How Pharmacists Can Collaborate with Retail Clinicians on Patient Care

Pharmacists have many opportunities for collaborating with nurse practitioners (NPs) and physician assistants (PAs) on managing chronic and acute conditions commonly seen in the retail health practice setting.

That was a central theme of the 1^st Annual Convenient Healthcare and Pharmacy Collaborative (CHPC), which featured 10 clinical sessions providing continuing education credits for pharmacists, NPs, PAs.

Throughout the 2-day event in Orlando, Florida, pharmacists, NPs, and PAs reviewed current treatment standards and guideline recommendations for the management of chronic obstructive pulmonary disease (COPD), allergic rhinitis, asthma, immunizations, acne, upper respiratory tract infections (URTIs), type 2 diabetes mellitus (T2DM), and obesity.

Within those 8 clinically relevant areas, experts detailed the following opportunities where pharmacists can collaborate with clinicians in the retail setting.

Optimal collaborative care strategies for COPD

· The clinical strengths of pharmacists and convenient care clinicians combined with their proficiency as liaisons between physicians and other health care professionals make them uniquely qualified to be managers of transitions of care for COPD patients.

· Through a combination of comprehensive counseling and nicotine replacement medication, pharmacists and convenient care clinicians are perfectly poised to guide COPD patients through smoking cessation.

· Face-to-face pharmacist counseling makes a key difference in improving adherence, but it must be continued to maintain success.

Source: Kimberly Henderson, MD, JD, medical director for the Health Systems Alliance at CVS Health and regional medical director for MinuteClinic.

Role of collaborative care in allergic rhinitis

· Pharmacists and licensed independent practitioners should be aware of allergic rhinitis symptoms (nasal congestion, itchy nose) and knowledgeable about nonpharmacologic interventions, pharmacotherapy, and immunotherapy.

· Pharmacists can coach allergic rhinitis patients on medication adherence, balancing the benefits of treatment with adverse effects.

· Both pharmacists and advanced practice clinicians should provide medical referral for alarm symptoms, treatment failures, or immunotherapy evaluation.

Source: Mary M. Bridgeman, PharmD, BCPS, CGP, clinical associate professor at the Ernest Mario School of Pharmacy at Rutgers University.

Collaborative approaches to asthma management

· Recognize customers with questions about asthma symptoms or those who buy OTC products for allergies or other related indications.

· To raise asthma awareness, provide educational materials about what asthma is, how to recognize it, and the importance of diagnosis and treatment.

· Pharmacists should deliver interventions to asthma patients and exchange information with prescribers regarding the need for a written asthma action plan, a switch in therapy, or nonadherence.

Source: Kristen L. Marjama, DNP, MSN, FNP-BC, clinical educator with Healthcare Clinic at Walgreens in Fort Lauderdale, Florida.

Recommendations to improve vaccinations

· Address patient concerns about vaccinations, including questions about autism, febrile seizures, Guillain-Barre Syndrome, and thimerosal.

· Increase provider education to avoid missed opportunities.

· Expand standing orders for vaccines.

Source: Rupal Mansukhani, PharmD, clinical assistant professor at the Ernest Mario School of Pharmacy at Rutgers University.

Opportunities for collaborative care for acne

· Apply counseling strategies to address common patient questions and misconceptions

· Offer coaching and support for patients’ psychosocial health and well-being

· Provide disease state and medication patient education

Source: Angela Patterson, MSN, FNP-BC, NEA-BC, vice president at CVS Health and chief nurse practitioner officer of CVS/MinuteClinic.

Appropriate management of URTIs

· Identify patients with URTIs through point-of-care testing, observe and follow-up with them, and provide education on their infection and medications.

· Encourage vaccination to provide primary URTI prevention.

· Counsel patients on available OTC products while stressing that not all of them are effective for URTIs or all individuals.

Source: Erin Dorval, PharmD, assistant professor of pharmacy practice at the Lloyd L. Gregory School of Pharmacy at Palm Beach Atlantic University.

Trends in T2DM collaborative care

· Due to the chronic and advancing nature of diabetes, continuous treatment monitoring and the need for self-care requires a readily available health care provider who is familiar with the patient, such as a pharmacist.

· Pharmacists are poised to meet the demand for ongoing, follow-up diabetes care and management, and they may prevent related hospitalizations.

· Set goals with patients while validating their concerns. Allow them to come up with a solution, but then the provider should add his or her own suggestions.

Source: Kristene Diggins, FAANP, DNP, DCC, MBA, manager of professional practice for MinuteClinic.

Optimized collaborative care strategies for obesity

· The initial discussion about obesity is most difficult. Follow the 5 A’s of obesity counseling:

1. Ask for permission to discuss body weight.

2. Assess body mass index and waist circumference.

3. Advise the patient about health risks of obesity and benefits of modest weight loss.

4. Agree on realistic weight loss goals and a treatment plan.

5. Arrange regular follow-up that addresses barriers.

· Emphasize that weight-loss medications are only adjunctive to lifestyle changes, so weight loss is a substantial lifelong commitment.

Source: Daniel E. Hilleman, PharmD, FCCP, professor of pharmacy and medicine at Creighton University Schools of Pharmacy and Medicine.

The CHPC conference was held from August 6-7, 2015, at the Gaylord Palms Resort and Convention Center in Orlando, Florida, and jointly sponsored by the Convenient Care Association and the Pharmacy Times Office of Continuing Professional Education.