Wellness Pharmacists Synergize Prevention with Patient Care: What to Know About This New Branch of Pharmacy

Marissa Mauricio, PharmD, MBA, is one of the nation's first clinical wellness pharmacists. Mauricio, who works in the Baptist Health system in Miami, Florida, joins Pharmacy Times to try answering "What is wellness?", especially wellness the pharmacy setting. She also dives into the importance of the wellness pharmacist for our communities, a new pharmacy wellness course, disease state management, and the growth of pharmacy wellness trends.

PT Staff: What kind of pharmacists fit the bill for becoming a wellness pharmacist?

Marissa Mauricio, PharmD, MBA: So that's a great question. Currently, the way we have our practice set up is that it's in an ambulatory care setting. So, it's like an outpatient clinic and a lot of people who are already coming in to have some kind of chronic care management or anything like that. Really any pharmacists can do wellness in their space, whether it's retail or clinical-based, but how we have our practice is in the ambulatory setting, so I feel like ambulatory care pharmacists would definitely be able to integrate this into their practice. But anyone with a wellness background (I know lots of people who used to be personal trainers or wellness coaches, and there's lots of certificates and things like that out there) or anyone with any training in like lifestyle medicine, diabetes care specialists, or people who may have already counseled on lifestyle modifications would be the perfect fit to integrate wellness into their practice or create a new wellness program.

PT Staff: Diving into it, I think that it feels like wellness is such an umbrella term. So, despite it becoming a popular word that's thrown around a lot, what does wellness mean? Especially in relation to the pharmaceutical setting?

Marissa Mauricio, PharmD, MBA: That's something we talk about all the time. We get questions like, “What is wellness? And what does that mean for our program?” When I think of wellness in terms of pharmacy, I really think…about what we were saying around [the idea of] when you think of a pharmacist, wellness is typically not the first thing that comes to your mind. You may think white coats and medications and things like that, but when you think of wellness as a part of pharmacy, I look at it more from a prevention standpoint, as well as synergizing with current patient care. So anything we can do to either prevent further chronic disease states or anything like that and also take on the management side. We say, “Okay. What can we [wellness pharmacists] do in addition to your current medication and your current therapy to really help you [the patient] with your personal well-being?”

It can make a difference in how a patient feels and their overall quality of life. So that's something that I think is an important aspect of wellness and pharmacy, and with pharmacists being the most accessible health care professionals, we are definitely in that space and able to provide that type of care for patients.

PT Staff: It sounds like a middle ground between helping the patient with daily life but having that [deeper] understanding of medications. That was a great word— synergizing. So Baptist Health is now partnering with Nova Southeastern University (NSU) to offer a new pharmacy wellness course. How does this diverge from a generalized nutrition or wellness course?

Marissa Mauricio, PharmD, MBA: That's a great question. So we actually just finished the first summer term and we're preparing for the fall semester to kick off in just a couple of weeks. So, we're very excited for it.

This is different from your typical general nutrition or wellness course because we look at it from a more clinical standpoint. We include a lot of patient cases in there, which pharmacy students are very familiar with, but then we ask them more wellness-related questions and try to get them really thinking about how they would integrate this.

Yes, I want [the students] to ace the medication part, but [I want them to] really dig in deep to understand the patient, really understand them, and have empathy for the patient as well—understanding them as a person and where they come from their background, their job, social determinants of health (SDOH) and things like that. So, we get them critically thinking about how they would help this patient. We also dive into (what I mentioned earlier) disease state management and prevention; lifestyle behaviors and we also look at nutrient deficiencies. That's looking at labs and understanding what the labs mean and how the pharmacist can then make recommendations based off the labs. So, we're really looking at those gaps of care and seeing how we can help them, not only with their medications, but those other wellness strategies as well.

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PT Staff: Looking at labs, is that something that's new for pharmacy students to see is that something that was not usually taught in previous courses?

Marissa Mauricio, PharmD, MBA: Yes. So I didn't get a lot of experience in labs when I was in pharmacy school. It's definitely touched on but it was not a primary focus in any of our courses. So that's something that's kind of special to the NSU, the pharmacy wellness course. We're really talking about labs and understanding them and trying to get [students] to understand how you can help with how it helps with the patients’ assessment. It’s also something that you look at for your overall patient cases. And then when you take the The North American Pharmacist Licensure Examination (NAPLEX) after you finish pharmacy school, that's also another component that helps you understand how to treat your patient or what is potentially going on with them in terms of their disease state management. So it's definitely unique to the course and we're happy to kind of open up that that area for pharmacy students.

