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Liz Unruh (Host): Hello listeners, and thanks for tuning in to the Well Within Reach podcast, brought to you by Riverside Healthcare.

I'm your host Liz Unruh, and joining me today is Kellye Eagan, who is our lead ambulatory care clinical pharmacist with the Riverside Cardiology Pharmacotherapy Clinic. Thanks for joining us today, Kellye.

Kellye Eagan, PharmD, BCPS, BCACP, CDCES: Hi. Hi, Liz. Thanks so much for inviting me.

Host: Yeah. So before we jump into our topic here today, we're going to hear a quick message about MyChart.

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Host: And we're back. So, Kellye, can you tell us a little bit about what you do here at Riverside and about our cardio pharmacotherapy, or it's called CPC for short, just so that everyone knows what that is, clinic, that we're gonna be talking about here today?

Kellye Eagan, PharmD, BCPS, BCACP, CDCES: Yeah, absolutely. So I'm an ambulatory care clinical pharmacist. And what that means is that, I'm a pharmacist that works on the outpatient setting. I work similarly to, advanced practicing clinicians, so meet with patient's one-on-one, ensuring that they're reaching their health goals, with the focus primarily being on treatment, not diagnosis.

My role here at Riverside is actually to expand our ambulatory care services. So I come from the Chicago setting, practicing chronic disease management and so excited to actually come to Riverside and be able to bring all of that knowledge here and expand those services here. It's been a goal of mine because I'm actually from the area.

Host: Oh, that's great. We always love it when we hear people have come back to Riverside because they know the great care that is offered here and we can help expand services. So start us off, can you explain what the CPC clinic is and what your team's role is in a patient's care?

Kellye Eagan, PharmD, BCPS, BCACP, CDCES: Yeah, absolutely.

So, it is a bit of a mouthful, So, It is called the Cardiology Pharmacotherapy Clinic. We call it the CPC for short. It previously was called the Anticoagulation Clinic. However, we've recently expanded those services. So we not only do pharmacist led anticoagulation management, but now we're also doing pharmacist led hypertension.

So high blood pressure, high cholesterol, stable heart failure, and then also cardiovascular risk reduction with some weight loss medications, adjustments.

Host: Okay. So that's really great. You help manage people's medications to make sure they're getting the right doses and they're on the correct medications for them.

Kellye Eagan, PharmD, BCPS, BCACP, CDCES: Absolutely. So our goal is really to partner with the patient, the provider, and really what we focus on is a service called medication optimization. So we make sure that every medication that patient's on is indicated for that patient. So they're taking it for a reason, it's working for that patient, it's safe for that patient, and it's something that that patient can actually take, whether it's cost, frequency, pill size. We make sure that that treatment plan is really individualized for that patient.

Host: I think that's great. I think so many people here are like healthcare and medication and they're like, ah, this is just a cookie cutter thing. They're just going to prescribe me a medication. But your team really makes sure that what the patient is being offered is what's best for them.

Kellye Eagan, PharmD, BCPS, BCACP, CDCES: Yeah, everything we have in healthcare is evidence-based. And so we utilize treatment guidelines to kind of dictate how we treat certain conditions. However, not all patient's fit that mold, and so pharmacists are actually really well equipped to be able to choose different treatment options based on how the patient's are feeling on medications and what works with their lifestyle as well.

So we make a great addition to the patient care team.

Host: Yeah. So can you, I know some, people might hear like blood thinner or hypertension or those things. Can you explain what kind of like medications that you manage, maybe some names that people might recognize?

Kellye Eagan, PharmD, BCPS, BCACP, CDCES: Sure, sure. So, like I said before, the anticoagulation clinic, has been around since 2016 and primarily those pharmacists manage a blood thinner called warfarin.

Reason being is because that blood thinner has a lot of drug interactions and a lot of diet interactions and requires a lot more frequent monitoring. So pharmacists, again, are very well equipped to be able to, complete that frequent monitoring and assessments of all of the interactions that potentially could exist.

