Nolan Alexander (Host): Meaningful Medicine is a Novant Health podcast bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future.

Today, we're speaking with Glenn Herrington, a clinical pharmacist practitioner, about comprehensive medication management. Glenn, welcome to Meaningful Medicine.

Glenn Herrington, CPP, PHARMD: Thanks for having me. I'm excited to talk a a little bit more about this.

Host: Now, we're excited to explore it with you. And think most listeners are familiar with the role of a pharmacist. But to start with, can you explain more about the role of a clinical pharmacist practitioner?

Glenn Herrington, CPP, PHARMD: Sure. Absolutely. Yeah, I agree, most people are familiar with pharmacists, and they've all interacted with their community pharmacist. Here in North Carolina, all pharmacists that graduate now graduate with a Doctorate of Pharmacy degree. Those of us that want to work in a clinical setting, whether that's in a hospital or a doctor's office, can do one to two years of residency training. We can pursue board certification. And the state of North Carolina allows pharmacists to pursue a clinical pharmacist practitioner license, which basically allows us to provide comprehensive medication management in collaboration with a supervising physician and other advanced practice providers, and we can order prescriptions and order labs and blood work to help manage medications the same way that other providers can.

Host: We a lot about the importance of a heart-healthy diet and exercise and prevention, but I know it's also important to be aware of risk factors. What's top of mind for you about your approach on risk assessment, and what is it that you're looking for in patients?

Glenn Herrington, CPP, PHARMD: That's a great question. So absolutely, without a doubt, healthy diet and exercise are the foundation to everything. So, it's not all about medications. Even though I'm a pharmacist, I need to be aware of that. But when we think about risk assessment, we think about things like genetics, family history. There's some things that go beyond diet and exercise that are somewhat out of our control. So, I look at a patient's personal medical history. Do they have things like diabetes or pre-diabetes, or do they have high blood pressure? Do they have bad cholesterol? What's their family history? We can take some of that information and plug it into some validated risk assessment tools. Like, the AHA and ACC have a Prevent calculator, which will give us an estimate on what somebody's 10- to 30-year risk of cardiovascular disease may be. But that's kind of just general population level things.

And so, we also can further look at a person's individual risk by checking other blood work. So beyond what might just get in a routine screening, things like ApoB, LP(a) cholesterol, inflammation markers. And sometimes we get things like coronary artery calcium scores if we're just not quite sure. So, looking at the overall picture. But then, also specific things about that person to kind of figure out what their individual risk is.

Host: Glenn, the end, you mentioned some markers that have become more common when it comes to talking about heart health over the past few years. This seems to be a pretty comprehensive look at things.

Glenn Herrington, CPP, PHARMD: Absolutely. And like you said, it has become more common over the past few years, but these aren't really new things. It's just now becoming more ingrained with the general recommendations. And honestly, these are things that people should be getting screened at least once in their lifetime. But as a pharmacist, when people come to see me, I notice a lot of times they're not having these things checked, and it's a good opportunity to kind of pause, look at the big picture, provide some education to my patients, and explain why it's important to check these things.

And then, ultimately, it's really to help my patients make the best informed decisions, and the more information we have, the better we can do that.

Host: So, it seems you're very careful in your assessment and how you go about things. And in process doing that, if you find someone's at risk, how do you work to reduce it?

Glenn Herrington, CPP, PHARMD: So again, I don't want to skip over diet and exercise. Those are the foundation to everything that we do. So focusing on that, and then also connecting with other specialists that work in those fields. So, a lot of times, we may coordinate a referral to our cardiac rehab team, and that's more of a structured exercise program that's focused on preventing or reducing cardiovascular risk.

And then, also we lean heavily on our nutrition and dietician team to support some of the things that we do. But then also, again, looking at the big picture, looking at that patient's individual medical history and all the medications they're on and what can we do to minimize drug therapy problems, duplicates, or medications being used to treat a side effect of another medication, and how can we streamline things and use medications that maybe address multiple problems that they have going on.

Host: So, I'm a little curious, locally in North Carolina, how are patients learning about this? Is it referrals from other heart specialists and primary care?

