Insight of a Counseling Pharmacist

My days as a retail pharmacist were not what I envisioned for myself as a pharmacist. They were rewarding in their own right, but I often felt like I spent more time doing routine, robotic work instead of changing and impacting patients' lives.

Through the misfortune of being laid off from my retail job to the fortune of finding my dream job of being an MTM (medication therapy management) pharmacist, I learned to appreciate the hefty importance of being a retail pharmacist.

Retail pharmacists are essentially gatekeepers of protecting and preventing medication problems before they begin (drug interactions, detecting incorrect dosages, medication misuse etc.). However, between dispensing medication, handling inventory, tending to phone calls with doctors, patients and insurance companies and now immunizing, pharmacists don't get a heck of a lot of time to sufficently counsel their patients. For most of us, that's the reason we became pharmacists in the first place.

When I became an MTM pharmacist, I now had the time to address problems that their pharmacy and/or doctor(s) have missed. Most plans allow this review to be completed annually. Being an MTM pharmacist means you get the opportunity to spend roughly half an hour reviewing a comprehensive list of patients' prescriptions and over the counter medications. You also have the opportunity to adequately review their drug allergies and medical conditions. You are essentially screening for drug interactions, therapeutic duplications, medication overuse/misuse, gaps in therapy and inappropriate or unnecessary medications. Issues do occur and they are often related to patients seeing multiple doctors, or patients being confused or overwhelmed and quite frankly, the pharmacy not having enough time to build a relationship with the hundreds or even thousands of patients they come across. I'm not shaming retail pharmacists or doctors. As a retail pharmacist, I may have let my fair share of potential problems slip through the cracks as well. This is why medication therapy management is so important and why it should be mandatory as a safeguard.

The following are some of the common issues I come across as an MTM pharmacist.

1.Inappropriate medications in elderly patients. Elderly patients are more susceptible to adverse drug reactions due to poor drug metabolism, comorbid disease states and concomitant medications. Medications that were once safe, start to become problematic.

2.Inappropriate Beta Blocker selection for Heart Failure patients and/or patients not being aware they have heart failure

3.Therapeutic duplication with Ace inhibitors & Angiotension receptor blockers

4.Overuse of SABA (Short acting beta agonists)in Asthma or COPD

5.Misuse of long acting and short acting respiratory inhalers

6.Lack of Potassium monitoring when on mulitple medications that increase potassium

7.Chronic use of hypnotics such as Zolpidem without mention of proper sleep hygeine

8.Diabetic patients not being aware of signs and symptoms of high or low blood sugar and how to treat it

9.Inappropriate statin intensity selection based on cardiovascular risk factors

10.Poor medication compliance

Those issues mentioned above of course can be expanded upon and are just scratching the surface. For those of you that are retail pharmacists, I highly suggest you get your company to take MTM more seriously. You will feel rewarded and validated for improving the quality of lives of your patients. For those of you that are not pharmacists, I hope this article provides insight into the pharmacy world and empowers you to be more proactive with medication safety. If not for yourself, you may have an elderly family member or friend that can benefit from a comprehensive annual review of their medications. If your insurance company does not pay for this service, ask your pharmacist to carve out some time to provide extra counseling. In my experience, patients or caregivers forgo their complimentary medication review because their medications have not changed in several years. Please understand that guidelines and warnings on medications DO change. Even in cases where medication lists remain the same, an annual medication review is still important.

Margaret Tsopanarias, PharmD is a Supervising Clinical Pharmacist at Aureus Health Services