 But we also manage other medications that patient's are commonly prescribed as well. So, high blood pressure medications like amlodipine, hydrochlorothiazide, we've got heart failure medications like Jardiance, Farxiga, Entresto, beta blockers, so like carvedilol, metoprolol. And then, the biggest ones that we also do help adjust are those, weight loss medications like your, Zepbound and your Wegovy.

Host: Okay. Yeah, those are, I'm sure people who are on those medications are like, oh, I hear that. What I hear is, wow, you remember a lot of really big words. And that's what I feel like medication to me is all just like a lot of really big words and I'm like, oh, they sound scary, but your team can really help make them less scary.

 So, you're a clinical pharmacist working closely with both primary care providers and cardiologists. Can you talk about how that collaboration works for our patient's?

Kellye Eagan, PharmD, BCPS, BCACP, CDCES: Sure. I think it comes down to, gosh, we just have so much knowledge now in the world, and we're learning so much about healthcare and it's not so straightforward and not so simple anymore.

So I think what it comes down to is just that two heads are better than one in the care team and pharmacists are really great because we are those medication experts. And so when a provider refers a patient to us, for a specific disease state, they're really asking us to help with that treatment plan and make sure that that treatment plan is individualized for that patient.

And so we typically see patient's a little bit more frequently. I'm a big believer in smaller, more frequent changes. So if a patient doesn't tolerate a change or that medication isn't working for them, we catch it pretty quickly, or we catch that side effect really quickly and we're able to kind of pivot, with their treatment plan in other ways.

So hopefully with all of those tiny adjustments, they're able to return to their provider, whether that's quarterly, sometimes cardiologists don't need to see their patient's for every six months or so, but hopefully by the time they get back to that provider, they've made some significant strides towards those health goals.

Host: Yeah, so I think that's a big part of this, is understanding that you are not a replacement for their primary care or their cardiologist. You are an addition to help make sure that they're making those changes and they don't have to wait six months to see their cardiologist to make a change.

Kellye Eagan, PharmD, BCPS, BCACP, CDCES: Yes, absolutely. One of my favorite analogies, so I never replace the provider ever, ever, ever. My favorite analogy is if you think of the provider as a professor, I'm like a tutor, so patient's don't always need to stay with me forever. So, with the anticoagulation clinic or like blood thinner management, we typically do manage those patient's long-term, but for someone who's being referred to me for maybe heart failure or for, high blood pressure, high cholesterol, once we get them to their cholesterol goals, their blood pressure goals, and that patient is stable on that medication regimen; they actually don't have to follow with me anymore. So, it, that's a conversation between myself, the patient, and the provider. We may either just extend the in-between visits or we may then just discharge the patient from the CPC, and that's not to say that they can never come back and get re-referred. But, no, never ever replace that provider. Just collaborate with them.

Host: Yeah. And I think that's great. Collaboration is great. We always talk about your primary care is your like quarterback on your team, but they always need those support players. So you talked a little bit about this, but how does your clinic help determine, the right medication for a patient, especially knowing if someone has like specific health history or risks?

Kellye Eagan, PharmD, BCPS, BCACP, CDCES: Sure. And that comes down to all of us in the CPC have been trained, patient-centered care. Again, we start off with what's best practice and evidence-based practice. However, we're really using that medication optimization in our minds.

And so we have this flow chart, so we want to make sure that they're on, we're choosing medications that have the most benefit with the least amount of risk. And we try that out, making sure that, of course it works well with the patient based on their labs, their side effects, allergies, other medications they're taking, other conditions they have.

But then we choose an agent. We bring them back within maybe two weeks or so. See how they're feeling on that medication. If they don't feel good then we go on to plan B, plan C, plan D, things like that. So always a conversation with the patient. Always a lot of education on expectations so that they know kind of what to expect as well. And then we come together and see is it working or not.

