Transcription:
The Patient’s Experience with Pharmacists as Part of Their Cardiac Care Team

Melanie Cole (Host): Welcome. Today we’re talking about the patient’s experience with pharmacists as part of their cardiac care team. and my guest is Tracy Macaulay. She is a pharmacist with UK’s Gill Heart and Vascular Institute specializing in cardiovascular pharmacotherapy. Tracy, I’m so glad to have you with us today. People often wonder about the role of the pharmacist. Tell us how you work and have a diverse and integrated role within the healthcare team.

Tracy Macaulay, PharmD, AACC, BCPS (Guest): Well thanks Melanie. My role within our team is to help provide the physicians and the patients with medication advice and medication education. And so within our cardiac team, my specific role is now to see patients in the outpatient setting about a week after they have experienced a heart attack and been managed at UK Healthcare.

Host: So, when you see them, how do you work with them to help them manage their medications and even some of their lifestyles?

Tracy: Yeah, we see out patients in clinic to review all the medication changes we made. It’s not unusual for a patient who experiences a heart attack to have at least five to even eight of their medications changed at the time of that event or for them all to be brand new. And so, we see the patients and see how they are tolerating their new therapy, make sure they have had access to their medications, make sure that their blood pressure and some of their other goals are being met and that all the medications are responding safely within their body.

As far as the lifestyle, we spend a lot of time talking about all the things that may be a blur from the hospital stay. The hospital stay has gotten increasingly short in length and therefore the patients end up with a lot of information being given to them in a hard time sorting through that information on their own. So, we spend time going through what happened with them and what kinds of things are important for them to prioritize as far as changing with their lifestyle.

Host: That’s really great that you are able to do that and as I understand it Tracy, you literally come to their bedsides to talk to them. Tell us about this specialized service that you do.

Tracy: Yes, our pharmacy team is very diverse at the University of Kentucky and it really highlights all the different roles a pharmacist can play within the healthcare setting. So, we actually have three different pharmacists involved in their care. Our inpatient clinical pharmacists come to the patient’s bedside and provide their discharge medications to them along with specialized individualized counseling on how those medications were chosen and what’s important for the patient to understand about taking them.

And so this service is provided at a time when the patients are ready to go home and, in the setting, where they have family with them to help make sure that they understand exactly how to take their medicines moving forward.

Also our pharmacists are involved on filling those medications, so we have traditional retail pharmacists who participate in the care of the patients through orders sent to them and them delivering them to the bedside for our patients.

Host: Wow, what a great service and people don’t think of their pharmacists as someone that they can ask questions to. What questions would you encourage patients to ask you about their medications?

Tracy: Yeah, I think patients often recognize that their community pharmacists can be a valid resource for them, but they may be don’t know how many questions and what is appropriate to ask. So, they can always ask patients about what medications are for and why a medication might be prescribed to them for their certain illnesses. It’s important to always ask about if things are safe to take with other medications. So, asking them about over-the-counter or herbal products that they might be interested in taking and how they interact with their diseases and their drugs.

And it’s always a good idea to ask them if they have concerns. So, if they experience something that seems unusual or may be affect of a medication that is not desirable that they discuss that with their pharmacist so that they might help them either change therapy or address if that’s appropriate with their provider.

Host: So, Tracy heart disease remains common and higher in Kentucky than many other states. What would you like patients to know about heart disease and the medications involved that could help manage their disease before they have a cardiac event?

Tracy: That’s a great question. So, we know a lot of the risk factors that lead to heart disease and not only is heart disease common in Kentucky but the risk factors that lead to it are very prevalent and higher than most states as well. So, things like high blood pressure, high blood cholesterol; that can be both diet modified but also there are some important medications that once these risk factors are identified in a patient can lead to decreasing their risk of having a cardiovascular event.

So, things like cholesterol lowering medications, the statin medications can play an important role in preventing disease in patients who have the risk factors. Making sure their blood pressure is well-controlled, making sure they know these numbers. So, beginning at 20; it’s recommended that everyone know their blood pressure and their cholesterol and in some at risk patients, even younger. So, almost all adults out there should know what their heart disease risk factors are and if they’ve reached thresholds to be treated in order to prevent disease.