PT Staff: When talking about wellness and it being a lifestyle-first approach to care, what does it look like in the pharmacy setting? For instance, in the retail pharmacy setting, what would the pharmacist (the wellness pharmacist) ask the patient and how would they interact with them?

Marissa Mauricio, PharmD, MBA: Instead of immediately offering an over-the-counter (OTC) prescription or supplement, or potentially referring [the patient] back to their prescriber for a prescription recommendation, we like to look at other areas of wellness to see if there's an opportunity for improvement.

For example, if a patient is coming in and they're saying “ Hey, I'm really, really sleepy. I'm having a hard time getting started [and] I'm having a hard time falling asleep at night. You know, I'm on this medication and I feel like maybe it's not working. Is there anything else that I can take?” or something like that.

Instead of recommending a supplement like melatonin or something else, we could then say, “Okay, well, what are you doing to go to sleep?” We could talk to them about sleep hygiene, and give them easy recommendations that they can make. “Do you have blackout curtains or have you ever used blackout curtains? it makes a significant difference for some people.”

I recently moved into a new apartment and I sleep like a baby having completely dark curtains. it makes a huge difference for me. [So does] turning down the air at night and reducing screen time. You don't want to be on your phone or watching TV more than probably 30 minutes before bed because your brain is going to have a hard time turning off. So things like that are easy conversations and a piece of wellness that you can integrate into those conversations with a patient before you're referring them to another medication or therapy.

PT Staff: So it's a step by step approach. You're starting here and if the patient comes back and needs other suggestions, you're then to then recommend the supplements and figure out everything else.

Marissa Mauricio, PharmD, MBA: Exactly. And even looking at other areas like movement and [asking], “Are you getting enough movement throughout the day? Are you exercising?” But when you exercise right before you go to bed, your body's going to be stimulated and your brain is going to be on. So these are just like little things that you can like change or modify in your daily habits that would help your overall wellness as well as help you go to sleep and those different things.

PT Staff: How do SDOH impact a person's ability to achieve wellness? That should be factored in because we're all coming from different backgrounds and have different upbringings.

Marissa Mauricio, PharmD, MBA: Yes, and I think this is something that pharmacists are pretty good at. And we actually do like more of this than you would think and a daily basis when it comes to like health care; looking at insurance, all these different things we're always faced with looking at SDOH.

I would say that when it comes to wellness, it's not always going to be covered by insurance. So I look at wellness as an investment in my personal health and well-being. It doesn't always have to be costly. It's just that you must be more intentional about it. And it depends on your personal goals, background, and it depends on what you're willing to put into it. So when it comes to wellness and looking at SDOH, I really like to offer free resources. There are a lot of really good stuff out there. I also like to recommend free things that people can engage with in the community that's already being provided.

For example, instead of getting a gym membership (and [the patient] wants to work out more) they can start to do at-home exercises. YouTube is a great way to connect with people who are very educated in the fitness industry and have great content out there. You don't have to pay for them and you can literally just get on that and do a quick 15-minute exercise. That's just one very basic example.

But looking at access, transportation, and things like that, those can make or break someone's decision into what they want to do on a daily basis. So as a pharmacist, when you're having these conversations, you can really work with the patient to figure out what meets their needs, and really getting a better understanding of them and what their support group is like at home. Do they have family members who can help them out or are maybe their caregiver, and so they have limited time. Those are things that you have to get a better understanding of so you can offer the right support and resources.

PT Staff: Now as you're focusing more on wellness and pharmacy, and hopefully as we see this expand, how could it impact those communities social determinants?

Marissa Mauricio, PharmD, MBA: I definitely see, as wellness becomes more important and a more of a priority to people, more of these events and community resources becoming available. One of the things I like to do is go on walks. I walk all the time, and I found a community in my area of women who like to go on walks on Saturdays. I love that because it creates a community of people who like to do like minded things and it's free and I don't have to pay for it. I just literally show up, I get to work on my social well-being and make connections with people, and I'm also exercising at the same time in the nature. It's giving me all of the dopamine, oxytocin—all those different things, the happy chemicals.

As I see more people doing things like this, I definitely see it expanding and growing. There's people from other states who are inspired and they actually post about what I'm doing. They're like, “I would love to see something like this, where I am.” And whether it's them who were able to create that opportunity for their community or someone else coming together, I definitely see this growing and expanding in different aspects, and in whatever area of wellness it is that they want to do. So, it's just a matter of finding the resources for the community and how that looks. And there's lots of organizations who put on a lot of events that are focused on wellness. So just finding out like what your interests are and I think it'll kind of expand from there.

PT Staff: You brushed on earlier, but I'd like to go a little more into the services of the wellness pharmacist. Not only how it differs from the traditional role but understanding the scope of the services.

