotic ointment, walked him through how to clean and bandage it properly, and told him exactly what signs of infection to watch for in the meantime. That's not something I could bill for. It's just what you do for your neighbor."
A Healthcare Landscape That's Gotten Harder Since COVID
Dearing said the years since the pandemic have made rural healthcare access noticeably harder, not easier. Provider shortages have stretched wait times for a routine appointment from days to weeks, or longer. Healthcare costs have climbed. And Medicare and insurance coverage - particularly Part D plan selection and prior authorization requirements - have grown more complicated, not less.
"Every one of those things hits rural communities harder," Dearing said. "When you're already driving 40 minutes to see a specialist, you don't have room for one more barrier. People need someone local who can help them sort through it, and more and more, that's us."
Building Out Free Tobacco Cessation, County by County
That same philosophy is driving Dearing's next project: expanding free, one-on-one tobacco cessation counseling across four of his stores: Hometown Drugs (Roseburg, OR); Myrtle Drugs (Myrtle Creek, OR); Economy Drugs (Sweet Home, OR); and Brownsville Pharmacy & Gifts (Brownsville, OR). The effort builds on Cascadia Pharmacy Group's (CPG) Small Pharmacy. Big Care. campaign - the Oregon Health Authority (OHA)-funded, OSU College of Pharmacy-facilitated public awareness effort that has put billboards up across southern Oregon directing residents to Bigcare.Video, a documentary highlighting what independent pharmacies can offer beyond filling prescriptions.
Dearing is turning that awareness into infrastructure. At each of his pharmacies, he's assigning a lead pharmacist to own the cessation program - someone who meets monthly with lead pharmacists from other CPG stores to share what's working, and who is building a direct referral relationship with the Tobacco Prevention and Education Program (TPEP) coordinator in their county. The goal is a two-way pipeline: TPEP coordinators refer patients who are ready to quit to the pharmacy, and pharmacy staff can refer patients back into county-level resources.
The in-store program includes signage and flyers at the pharmacy counter, materials shared with TPEP coordinators, and a simple, confidential web page where patients can request to start counseling on their own time - modeled after the page already live for Red Cross Drug Store, a fellow CPG pharmacy in La Grande, at redcrossdrugstore.com/tobacco-cessation. Matching pages are being built for four of Dearing's stores, with more CPG pharmacies expected to follow.
Dearing isn't the only CPG owner building out the model. Grants Pass Pharmacy (Grants Pass, OR), owned by Michele Belcher, and Red Cross Drug Store (La Grande, OR) and Baker City Pharmacy (Baker City, OR), both owned by Bob and Leah Coulter, are standing up the same lead-pharmacist structure in their own counties.
"Having a dedicated lead pharmacist and a real connection to our county's TPEP coordinator means we can actually follow up with people, not just point them toward a hotline and hope," said Leah Coulter, co-owner of Red Cross Drug Store and Baker City Pharmacy.
"It often takes multiple tries to quit tobacco for good; for some people, it can take dozens of attempts before it sticks," Dearing said. "That's not a failure. That's just how hard it is. Our job isn't to judge somebody for the tries that didn't work. It's to be there for the one that does, especially for our older patients who've been smoking for 40 or 50 years and have heard every lecture already."
According to the CDC, roughly two-thirds of adult smokers say they want to quit, yet fewer than 1 in 10 succeed in a given year. Research published in BMJ Open following smokers over several years found the real average may be closer to 30 quit attempts before one finally succeeds - far higher than the "five to seven attempts" figure often cited.
Flu Season: A Natural Moment to Start the Conversation
Dearing's team is also using flu shot season as a low-pressure entry point. Smokers face a higher risk of respiratory infections and complications, including pneumonia, according to the CDC, making a flu vaccine appointment a natural moment to bring up cessation without it feeling like an ambush.
"Someone comes in for their flu shot, and if they're a smoker, that's already a conversation about protecting their lungs," Dearing said. "It's an easy, gentle way to say, 'Hey, while we're talking about keeping you healthy this winter, want to talk about quitting, too?' No pressure, no lecture. Just an open door."
A Model Other Rural Pharmacies Can Follow
CPG sees Dearing's approach - pairing a statewide awareness campaign with a concrete, county-by-county referral system - as a template other independent pharmacies could replicate as tobacco cessation and public health funding evolves.
"At the end of the day, we're not just filling bottles," Dearing said. "We're the ones who see these folks every month, sometimes every week. If we're not looking out for them, who is?"
Watch the Documentary: Bigcare.Video
Learn More: cascadiapharmacygroup.com/advocacy
