The College of Pharmacy’s HelixTalk is one of the most recognized and downloaded podcasts in the pharmacy profession. Its 100th episode, posted on Aug. 20, 2019, features a conversation with COP Dean Marc S. Abel, PhD, about the profession and the future of pharmacy education. Here, HelixTalk hosts Sean Kane, PharmD, BCPS, and Khyati Patel Kotak, PharmD, BCPS, both faculty and practicing clinicians, discuss how they teach and practice the art of caring and how pharmacists are leading innovations in patient care and population health.
The art of caring is at the heart of HelixTalk episode 79, in which you discuss a 2018 New England Journal of Medicine article that drew national attention to the role of pharmacist-led interventions — in this case treating high blood pressure via care offered in black barbershops. The study found that the barbershop pharmacists prescribed "more combination drug therapy with long-acting first-line drugs than did community practitioners treating men in the control group” and “resulted in larger reductions in blood pressure.” What does this say about the approach?
In this study, pharmacists were able to establish trust with participants via a trusted community resource — their local barbershops. Instead of asking patients to come to a clinic, they took patient care to the environment that was comfortable and inviting to patients. In this trusted environment, the pharmacist was able to listen to patient concerns about their previously prescribed blood pressure medications. Employing shared decision-making, the pharmacist and patient together were able to devise a new treatment plan. In doing so, the pharmacist empowered patients to participate in their own care and in the comfort of a familiar setting. Patients were more likely to adhere to a regimen that was derived with their “say” in it. Additionally, while blood pressure measurements were occurring, the pharmacist was able to talk to patients about lifestyle modifications and other personal factors that can greatly impact this disease. It is the care and trust demonstrated by the pharmacists that likely increased patients’ adherence to blood pressure medications resulting in the positive study outcomes that were observed.
The authors of the study surmise that success in lowering blood pressure was a result of many factors, including making drug therapy more convenient, more tailored to patients — in this case African American men — facilitated by peer support and endorsed by trusted community members. That sounds like a model that should be replicated, especially among at-risk populations! Thoughts?
The study demonstrates how non-traditional approaches and settings for care in underserved patient populations can help achieve better health outcomes. It propels health care communities, and more importantly pharmacists, to think outside the box. For example, in the public health sector, pharmacists are establishing flu vaccine clinics in the workplace to increase influenza vaccine rates and promote public health and safety. Such treatment and preventative care practices should serve as an example to reach communities that normally lack proper medical care but need it the most.
How are our students learning the skills of caring: communication, empathy, shared decision-making, team-building?
The skills of caring are deeply integrated into our pharmacy curriculum at each year of the program. Students learn to appreciate shared decision-making during pharmacotherapy recitation in which a patient case is presented and students are asked to develop a treatment plan for the patient. Often, there are multiple different treatment pathways to consider, which is where communication and shared decision-making play an important role. Skills for communication with patients and healthcare providers are also taught in our pharmacy skills courses. Students practice their medication counseling skills in their first didactic year when they teach patients how to safely and effectively use medications to improve health outcomes. They learn the SBAR communication method — situation, background, assessment, recommendation — in their second year, how to relay concerns and recommendations regarding pharmacotherapy to other healthcare providers in a succinct and confident manner, again with a goal for improving their patient’s health outcomes.
How does your mentorship of students and others instill caring behaviors?
Almost all students choose to pursue health professions education with the goal of helping others. The caring tendencies are already there and we nurture and polish them through various didactic interactions, but most importantly through experiential education activities. During experiential rotations, students observe how pharmacists work interprofessionally in a collaborative team environment to provide the best possible care to their patients. Actions speak louder than words. When students see that ‘Aha!’ moment in a patient-pharmacist interaction, see pharmacists take the additional time to educate fellow providers regarding a new medication, or go the extra mile to find a rare and hard to procure medication for a patient in desperate need — that’s when they understand what the “care” in health care really means and how it should be practiced.