Host: I think one of the things that people often worry about is the cost of medications and so maybe they might not be as adherent or compliant. How can you help the healthcare team to help the patient get their lower costs and advise them in safe and cost effective medications? How do you help them in that realm?

Tracy: Yes, adherence or medication taking behavior as we often refer to it is so multifaceted, and you hit the nail on the head that cost is one big component to that. And so, part of our service by filling patient’s discharge prescriptions before they leave the hospital, we are able to have a cost conversation with the patient about what their actual costs will be. And you really can’t know that in today’s world without filling those prescriptions. So, that’s an important part of our service.

And so, we are able to look at the most expensive medications in their regimen and decide sort of the risk benefit of paying for those medications and what – if the patient is financially able to do so or not and if we can change them to a more cost effective regimen. And that’s a huge role for pharmacists across the country.

We also have the ability and there are some pharmaceutical sponsored companies that allow certain patients to enter into patient assistance programs and we can help the patient apply for those. Those are difficult things to navigate for even healthcare professionals. So, helping the public be able to do that in a quick and efficient manner can help them be on the most effective therapy for the lowest possible cost.

Host: That’s really great and so important. Now what about after discharge? How are you involved within a week or so and how do you pass off to the cardiologist for future follow up care? How do you work with the patient after they’ve been discharged?

Tracy: Yes, that’s probably the most unique part of our service. And that’s where patients are given before they leave the hospital a planned follow up appointment with the clinical pharmacist in the outpatient setting. And so, that first appointment is with myself or one of my colleagues where we can do all those things we talked about earlier and helping make sure that the medications are working the best way for the patient.

And what we do after that visit is we make sure that our documentation of that visit is shared with their primary care providers, with their cardiologist whether or not they are inside the UK system or referred from the outside. And we make sure that the patient is clear on all of these things as well. And so, when we identify something, or we start a new medication, or we increase the dosage of a medication that is directly passed of to the person who is going to see them next so that we can make sure that the goals of that therapy are being achieved.

There’s definitely no point in paying for the medicines if they don’t work safely and effectively in you as a patient.

Host: One thing I notice with postcardiac events or really any disease state Tracy is that people can’t always manage their own medications. Can you be involved with the family members to help them so that they can sort out the meds, know what each one does and help their loved one to adhere, so they are getting a better result?

Tracy: For sure. I think and especially in this situation where so many medications are taken; most patients have a situation that we consider polypharmacy meaning they take multiple medications to treat these conditions. And so a family member or caregiver who can help support them and hear the same things is vital. And so often we are going through with spouses or significant others or any type of family member exactly how to take the medicines.

In some situations, we help set up pill boxes to allow them to see exactly how to take them and often we are printing new calendars and medication reminder kind of programs for the patient to be able to ensure adherence to that therapy. But it is always refreshing to see the patient has additional support with them that can help ensure their understanding and their ability to fulfill the medication orders.

Host: What an important part of your job. Tracy as we wrap up, what would you like listeners to know about working with their pharmacist to ensure that they are using their meds properly and getting the safest most cost effective help with their medications?

Tracy: I think I would just like patients and the public to know that the pharmacists are often involved in your care and often it’s behind the scenes. We have been fortunate enough at UK to have the pharmacists brought more to the forefront but there is almost always a pharmacist in some capacity behind the care in the hospital and in the outpatient setting.

So, just making sure that you have utilized that resource and you make sure that you involve the pharmacist in your care can help ensure that there aren’t important drug interactions and that the therapies are the most cost effective and safe for you as a patient. And I have neve met a pharmacist who is not happy to help a patient.

Host: Great points all. Thank you so much Tracy, for coming on and sharing your expertise and explaining how the pharmacist really plays a very central role when a person has to manage their medications and how you help them. Thank you again.

And that wraps up another episode of UK HealthCast with the University of Kentucky healthcare. To learn more about our heart program head on over to our website at www.ukhealthcare.uky.edu/gillheartvascularinstitute for more information and to get connected with one of our providers. If you found this podcast as informative as I did, please share with your friends and family and anyone you know that may be having trouble managing their medications, share on your social media and be sure to check out all the other interesting podcasts in our library. Until next time, I’m Melanie Cole.