Transcription:

Prakash Chandran (Host):  The days of being treated by just a doctor are long gone. It takes a multidisciplinary team of people that work collaboratively to provide the best care to patients and pharmacists who are a valuable part of that team are often overlooked. We’ll learn more about it today with Megan Aslanian, the Chief Clinical and Technology Support Pharmacist at Ridgecrest Regional Hospital. This is a podcast from Ridgecrest Regional Hospital. I’m Prakash Chandran. So, first of all Meghan, what exactly makes up a multidisciplinary medical team?

Meghan Aslanian, PharmD, BCPS (Guest):  So, multidisciplinary teams vary across different institutions. However, the main core of the team is made up of the treating physician, the nurse, the pharmacist and usually a case manager or a social worker.

Host:  Okay, great. And just focusing in on the pharmacists, what role do they typically play or how do they contribute to this team?

Meghan:  So, a pharmacist’s role on the team is pretty much all things medication. We are responsible for checking for drug-drug interactions, opportunities for therapy adjustment or optimization. If you have changes in your kidney function, we renally adjust doses, therapy changes to reduce collateral damage or to even simplify a patient’s regimen. Our suggestions even help to reduce the costs or ease the transition of care from inpatient to outpatient.

Host:  Okay. So, normally when I see my doctor, they will issue me a prescription and that prescription is filled at a pharmacy. So, maybe talk a little bit about how the communication between the pharmacist and the doctor happens.

Meghan:  So, typically the interaction that happens between doctors and pharmacists prior to that prescription being written is mostly on the inpatient side. Not so much on the outpatient side. Like if you go see your family physician to get a medication for your blood pressure. Or Urgent Care to get a medication for an upper respiratory tract infection. When you are admitted to the hospital, the conversation that happens between the physician and the pharmacist is much more in depth because you’ve got multiple people following your case and making sure that your treatment is optimized. So, we would call the physician if we saw an order that we could make better maybe by changing the dose or switching it to a medication that was less likely to interact with something else that you were already on.

Maybe even giving you an alternative therapy that was going to be easier for your pocketbook to handle. Less likely to be lost to adherence because you couldn’t afford to get it.

Host:  Yeah, that makes a lot of sense. So, when the pharmacist sees the patient, and they potentially make a decision to either swap out the medication or switch to something that’s a little more cost effective; is this something that they are in constant communication with the physician about?

Meghan:  Most cases yes. In some cases, there are collaborative practices in place through specific pharmacists or specific clinics where physicians have come to an understanding with a certain team of pharmacists that they are fine with pharmacists making adjustments to the certain types of therapies or these certain medications; in which case those pharmacists may make those adjustments automatically without contacting the physician ahead of time and just let them know after the fact. But in most cases, yeah, there’s a strong collaboration between the - communication line between the pharmacist and the physician before those changes happen.

Host:  Got it. Okay so I’m curious to understand a little bit more about what points in a hospital visit that the pharmacist might be involved in a patient’s treatment.

Meghan:  Probably the beginning, middle and end. To be honest with you. At admission, when your medication reconciliation is completed. When they get a list of all the medications that you are on. Oftentimes, a pharmacist will review these medications for appropriateness and validate them with your outpatient pharmacies if it’s necessary. There are a lot of errors that are caught by pharmacists because patients may misremember what medications they are on. Every time a medication is ordered during a hospital stay, it’s reviewed by a licensed pharmacist and checked for appropriateness and safety. Even at discharge, there’s an opportunity for interaction with the pharmacist. If a new medication is prescribed or one that carries a great deal of risk is being given; often times the pharmacist will personally consult the patient to assure they understand what’s required to succeed with treatment.

In larger facilities, with the resources, there are even what we call MTM or medication therapy management pharmacists who are responsible for transitions of care. They follow up with patients after they have left the hospital even to assure that they were able to get their meds and have been taking them as prescribed.

Host:  Yeah, I’m really impressed with all of this. because I feel like so many of use, I mean even when I’ve gone to the hospital, it’s very easy to assume that the pharmacist is just filling a prescription that the physician is sending downstairs. But it just sounds like you are all so much more involved than one might think. Following up after the visit, really being an advocate for the patient wouldn’t you say?

Meghan:  Definitely. Definitely.

Host:  Yeah, that’s fantastic. So, I understand also that the pharmacists who works with case managers and social workers to navigate through the complex insurance benefits and plans. Can you tell us a little bit more about this?

