Pharmacist Roles Expanding in Chronic Disease Management

From optimizing inhaler technique in patients with chronic obstructive pulmonary disease (COPD), to catching red flags when dispensing controlled substances to patients with chronic pain, pharmacists can improve patient outcomes in an evolving treatment landscape.

That was the fundamental theme of the Directions in Pharmacy 5th Annual CE Conference, which featured 6 interactive sessions held today at the Crowne Plaza Princeton in Plainsboro, New Jersey.

Throughout the event, pharmacists reviewed current treatment standards and guideline recommendations for the management of type 2 diabetes, dyslipidemia, allergic rhinitis, asthma, and COPD. In addition, participants learned the pharmacist’s legal responsibilities when a controlled substance prescription is dispensed.

Within those 6 clinically relevant areas, experts presented opportunities where pharmacists can expand their roles:

1. To get a head start on treating allergic rhinitis, pharmacists can:

· Inform patients about the advantages and disadvantages of nonpharmacologic interventions, pharmacotherapy, and immunotherapy.

· Counsel patients on adherence to treatment, balancing the benefits with potential adverse effects.

· Provide referrals for alarm symptoms, treatment failures, or immunotherapy evaluation.

Source: Mary M. Bridgeman, PharmD, BCPS, CGP, Clinical Associate Professor in the Department of Pharmacy Practice and Administration at the Ernest Mario School of Pharmacy at Rutgers.

2. To improve asthma outcomes, pharmacists can:

· Ask patients how often they use a rescue inhaler and watch their refills, keeping in mind that most inhalers contain 200 inhalations.

· Screen for use of nonselective beta-blockers, which can worsen asthma.

· Watch for purchases of OTC asthma medications or support supplements.

Source: Maria Marzella Mantione, PharmD, CGP, Associate Clinical Professor in the College of Pharmacy and Health Sciences at St. John's University.

3. To optimize COPD inhaler technique, pharmacists can:

· Demonstrate proper step-by-step administration to ensure correct device use.

· Verify that patients understand correct technique by asking them to explain the steps in their own words.

· Recommend a single type of inhaler, which leads to fewer critical errors in device use and improves adherence.

Source: Carmela Avena-Woods, BSPharm, PharmD, CGP, Assistant Clinical Professor of Clinical Pharmacy Practice in the College of Pharmacy and Health Sciences at St. John's University.

4. To individualize diabetes care, pharmacists can:

· Identify a comprehensive treatment plan for each patient that focuses on concomitant disease state risk reduction.

· Adjust glucose control in geriatric patients based on hypoglycemic symptom recognition and functional and cognitive status.

· Educate patients reluctant to start insulin therapy about the benefits and limitations.

Source: Jennifer Costello, PharmD, BCPS, BC-ADM, Ambulatory Care Clinical Pharmacist in the Internal Medicine Faculty Practice at Saint Barnabas Medical Center in Livingston, New Jersey.

5. When dispensing controlled substances, pharmacists should:

· Understand that a corresponding legal responsibility for proper prescribing and dispensing of controlled substances rests with the pharmacist who fills the prescription.

· Look for red flags, which include frequent requests for early refills, dosages or quantities that appear inappropriate for the patient, and prescriptions for the same drugs and quantities coming from the same prescriber.

· Assess abuse and misuse risk through prescription drug monitoring programs, if available.

Source: Daniel Abazia, PharmD, BCPS, Clinical Assistant Professor in the Department of Pharmacy Practice and Administration at the Ernest Mario School of Pharmacy at Rutgers.

6. To help manage dyslipidemia, pharmacists can:

· Ask patients what their goals are, aside from lowering cholesterol. Also focus on blood pressure, controlling diabetes, and modifying risk factors, such as smoking.

· Focus patients more on adherence to statin therapy and less on specific lipid levels.

· Recommend nonstatin options to high-risk patients with a less than anticipated response to statin therapy.

Source: Patrick Curtin, PharmD, BCPS, Clinical Coordinator at Overlook Medical Center in Summit, New Jersey.