Marissa Mauricio, PharmD, MBA: In terms of my scope, I do have my consultant pharmacist license, and I work within a collaborative practice agreement in my health system. I work very closely [with it]. What that means is I work very closely with a physician who kind of gives me that authority to have the responsibility to make adjustments and modifications to prescriptions if needed.

I can also order Labs, which is, again, like I talked about, very helpful in terms of assessing where your patients are and how their progress is. Because when you think about wellness with it being so general, it's hard to measure. So labs are something that we look at pretty often.

In terms of services, like I said, [I do] lab assessment. We obviously do the medication management, looking at medication history, family history, social history, and all those different things. We also look at their OTC medications that are often left off in the list. We also look at supplements, because a lot of people do take supplements based on some kind of recommendations.

One of my specialty areas is women's health. So, I look at prenatal vitamins— that's a popular conversation that we have, understanding how much of each you know vitamin that they should have and what works best for them—and we do a lot of things like that. We also look at other areas of wellness, like digital health. So I'm looking at your Apple Watch or maybe an Oura Ring, or whatever digital health device you have, if that's something you're interested in (in terms of checking your metrics).

So we can help patients with identifying those types of things as well. And then we look at nutrient deficiencies. So again, with labs and genetic testing, that's another great way to really understand how to personalize someone's approach to care. And then we also look at evidence-based wellness approaches as well as identifying meal plans (not necessarily creating a meal plan) and identifying foods and like food groups that would be helpful for a patient. So we have some patients who will ask us to help them build a grocery list. And so, if they're going to Publix or Walmart or wherever it is, we ask them where they're going and we can help them find healthier options. So they know what to eat when they go home. Or if they want some meal ideas and things like that, we can help them with that, too. It's not to replace the nutritionist or anything like that, but just to help guide them through that process.

Same thing when it comes to exercise. We can definitely recommend that you should be doing 150 minutes of exercise throughout the week, according to American Heart Association guidelines, but we can give them ideas for yoga or things like classes that may be offered. However, we're not going to create an exercise plan for them, that would be something we would kind of refer out to them. So, sticking within our guidelines and being able to use the resources. We give our patients the handbook of “This is what you can do,” and them really being able to finish it out and do their part of the work. That is how we can help them. That's really what we're here to do.

PT Staff: Based on trends you've already seen during your time as a wellness pharmacist, what trends do you see growing more?

Marissa Mauricio, PharmD, MBA: I see a lot of personal wellness and group wellness in the workplace. So burnout is definitely a topic that I hear a lot about in the medical field and pharmacy amongst physicians. It's very prevalent. So I see a lot of employers and departments asking for advice and resources on what they can do as a group or in the workplace to help with personal well-being. So, I see that growing—people taking more time to come together and have a better understanding of what employees goals and what's important to them. And then taking the time and find good activities to implement in the workplace.

One of the things that we've done here at Baptist is created a well-being and belonging committee. So we have a designated a committee for wellbeing practices, and it's very exciting because we have people who are super motivated to implement this in their departments. So that's an example of something that we've done; just seeing the need of that. And then taking the time to have personal days. I've seen that as a trend as more employers are adding these personal days and being more accepting of like work from home and having a better understanding of the flexibility that you can that you can have when it comes to working. So, I think that's definitely something that I see as a trend that's happening and I think it'll stay and continue.

PT Staff: Turning back to the collegiate level. What do you see being the impact of pharmacy wellness training at a younger age?

Marissa Mauricio, PharmD, MBA: I definitely see this course impacting pharmacy students in multiple ways. I would say probably in like about 3 ways:

• I would see it impacting them on a personal level, so having a better insight into their own personal well-being. That means taking care of themselves, having stress management tactics and things like that.
• Once you get out into the field, you're going to have that experience. So we can make them a great wellness pharmacists in the future, but also being able to share what they've learned in their practice, whatever field it is that they go to, so they can really help have that impact on their patients.
• Putting it out there in their practice. Really having an overall positive outcomes and impact on their patients in their care. That’s the goal for us is that the outcomes for patient care and treatment are positive, and that [patients] have a better quality of life and just overall feel supported and their health care options and their wellness goals.

PT Staff: It strikes me that wellness really highlights that quality of life, which I think is undervalued a lot of times.

Marissa Mauricio, PharmD, MBA: Yes, I agree. And for me, one of my areas that I work in is oncology. And so that's a topic that is honestly 1 of the only disease states where I hear quality of like mentioned so often. It's a more sensitive area, but I think if each disease state took that same approach and that same priority to integrate that, I think we would see better outcomes in terms of their patient care and the results that they're seeing.