When you think of a pharmacist, you may have in mind the person who fills your prescriptions at your local drugstore.
You may never have thought your doctor would refer you to meet with a pharmacist in the clinic to review the medications you are taking.
That’s what’s happening at St. Luke’s clinics in McCall, where providers are embarking on a new way to improve people’s health through a service called clinical pharmacy.
Clinical pharmacy is “a health science discipline in which pharmacists provide patient care that optimizes medication therapy and promotes health, wellness, and disease prevention,” according to the American College of Clinical Pharmacy.
Karl Johnson, PharmD, has been hired in this new role. He has worked for St. Luke’s McCall since 2012, as a flex staff pharmacist in the hospital, and in the anti-coagulation clinic starting in 2013.
“Traditionally, when you make an appointment at the clinic, you would see only your physician,” Clinic Manager Don McKenzie said. “This is still the case, but now you have a whole team of healthcare professionals collaborating with your physician in support of your care and available to meet with you if needed.”
This team-based model of care began to take shape in 2014, when St. Luke’s McCall first employed a patient access navigator to help connect patients with resources and financial aid. Nurse care coordinators soon followed to help organize patient’s care in what is often a complicated process. In 2015, behavioral health professionals joined the team to screen for and address mental health issues.
“In the past two years, the new team approach has led to more effective care for our patients and improved patient satisfaction,” McKenzie said. “It’s still early, but initial results are showing improved health and outcomes for our patients.”
The addition of Johnson fills a vital gap in explaining medications, dosages and drug interactions, and answering questions.
As the idea of a clinical pharmacist was explored, McCall providers and patients were informally surveyed. Local providers reported medication non-adherence as a common problem, and estimated 40 percent to 60 percent of patients have issues with taking their medication correctly. Nearly 40 percent of patients surveyed fell in either the moderate- or high-risk category for non-adherence.
“With some patients, we are addressing the same issue about medications month after month. We need a new model to break the cycle,” one provider noted in comments submitted with the survey.
The local findings mirror national patterns.
Medication non-adherence has been identified as an issue with dire health consequences for those with chronic conditions and is a growing public health concern, according to the National Consumers League.
“Nearly three out of four Americans report that they do not always take their medication as directed, a problem that causes more than one-third of medicine-related hospitalizations, nearly 125,000 deaths in the United States each year, and adds $290 billion in avoidable costs to the healthcare system annually,” the league states in its national “Script Your Future” campaign.
“Many barriers can exist that cause people to take their medication incorrectly,” Johnson said. “Many times, it’s cost or not understanding the timing, dosing and how frequently to take the medication.”
One of the advantages of having a clinical pharmacist is the one-on-one time with patients. A clinical pharmacist can know a patient’s medical history and diagnosis, which is important when evaluating medication therapy.
“We’re pleased to add Karl to the team,” McKenzie said. “His knowledge and expertise in the therapeutic use of medications will be a boost to the level of care we can provide our patients.”
Another issue facing many patients is polypharmacy, the use of a large number (typically five or more) of different prescription medications.
“Some patients may suffer from high blood pressure, diabetes and depression, all requiring different medications,” Johnson said. “I can evaluate the prescriptions and advise on the safe, appropriate and cost-effective use of the medications.”
This new service is made possible through the support of a two-year, $160,000 grant received by the St. Luke’s McCall Foundation from the Cambia Health Foundation. This is the second grant awarded to St. Luke’s McCall Foundation from Cambia Health. In 2014, the organization provided start-up funding for the nurse care coordination program with a $46,500 grant.
“Our foundation is excited to partner in this important model that helps move prescription medication from a product-centered to a patient-centered role,” said Scott Kreiling, Cambia Health Foundation board member. “This model will support a shift to more collaboration with patients, where the health care system should be.”
Laura Crawford works in the Communications and Marketing department at St. Luke's.