Nontraditional Pharmacy Models Can Benefit Patients, Pharmacists

In an interview with Pharmacy Times, Nazia Somani Babul, PharmD, BCACP, discussed her presentation at the 2024 American Pharmacists Association (APhA) Annual Meeting and Exposition, happening in Orlando, Florida, March 22 to 25. Babul’s presentation will discuss nontraditional pharmacy models, and particularly a model at her facility focused on comprehensive pain management counseling.

Q: Have you seen growth in nontraditional pharmacy practice models? Why is that?

A: I think [there has] definitely [been] a growth in nontraditional pharmacy practice models due to a lot of reasons, one of them being with new medications evolving, there's a lot more, for example, injectable medications on the market that are used for chronic medical conditions and specialty medications, and these medications require more monitoring. They require the pharmacists to go out and teach the patients how to use them and how they work in the body and adverse effects to look out for, and how to manage the side effects. And due to that, also, the scope of practice of pharmacists is also changing. So, they're doing more than just dispensing these medications. And laws also support this, so just in the last decade, looking at how pharmacists provide services in the pharmacies and what they do, laws have changed. Before, the pharmacist was just required to offer counseling, or the technician might just offer counseling at the outpatient window when the patients are picking up their medications. But now they're actually required to go out and counsel on all new prescription medications and they are required to counsel on high-risk medications, including opioid medications. And there's a lot of protocols that also support pharmacists being a bigger part of the health care team. So, they are recommending immunizations, they can do point of care testing. During the pandemic, they were at the forefront, they were providing the vaccines and providing point of care testing for flu and COVID. Now, they're also able to prescribe birth control pills and prescribe naloxone.

In particular, I want to talk about my practice site at UI Health Medical Center. The providers really look for support from the pharmacists, they want us to use our expertise in counseling and educating and teaching patients on how to manage their blood pressure, for example. So, I'm currently working with a health care team to educate and teach patients how to manage their blood pressure, and the providers are supporting the initiative by giving us the education tools that they would like us to use to educate the patients on how to manage their blood pressure. And they're also providing us with the blood pressure monitors, and these are new monitors that have Bluetooth capability and they're able to sync with their medical chart. When the patient checks their blood pressure at home—and we also teach them how to properly check their blood pressure at home—those blood pressure numbers get uploaded into the medical chart and the provider is able to see how their blood pressures are doing at home.

Q: Can you define what “nontraditional” means in the pharmacy context?

A: Sure, in particular, in my role as a clinical pharmacist, I'm able to step out of workflow from the workflow that involves, you know, dispensing the prescription to get it to the patient. So, I'm able to focus on the actual counseling and offer patients clinical pharmacy services at my practice site, which is a pharmacy located in the specialty care building at UI Health. And one of the clinical services I'm able to actually offer all of our patients includes wellness counseling, so I'm able to counsel on emotional wellbeing, nutrition, physical activities; we're able to set goals on 8 dimensions of wellness. And the nice part of the service is anyone can use wellness counseling, so it can be for patients that have chronic medical conditions or are even just picking up medications like an antibiotic for short term use. So, this is a service that can be offered to everyone.

Q: You also lecture on nontraditional pharmacy services at UIC College of Pharmacy. What does that look like from the academic side?

A: Sure, actually, one of my lectures that I provide to pharmacy students is on the topic of nontraditional pharmacy services and I lecture to students that are actually on rotation at pharmacy sites. And what I talk about during my lecture is how there are opportunities for pharmacists to do more counseling with patients and to provide services like a comprehensive medication review, where they could talk to patients about their medications, making sure they're taking them the right way, making sure they know what they're taking the medication for. And also, to offer different kinds of services like blood pressure checks or blood glucose checks and recommend immunizations. So really encouraging them to take this opportunity to offer these nontraditional clinical pharmacy services and take time to do it when they can as a student.

Q: What nontraditional pharmacy model will you be discussing in your presentation at APhA?

A: The clinical service that I'll be presenting on at APHA will be a comprehensive pain management counseling service that we provide and offer to our patients who are picking up medications for pain at one of the pharmacies at UI Health. So, during the presentation, I'll be talking about what offering the visit entails and how pharmacists work with the patient together to come up with a pain management plan, which includes counseling and talking about their medication regimen that they're using for pain, but also incorporating nonpharmacological ways to manage their pain as well.

Q: How does this model impact patient outcomes?

A: In general, the patients that choose to participate in the service are more educated and know how their pain medications work, how to appropriately use their medications, and risks that come with the opioid pain medications. In particular, they also get insight and learn ways and approaches to manage pain, including nonpharmacological ways. And I wanted to mention that as part of our clinical pharmacists team, we also work with the PGY-1 community pharmacy residency program, so our community resident actually did research on the pain management service that we offer at our pharmacy and she'll be presenting her research findings at the APhA Annual Meeting this year, as well. But one of the strongest outcomes that she was able to find was that 100% of the patients that were on opioids either had access to Naloxone already at home or were able to be provided access to Naloxone after the pain management visit. And also, some of the patients that participated in the visit did come across some changes in their pain medication regimen. So, we might have made some recommendations to patients about other medications that they might be able to use to better manage their pain, and their prescribers had actually made these changes to their pain management regimen.

Q: Can nontraditional models also impact pharmacists’ job satisfaction?

A: I think definitely, it can impact job satisfaction because, for example, one of the reasons why I became a pharmacist is that I can work with patients directly and empower patients to take care of their own health and educate them about their medications. So, when I'm able to step out of workflow and really work on counseling patients, I'm able to do exactly what I wanted to do when I became a pharmacist. And I am able to help patients to be better informed about their medications and how to better take care of their own health.