Glenn Herrington, CPP, PHARMD: For the most part, yes. Here in North Carolina at the coast, we've started a new cardiovascular kidney metabolic clinic here within the cardiology practice. So, we've started that here, and the is to ultimately,you know, reach out and connect with other primary care providers, endocrinologists, and then gradually grow that into a larger, more formal thing.

So for now, the patients that see me every day are being referred by their cardiologist. But we do work very closely with all the providers across Novant. So, patients also hear from family members, and they may reach out to their other providers. And so, we get a lot of patients either through the cardiology team or through their primary care doctor. But it's referral-based through other Novant providers right now for the most part.

Host: So Glenn, feel like in everyone's point in time, there becomes a time in life where we're trying balance medications. And I'm trying to put myself in your shoes. I can imagine the cardiology space. There are a number of medication and dosage options to navigate. And patients, they might be on multiple prescriptions. So, how do you support patients like this? Is that what we mean by comprehensive medication management?

Glenn Herrington, CPP, PHARMD: Yes, 100%. So, comprehensive medication management really is the foundation of the pharmacist kind of care model, regardless of where we practice. If it's a community-based pharmacy, they're dispensing medications, they're really screening for interactions and things as the medications are being dispensed.

When we see patients in the clinic, we're being a little bit more proactive. So, we start getting that full medical history and looking at the patient's health problems. And then, looking at their full medication list, including all the vitamins and supplements and things that they're taking. And we start by making sure that each problem is being addressed appropriately, but then also each medication is used for an appropriate indication.

And then, we try to weed out things that maybe are not necessary or potentially harmful, and then focus on, like I said earlier, medications that may actually address multiple things. So, we have medications like the SGLT2 inhibitors or the GLP-1 receptor agonists that people are hearing a lot about now that kind of get at the core of the problem with metabolic health. And if you can use medications that help address blood sugar and body weight and blood pressure and reduce the number of other medications that maybe lower blood sugar or lower blood pressure but don't offer a larger benefit, we can really streamline and optimize the medications that people are taking while achieving the bigger goals, which is reducing things like heart disease and kidney disease.

Host: So, do patients really notice it when you try to weed out some unnecessary medications, then try to look at ones if fits to kill two birds with one stone?

Glenn Herrington, CPP, PHARMD: Oh, absolutely. I feel like patients come away with such positivity and such empowerment after their pharmacy visit because, again, we all come at things with different expertise and backgrounds, and a lot of times patients are just taking a medication because they were told to take it. And then, the next thing they know they're taking 10 or 15 different medications and don't really understand the pros and cons and what to look out for with each of those medications.

So when we can step back and look at the bigger picture and explain the pros and cons to medications and, and really help the patient ultimately guide the decision-making process and be there to support them through that, these are oftentimes the most meaningful visits that patients have. And we hear that from our patients a lot. It's very rewarding as a pharmacist.

Host: As prepare to close, because you're so passionate, Glenn, I want to ask, what drew you to focus cardiology?

Glenn Herrington, CPP, PHARMD: I get that a lot from my students and residents that come through on rotation with me. They'll have a good experience and they may ask, "Well, how do I get to be in your role?" And it's not really a straightforward answer. So, I was fortunate to come through Wilmington at New Hanover Regional Medical Center in the cardiology practice as a student and then as a resident, and developed a lot of strong mentors both in cardiology and primary care.

And as I was coming up through training and early in my practice was when we started having medications like the SGLT2 inhibitors and GLP-1 receptor agonists that initially were used for diabetes, but then have now become more of a cardiovascular medication. So, just kind of this pathway and relationships and preceptors I had along the way just kind of laid this foundation for me, and it's been a great ride. It's been almost years now, and I couldn't ask for anything better

Host: That's fantastic. Glenn, thank you so much for joining us today on Meaningful Medicine.

Glenn Herrington, CPP, PHARMD: Thank you so much for having me.

Host: That was Glenn Herrington, a clinical pharmacist practitioner. To find a physician, visit novanthealth.org. For more health and wellness information from our experts, visit healthyheadlines.org