Host: Yeah, I think that's great information. We're going to take a quick break to hear about primary care at Riverside.

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 And back to our conversation here with Kellye. So what does a typical visit or interaction with the CPC team look like for a patient? And I know you touched on like coming back in a couple weeks, but like how often do you check in with them?

Kellye Eagan, PharmD, BCPS, BCACP, CDCES: Sure. So initial visits tend to be a little bit longer. So initial visits are 60 minutes. Typically we go over why they're there. A lot of education about the disease state, why they're here.

So maybe that's for blood thinner, it might be for blood pressure, high cholesterol. We go over what's going on in their body, lifestyle changes they can make to help manage their condition, ways to monitor their condition, what medications they're taking for their condition. We also go over what their day looks like as well.

So it's very important to us to understand what's your routine like, because based on what your routine is, that kind of depends on what medications then we're going to choose. If you're busy all the time, I'm not going to choose a medication that's dosed three times a day unless we really have a conversation about it.

So we really want to get to know the patient the first visit. We then go over vitals, so we'll vital the patient. Very similar to a traditional advanced practicing clinician visits, just you're, meeting with someone whose primary focus is going to be on education and medication. So again, the first visit's really just to get to know you, explain what we're doing.

Then follow-up visits really depend on where you're at in your condition. So if you have severe high blood pressure, I might want to see you a little bit sooner. So that might be three days later. That might be a week later. If your blood thinner levels are higher, so you have a high INR, that might mean that we need to see you a little sooner.

But the more stable you become in your condition and the closer we get to goal, then we spread out those appointments. So, it might be once monthly, it might be every three months. And it might ultimately, like we said, be discharged from the clinic in itself, which is not necessarily a bad thing.

Host: Yeah, it means that you've leveled out and you are set in your medication management, and I think that's great. I know that when you get diagnosed with something, it can be overwhelming, to have to manage med different medications. How does your clinic help a patient feel like more confident and supported and informed about the medication that they're taking?

Kellye Eagan, PharmD, BCPS, BCACP, CDCES: Yeah, I think that's the hardest part, right? It is very overwhelming and people don't really know what to expect. And I think it comes down to knowledge is power. So our biggest belief is that if we can empower patient's and we can help expand their knowledge about whether the medications, the disease state, what have you, each time we see them, then we can empower them to manage their own condition and kind of take the wheel, right?

So I think it's also just managing their expectations. Oftentimes people come in and I will say, Hey, listen, it's not your fault. This might be genetic. This condition typically requires two or three medications. So when we add more medications, it doesn't necessarily mean that you're bad, it just means that we need a little bit more help. So I think just explaining things and when they understand the why, they're a little bit more confident and in understanding, the overall goal and treatment plan.

Host: Yeah, I think that's great. And I know, advocating for yourself and knowing, I don't feel just right is a great thing to bring up to your team to be like, maybe that's not the right medication. Mm-hmm. So what are some common challenges or concerns that patient's might have, about coming for their medication management? And how does your team help prevent those?

Kellye Eagan, PharmD, BCPS, BCACP, CDCES: Sure. I think the biggest fear is side effects. So we always talk about, and, when you go to the pharmacy, you get this long pamphlet and it's got 400 things that could potentially happen to you. So again, discussing and talking about what is possible and what's probable. So we always talk about like the rare but scary side effects and how to identify when something's an emergency and it's not going well because there's risks with everything we do, including taking medications. And then also what the benefit is, right? So what will this medication do that's good.

 When will we expect that it's going to start working? How much can we expect it to start working? So I think just again, settling the mind more so with what to expect with each medication choice. And ultimately it is a bit of a trial and error. If I have patient's that come in who are a bit nervous, what I'll do is just bring them back a little sooner.

So, it's like, if you're nervous about having this potential side effect, let's give it a go, but let's bring you back in a week. So that way we know. You don't have to like, go through all of the site of these side effects potentially without some end in sight, right? So, it's just a lot of support being there.