Discuss the importance of connecting with patients as a means to increasing medication adherence and promoting lifestyle changes to improve health.
Establishing trustworthy relationships is the key to providing compassionate care in the community. Pharmacists are the most approachable healthcare providers, even on the weekends when many other providers are not in the office. Pharmacists ensure that medicines work safely and effectively for patients by taking the time to explain the proper use of a drug or device, teaching them how to manage or avoid harmful drug interactions, providing strategies to help them remember to take their medication, and by genuinely listening to patient concerns and incorporating their opinions and values to make a therapy decision. This important interaction goes a long way toward improving patient care. Patients develop trust and may be more likely to take their prescribed therapy, return for follow-up appointments and include other measures of self-care such as lifestyle modifications as part of their treatment plan. Dr. Patel has plenty of patients in her clinic who have reached their health-related goals, but still return to see her regularly because they value this relationship. They know that she will screen their medications for any discrepancies, make sure their prescribed therapies meet the most updated practice guidelines and address any concerns they may have regarding their existing or future medications.
How do pharmacists, pharmacies and systems take a proactive approach to patient care?
As the saying goes, an ounce of prevention is worth a pound of cure. We need to be proactive in addressing potential problems. Pharmacists rounding with medical teams in the inpatient setting or identifying and intervening on behalf of patients who are at-risk for hospital readmission are two simple approaches that both save money and improve patient care. Pharmacists can play an important role by optimizing drug therapy (to make it safer and more effective) and by providing high-quality education so that patients understand the medications they take and can be better advocates for themselves.
How do the skills of caring help build teams and improve the performance of those teams?
On an interprofessional team, the pharmacist is the drug expert. While this expertise plays an important role in optimizing drug therapy, a pharmacy perspective and approach to drug therapy are also important in conveying the skills of caring. Pharmacists frequently consider drug cost, pill burden, adverse effects and patient values or preferences when evaluating multiple different therapeutic options. As healthcare providers with this unique focus, pharmacists play an integral role in the interprofessional team’s performance and ability to practice the art of caring.
How are you practicing the art of caring, given the time constraints and other challenges of your work?
Dr. Kane: The art of caring can be exemplified by so many different facets of a pharmacist’s job. For me, it means staying late and assisting with drug therapy decisions when a critically ill patient is admitted to the unit at the end of my shift, or helping a family member better understand the medications that their loved one is receiving. As an educator, I think COP faculty do a wonderful job helping students to understand the art of caring. I am a big advocate of shared decision-making, in which a healthcare provider educates the patient about a range of possible treatment options and both the patient and provider make a decision about a plan of care, such as starting a new medication. Communication, empathy, caring and a number of other factors play an enormous role in providing high-quality care.
Dr. Patel: In a given day at my practice site, there are 20 different tasks at hand, including keeping up with the patient schedule, addressing drug information questions, responding to clinical communications from providers, documenting interventions and incorporating experiential teaching for students. But the most important task at hand is taking care of patients. That may mean stretching a simple phone call for relaying lab results and care plan to 20 minutes because you find out that the patient had a fall and was afraid to report it, and now you are tasked with bringing medical, social, and safety resources to her along with proper education to ensure prevention of falls and subsequent health problems.
How can pharmacists treat patients holistically?
Dr. Kane: In school, it’s easy to see clinical decision-making as a black or white problem. But in reality, most of medicine is very gray. The longer I have been in practice as a critical care pharmacist, the more I have been able to appreciate differences in prescriber practice, patient values and preferences, and even geographic variations in practice. This appreciation has instilled in me the value of holistic treatment and the pitfalls of a one-size-fits-all strategy to medicine.
Dr. Patel: For me, holistic practice is valuing a patient’s opinion when it comes to their own health and allowing them to contribute ideas while making a shared decision about their medications. If they inform us that they want to eat more fresh leafy vegetables while they are on warfarin, we can make changes in warfarin therapy to ensure their INR levels stay in range while they adopt this healthy eating habit.