More than Medication: How Pharmacists Help in Your Care

**By Alison Koop**

When her pharmacist left the neighborhood drugstore, my friend felt adrift. This one pharmacist had always been there to answer her questions in between doctor visits. She could ask him whether a new drug prescribed by her endocrinologist might interact with another medication prescribed by her gastroenterologist. And she knew she needed to take her thyroid pill on an empty stomach — but coffee didn’t count, did it? (Thank goodness, it doesn’t.) She trusted in the ongoing relationship.

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The benefits that come from attention to medication management are why more pharmacists are joining patient care teams. At Virginia Mason, about 20 pharmacists see patients in primary care, cardiology, endocrinology, transplant nephrology, and physical medicine and rehabilitation clinics.

The clinic pharmacist has the unique ability to answer all medication questions for the patient, while at the same time make adjustments within the patient’s chart. Due to their integration with the care team, pharmacists in the clinic setting are able to go one step further in providing care than the pharmacists at the neighborhood drugstore. Recently the Virginia Mason Neurology Department added Lorifel Nabong, PharmD to the team, a dedicated clinic pharmacist.

Nabong explains her role this way: As partners in care, pharmacists prescribe, assess  and monitor a patient’s medications related to a particular health condition. They can order lab tests, interpret results and adjust medication dosages. “We have a very collaborative relationship with providers,” says Nabong. “As another patient advocate, we assist in optimizing patient medication management.”

This is particularly helpful for patients seeing several physicians. A pharmacist may spot medications the patient no longer needs to take, or potential interactions that could occur when new drugs are prescribed.

Typically a patient’s provider will make a referral to the department pharmacist for an initial consultation, with shorter follow-up appointments as needed. Patients who are referred are often those with a chronic condition such as diabetes or hypertension. Pharmacists at Virginia Mason may also see patients with other conditions including chronic pain, seizures or renal transplant.

Pharmacist as Educator

Nabong views herself as a patient educator. Because appointments focus solely on medication management, pharmacists can take a deep dive into medication-related issues. Nabong can take time to discuss in detail why a drug has been prescribed, why that particular medication was chosen over another, and what the patient can expect in terms of potential side effects.

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Lorifel Nabong, PharmD

Nabong is also a patient advocate who can follow up with prescribing physicians on a patient’s behalf. “Sometimes patients just feel more comfortable bringing medication questions and concerns to their pharmacist,” says Nabong. “It might be discussing pain medications, or asking about new drugs they’ve read about online.”

How to Get the Most from a Pharmacist Appointment

  • Tell your pharmacist of any drug allergies and potential side effects you may be experiencing. Some medications can lower blood pressure so much that the patient becomes dizzy. Your pharmacist can check with the doctor who prescribed it to discuss whether the dosage can be decreased.
  • Don’t assume that a medication you’ve taken without issue for years is still the best therapy for you now. Or that it couldn’t be the source of new problems you’re experiencing. As we age, there are changes in how our bodies process drugs. New health conditions — especially those affecting your kidneys or liver — may also require dosing changes.
  • If you start an herbal supplement or treatment, check with your pharmacist for possible interactions. For example, St John’s Wort interacts with psychiatric medications. Cranberry supplements can cause problems for people on blood thinners.
  • Ask about pain medications you buy over the counter. Even drugs that don’t require a prescription can cause harm. NSAIDs (including ibuprofen and naproxen), even when taken short term, can cause numerous adverse effects or worsen current conditions. Or in the case of acetaminophen (Tylenol), it’s important to know when it’s included in over-the-counter drugs (think multi-symptom medicines) as well as some prescription medications. Patients may not realize when the total amount in their medications exceeds a safe dosage.

Educators, advocates and attentive managers of medication. So what can’t a pharmacist do? “We cannot diagnose!” says Nabong. “Someone will ask me to assess their swollen toe and tell them if it’s gout. I could assess, but ultimately the doctor who referred the patient to me must diagnose the problem and decide whether or not to start medications. I’ll notify the provider about the issue, though. I send the doctor my notes at the end of every consultation.”

Comments

  1. Marlys Dolney says:

    I think having a pharmacist on site in Federal Way is a terrific addition. However, I also think having more internal medicine doctors and dermatologists available is a necessity. I just made an appointment with Dr. Masters (Dermatologist) who splits his time between downtown and FW. This is November and the first appointment I can get is APRIL. That’s ludicrous! Driving downtown, parking, etc., is not a very good option these days.

    • Thank you for the feedback, Marlys. We will forward this to our team. We appreciate hearing from you and are sorry that you have not had a good experience with getting a dermatology appointment.

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