They also know that they have our phone numbers. We, pharmacists typically are providers that are easily accessible and I, that comes from more of like the retail setting. But, I think we pride ourselves in the CPC for also being pretty available to our patient's as well.

Host: Yeah, I think that's great. Knowing that you can call and ask the question is probably really huge. For someone who might be newly diagnosed and newly prescribed, a drug for blood thinners or, some of those other, the hypertension or things, or maybe someone who's been on one of those drugs for a while.

Why would you encourage them to ask their primary care provider to refer them to the CPC? Or what difference could it make in their health long-term to be referred?

Kellye Eagan, PharmD, BCPS, BCACP, CDCES: Sure. Let's start off with who would make a great referral to the CPC. So they can't just come in and see us. The doctor does have to, whether it's a primary care or cardiologist, they do have to send in a referral. It could be for one thing, it could be for a couple different things. So, they can absolutely come and see us, but I think a great patient that would potentially benefit from us, would be someone who is struggling to get to their health goal.

Potentially has a lot of side effects to medications, a lot of medication concerns or questions. And then patients who just in general, have a lot of allergies to medications too. So, all of those patient's would benefit from having a pharmacist. Maybe they're on a significant amount of medications too.

So that would be, to me, something more than 10 medications. That might make a great referral to come see us so that way we can kind of make sure that all those medications are working well together, all those medications are doing what they're supposed to be doing, and then be able to organize those medications.

And sometimes we even take patient's off of medications. So even though we are pharmacists, we don't always think that medications are the answer. We support lifestyle as well. So again, just kind of optimizing those medications. So if they feel like they fit one of those categories, then by all means ask your primary care provider. Ask your cardiologist, Hey, I heard you have a pharmacist there. Could I see them?

Host: Yeah, I think that's great. And that's, kind of leading into my last question here. So for those listeners who are on some type of heart medication who think they might benefit from the extra support of your team managing their medication and helping them get to that stability level, what's the best next step?

Kellye Eagan, PharmD, BCPS, BCACP, CDCES: Sure. Asking, you know? Yeah, asking. Um, go again. I think I've heard that you guys have a pharmacy team there. I'm on a lot of medications. Do you think that I would benefit from this program? Or even just say, I'd like to go to this program or this clinic. All the provider has to do is actually just enter in that referral. Once the provider enters in that referral for the CPC, someone from our team will then go ahead and call the patient and ensure that they schedule that initial visit. And that typically can happen sometimes next day or even within the next month. Definitely within the next month.

Host: Yeah. I think that's great and it's a great service that's provided here in the community where you don't have to go up north like we are right here. And there are several different locations that people can visit. I know there are a few right now. Can you tell us where those clinics are?

Kellye Eagan, PharmD, BCPS, BCACP, CDCES: Absolutely. So right now the main hub is going to be in Kankakee. So we do blood thinner management, and that's where we do all of the high blood pressure, cholesterol, heart failure, and then, the cardiovascular risk reduction with the weight management there. However, we do have other blood thinner clinics. So, for patient's who are on blood thinners that are closer north, we've got Bourbonnaise that we see patient's in. We have patient's that we see in Watseka, and then the hope is that we're also going to open a clinic in Coal City and potentially Frankfurt as well.

Host: Yeah. So it'd be great, expanding the services, as we know there is a need. And that's one thing that Riverside does. Try to do is we try to bring the care to the patient's, and I think your team does a great job of that. Thank you so much, Kellye, for joining us today and sharing all this great information. And thank you listeners for tuning into the Well Within Reach podcast with Kellye Eagan.

Kellye Eagan, PharmD, BCPS, BCACP, CDCES: And I'm from the Cardiology Pharmacotherapy Clinic. Thank you so much for letting us represent our team here today.

Host: Yeah. To learn more about the full range of services offered by Riverside, visit riversidehealthcare.org.