Meghan:  So, that’s usually the responsibility of an MTM pharmacist on the inpatient side. They would work with case managers to obtain prior authorizations or any other documentation that may be needed to get a patient’s medications covered once they are discharged. The last thing we want is an interruption in treatment because it takes a few days to get all the paperwork in order. This is really important when you’ve got extremely expensive or specialty medications that insurance companies will require you to jump through a bunch of hoops before they will even be willing to cover.

Host:  One of the things that I love about Ridgecrest is how proactive they are in getting the word out around what role a pharmacist plays in this multidisciplinary team. But what are some other facts that you want to share with our audience around what a pharmacist does and how you might interact with them?

Meghan:  I would say one of the things that outpatient pharmacy even is moving towards just as a whole, is a more medication therapy management approach. You have to consider the fact that whether your pharmacist is standing at a counter at CVS or Walgreens or is locked in a cave in a hospital pharmacy; they all have the same education. That’s somebody who likely has a doctorate in medication management and therapeutics. So, if you have a question about how your medication works or a side effect you may be experiencing or whether or not something may be related to your medication; that’s a perfect question that you should be asking a pharmacist. Because most people don’t realize those pharmacists that are in retail pharmacies those are frontline providers. They are easier to access than your general care practitioner. You don’t even need to make an appointment to ask a question from your Walmart pharmacist. And they offer a lot of services that may not be overtly obvious.

So, if you have a lot of medications or you are getting a lot of different medications from different doctors; it may be worthwhile to sit down and have a conversation with your pharmacist about how your therapy may be able to be optimized. Maybe you could get rid of two medications and take a combo medication. Maybe you are taking a lower dose of something and a second medication was added whereas the dose could have been optimized and you may not need that second medication after all. So, those are all opportunities for cost savings as well as just treatment simplification that can help a patient’s every day life. Nobody wants to have to take 20 pills a day and at least you want to know that the five or ten pills that you do have to take are the best possible options for what your actual indications are.

A lot of time, prescribers prescribe based on habit or the newest thing that’s come up but the newest and brightest may not necessarily be the best. The tried and true may be a better option for a patient who has a more complex medication regimen.

Host:  Yeah, that’s really fantastic advice. And something I was curious about is let’s say a pharmacist looks at a medication that was prescribed and they might have a recommendation for something different. What steps do they go through in order to contact the physician and potentially get that changed?

Meghan:  So, it’s going to depend on the workflow of that specific pharmacist and how much time they have to allocate to it. Sometimes, the alternatives are given to the patient which is not the ideal situation because they may misremember them or forget to mention them at their next appointment. Best case scenario would be the pharmacist picks up the phone and contacts the provider and says you know I’m looking at Mrs. So and so’s chart and I see she’s on these three medications. She’s also on this medication from a different cardiologist. Do you think this might be a better option so that we could optimize her treatment rather than adding something that may not prove beneficial given everything else that she’s on? A lot of times, when patients are seeing multiple doctors; every doctor doesn’t know every single other doctor that’s treating this patient and what medications the other physicians are prescribing. That can be a point of contention because the pharmacy is kind of where all of that information converges.

And it gives the pharmacist a unique insight into all the information that’s flowing from the different areas and gives them an opportunity to reach out to the different contributors and say heh, I’ve got two other people that are treating the same thing. Can we put our heads together and make sure this is the best case scenario for the patient. Because each doctor does things a little bit differently, but I think they can usually work together to find a more simplified or beneficial regimen for our patients that have complex medical conditions.

Host:  Yeah, this has been hugely informative, at least for me today just to know that the pharmacy is a one place where all of your medical information converges, right so, the pharmacy has the most in depth look into everything that you are taking and really can be an advocate for your health. So, it really is important that you talk to them. You know Meghan as we wrap up here, is there anything else that you’d like to share with our audience today?

Meghan:  I would just say you’d be really hard pressed to find any individual inside or outside the hospital who knows as much about medications as the pharmacist, how they work in and with your body and what considerations that really need to be taken into account when choosing or continuing a medication. So, I would definitely encourage people to reach out to their pharmacist. I’m not saying don’t ask your doctor, but you may get a different or more intuitive response from a pharmacist just because we are more familiar, more intimately familiar with the medications and how they work.

Host:  All right Meghan, really appreciate your time today. That’s Meghan Aslanian, the Chief Clinical and Technology Support Pharmacist at Ridgecrest Regional Hospital. Thanks for checking out this episode of Ridgecrest Regional Hospital Podcast. Head to www.rrh.org for more information. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk soon.